Acuren

• Hypertension (High Blood Pressure)
• Monotherapy or combination therapy to reduce blood pressure and prevent cardiovascular events.
• Edema
• Management of edema associated with congestive heart failure, hepatic cirrhosis, or renal disorders (including nephrotic syndrome).
• Off-label / clinically accepted uses
• Prevention of calcium-containing kidney stones in patients with hypercalciuria.
• Adjunct therapy in idiopathic hypercalciuria and certain cases of diabetes insipidus (to reduce urine output).

Administered orally, with or without food. Adjust based on clinical response and renal function.

• Hypertension
• Adults: 12.5–50 mg once daily
• Elderly: Start at 12.5 mg once daily, monitor for electrolyte disturbances.
• Edema
• Adults: 25–100 mg daily in single or divided doses
• Severe cases may require titration up to 200 mg/day (monitor closely)
• Pediatrics
• Usually 1–2 mg/kg/day in single or divided doses, maximum 3 mg/kg/day
• Special populations
• Renal impairment: Use lower doses; efficacy reduced if creatinine clearance <30 mL/min
• Hepatic impairment: Use cautiously; monitor for electrolyte imbalances

Hydrochlorothiazide is a thiazide diuretic that acts on the distal convoluted tubule of the nephron. It inhibits the sodium-chloride symporter, reducing sodium and chloride reabsorption. This leads to increased excretion of sodium, chloride, and water, thereby reducing extracellular fluid volume. It also decreases renal calcium excretion, which contributes to its role in preventing kidney stones. The resultant diuresis reduces blood pressure, edema, and cardiac preload, while long-term vascular effects further decrease peripheral resistance.

• Absorption: Rapid oral absorption; bioavailability ~70–80%
• Distribution: Widely distributed; 40–60% plasma protein bound
• Metabolism: Minimal hepatic metabolism
• Excretion: Primarily renal (~95% unchanged in urine)
• Onset: 2 hours (oral), peak effect 4–6 hours
• Duration: 6–12 hours for diuretic effect; antihypertensive effect may take several weeks

• Pregnancy: Category B; use only if clearly needed. Monitor blood pressure and electrolytes.
• Lactation: Excreted in breast milk in small amounts; generally considered compatible but monitor infant for electrolyte disturbances or dehydration.

• Primary therapeutic class: Diuretic / Antihypertensive
• Subclass: Thiazide diuretic

• Known hypersensitivity to hydrochlorothiazide or sulfonamides
• Anuria or severe renal impairment
• Electrolyte imbalances (e.g., severe hyponatremia, hypokalemia)
• Concomitant use with certain drugs causing hypercalcemia may be contraindicated

• Monitor electrolytes, particularly potassium, sodium, magnesium, and calcium
• Risk of hyperuricemia/gout attacks in predisposed patients
• Diabetes mellitus: May increase blood glucose levels; monitor glycemic control
• Hypersensitivity reactions including rash or photosensitivity
• Volume depletion: Risk of hypotension, dizziness, or fainting, especially in elderly
• Renal or hepatic impairment: Use cautiously; monitor renal function

• Common
• Dizziness, hypotension, headache
• Polyuria, thirst, mild gastrointestinal upset
• Electrolyte disturbances
• Hypokalemia, hyponatremia, hypomagnesemia, hypercalcemia
• Metabolic effects
• Hyperuricemia, hyperglycemia, hyperlipidemia
• Rare / serious
• Severe hypotension, pancreatitis, interstitial nephritis, severe allergic reactions
• Photosensitivity or dermatologic reactions

• Antihypertensives: Additive hypotensive effect
• Lithium: Risk of lithium toxicity due to decreased renal clearance
• Corticosteroids / ACTH: Increased risk of hypokalemia
• Digitalis: Hypokalemia may enhance arrhythmogenic risk
• NSAIDs: May reduce diuretic and antihypertensive efficacy
• No significant CYP450 interactions

• Thiazide diuretics remain first-line therapy for uncomplicated hypertension according to JNC 8, ACC/AHA 2017.
• Monitoring of serum electrolytes recommended within 1–2 weeks of initiation or dose adjustment.
• Use with caution in elderly patients, adjusting dose to minimize hypotension and electrolyte disturbances.

• Store at 20°C to 25°C (room temperature)
• Protect from moisture and light
• Keep in tight, well-closed container
• Do not freeze; discard if tablets are discolored or damaged