Formulary
Chlortalidone: Indications, Dosing, Side Effects and Interactions
Chlortalidone clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Chlortalidone: Indications, Dosing, Side Effects and Interactions
Chlortalidone clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Ascites due to cirrhosis in stable patients (under close supervision),Oedema due to nephrotic syndrome**
- **Adult** (By Mouth): Up to 50 mg daily.
**Hypertension**
- **Adult** (By Mouth): 25 mg daily, dose to be taken in the morning, then increased if necessary to 50 mg daily.
**Mild to moderate chronic heart failure**
- **Adult** (By Mouth): 25-50 mg daily, dose to be taken in the morning, then increased if necessary to 100-200 mg daily, reduce to lowest effective dose for maintenance.
**Nephrogenic diabetes insipidus,Partial pituitary diabetes insipidus**
- **Adult** (By Mouth): Initially 100 mg twice daily, then reduced to 50 mg daily.
**Ascites, Oedema in nephrotic syndrome for chlortalidone**
- **Child 5-11 years** (By mouth): 0.5-1 mg/kg every 48 hours (max. per dose 1.7 mg/kg every 48 hours), dose to be taken in the morning.
- **Child 12-17 years** (By mouth): Up to 50 mg daily.
**Hypertension for chlortalidone**
- **Child 5-11 years** (By mouth): 0.5-1 mg/kg every 48 hours (max. per dose 1.7 mg/kg every 48 hours), dose to be taken in the morning.
- **Child 12-17 years** (By mouth): 25 mg daily, dose to be taken in the morning, then increased if necessary to 50 mg daily.
**Stable heart failure for chlortalidone**
- **Child 5-11 years** (By mouth): 0.5-1 mg/kg every 48 hours (max. per dose 1.7 mg/kg every 48 hours), dose to be taken in the morning.
- **Child 12-17 years** (By mouth): 25-50 mg daily, dose to be taken in the morning, then increased if necessary to 100-200 mg daily, reduce to lowest effective dose for maintenance.
Cautions
For all thiazides and related diuretics Diabetes; gout; risk of hypokalaemia; systemic lupus erythematosus Cautions, further information Existing conditions Thiazides and related diuretics can exacerbate diabetes, gout, and systemic lupus erythematosus. Potassium loss Hypokalaemia can occur with thiazides and related diuretics. Hypokalaemia is dangerous in severe cardiovascular disease and in patients also being treated with cardiac glycosides. Often the use of potassium-sparing diuretics avoids the need to take potassium supplements. In hepatic impairment, hypokalaemia caused by diuretics can precipitate encephalopathy. Elderly Lower initial doses of diuretics may be necessary in the elderly because they are particularly susceptible to the side-effects. The dose should then be adjusted according to renal function. M Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: with current significant hypokalaemia (serum potassium less than 3 mmol/L), hyponatraemia (serum sodium less than 130 mmol/L), or hypercalcaemia (corrected serum calcium greater than 2.65 mmol/L)-contra-indicated; hypokalaemia, hyponatraemia, and hypercalcaemia can be precipitated by a thiazide diuretic with a history of gout (gout can be precipitated by a thiazide diuretic)
Contraindications
For all thiazides and related diuretics Addison's disease; hypercalcaemia; hyponatraemia; refractory hypokalaemia; symptomatic hyperuricaemia
Side effects
For all thiazides and related diuretics Common or very common Alkalosis hypochloraemic; constipation; diarrhoea; dizziness; electrolyte imbalance; erectile dysfunction; fatigue; headache; hyperglycaemia; hyperuricaemia; nausea; postural hypotension; skin reactions; vomiting Uncommon Agranulocytosis; aplastic anaemia; leucopenia; pancreatitis; photosensitivity reaction; thrombocytopenia Rare or very rare Paraesthesia Side-effects For chlortalidone Common or very common Appetite decreased; gastrointestinal discomfort Uncommon Gout Rare or very rare Arrhythmia; diabetes mellitus exacerbated; eosinophilia; glycosuria; hepatic disorders; nephritis tubulointerstitial; pulmonary oedema; respiratory disorder
Interactions
**Other interactions (12):**
- Due to atenolol: Combined use of beta-blockers and calcium channel blockers with negative inotropic effects, e.g.
- Class I anti-arrhythmic drugs (e.g.
- Digitalis glycosides, in association with beta-blockers, may increase atrio-ventricular conduction time.
- Beta-blockers may exacerbate the rebound hypertension which can follow the withdrawal of clonidine.
- If replacing clonidine by beta-blocker therapy, the introduction of beta-blockers should be delayed for several days after clonidine administration has stopped.
- Concomitant use of sympathomimetic agents, e.g.
Pregnancy
For all thiazides and related diuretics Thiazides and related diuretics should not be used to treat gestational hypertension. They may cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte disturbances, and hypoglycaemia; placental perfusion may also be reduced. Stimulation of labour, uterine inertia, and meconium staining have also been reported.
Breast feeding
The amount present in milk is too small to be harmful. Large doses may suppress lactation.
Hepatic impairment
For all thiazides and related diuretics In general, manufacturer advises caution in mild to moderate impairment; avoid in severe impairment.
Renal impairment
For all thiazides and related diuretics In general, manufacturers advise caution in mild to moderate impairment (risk of electrolyte imbalance and reduced renal function); avoid in severe impairment (ineffective if creatinine clearance less than 30 mL/minute). See Prescribing in renal impairment .
Medicinal forms
Suspension
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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