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Hydrochlorothiazide: Drug information

Hydrochlorothiazide: Drug information
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For additional information see "Hydrochlorothiazide: Patient drug information" and "Hydrochlorothiazide: Pediatric drug information"

For abbreviations, symbols, and age group definitions show table
Brand Names: US
  • Inzirqo
Brand Names: Canada
  • APO-Hydro [DSC];
  • APO-Hydrochlorothiazide;
  • MINT-Hydrochlorothiazide;
  • PMS-Hydrochlorothiazide;
  • TEVA-Hydrochlorothiazide
Pharmacologic Category
  • Antihypertensive;
  • Diuretic, Thiazide
Dosing: Adult
Calcium nephrolithiasis, prevention

Calcium nephrolithiasis, prevention (off-label use):

Oral: Initial: 25 mg once daily; titrate based on tolerance and urinary calcium levels to usual effective dose of 50 to 100 mg/day in 1 to 2 divided doses (Ref).

Diabetes insipidus, nephrogenic

Diabetes insipidus, nephrogenic (off-label use):

Note: Consider for use in addition to a low-solute diet to help reduce polyuria (Ref).

Oral: 25 mg once or twice daily (Ref).

Edema or general volume overload

Edema or general volume overload (adjunctive to loop diuretic):

Note : Optimize loop diuretic therapy before adding hydrochlorothiazide; combination diuretic therapy is typically for short-term use to restore euvolemia in patients already taking high-dose loop diuretic therapy who are resistant (eg, furosemide total daily dose of 160 to 320 mg/day IV or the oral equivalent). Combination diuretic therapy can cause severe electrolyte depletion (eg, potassium, magnesium, sodium); prior to and during therapy, electrolytes should be monitored and appropriately managed (Ref).

Oral: Initial: 25 to 50 mg once or twice daily; may increase dose as needed based on response and tolerability up to a maximum of 200 mg/day; may be administered in combination with or shortly before the scheduled loop diuretic. Assess volume status frequently (eg, daily or at least every 2 to 3 days) to determine effectiveness and avoid over-diuresis. Continue until euvolemia is restored, although some patients may require maintenance therapy (Ref).

Hypertension, chronic

Hypertension, chronic (alternative agent):

Note: When a thiazide diuretic is chosen, chlorthalidone or indapamide is preferred (Ref). For patients who warrant combination therapy (blood pressure ≥20/10 mm Hg above goal or suboptimal response to initial monotherapy), may use in combination with another appropriate agent (eg, angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, dihydropyridine calcium channel blocker) (Ref). However, some experts prefer regimens that do not include thiazide diuretics for combination therapy (Ref).

Oral: Initial: 12.5 to 25 mg once daily; evaluate response after ~2 to 4 weeks and titrate dose, as needed, up to 50 mg once daily (Ref); some experts do not recommend doses higher than 25 mg/day because of greater adverse effects without additional antihypertensive effect; if additional blood pressure control is needed, consider combination therapy. Patients with severe asymptomatic hypertension and no signs of acute end organ damage should be evaluated for medication titration within 1 week (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Altered kidney function:

CrCl ≥10 mL/minute: No dosage adjustment necessary. The diuretic effect is diminished with CrCl <30 mL/minute, but small, short-term studies suggest hypertensive benefit may be preserved (Ref). Switching to a loop diuretic may be considered if BP is no longer controlled or if management of fluid overload is required (Ref).

CrCl <10 mL/minute: Use not recommended due to lack of efficacy (Ref).

Hemodialysis, intermittent (thrice weekly): Not dialyzable (Ref); use not recommended due to lack of efficacy (Ref).

Peritoneal dialysis: Use not recommended due to lack of efficacy (Ref).

CRRT: In general, use not recommended; fluid management can be more effectively managed using CRRT ultrafiltration (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): In general, use not recommended; fluid management can be more effectively managed using PIRRT ultrafiltration (Ref).

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. However, use with caution and monitor for precipitation of hepatic coma.

Dosing: Older Adult

Oral: Initial: 12.5 mg once daily; titrate as necessary in increments of 12.5 mg. Minimal increase in response and more electrolyte disturbances are seen with doses >50 mg daily.

Dosing: Pediatric

(For additional information see "Hydrochlorothiazide: Pediatric drug information")

Dosage guidance:

Dosing: Oral suspension may be available in multiple concentrations (commercially available: 10 mg/mL; extemporaneous preparation: 5 mg/mL); use extra precaution to verify and avoid confusion between the different concentrations; dose should be clearly presented as mg as appropriate (ie, not in mL or number of tablets).

Bronchopulmonary dysplasia

Bronchopulmonary dysplasia (BPD): Limited data available; efficacy results variable. Note: Although the benefits of diuretic therapy in management of BPD are variable (eg, optimal duration of therapy, impact on pulmonary endpoints), diuretics continue to be used in clinical practice (Ref).

Infants: Oral: 3 to 4 mg/kg/day in 2 divided doses (Ref).

Diabetes insipidus, central

Diabetes insipidus, central: Very limited data available: Infants and Children <3 years: Oral: 1 to 2 mg/kg/day. Dosing based on retrospective descriptive analysis (n=13, age range: 0.5 to 27 months) (Ref).

Edema

Edema (diuresis):

Infants <6 months: Oral: 1 to 2 mg/kg/day in 1 to 2 divided doses; some infants may require 3 mg/kg/day in 2 divided doses; maximum daily dose: 37.5 mg/day (Ref).

Infants ≥6 months and Children <2 years: Oral: 1 to 2 mg/kg/day in 1 to 2 divided doses; maximum daily dose: 37.5 mg/day (Ref).

Children ≥2 years: Oral: 1 to 2 mg/kg/day in 1 to 2 divided doses; maximum daily dose: 100 mg/day (Ref).

Adolescents: Limited data available: Oral: 1 to 2 mg/kg/day in 1 to 2 divided doses (Ref). Note: Maximum adult daily dose recommended for heart failure-related edema: 200 mg/day (Ref).

Hypertension

Hypertension:

Infants <6 months: Oral: 1 to 2 mg/kg/day in 1 to 2 divided doses; some infants may require 3 mg/kg/day in 2 divided doses; maximum daily dose: 37.5 mg/day (Ref).

Infants ≥6 months and Children <2 years: Oral: 1 to 2 mg/kg/day in 1 to 2 divided doses; maximum daily dose: 37.5 mg/day (Ref).

Children ≥2 years: Oral: 1 to 2 mg/kg/day in 1 to 2 divided doses; maximum daily dose: 100 mg/day (Ref); a lower maximum dose of 37.5 mg/day has been suggested by recent guidelines (Ref).

Adolescents: Limited data available: Oral: Initial: 1 mg/kg/day once daily; may increase to maximum daily dose: 3 mg/kg/day or 50 mg/day, whichever is lower (Ref).

Hypercalciuria

Hypercalciuria: Limited data available: Infants, Children, and Adolescents: Oral: Initial: 1 to 2 mg/kg/day in 1 to 2 divided doses; lower initial doses of 0.5 mg/kg/day has been reported in infants and children; titrate until goal urinary calcium excretion goals reached and symptoms resolve; treatment usually continued for 1 year; usual adult dose: 25 to 100 mg/day (Ref).

Nephrogenic diabetes insipidus, congenital

Nephrogenic diabetes insipidus, congenital: Limited data available: Infants, Children, and Adolescents: Oral: Usual dosage range: 1 to 3 mg/kg/day in combination with amiloride. Dosing based on a retrospective descriptive analysis (n=30, age range: 1 month to 40 years), and a retrospective analysis (n=10, median age at diagnosis: 1.6 years [age range: 0.16 to 6.33 years]), and a pediatric case series (n=4) in patients receiving hydrochlorothiazide in combination with amiloride (Ref). In adults, usual dose is 25 mg once or twice daily (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Altered kidney function: Infants, Children, and Adolescents:

There are no dosage adjustments provided in the manufacturer's labeling; however, the following adjustments have been recommended (Ref):

GFR ≥30 mL/minute/1.73 m2: No dosage adjustment necessary.

GFR <30 mL/minute/1.73 m2: Use not recommended; use is contraindicated with anuria.

Hemodialysis, intermittent: Not dialyzable (Ref); there are no dosage adjustments provided in the manufacturer's labeling; use not recommended (Ref).

Peritoneal dialysis: There are no dosage adjustments provided in the manufacturer's labeling; use not recommended (Ref).

Dosing: Liver Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however, use with caution in patients with liver impairment and monitor for precipitation of hepatic coma.

Adverse Reactions (Significant): Considerations
Dermatologic toxicity

Skin photosensitivity may occur with hydrochlorothiazide. Cumulative use may increase the risk for squamous cell carcinoma (SCC) of skin (lip) and basal cell carcinoma (BCC) of skin (Ref).

Mechanism: Skin photosensitivity: Non-dose-related; idiosyncratic. Diuretics reduce the minimum UV radiation needed to produce a sunburn-like response, increasing the risk of phototoxicity and potentially photocarcinogenesis (Ref). SCC and BCC: Dose- and time-related (Ref); risk may be mediated through skin photosensitivity (Ref).

Onset: SCC/BCC: Delayed (Ref)

Risk factors:

SCC/BCC:

• Cumulative use (ie, ≥5 years) (Ref)

Electrolyte disturbances

Reversible hypokalemia, hypomagnesemia, hypercalcemia, and hyponatremia may occur with hydrochlorothiazide and may increase the risk of arrhythmias. Development of electrolyte disturbances may be minimized when used in combination with other electrolyte-sparing antihypertensives (eg, angiotensin-converting enzyme, angiotensin receptor blockers, or aldosterone inhibitors) (Ref).

Mechanism: Dose-related; related to the pharmacologic action. Thiazide diuretics block the NaCl cotransporter in the distal convoluted tubule, leading to decreased reabsorption of sodium and chloride and increased delivery of sodium to the collecting duct, which leads to increased potassium wasting. Diluting capacity of the kidney is also impaired, leading to decreased magnesium and increased calcium concentrations (Ref).

Onset: Varied; hypokalemia generally occurs within 2 weeks of initiation (Ref). Hyponatremia onset may range from 2 weeks to 10 years after treatment initiation (Ref).

Risk factors:

• High doses (>25 mg/day) (Ref) or concurrent loop diuretic therapy (Ref)

• Hypokalemia: GI losses (eg, vomiting, diarrhea) (Ref)

• Hypomagnesemia: Heart failure, poor magnesium intake, high alcohol intake (Ref)

• Hyponatremia: Increased water intake (Ref); older patients, females (Ref)

• Hypercalcemia: Older patients, females (Ref)

Gout

Hydrochlorothiazide may cause hyperuricemia and precipitate gout or gouty arthritis in susceptible individuals (Ref).

Mechanism: Dose- and time-related; related to the pharmacologic action. Diuretics increase reabsorption of uric acid in the proximal tubule, reducing urinary excretion, increasing the risk of hyperuricemia and gout (Ref). Volume contraction with use of diuretics may also contribute (Ref).

Onset: Rapid; hyperuricemia and gout generally occur within the first few days of treatment initiation (Ref) but may occur up to one year after treatment initiation (Ref).

Risk factors:

• High doses (Ref)

• Increased duration of therapy (Ref)

• Personal or family history of gout (Ref)

Hypersensitivity reactions (immediate and delayed)

Hypersensitivity reactions, both immediate and delayed, have been reported (Ref). Delayed hypersensitivity reactions range from maculopapular skin rash to severe cutaneous adverse reactions, including acute generalized exanthematous pustulosis (Ref). Other hypersensitivity reactions include interstitial nephritis and interstitial pneumonitis (Ref). Additionally, hydrochlorothiazide has been associated with noncardiogenic pulmonary edema (Ref).

Mechanism: Immediate hypersensitivity reactions: Non-dose-related; immunologic (ie, IgE-mediated, with specific antibodies formed against a drug allergen following initial exposure) (Ref). Delayed hypersensitivity reactions: Non-dose-related; immunologic (ie, involving a T-cell mediated drug-specific immune response) (Ref). Noncardiogenic pulmonary edema: Unknown; various proposed mechanisms including immunologic (Ref), idiosyncratic (Ref), and mast cell or complement activation (Ref).

Onset: Immediate hypersensitivity reactions: Rapid; generally occur within 1 hour of administration but may occur up to 6 hours after exposure (Ref). Delayed hypersensitivity reactions: Varied; typically occur days to 6 weeks after drug exposure, but may occur more rapidly (usually within 1 to 4 days) upon reexposure (Ref). Noncardiogenic pulmonary edema: Rapid; occurs within 10 to 150 minutes (Ref); upon rechallenge, symptoms develop more rapidly and are often severe (Ref).

Risk factors:

• Cross-reactivity: Limited published information regarding possible cross-reactivity between hydrochlorothiazide and other sulfonamides (Ref). Cross-reactivity due to antibody production (anaphylaxis) is unlikely to occur with nonantibiotic sulfonamides and antibiotic sulfonamides (Ref). Cross-reactivity among thiazide diuretics is unknown.

Ocular Effects

Sulfa derivatives, such as hydrochlorothiazide, may cause acute transient myopia and acute angle-closure glaucoma which is generally reversible (Ref).

Mechanism: Non-dose-related; idiosyncratic (ie, suggested to involve ciliochoroidal effusion and anterior rotation of the ciliary body, leading to myopic shift and angle closure) (Ref). Hyponatremia may also play a role (Ref).

Onset: Varied; reported to occur between 2 days and 7 years after initiation (Ref).

Adverse Reactions

The following adverse drug reactions are derived from product labeling unless otherwise specified.

Frequency not defined:

Cardiovascular: Hypotension, vasculitis

Dermatologic: Alopecia, skin rash, toxic epidermal necrolysis, urticaria

Endocrine & metabolic: Hypomagnesemia

Gastrointestinal: Abdominal cramps, anorexia, constipation, diarrhea, gastric irritation, nausea, vomiting

Genitourinary: Glycosuria

Hematologic & oncologic: Aplastic anemia, thrombocytopenia

Hepatic: Intrahepatic cholestatic jaundice

Hypersensitivity: Anaphylaxis

Nervous system: Asthenia, dizziness, headache, paresthesia, restlessness, vertigo

Neuromuscular & skeletal: Muscle spasm

Ophthalmic: Blurred vision, xanthopsia

Renal: Decreased urinary calcium excretion

Miscellaneous: Fever

Postmarketing:

Dermatologic: Acute generalized exanthematous pustulosis (Ref), basal cell carcinoma of skin (Ref), malignant neoplasm of lip (Ref), psoriasis (Ref), skin photosensitivity (Ref), squamous cell carcinoma of skin (Ref), Stevens-Johnson syndrome (Ref)

Endocrine & metabolic: Hypercalcemia (Ref), hyperglycemia (Ref), hyperuricemia (Ref), hypochloremic alkalosis (Ref), hypokalemia (Ref), hyponatremia (Ref)

Gastrointestinal: Pancreatitis (Ref), sialadenitis (Ref)

Genitourinary: Erectile dysfunction (Ref)

Hematologic & oncologic: Agranulocytosis (Ref), hemolytic anemia (Ref), leukopenia (Ref), methemoglobinemia (Ref), purpuric disease (Ref)

Hepatic: Cholestatic hepatitis (Ref), hepatotoxicity (including cholangitis, increased serum alkaline phosphatase, increased serum transaminases, intrahepatic cholestasis) (Ref)

Hypersensitivity: Angioedema (Ref), hypersensitivity angiitis (Ref)

Neuromuscular & skeletal: Systemic lupus erythematosus (Ref)

Ophthalmic: Acute angle-closure glaucoma (Ref), myopia (Ref)

Renal: Interstitial nephritis (Ref)

Respiratory: Interstitial pneumonitis (Ref), noncardiogenic pulmonary edema (Ref)

Contraindications

Hypersensitivity to hydrochlorothiazide, any component of the formulation, or sulfonamide-derived drugs; anuria

Note: Although the FDA-approved product labeling states this medication is contraindicated in patients with hypersensitivity to sulfonamide-containing drugs, the scientific basis of this cross-sensitivity has been challenged.

Canadian labeling: Additional contraindications (not in US labeling): Increasing azotemia and oliguria during treatment of severe progressive renal disease; breast-feeding

Warnings/Precautions

Concerns related to adverse effects:

• Sulfonamide (“sulfa”) allergy: The FDA-approved product labeling for many medications containing a sulfonamide chemical group includes a broad contraindication in patients with a prior allergic reaction to sulfonamides. There is a potential for cross-reactivity between members of a specific class (eg, two antibiotic sulfonamides). However, concerns for cross-reactivity have previously extended to all compounds containing the sulfonamide structure (SO2NH2). An expanded understanding of allergic mechanisms indicates cross-reactivity between antibiotic sulfonamides and nonantibiotic sulfonamides may not occur or at the very least this potential is extremely low (Brackett 2004; Johnson 2005; Slatore 2004; Tornero 2004). In particular, mechanisms of cross-reaction due to antibody production (anaphylaxis) are unlikely to occur with nonantibiotic sulfonamides. T-cell-mediated (type IV) reactions (eg, maculopapular rash) are less well understood and it is not possible to completely exclude this potential based on current insights. In cases where prior reactions were severe (Stevens-Johnson syndrome/TEN), some clinicians choose to avoid exposure to these classes.

Disease-related concerns:

• Adrenal insufficiency: Avoid use of diuretics for treatment of elevated blood pressure in patients with primary adrenal insufficiency (Addison disease). Adjustment of glucocorticoid/mineralocorticoid therapy and/or use of other antihypertensive agents is preferred to treat hypertension (Bornstein 2016; Inder 2015).

• Ascites due to cirrhosis: Use with extreme caution or avoid hydrochlorothiazide in the management of ascites due to cirrhosis; may lead to rapid development of hyponatremia when used in combination with spironolactone and furosemide (AASLD [Runyon 2012]).

• Bariatric surgery: Dehydration: Avoid diuretics in the immediate postoperative period after bariatric surgery; electrolyte disturbances and dehydration may occur. Diuretics may be resumed, if indicated, once oral fluid intake goals are met (Ziegler 2009).

• Diabetes: Use with caution in patients with prediabetes or diabetes mellitus; may see a change in glucose control.

• Hepatic impairment: Use with caution in patients with severe hepatic dysfunction; in progressive or severe liver disease, avoid electrolyte and acid/base imbalances that might lead to hepatic encephalopathy/coma.

• Hypercholesterolemia: Use with caution in patients with moderate or high cholesterol concentrations; increased cholesterol and triglyceride levels have been reported.

• Parathyroid disease: Thiazide diuretics reduce calcium excretion; pathologic changes in the parathyroid glands with hypercalcemia and hypophosphatemia have been observed with prolonged use; should be discontinued prior to testing for parathyroid function.

• Renal impairment: Cumulative effects may develop, including azotemia, in patients with impaired renal function. Avoid in severe renal disease (ineffective).

• Systemic lupus erythematosus (SLE): May cause SLE exacerbation or activation.

Special populations:

• Surgical patients: If given the morning of surgery, hydrochlorothiazide may render the patient volume depleted and blood pressure may be labile during general anesthesia.

Dosage form specific issues:

• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated with hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP 1997; Zar 2007). See manufacturer's labeling.

Warnings: Additional Pediatric Considerations

Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral:

Generic: 12.5 mg

Suspension Reconstituted, Oral:

Inzirqo: 10 mg/mL (80 mL) [contains propylene glycol; caramel-mint flavor]

Tablet, Oral:

Generic: 12.5 mg, 25 mg, 50 mg

Generic Equivalent Available: US

May be product dependent

Pricing: US

Capsules (hydroCHLOROthiazide Oral)

12.5 mg (per each): $0.42 - $0.43

Suspension (reconstituted) (Inzirqo Oral)

10 mg/mL (per mL): $5.71

Tablets (hydroCHLOROthiazide Oral)

12.5 mg (per each): $0.17 - $0.82

25 mg (per each): $0.08

50 mg (per each): $0.13 - $0.16

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Tablet, Oral:

Generic: 12.5 mg, 25 mg, 50 mg, 100 mg [DSC]

Administration: Adult

Oral: May administer with or without food; administer early in day to avoid nocturia. Take the last dose of multiple doses no later than 6 PM unless instructed otherwise. Shake oral suspension well prior to use. Administer with an accurate measuring device (eg, calibrated oral syringe); do not use a household teaspoon or tablespoon to measure dose (overdosage may occur).

Administration: Pediatric

Oral: May administer with or without food; administer early in day to avoid nocturia; if multiple daily dosing, the last dose should not be administered later than 6 PM unless instructed otherwise.

Oral suspension (commercially available): Shake well before use. Administer with an accurate measuring device (eg, calibrated oral syringe); do not use a household teaspoon or tablespoon to measure dose (overdosage may occur).

Use: Labeled Indications

Edema or general volume overload: Treatment of edema due to heart failure, various forms of renal dysfunction (eg, nephrotic syndrome, acute glomerulosclerosis, chronic renal failure), or corticosteroid or estrogen therapy. Note: Loop diuretics are typically favored, but hydrochlorothiazide may be used as an adjunctive agent for refractory edema (Brater 2011).

Hypertension, chronic: Management of mild to moderate hypertension.

Use: Off-Label: Adult

Calcium nephrolithiasis, prevention; Diabetes insipidus, nephrogenic

Medication Safety Issues
Sound-alike/look-alike issues:

HydroCHLOROthiazide may be confused with hydrALAZINE, hydrocortisone, hydroxychloroquine, hydrOXYzine, Viskazide

International issues:

Esidrex [multiple international markets] may be confused with Lasix brand name for furosemide [US, Canada, and multiple international markets]

Esidrix [Germany] may be confused with Lasix brand name for furosemide [US, Canada, and multiple international markets]

Microzide [Puerto Rico] may be confused with Maxzide brand name for hydrochlorothiazide/triamterene [US, multiple international markets] and Micronase brand name for glyburide [multiple international markets]

Older Adult: High-Risk Medication:

Beers Criteria: Diuretics are identified in the Beers Criteria as potentially inappropriate medications to be used with caution in patients 65 years and older due to the potential to cause or exacerbate syndrome of inappropriate antidiuretic hormone secretion (SIADH) or hyponatremia; monitor sodium concentration closely when initiating or adjusting the dose in older adults (Beers Criteria [AGS 2023]).

Hydrochlorothiazide is identified in the Screening Tool of Older Person's Prescriptions (STOPP) criteria as a potentially inappropriate medication in older adults (≥65 years of age) with severe hypokalemia, hyponatremia, hypercalcemia, history of gout, or severe symptomatic aortic stenosis (O’Mahony 2023).

Other safety concerns:

HCTZ is an error-prone abbreviation (mistaken as hydrocortisone, seen as HCT250 mg)

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Agents with Clinically Relevant Anticholinergic Effects: May increase serum concentration of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Ajmaline: Sulfonamides may increase adverse/toxic effects of Ajmaline. Specifically, the risk for cholestasis may be increased. Risk C: Monitor

Alcohol (Ethyl): May increase orthostatic hypotensive effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Alfuzosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Allopurinol: Thiazide and Thiazide-Like Diuretics may increase hypersensitivity effects of Allopurinol. Risk C: Monitor

Amifostine: Blood Pressure Lowering Agents may increase hypotensive effects of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider Therapy Modification

Aminolevulinic Acid (Systemic): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Systemic). Risk X: Avoid

Aminolevulinic Acid (Topical): Photosensitizing Agents may increase photosensitizing effects of Aminolevulinic Acid (Topical). Risk C: Monitor

Amphetamines: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Angiotensin-Converting Enzyme Inhibitors: Thiazide and Thiazide-Like Diuretics may increase hypotensive effects of Angiotensin-Converting Enzyme Inhibitors. Thiazide and Thiazide-Like Diuretics may increase nephrotoxic effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

Antidiabetic Agents: Hyperglycemia-Associated Agents may decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor

Antidiabetic Agents: Thiazide and Thiazide-Like Diuretics may decrease therapeutic effects of Antidiabetic Agents. Risk C: Monitor

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may increase hypotensive effects of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor

Arginine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Arsenic Trioxide: Thiazide and Thiazide-Like Diuretics may increase hypotensive effects of Arsenic Trioxide. Thiazide and Thiazide-Like Diuretics may increase QTc-prolonging effects of Arsenic Trioxide. Management: When possible, avoid concurrent use of arsenic trioxide with drugs that can cause electrolyte abnormalities, such as the thiazide and thiazide-like diuretics. Risk D: Consider Therapy Modification

Barbiturates: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Benperidol: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Beta2-Agonists: May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Bile Acid Sequestrants: May decrease absorption of Thiazide and Thiazide-Like Diuretics. Management: Separate administration of bile acid sequestrants and oral thiazide diuretics by at least 4 hours. Monitor for decreased therapeutic effects of thiazide diuretics if coadministered with a bile acid sequestrant. Risk D: Consider Therapy Modification

Brigatinib: May decrease antihypertensive effects of Antihypertensive Agents. Brigatinib may increase bradycardic effects of Antihypertensive Agents. Risk C: Monitor

Brimonidine (Topical): May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Bromperidol: May decrease hypotensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase hypotensive effects of Bromperidol. Risk X: Avoid

Calcium Salts: Thiazide and Thiazide-Like Diuretics may increase serum concentration of Calcium Salts. Risk C: Monitor

Cardiac Glycosides: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of Cardiac Glycosides. Specifically, cardiac glycoside toxicity may be enhanced by the hypokalemic and hypomagnesemic effect of thiazide diuretics. Risk C: Monitor

Corticosteroids (Systemic): May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

CycloPHOSphamide: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of CycloPHOSphamide. Specifically, granulocytopenia may be enhanced. Risk C: Monitor

Desmopressin: Hyponatremia-Associated Agents may increase hyponatremic effects of Desmopressin. Risk C: Monitor

Dexketoprofen: May increase adverse/toxic effects of Sulfonamides. Risk C: Monitor

Dexmethylphenidate: May decrease therapeutic effects of Antihypertensive Agents. Risk C: Monitor

Diacerein: May increase therapeutic effects of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased. Risk C: Monitor

Diazoxide Choline: May increase adverse/toxic effects of Thiazide and Thiazide-Like Diuretics. Specifically, the hyperglycemic and hyperuricemic effects may be increased. Risk C: Monitor

Diazoxide: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of Diazoxide. Risk C: Monitor

Dichlorphenamide: Thiazide and Thiazide-Like Diuretics may increase hypokalemic effects of Dichlorphenamide. Risk C: Monitor

Dofetilide: HydroCHLOROthiazide may increase QTc-prolonging effects of Dofetilide. HydroCHLOROthiazide may increase serum concentration of Dofetilide. Risk X: Avoid

DULoxetine: Blood Pressure Lowering Agents may increase hypotensive effects of DULoxetine. Risk C: Monitor

EPINEPHrine (Systemic): Diuretics may increase arrhythmogenic effects of EPINEPHrine (Systemic). Diuretics may decrease vasopressor effects of EPINEPHrine (Systemic). Risk C: Monitor

Flunarizine: May increase therapeutic effects of Antihypertensive Agents. Risk C: Monitor

Herbal Products with Blood Pressure Increasing Effects: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Herbal Products with Blood Pressure Lowering Effects: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Hypotension-Associated Agents: Blood Pressure Lowering Agents may increase hypotensive effects of Hypotension-Associated Agents. Risk C: Monitor

Iloperidone: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Indoramin: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Ipragliflozin: May increase adverse/toxic effects of Thiazide and Thiazide-Like Diuretics. Specifically, the risk for intravascular volume depletion may be increased. Risk C: Monitor

Isocarboxazid: May increase hypotensive effects of Diuretics. Risk X: Avoid

Ivabradine: Thiazide and Thiazide-Like Diuretics may increase arrhythmogenic effects of Ivabradine. Risk C: Monitor

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may increase hypotensive effects of Levodopa-Foslevodopa. Risk C: Monitor

Levosulpiride: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of Levosulpiride. Risk X: Avoid

Licorice: May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Lithium: Thiazide and Thiazide-Like Diuretics may decrease excretion of Lithium. Management: Reduce the lithium dose if coadministered with thiazide or thiazide-like diuretics. Monitor serum lithium levels during coadministration with thiazide and thiazide-like diuretics. Risk D: Consider Therapy Modification

Loop Diuretics: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Lormetazepam: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Mecamylamine: Thiazide and Thiazide-Like Diuretics may increase adverse/toxic effects of Mecamylamine. Management: Consider avoiding the use of mecamylamine and thiazide diuretics. If combined, mecamylamine prescribing information suggests reducing the mecamylamine dose by 50% in order to avoid excessive hypotension. Risk D: Consider Therapy Modification

Metergoline: May decrease antihypertensive effects of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may increase orthostatic hypotensive effects of Metergoline. Risk C: Monitor

Methenamine: Thiazide and Thiazide-Like Diuretics may decrease therapeutic effects of Methenamine. Risk C: Monitor

Methotrexate: HydroCHLOROthiazide may increase nephrotoxic effects of Methotrexate. Risk C: Monitor

Methoxsalen (Systemic): Photosensitizing Agents may increase photosensitizing effects of Methoxsalen (Systemic). Risk C: Monitor

Methylphenidate: May decrease antihypertensive effects of Antihypertensive Agents. Risk C: Monitor

Molsidomine: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Multivitamins/Fluoride (with ADE): May increase hypercalcemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Multivitamins/Minerals (with ADEK, Folate, Iron): Thiazide and Thiazide-Like Diuretics may increase hypercalcemic effects of Multivitamins/Minerals (with ADEK, Folate, Iron). Risk C: Monitor

Multivitamins/Minerals (with AE, No Iron): Thiazide and Thiazide-Like Diuretics may increase serum concentration of Multivitamins/Minerals (with AE, No Iron). Specifically, thiazide diuretics may decrease the excretion of calcium, and continued concomitant use can also result in metabolic alkalosis. Risk C: Monitor

Naftopidil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Neuromuscular-Blocking Agents (Nondepolarizing): Thiazide and Thiazide-Like Diuretics may increase neuromuscular-blocking effects of Neuromuscular-Blocking Agents (Nondepolarizing). Risk C: Monitor

Nicergoline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nicorandil: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Nitroprusside: Blood Pressure Lowering Agents may increase hypotensive effects of Nitroprusside. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents (Topical): May decrease therapeutic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents: May decrease therapeutic effects of Thiazide and Thiazide-Like Diuretics. Thiazide and Thiazide-Like Diuretics may increase nephrotoxic effects of Nonsteroidal Anti-Inflammatory Agents. Risk C: Monitor

Obinutuzumab: May increase hypotensive effects of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider Therapy Modification

Opioid Agonists: May increase adverse/toxic effects of Diuretics. Opioid Agonists may decrease therapeutic effects of Diuretics. Risk C: Monitor

Palopegteriparatide: Thiazide and Thiazide-Like Diuretics may increase therapeutic effects of Palopegteriparatide. Thiazide and Thiazide-Like Diuretics may decrease therapeutic effects of Palopegteriparatide. Risk C: Monitor

Pentoxifylline: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Perazine: May increase hypotensive effects of Antihypertensive Agents. Risk C: Monitor

Pholcodine: Blood Pressure Lowering Agents may increase hypotensive effects of Pholcodine. Risk C: Monitor

Phosphodiesterase 5 Inhibitors: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Piperacillin: May increase hypokalemic effects of Diuretics. Risk C: Monitor

Polyethylene Glycol-Electrolyte Solution: Diuretics may increase nephrotoxic effects of Polyethylene Glycol-Electrolyte Solution. Risk C: Monitor

Porfimer: Photosensitizing Agents may increase photosensitizing effects of Porfimer. Risk X: Avoid

Prazosin: Antihypertensive Agents may increase hypotensive effects of Prazosin. Risk C: Monitor

Promazine: Thiazide and Thiazide-Like Diuretics may increase QTc-prolonging effects of Promazine. Risk X: Avoid

Prostacyclin Analogues: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Quinagolide: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Reboxetine: May increase hypokalemic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Selective Serotonin Reuptake Inhibitor: May increase hyponatremic effects of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor

Silodosin: May increase hypotensive effects of Blood Pressure Lowering Agents. Risk C: Monitor

Sodium Phosphates: Diuretics may increase nephrotoxic effects of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Risk C: Monitor

Sotagliflozin: HydroCHLOROthiazide may decrease therapeutic effects of Sotagliflozin. Sotagliflozin may decrease serum concentration of HydroCHLOROthiazide. Risk C: Monitor

Terazosin: Antihypertensive Agents may increase hypotensive effects of Terazosin. Risk C: Monitor

Topiramate: Thiazide and Thiazide-Like Diuretics may increase hypokalemic effects of Topiramate. Thiazide and Thiazide-Like Diuretics may increase serum concentration of Topiramate. Risk C: Monitor

Toremifene: Thiazide and Thiazide-Like Diuretics may increase hypercalcemic effects of Toremifene. Risk C: Monitor

Urapidil: Antihypertensive Agents may increase hypotensive effects of Urapidil. Risk C: Monitor

Verteporfin: Photosensitizing Agents may increase photosensitizing effects of Verteporfin. Risk C: Monitor

Vitamin D Analogs: Thiazide and Thiazide-Like Diuretics may increase hypercalcemic effects of Vitamin D Analogs. Risk C: Monitor

Reproductive Considerations

When diuretics are used for the treatment of heart failure in patients planning to become pregnant, adjust dose prior to conception to minimize risk of placental hypoperfusion (AHA/ACC/HFSA [Heidenreich 2022]).

Medications considered acceptable for the treatment of chronic hypertension during pregnancy may generally be continued in patients trying to conceive. Hydrochlorothiazide is a second-line agent for the treatment of hypertension in pregnant patients (ACC/AHA [Whelton 2018]; ACOG 2019; NICE 2019; SOGC [Magee 2022]).

Pregnancy Considerations

Hydrochlorothiazide crosses the placenta (Beerman 1980).

Maternal use may cause fetal or neonatal jaundice, thrombocytopenia, or other adverse events observed in adults.

Chronic maternal hypertension is associated with adverse events in the fetus/infant. Chronic maternal hypertension may increase the risk of birth defects, low birth weight, premature delivery, stillbirth, and neonatal death. Actual fetal/neonatal risks may be related to the duration and severity of maternal hypertension. Untreated chronic hypertension may also increase the risks of adverse maternal outcomes, including gestational diabetes, preeclampsia, delivery complications, stroke and myocardial infarction (ACOG 2019). Patients with preexisting hypertension may continue their medication during pregnancy unless contraindications exist (ESC [Regitz-Zagrosek 2018]). Hydrochlorothiazide is a second-line agent for the treatment of hypertension in pregnant patients (ACOG 2019; SOGC [Magee 2022]).

Use of thiazide diuretics during pregnancy may be considered to treat edema due to pathologic causes (as in the nonpregnant patient); monitor.

Heart failure in pregnancy is associated with adverse maternal and fetal outcomes, including premature birth, infants born small-for-gestational-age, increased risk of maternal and fetal death (Bright 2021). Thiazide diuretics may be used for symptom management in pregnant patients with heart failure complicated by pulmonary congestion; closely monitor volume status and adjust dose to minimize risk of placental hypoperfusion (AHA/ACC/HFSA [Heidenreich 2022]; ESC [Regitz-Zagrosek 2018]).

A case report describes the use of hydrochlorothiazide for the treatment of nephrogenic diabetes insipidus during pregnancy (Gala-Błądzińska 2018).

Breastfeeding Considerations

Hydrochlorothiazide is present in breast milk.

Data related to the presence of hydrochlorothiazide in breast milk are available from one mother taking hydrochlorothiazide 50 mg once daily for 3.5 years. The study was conducted 28 days postpartum; breast milk was sampled prior to and at intervals for ~23 hours after the dose. Trough breast milk concentrations were ~50 ng/mL and the mean breast milk concentration was 80 ng/mL. The highest breast milk concentrations of hydrochlorothiazide occurred between ~4 to 10 hours after the dose. Hydrochlorothiazide was not detected in the infant serum (limit of detection 20 ng/mL) (Miller 1982).

• Using a mean milk concentration of 80 ng/mL, the estimated exposure of hydrochlorothiazide to the breastfeeding infant would be 0.012 mg/kg/day (relative infant dose [RID] 0.6% to 1.2% when compared to an infant therapeutic dose of 1 to 2 mg/kg/day).

• In general, breastfeeding is considered acceptable when the RID is <10% (Anderson 2016; Ito 2000).

Due to the potential for serious adverse reactions in the breastfeeding infant, the manufacturer recommends a decision be made whether to discontinue breastfeeding or to discontinue the drug, considering the importance of treatment to the mother. Hydrochlorothiazide is considered compatible with breastfeeding (WHO 2002). However, thiazide diuretics have the potential to decrease milk volume and suppress lactation; use should be avoided when possible (ACOG 2019; WHO 2002).

Monitoring Parameters

Blood pressure; fluid intake and output; serum electrolytes; BUN, serum creatinine; skin to assess for photosensitivity and skin cancer; visual acuity, ocular pain.

Mechanism of Action

Inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium and water as well as potassium and hydrogen ions

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Diuresis: Infants: 2 to 6 hours (Chemtob 1989); Adults: ~2 hours.

Peak effect: ~4 hours.

Duration: Infants: 8 hours (Chemtob 1989); Adults: 6 to 12 hours.

Absorption: Well absorbed; absorption is reduced in patients with CHF.

Distribution: 3.6 to 7.8 L/kg (correlates with dose administered and concentration achieved).

Protein binding: ~40% to 70%.

Metabolism: Not metabolized.

Bioavailability: 65% to 75%.

Half-life elimination: Capsule/tablet: ~6 to 15 hours; oral suspension: ~10 hours.

Time to peak: Capsule/tablet: ~1 to 5 hours; oral suspension: ~1.5 hours, delayed 2 hours when administered after a high-fat, high-calorie meal.

Excretion: Urine (≥61% as unchanged drug).

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Altered kidney function: Hydrochlorothiazide plasma concentration is increased and the half-life is prolonged.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Dichlotride | Esidrex | Monozide;
  • (AR) Argentina: Diural | Diurex | Diuriten | HCT 25 | Klortiazida | Tandiur;
  • (AT) Austria: Hct Lannacher;
  • (AU) Australia: Dithiazide;
  • (BD) Bangladesh: Acuren | Htz;
  • (BG) Bulgaria: Dehydratin Neo | Dehydrazid | Hypodehydra;
  • (BR) Brazil: Clorana | Clorizin | Diureclor | Diurepina | Diuretic | Diuretil | Diurezin | Diurix | Drenol | Farmanguinhos hidroclorotiazida | Furp hidroclorotiazida | Hidrazim | Hidrobio | Hidroclorana | Hidroclorotiazida | Hidrofall | Hidroflux | Hidrogen | Hidrol | Hidrolan | Hidroless | Hidromed | Hidrotiazida | Iquego hidroclorotiazida | Lafepe hidroclorotiazida | Lfm hidroclorotiazida | Lqfex hidroclorotiazida | Mictrin | Neo hidroclor;
  • (CH) Switzerland: Esidrex;
  • (CI) Côte d'Ivoire: Apo hydro;
  • (CL) Chile: Hidroclorotiazida | Hidroronol;
  • (CN) China: Hydrochlorothiazid;
  • (CO) Colombia: Diclotride | Diurizir | Hidroclorotiazida | Hidroclorotiazida mk | Hydrug | Hydruretic | Lonpra;
  • (CR) Costa Rica: Hidroclorotiazida fb;
  • (CZ) Czech Republic: Hydrochlorothiazid | Hydrochlorothiazid tainex | Hydrochlorothiazide aurovitas;
  • (DE) Germany: Diu-melusin | Esidrex | Esidrix | Hct Aaa | Hct Actavis | Hct aiwa | Hct AL | Hct basf | Hct beta | Hct biochemie | Hct CT | Hct Dexcel | HCT Dura | Hct gamma | Hct hexal | Hct Intermuti | Hct Isis | Hct puren | Hct ratiopharm | HCT Sandoz | Hct Stada | HCT Teva | Hctad | Hydrochlorothiazid Dexcel | Hydrochlorothiazide 1a pharma;
  • (DO) Dominican Republic: H pres | Hiclor | Hidro Pres | Hidrocard | Hidroclorotiazida | Hidroclorotiazida feltrex | Hidroclorotiazida lam | Hidroclorotiazide | Hidrotiadol | Hypress | Olina | Tiaretic;
  • (EC) Ecuador: HCT 25 | Hidroclorotiazida;
  • (EE) Estonia: Hypothiazid;
  • (EG) Egypt: Hct georetic | Hydretic | Hydrex | Hydrozide;
  • (ES) Spain: Drine | Esidrex | Hidroclorotiazid Kern Pharma | Hidroclorotiazida apotex | Hidroclorotiazida aristo | Hidroclorotiazida aurovitas | Hidroclorotiazida kern pharma | Hidroclorotiazida Stada | Hidroclorotiazida vir | Hidrosaluretil | Hydrochlorothiazide sandoz;
  • (FI) Finland: Dichlotride | Hct-sal | Hyclosid | Hydresis | Hydrex | Hydrex semi;
  • (FR) France: Esidrex | Hydrochlorothiazide arrow;
  • (GB) United Kingdom: Direma | Hydrosaluric;
  • (GR) Greece: Diuren | Esidrex | Hydrochlorothiazid;
  • (HK) Hong Kong: Apo hydrochlorothiazide | Dichlotride | Hydrochlorothiazid | Hydrozide;
  • (HU) Hungary: Hypothiazid;
  • (ID) Indonesia: Hct | Hydrochlorothiazid;
  • (IE) Ireland: Hydrosaluric;
  • (IL) Israel: Disothiazide | Esidrex;
  • (IN) India: Aquazide | Clothy | Hctzide | Hydrazide | Hydride | Hydronol | Hydrotz | Hyzide | Klorzide | Pedizide | Xenia;
  • (IQ) Iraq: Diuzid | Hydrazidawa | Urozide;
  • (IS) Iceland: Aquazid;
  • (IT) Italy: Esidrex | Idroclorotiazide Aurobindo;
  • (JO) Jordan: Esidrex | Modrex | Monozide;
  • (JP) Japan: Dichlotride | Maschitt | Maschitt showa | Newtolide | Pantemon;
  • (KE) Kenya: Hymet | Hyzide;
  • (KR) Korea, Republic of: Dichlodide | Dichlozid | Ildong hydrochlorothiazide;
  • (KW) Kuwait: Esidrex;
  • (LB) Lebanon: Esidrex;
  • (LT) Lithuania: Apo hydro | Dehydratin Neo | Hypothiazide;
  • (LU) Luxembourg: Dichlotride | Esidrix;
  • (LV) Latvia: Dehydratin Neo | Disalunil | Hypothiazide;
  • (MA) Morocco: Esidrex;
  • (MX) Mexico: Acortiz | Bidrociral | Diclotride | Diziver | Hidroclorotiazida | Naxtrol | Rofucal | Systocal | Top k | Waser;
  • (MY) Malaysia: Apo hydro | Hydrochlorzide | Hydrorazide | Hydrozide;
  • (NG) Nigeria: Emzor hydrochlorothiazide | Esinil | Exus hydrochlorothiazide | Hydrex | Redrex;
  • (NL) Netherlands: Hydrochloorthiazide | Hydrochloorthiazide A | Hydrochloorthiazide Alpharma | Hydrochloorthiazide apotex | Hydrochloorthiazide ratiopharm | Hydrochloorthiazide sandoz | Hydrochloroth;
  • (NO) Norway: Esidrex | Hydrochlorothiazide orion | Hydromed;
  • (PE) Peru: Acuren | Diclotride | Diurace | Hidroclorotia | Hidroclorotiaz | Hidroclorotiazida | Hidrotiazida | Tiazid | Zinoxid;
  • (PH) Philippines: Altiazide | Dichlotride | Diucare | Diuzid | Diuzide | Hydrax | Hytaz | Pharex hydrochlorothiazide | Urilzid;
  • (PK) Pakistan: Diuza | Urozide;
  • (PL) Poland: Disalunil | Hydrochlorothiazid | Hydrochlorothiazide aurovitas | Hydrochlorothiazide orion | Hypothiazide;
  • (PR) Puerto Rico: Esidrix | Hydrochlorothiazid | Hydrodiuril | Microzide | Oretic;
  • (PT) Portugal: Hidroclorotiazida | Hidrosaluteril;
  • (PY) Paraguay: As farmil | Clorfal | Daretic | Diurex | Hidramil | Hidroclorotiazida heisecke | Hidroclorotiazida polimed | Hidroclorotiazida vivele | Micciol | Rifor;
  • (QA) Qatar: Esidrex | HCT Hexal;
  • (RU) Russian Federation: Dichlothiazid | Hydrochlorothiazid | Hydrochlorothiazide sar | Hypothiazide;
  • (SA) Saudi Arabia: Apo hydro | Apo hydrochlorothiazide | Esidrex | Monozide | Pms hydrochlorothiazide;
  • (SE) Sweden: Esidrex | Hydrochlorothiazide bluefish | Hydrochlorothiazide orifarm | Hydrochlorothiazide orion | Hydroklortiazid ebb | Hydroklortiazid evolan;
  • (SG) Singapore: Apo hydro | Di-Ertride | Didralin | Hichlozide | Hydrochlorzide | Hydrozide;
  • (SK) Slovakia: Hydrochlorothiazid | Hydrochlorothiazid leciva;
  • (SR) Suriname: Apo hydro | Apo hydrochlorothiazide | Hydrochloorthiazide | Hydrochloorthiazide actavis | Hydrochloorthiazide apotex | Hydrochloorthiazide aurobindo | Hydrochloorthiazide mylan | Hydrochloorthiazide sandoz;
  • (TH) Thailand: Apo hydro | Cozide | Didralin | Diuret-p | Hctz | Hychlortide | Hychlorzide | Hydozid | Hydril | Hydrochlorothiazid | Hydromed | Hydrozide | Med-hyazide | Thiazide | Urazide;
  • (TN) Tunisia: Esidrex;
  • (TR) Turkey: Esidrex;
  • (TW) Taiwan: Colonraitai | Depress | Dichlortride | Dichlotride | Dicomtride | Dihydrodiazid | Dithiazide | Hybozide | Hychlotozide | Hychlozide | Hydrochlorothiazid | Hydrochorothiazide | Koliside | Lisuzone | Nisidrex | Uresan;
  • (UA) Ukraine: Hydrochlorothiazid | Hydrothiazide | Hypothiazide | Tiurex;
  • (UY) Uruguay: Di Tiaziden | Diclorazida | Ditiazid | Diurotiazida | Esidrex | Hidroclorotiazida | Hidrotiazida | Modiur | Moduron | Tiaziden;
  • (VE) Venezuela, Bolivarian Republic of: Di-Eudrin | Diclotride | Hidroclorotiazida | Hytide;
  • (ZA) South Africa: Gulf hydrochlorothiazide | Hexazide | Ridaq | Urirex;
  • (ZM) Zambia: Hexazide | Hydrex 50;
  • (ZW) Zimbabwe: Staplex | Varidrex
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Topic 8529 Version 733.0