Hydrochlorothiazide Spironolactone

Hydrochlorothiazide Spironolactone Brand Name– Aldactazide

What is Hydrochlorothiazide Spironolactone

Hydrochlorothiazide Spironolactone are diuretics used together to treat hypertension or edema associated with congestive heart failure, cirrhosis, or the nephrotic syndrome.

The two diuretics have complementary mechanisms of action; hydrochlorothiazide promotes sodium and water excretion primarily by inhibiting their reabsorption in the renal cortical diluting segment, whereas spironolactone is an aldosterone antagonist at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted renal tubule.

The drug combination is not indicated for the initial treatment of hypertension or edematous conditions.

Hydrochlorothiazide spironolactone may be appropriate for some patients, such as those with hyperaldosteronism or hypokalemia, if the titrated dose of each drug component represents the combination product doses.

The risk of primary cardiac arrest after adjustment for potential confounding factors was lower for patients with hypertension that received a thiazide and a potassium-sparing diuretic than for patients that received only a thiazide diuretic. In contrast, addition of potassium supplements to a thiazide diuretic was not associated with a lower risk.

The National Council on Potassium in Clinical Practice recommends the use of a low-dose diuretic combined with a drug with potential for sparing potassium, such as a potassium-sparing diuretic for patients that need diuretic therapy.

The Joint National Committee for Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) recommends increased potassium intake and drugs to increase potassium for the treatment of hypertension.

Diuretics have been shown to reduce hypertension-related morbidity and mortality. The combination tablets contain hydrochlorothiazide and spironolactone in the recommended dose range for hypertension of 12.5—50 mg daily and 25—50 mg daily, respectively.

Hydrochlorothiazide, spironolactone (Aldactazide®) was approved by the FDA in December 1982.

Indications

  1. chronic lung disease (CLD)
  2. edema
  3. hypertension

For the treatment of edema associated with cirrhosis of the liver, congestive heart failure, or the nephrotic syndrome

Side Effects

  1. abdominal pain
  2. agranulocytosis
  3. alopecia
  4. amenorrhea
  5. anaphylactoid reactions
  6. anorexia
  7. aplastic anemia
  8. ataxia
  9. azotemia
  10. blurred vision
  11. cholestasis
  12. confusion
  13. constipation
  14. diarrhea
  15. dizziness
  16. drowsiness
  17. erythema
  18. erythema multiforme
  19. fever
  20. gastritis
  21. glycosuria
  22. gout
  23. gynecomastia
  24. headache
  25. hemolysis
  26. hemolytic anemia
  27. hepatic failure
  28. hypercalcemia
  29. hypercholesterolemia
  30. hyperglycemia
  31. hyperkalemia
  32. hypertriglyceridemia
  33. hyperuricemia
  34. hypomagnesemia
  35. hyponatremia
  36. hypovolemia
  37. impotence (erectile dysfunction)
  38. infertility
  39. interstitial nephritis
  40. jaundice
  41. lethargy
  42. leukopenia
  43. libido decrease
  44. lupus-like symptoms
  45. maculopapular rash
  46. mastalgia
  47. menstrual irregularity
  48. muscle cramps
  49. myopia
  50. nausea
  51. new primary malignancy
  52. ocular hypertension
  53. pancreatitis
  54. paresthesias
  55. photosensitivity
  56. polyuria
  57. postmenopausal bleeding
  58. pruritus
  59. rash
  60. renal failure (unspecified)
  61. restlessness
  62. sialadenitis
  63. Stevens-Johnson syndrome
  64. thrombocytopenia
  65. toxic epidermal necrolysis
  66. tumorigenicity
  67. urticaria
  68. vasculitis
  69. vertigo
  70. vomiting
  71. weakness
  72. xanthopsia

Monitoring Parameters

  • blood glucose
  • blood pressure
  • ECG
  • serum calcium
  • serum creatinine/BUN
  • serum electrolytes
  • serum magnesium
  • serum uric acid

Contraindications

  • adrenal insufficiency
  • anuria
  • asthma
  • breast-feeding
  • children
  • diabetes mellitus
  • driving or operating machinery
  • electrolyte imbalance
  • geriatric
  • gout
  • hepatic disease
  • hypercalcemia
  • hypercholesterolemia
  • hyperkalemia
  • hyperparathyroidism
  • hypertriglyceridemia
  • hyperuricemia
  • hypomagnesemia
  • hyponatremia
  • hypotension
  • hypovolemia
  • infertility
  • menstrual irregularity
  • new primary malignancy
  • orthostatic hypotension
  • penicillin hypersensitivity
  • preeclampsia
  • pregnancy
  • prostate cancer
  • renal failure
  • renal impairment
  • sulfonamide hypersensitivity
  • sunlight (UV) exposure
  • sympathectomy
  • syncope
  • systemic lupus erythematosus (SLE)
  • thiazide diuretic hypersensitivity
  • tumorigenicity
  • water intoxication

Interactions

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  • Acetaminophen; Butalbital
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  • Acetaminophen; Codeine
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  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
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