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Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Neonatal thrombocytopenia was reported in the offspring of several mothers who received chlorothiazide during pregnancy (Rodriguez et al., 1964), but not among infants in another series (Finnerty and Assali, 1964). An increased frequency of hypertension was reported in the offspring of rats treated with chlorothiazide at doses 30 times those employed in humans (Grollman and Grollman, 1962). Another group of investigators (Maren and Ellison, 1972) found no increase in malformations in offspring of rats treated with this agent in doses up to 12 times that used in humans.
Sodium Intake and Hypertension
Published in Austin E. Doyle, Frederick A. O. Mendelsohn, Trefor O. Morgan, Pharmacological and Therapeutic Aspects of Hypertension, 2020
T. O. Morgan, F. A. O. Mendelsohn, A. E. Doyle
Hypertensitivity reactions are the more serious side effects and are independent of dose. The other side effects are all dose dependent, and their incidence is reduced markedly if the dose of the thiazide is kept small. Doses of chlorothiazide of 500 mg daily or chlorthalidone of 25 mg daily have 70% of the antihypertensive action which can be achieved by larger doses, but have a lower incidence of complications. A dose of 2000 mg of chlorothiazide induces a maximal diuretic effect, but induces a much higher incidence of side effects than 500 mg. Further dose increases increase side effects with little extra therapeutic action (Figure 27).
Pharmacokinetic-Pharmacodynamic Relationships of Cardiovascular Drugs
Published in Hartmut Derendorf, Günther Hochhaus, Handbook of Pharmacokinetic/Pharmacodynamic Correlation, 2019
Wagner previously conducted a similar evaluation using the Emax model and a one-compartment pharmacokinetic model.11 He demonstrated that the largest increase in AUCE occurred when the dosing interval was decreased from 24 h to 12 h, with smaller increases occurring as the dosing interval was further decreased to 6 or 3 h (Table 1 results are also consistent with this observation). Furthermore, he showed that the increase in AUCE with shorter dosing intervals was relatively greater for drugs with shorter half-lives (Figure 7). These results were used to explain the greater overall diuretic effects of chlorothiazide when administered in divided doses compared to a single daily dose.29
Effectiveness of thiazide and thiazide-like diuretics in advanced chronic kidney disease: a systematic review and meta-analysis
Published in Renal Failure, 2023
Flávio Teles, Jorge Artur Peçanha de Miranda Coelho, Rosivânia Maria Albino, Fernanda Cristina Verçosa Pacheco, Evilly Rodrigues de Oliveira, Marcelo Augusto Duarte Silveira, Audes Diógenes M. Feitosa, Rodrigo Bezerra
Since the beginning of the use of thiazides, the concept has emerged that thiazides would be ineffective in patients with a GFR < 30 mL/min/1.73 m2. The origin of this concept was the study of Reubi and Cottier in 1961 [1]. In this study, 11 patients with variable stages of CKD received chlorothiazide. Of the eleven patients, six had a GFR greater than 50 mL/min/1.73 m2, and the others had a GFR less than 37 mL/min/1.73 m2. In the three patients with GFR values of 22, 32 and 37 mL/min/1.73 m2. FeNa+ increased approximately 2.5-fold after chlorothiazide. A similar effect was observed for the urinary excretion of potassium and chloride, as well as an important increase in urinary output. In the two patients with lower GFR (11 and 6 mL/min/1.73 m2), the effect of chlorothiazide on urinary FeNa+ was more modest, with an increase of approximately 1.5-fold. It is important to note that only three patients had a GFR less than 30 mL/min/1.73 m2 in this study, which makes the possibility of determining a threshold for ineffectiveness unlikely. Despite the fact that this study was performed before the era of the evidence-based medicine, its results have been cited in textbooks, for decades, stating that thiazides should not be used in patients with a GFR less than 30 mL/min/1.73 m2 [2]. But in the years since, evidence from observational studies and randomized trials has pointed to a different view [13,16,17].
Advances in treating bronchopulmonary dysplasia
Published in Expert Review of Respiratory Medicine, 2019
Other diuretics used in infants with BPD are thiazides such as chlorothiazide which acts on the distal convoluted tubules. They can cause hypokalaemia, hence they are often used in combination with potassium sparing diuretics such a spironolactone [57]. A single study showed thiazide and spironolactone decreased the risk of death and tended to decrease the risk for remaining intubated after eight weeks of age in infants [59]. A systematic review of six studies of a four-week treatment with thiazide and spironolactone in preterm infants aged greater than three weeks with BPD showed only an improvement in lung compliance and reduced need for frusemide. In addition, the authors concluded the positive effects should be interpreted with caution as the numbers of patients included in the studies were small. Nevertheless, dual therapy of chlorothiazide and spironolactone is often given to infants with BPD [61]. Yet, spironolactone used with thiazide diuretics can cause hypercalciuria.
A multidisciplinary approach to heart failure care in the hospital: improving the patient journey
Published in Hospital Practice, 2022
Vijay U. Rao, Atul Bhasin, Jesus Vargas, Vijaya Arun Kumar
Usual inpatient diuretic dosing for loop diuretics are: bumetanide (dose: 0.5–4.0 mg IV, 1–3 times/day; maximum dose: 5 mg/dose or dose: 0.5–2.0 mg/hour IV infusion; maximum dose: 4 mg/hour) and furosemide (dose: 40–160 mg IV, 1–3 times/day; maximum dose: 200 mg/dose or dose: 5–20 mg/hour IV infusion; maximum dose: 40 mg/hour). Usual inpatient diuretic dosing for thiazide-type diuretics are: chlorothiazide (dose: 0.5–1.0 g IV, 1–2 times/day; maximum dose: 2 g/day); hydrochlorothiazide (dose: 25–50 mg orally, 1–2 times/day; maximum dose: 100 mg/day); chlorthalidone (dose: 12.5–25.0 mg orally, 1–2 times/day; maximum dose: 100 mg/day); and metolazone (dose: 2.5–5.0 mg orally, 1–2 times/day; maximum dose: 20 mg/day) [6].