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Medication Safety Issues
Sound-alike/look-alike issues:
Enduron® may be confused with Empirin®, Imuran®, Inderal®
Pronunciation
(meth i kloe THYE a zide)
Index Terms
Generic Available
Yes
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Management of mild-to-moderate hypertension; treatment of edema in congestive heart failure and nephrotic syndrome
Pregnancy Risk Factor
B
Lactation
Excretion in breast milk unknown/use caution
Contraindications
Hypersensitivity to methyclothiazide or any component, thiazides, or sulfonamide-derived drugs; anuria; renal decompensation
Warnings/Precautions
Concerns related to adverse effects:
• Electrolyte disturbances: Hypokalemia, hypochloremic alkalosis, and hyponatremia can occur.
• Photosensitivity: Photosensitization may occur.
• Sulfa allergy: Chemical similarities are present among sulfonamides, sulfonylureas, carbonic anhydrase inhibitors, thiazides, and loop diuretics (except ethacrynic acid). Use in patients with thiazide or sulfonamide allergy is specifically contraindicated in product labeling, however, a risk of cross-reaction exists in patients with allergy to any of these compounds; avoid use when previous reaction has been severe. Discontinue if signs of hypersensitivity are noted.
Disease-related concerns:
• Diabetes: Use with caution in patients with prediabetes or diabetes mellitus; may see a change in glucose control.
• Gout: In certain patients with a history of gout, a familial predisposition to gout, or chronic renal failure, gout can be precipitated.
• Hepatic impairment: Use with caution in patients with severe hepatic dysfunction; in cirrhosis, avoid electrolyte and acid/base imbalances that might lead to hepatic encephalopathy.
• Hypercholesterolemia: Use with caution in patients with moderate or high cholesterol concentrations.
• Hypokalemia: Use with caution in patients with hypokalemia; correct before initiating therapy.
• Renal impairment: Avoid in severe renal disease (ineffective).
• Systemic lupus erythematosus (SLE): Can cause SLE exacerbation or activation.
Adverse Reactions
1% to 10%:
Cardiovascular: Orthostatic hypotension
Dermatologic: Photosensitivity
Endocrine & metabolic: Hypokalemia
Gastrointestinal: Anorexia, epigastric distress
<1% (Limited to important or life-threatening): Agranulocytosis, aplastic anemia, cutaneous vasculitis, erythema multiforme, hemolytic anemia, hepatic function impairment, hypercalcemia, leukopenia, necrotizing angiitis, pancreatitis, respiratory distress, Stevens-Johnson syndrome, thrombocytopenia, vasculitis
Drug Interactions
ACE Inhibitors: Thiazide Diuretics may enhance the hypotensive effect of ACE Inhibitors. Specifically, postural hypotension which can accompany ACE Inhibitor initiation. Thiazide Diuretics may enhance the nephrotoxic effect of ACE Inhibitors. Risk C: Monitor therapy
Alcohol (Ethyl): May enhance the orthostatic effect of Thiazide Diuretics. Risk C: Monitor therapy
Allopurinol: Thiazide Diuretics may enhance the potential for allergic or hypersensitivity reactions to Allopurinol. Thiazide Diuretics may increase the serum concentration of Allopurinol. Specifically, Thiazide Diuretics may increase the concentration of Oxypurinolol, an active metabolite of Allopurinol. Risk C: Monitor therapy
Amifostine: Antihypertensives may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, antihypertensive medications should be withheld for 24 hours prior to amifostine administration. If antihypertensive therapy can not be withheld, amifostine should not be administered. Risk D: Consider therapy modification
Analgesics (Opioid): May enhance the orthostatic effect of Thiazide Diuretics. Risk C: Monitor therapy
Antidiabetic Agents: Thiazide Diuretics may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy
Antihypertensives: May enhance the hypotensive effect of other Antihypertensives. Risk C: Monitor therapy
Barbiturates: May enhance the orthostatic effect of Thiazide Diuretics. Risk C: Monitor therapy
Bile Acid Sequestrants: May decrease the absorption of Thiazide Diuretics. The diuretic response is likewise decreased. Risk D: Consider therapy modification
Calcitriol: Thiazide Diuretics may enhance the hypercalcemic effect of Calcitriol. Risk C: Monitor therapy
Calcium Salts: Thiazide Diuretics may decrease the excretion of Calcium Salts. Continued concomitant use can also result in metabolic alkalosis. Risk C: Monitor therapy
Corticosteroids (Orally Inhaled): May enhance the hypokalemic effect of Thiazide Diuretics. Risk C: Monitor therapy
Corticosteroids (Systemic): May enhance the hypokalemic effect of Thiazide Diuretics. Risk C: Monitor therapy
Dofetilide: Thiazide Diuretics may enhance the QTc-prolonging effect of Dofetilide. Thiazide Diuretics may increase the serum concentration of Dofetilide. Risk X: Avoid combination
Herbs (Hypertensive Properties): May diminish the antihypertensive effect of Antihypertensives. Risk C: Monitor therapy
Herbs (Hypotensive Properties): May enhance the hypotensive effect of Antihypertensives. Risk C: Monitor therapy
Lithium: Thiazide Diuretics may decrease the excretion of Lithium. Risk D: Consider therapy modification
MAO Inhibitors: May enhance the orthostatic effect of Orthostasis Producing Agents. Risk C: Monitor therapy
Methylphenidate: May diminish the antihypertensive effect of Antihypertensives. Risk C: Monitor therapy
Nonsteroidal Anti-Inflammatory Agents: May diminish the therapeutic effect of Thiazide Diuretics. Risk C: Monitor therapy
Pentoxifylline: May enhance the hypotensive effect of Antihypertensives. Risk C: Monitor therapy
Phosphodiesterase 5 Inhibitors: May enhance the antihypertensive effect of Antihypertensives. Risk C: Monitor therapy
Prostacyclin Analogues: May enhance the hypotensive effect of Antihypertensives. Risk C: Monitor therapy
RiTUXimab: Antihypertensives may enhance the hypotensive effect of RiTUXimab. Risk D: Consider therapy modification
Yohimbine: May diminish the antihypertensive effect of Antihypertensives. Risk C: Monitor therapy
Ethanol/Nutrition/Herb Interactions
Herb/Nutraceutical: Avoid dong quai if using for hypertension (has estrogenic activity). Avoid dong quai, St John's wort (may also cause photosensitization). Avoid ephedra, yohimbe, ginseng (may worsen hypertension). Avoid garlic (may have increased antihypertensive effect).
Mechanism of Action
Inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water, as well as, potassium and hydrogen ions
Pharmacodynamics/Kinetics
Onset of action: Diuresis: 2 hours
Peak effect: 6 hours
Duration: ?1 day
Distribution: Crosses placenta; enters breast milk
Excretion: Urine (as unchanged drug)
Dosage
Adults: Oral:
Edema: 2.5-10 mg/day
Hypertension: 2.5-5 mg/day; may add another antihypertensive if 5 mg is not adequate after a trial of 8-12 weeks of therapy
Administration: Oral
May be taken with food or milk. Take early in day to avoid nocturia. Take the last dose of multiple doses no later than 6 PM unless instructed otherwise.
Monitoring Parameters
Blood pressure, fluids, weight loss, serum potassium
Patient Education
Take exactly as directed - with meals. May take early in day to avoid nocturia. Include bananas or orange juice in daily diet but do not take dietary supplements without advice or consultation of prescriber. Do not use OTC medication without consulting prescriber. Weigh weekly at the same time, in the same clothes. Report weight gain >5 lb/week. May cause dizziness or weakness; change position slowly when rising from sitting or lying position and avoid driving or tasks requiring alertness until response to drug is known. You may experience nausea or loss of appetite (small, frequent meals may help); impotence (reversible); constipation (increased exercise, fluids, fruit, or fiber may help); or photosensitivity (use sunscreen, wear protective clothing and eyewear, and avoid direct sunlight). This medication does not replace other antihypertensive interventions; follow instructions for diet and lifestyle changes. Report flu-like symptoms, headache, joint soreness or weakness, respiratory difficulty, skin rash, or excessive fatigue, swelling of extremities, or respiratory difficulty. Breast-feeding precaution: Consult prescriber if breast-feeding.
Cardiovascular Considerations
Thiazide diuretics are effective first-line therapeutic agents in the management of hypertension and have proven to be of benefit in terms of cardiovascular outcome. They may act synergistically to lower blood pressure when combined with an ACE inhibitor or beta-blocker. The initial concern about thiazide diuretic-induced hypokalemia, glucose intolerance, and lipid profiles does not appear to be of substantial clinical consequence in the treatment of hypertension. The benefits of this class of agents in the treatment of hypertension is established and compares well with other first-line therapeutic agents.
Diuretics are standard therapy for the management of edema in patients with heart failure.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Orthostatic hypotension.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May cause drowsiness
Mental Health: Effects on Psychiatric Treatment
May rarely cause agranulocytosis; use caution with clozapine and carbamazepine; may cause photosensitivity; use psychotropics with caution; may decrease lithium clearance resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels
Nursing: Physical Assessment/Monitoring
Monitor positional blood pressure and fluid balance on a regular basis. Monitor for signs of hypokalemia. If used to treat CHF, monitor for signs of effectiveness. Monitor and teach patient to monitor for effectiveness of therapy, possible side effects, precautions, and symptoms to report (see Patient Education). Note breast-feeding caution.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet: 5 mg
Pricing: U.S. (www.drugstore.com)
Tablets (Methyclothiazide)
5 mg (30): $24.40
References
Chobanian AV, Bakris GL, Black HR, et al, “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report,” JAMA, 2003, 289(19):2560-71.
International Brand Names
Lexi-Comp.com
Last full review/revision July 2009
Content last modified July 2009
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