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Inzirqo
hydrochlorothiazide
Adult Dosing .
Dosage forms: SUSPENSION: 10 mg per mL
HTN
- [12.5-50 mg PO qd]
- Start: 12.5-25 mg PO qd; Max: 50 mg/day
edema, adjunct tx
- [25-100 mg PO qd]
- Alt: may be dosed qod or 3-5x/wk; Info: in heart failure patients, start 25 mg PO qd-bid, max 200 mg/day
calcium nephrolithiasis prevention (off-label)
- [25-50 mg/day PO divided qd-bid]
- Info: for patients with hypercalcinuria
renal dosing
- [see below]
- CrCl <10: avoid use; anuria: contraindicated
- HD/PD: avoid use
hepatic dosing
- [see below]
- hepatic impairment/progressive hepatic disease: not defined, caution advised
Peds Dosing .
- Dosage forms: SUSPENSION: 10 mg per mL
HTN
- [<6 mo]
- Dose: 1-3 mg/kg/day PO divided bid; Max: 37.5 mg/day
- [6 mo-2 yo]
- Dose: 1-2 mg/kg/day PO divided qd-bid; Max: 37.5 mg/day
- [2-12 yo]
- Dose: 1-2 mg/kg/day PO divided qd-bid; Max: 100 mg/day
edema, adjunct tx
- [<6 mo]
- Dose: 1-3 mg/kg/day PO divided bid; Max: 37.5 mg/day
- [6 mo-2 yo]
- Dose: 1-2 mg/kg/day PO divided qd-bid; Max: 37.5 mg/day
- [2-12 yo]
- Dose: 1-2 mg/kg/day PO divided qd-bid; Max: 100 mg/day
bronchopulmonary dysplasia (off-label)
- [<24 mo]
- Dose: 2-4 mg/kg/day PO divided bid
calcium nephrolithiasis prevention (off-label)
- [children]
- Dose: 0.5-1 mg/kg/day PO divided qd-bid; Max: 50 mg/day; Info: for patients with hypercalcinuria; may incr. dose to 2 mg/kg/day PO divided qd-bid after 3mo if hypercalciuria persists
renal dosing
- [see below]
- CrCl <10: avoid use; anuria: contraindicated
- HD/PD: avoid use
hepatic dosing
- [see below]
- hepatic impairment/progressive hepatic disease: not defined, caution advised
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- breastfeeding (>50 mg/day dose)
- anuria
- CrCl <10
- neonatal jaundice
- avoid: sun exposure
- avoid: UV light exposure, artificial
- caution: hypersensitivity to sulfonamides
- caution: elderly patients
- caution: White patients (incr. risk of skin CA with >50,000 mg cumulative dose)
- caution: renal impairment
- caution: hepatic impairment
- caution: hepatic disease, progressive
- caution: electrolyte abnormalities
- caution: volume depletion
- caution: diabetes mellitus
- caution: seizure disorder
- caution: HTN, gestational
- caution: SLE
- caution: gout history
- caution: pancreatitis history
Drug Interactions .
Overview
hydrochlorothiazide
thiazide diuretic
- affected by altered gastrointestinal motility
- antihypertensive agent
- binds to anion exchange resin/polymer
- decreases renal perfusion/fxn
- diuretic
- hypercalcemia
- hyperglycemic effects
- hyperuricemic effects
- hypokalemia
- hypomagnesemia
- hyponatremia
- photosensitivity
- urine alkalinizer
Contraindicated
- dofetilide
- isocarboxazid
- methenamine
Avoid/Use Alternative
- aldesleukin
- amikacin
- aminolevulinic acid topical
- aripiprazole lauroxil
- chlorothiazide
- chlorthalidone
- clofarabine
- hydrochlorothiazide
- indapamide
- iodixanol
- iomeprol
- iopromide
- ioversol
- lofexidine
- mannitol
- metolazone
- porfimer
- sulfamethoxazole
- tretinoin topical
Monitor/Modify Tx
- abaloparatide
- abiraterone acetate
- acarbose
- acetazolamide
- acyclovir
- adefovir dipivoxil
- albuterol
- albuterol inhaled
- alfentanil
- alfuzosin
- allopurinol
- almotriptan
- aloe
- alogliptin
- alprostadil intracavernous
- amantadine
- amifostine
- amikacin inhaled
- amiloride
- amitriptyline
- amoxapine
- amphetamine
- amphotericin
- anthrax immune globulin
- apomorphine
- apraclonidine ophthalmic
- arformoterol inhaled
- aripiprazole bimonthly injection
- aripiprazole monthly injection
- aripiprazole oral
- armodafinil
- arsenic trioxide
- articaine
- asciminib
- asenapine
- asparaginase
- aspirin
- atogepant
- atomoxetine
- atropine ophthalmic
- auranofin
- avanafil
- axitinib
- azilsartan medoxomil
- balsalazide
- benazepril
- benzphetamine
- berberine
- betamethasone
- betaxolol ophthalmic
- bethanechol
- bevacizumab
- bexagliflozin
- bismuth subsalicylate
- bortezomib
- botulism immune globulin
- brexpiprazole
- brigatinib
- brimonidine ophthalmic
- brimonidine topical
- bromocriptine
- budesonide
- bumetanide
- bupivacaine
- bupivacaine liposomal
- buprenorphine
- bupropion
- burosumab
- butalbital
- butorphanol
- cabergoline
- cabozantinib
- caffeine
- caffeine citrate
- calcipotriene topical
- calcitriol
- calcitriol topical
- calcium acetate
- calcium carbonate
- calcium chloride
- calcium citrate
- calcium gluconate
- canagliflozin
- candesartan cilexetil
- cannabis
- capecitabine
- captopril
- carbamazepine
- carboplatin
- carfilzomib
- cariprazine
- carteolol ophthalmic
- celecoxib
- cetuximab
- chloroprocaine
- chlorpromazine
- cholecalciferol (vitamin D3)
- cholestyramine
- cidofovir
- cilostazol
- cisplatin
- citalopram
- clindamycin
- clomipramine
- clonidine
- clozapine
- cocaine
- codeine
- coenzyme Q-10
- colesevelam
- colestipol
- colistimethate
- copanlisib
- copper histidinate
- corticotropin
- cortisone
- creatine
- crizotinib
- cyclophosphamide
- cyclosporine
- cytomegalovirus immune globulin
- danazol
- dapagliflozin
- darbepoetin alfa
- decitabine
- deferasirox
- deferoxamine
- deflazacort
- denileukin diftitox
- desflurane
- desipramine
- desmopressin
- desvenlafaxine
- dexamethasone
- dexlansoprazole
- dexmedetomidine
- dexmedetomidine injection
- dexmethylphenidate
- dextroamphetamine
- diazoxide
- dichlorphenamide
- diclofenac
- diclofenac topical
- diethylpropion
- diflunisal
- digoxin
- dihydrocodeine
- dihydroergotamine
- dinutuximab
- dipyridamole
- doxapram
- doxazosin
- doxepin
- doxercalciferol
- dronabinol
- droxidopa
- dulaglutide
- duloxetine
- eletriptan
- emapalumab
- empagliflozin
- enalapril
- enalaprilat
- entacapone
- entrectinib
- ephedra
- ephedrine injection
- ephedrine oral
- epinephrine
- epinephrine inhaled
- epoetin alfa
- epoprostenol
- eptinezumab
- erenumab
- ergocalciferol (vitamin D2)
- ergotamine
- ertugliflozin
- escitalopram
- esketamine
- eslicarbazepine acetate
- esomeprazole
- estetrol (contraceptive)
- estradiol (contraceptive)
- ethacrynic acid
- ethanol (alcoholic beverage)
- ethanol injection
- ethinyl estradiol (contraceptive)
- etodolac
- etrasimod
- etripamil nasal
- exenatide
- fenfluramine
- fenoprofen
- fentanyl
- ferumoxytol
- fingolimod
- flaxseed
- flibanserin
- flucytosine
- fludrocortisone
- fluoxetine
- fluphenazine
- flurbiprofen
- fluvoxamine
- formoterol inhaled
- foscarnet
- fosfomycin injection
- foslevodopa
- fostamatinib
- fremanezumab
- frovatriptan
- fruquintinib
- furosemide
- galcanezumab
- ganciclovir
- garlic
- gentamicin
- gilteritinib
- glimepiride
- glipizide
- glyburide
- guanfacine
- haloperidol
- hoodia
- hydralazine
- hydrocodone
- hydrocortisone
- hydromorphone
- hydroxocobalamin IV
- ibrutinib
- ibuprofen
- ibuprofen lysine
- ifosfamide
- iloperidone
- iloprost
- imipramine
- immune globulin
- indomethacin
- insulin
- iohexol
- iopamidol
- iothalamate meglumine
- irbesartan
- iron sucrose
- isoflurane
- isoproterenol
- isosorbide dinitrate
- isosorbide mononitrate
- ketamine
- ketoprofen
- ketorolac
- landiolol
- lanreotide
- lansoprazole
- leflunomide
- lenalidomide
- lenvatinib
- leucovorin
- levalbuterol inhaled
- levobunolol ophthalmic
- levodopa
- levomilnacipran
- levorphanol
- levothyroxine
- licorice
- lidocaine
- linagliptin
- linezolid
- liothyronine
- liraglutide
- lisdexamfetamine
- lisinopril
- lithium
- lixisenatide
- lomustine
- lorlatinib
- losartan
- loxapine
- lubiprostone
- lumacaftor/ivacaftor
- lumateperone
- lurasidone
- luspatercept
- lutetium Lu 177 dotatate
- lutetium Lu 177 vipivotide tetraxetan
- magnesium citrate
- magnesium salicylate
- magnesium sulfate
- maraviroc
- meclofenamate
- mefenamic acid
- meloxicam
- meperidine
- mepivacaine
- mesalamine
- mesalamine rectal
- metformin
- methadone
- methamphetamine
- methazolamide
- methohexital
- methotrexate
- methoxy polyethylene glycol-epoetin beta
- methylene blue injection
- methylergonovine
- methylphenidate
- methylprednisolone
- methyltestosterone
- metoclopramide
- midazolam
- midodrine
- mifepristone
- miglitol
- milnacipran
- milrinone
- milsaperidone
- mirabegron
- mirtazapine
- mitomycin
- modafinil
- moexipril
- molindone
- morphine
- motixafortide
- nabumetone
- nalbuphine
- naphazoline ophthalmic
- naproxen
- naratriptan
- nateglinide
- nattokinase
- naxitamab
- necitumumab
- neomycin
- niacin (vitamin B3)
- nicotine
- nilotinib
- niraparib
- nitric oxide
- nitrite
- nitroglycerin
- nitroprusside
- nortriptyline
- nusinersen
- obinutuzumab
- olanzapine
- oliceridine
- olmesartan medoxomil
- olodaterol inhaled
- olsalazine
- omeprazole
- opicapone
- opium
- osilodrostat
- oxaliplatin
- oxaprozin
- oxazepam
- oxcarbazepine
- oxycodone
- oxymetazoline nasal
- oxymetazoline ophthalmic
- oxymetazoline topical
- oxymorphone
- oxytocin
- ozanimod
- paliperidone
- palopegteriparatide
- pamidronate
- panitumumab
- pantoprazole
- paricalcitol
- paromomycin
- paroxetine
- patiromer
- pazopanib
- pegloticase
- pemetrexed
- penicillamine
- pentamidine
- pentazocine
- pentobarbital
- pentostatin
- pentoxifylline
- perindopril
- perphenazine
- pexidartinib
- phendimetrazine
- phenelzine
- phenobarbital
- phentermine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- pioglitazone
- piroxicam
- plazomicin
- polyethylene glycol
- polyethylene glycol/electrolytes
- polymyxin B
- ponatinib
- ponesimod
- posaconazole
- pralsetinib
- pramipexole
- pramlintide
- prazosin
- prednisolone
- prednisone
- primidone
- probenecid
- procarbazine
- prochlorperazine
- promethazine
- propafenone
- propofol
- protriptyline
- pseudoephedrine
- quetiapine
- quinapril
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- quinine
- rabeprazole
- ramipril
- ramucirumab
- rasagiline
- rasburicase
- regorafenib
- remifentanil
- remimazolam
- repaglinide
- Rho(D) immune globulin
- rimegepant
- riociguat
- ripretinib
- risperidone
- rituximab
- rizatriptan
- romidepsin
- ropeginterferon alfa-2b
- ropinirole
- ropivacaine
- rosiglitazone
- rotigotine transdermal
- sacituzumab govitecan
- sacubitril
- safinamide
- salmeterol inhaled
- salsalate
- saxagliptin
- selegiline
- selegiline transdermal
- selinexor
- selpercatinib
- semaglutide
- sertraline
- sevoflurane
- sildenafil
- silodosin
- siponimod
- sirolimus
- sirolimus albumin-bound
- sitagliptin
- sodium benzoate
- sodium ferric gluconate complex
- sodium phenylacetate
- sodium phenylbutyrate
- sodium picosulfate
- sodium polystyrene sulfonate
- sodium thiosulfate
- sorafenib
- sotagliflozin
- sotalol
- sparsentan
- spironolactone
- streptomycin
- streptozocin
- sufentanil
- sulfate bowel prep
- sulindac
- sumatriptan
- sunitinib
- tacrolimus
- tadalafil
- tafasitamab
- tagraxofusp
- tamsulosin
- tapentadol
- taurine
- telavancin
- telmisartan
- temsirolimus
- tenofovir alafenamide
- tenofovir disoproxil
- terazosin
- terbutaline
- teriflunomide
- teriparatide
- testosterone
- tetrahydrozoline ophthalmic
- thalidomide
- thioridazine
- thiothixene
- thyroid
- timolol ophthalmic
- tiopronin
- tirzepatide
- tivozanib
- tizanidine
- tobramycin
- tobramycin inhaled
- tolcapone
- tolmetin
- topiramate
- toremifene
- torsemide
- tramadol
- trametinib
- trandolapril
- tranylcypromine
- trazodone
- treprostinil
- triamcinolone
- triamterene
- trifluoperazine
- trimipramine
- ubrogepant
- vaccinia immune globulin
- vadadustat
- valacyclovir
- valganciclovir
- valsartan
- vamorolone
- vancomycin
- vandetanib
- vardenafil
- vasopressin
- venlafaxine
- vilanterol inhaled
- vilazodone
- viloxazine
- voclosporin
- vonoprazan
- vortioxetine
- vosoritide
- willow bark
- yohimbe
- zavegepant
- ziprasidone
- ziv-aflibercept
- zoledronic acid
- zolmitriptan
- zonisamide
Caution Advised
- acitretin
- aclidinium inhaled
- atropine
- belladonna alkaloids
- benztropine
- brompheniramine
- carbinoxamine
- chlophedianol
- chlorcyclizine
- chlorpheniramine
- clemastine
- clidinium
- cyclobenzaprine
- cyproheptadine
- darifenacin
- dexbrompheniramine
- dexchlorpheniramine
- dicyclomine
- dimenhydrinate
- diphenhydramine
- disopyramide
- doxepin topical
- doxylamine
- fesoterodine
- flavoxate
- glycopyrrolate
- glycopyrronium topical
- homatropine
- hydroxyzine
- hyoscyamine
- icosapent ethyl
- ipratropium inhaled
- meclizine
- methoxsalen
- methscopolamine
- orphenadrine
- oxybutynin
- pheniramine
- pimozide
- pyrilamine
- scopolamine
- sofpironium topical
- solifenacin
- tiotropium inhaled
- tolterodine
- trihexyphenidyl
- triprolidine
- trospium
- verteporfin
Adverse Reactions .
Serious Reactions
- hypokalemia, severe
- electrolyte imbalance
- arrhythmia
- cholestatic jaundice
- pancreatitis
- anaphylaxis
- necrotizing angiitis
- erythema multiforme
- Stevens-Johnson syndrome
- exfoliative dermatitis
- toxic epidermal necrolysis
- photosensitivity
- non-melanoma skin CA
- renal failure
- interstitial nephritis
- aplastic anemia
- agranulocytosis
- leukopenia
- hemolytic anemia
- thrombocytopenia
- SLE exacerbation
- glaucoma, acute angle-closure
Common Reactions
- hypokalemia
- hypochloremia
- hyponatremia
- hypomagnesemia
- hypercalcemia
- hyperuricemia
- hyperglycemia
- hyperlipidemia
- hypotension, orthostatic
- dizziness
- anorexia
- diarrhea
- abdominal pain
- headache
- weakness
- muscle cramps
- photosensitivity
- rash
- sexual dysfunction
- blurred vision
Safety/Monitoring .
Monitoring Parameters
BUN/Cr; electrolytes at baseline, then periodically; dermatologic exams if incr. skin CA risk
Look/Sound-Alike Drug Names
hydroCHLOROthiazide confused with: hydrALAZINE; hydrocortisone; hydroxychloroquine; hydroxyurea; hydrOXYzine; Maxzide
Pregnancy/Lactation .
Pregnancy
Clinical Summary
may use during pregnancy if on chronic tx before conception, otherwise weigh risk/benefit; no known risk of teratogenicity based on human data; possible risk of decr. placental perfusion and neonatal adverse effects, including hypoglycemia, thrombocytopenia, and electrolyte abnormalities, based on limited or conflicting human data; risks not observed if chronic use before conception
Lactation
Clinical Summary
avoid use if dose >50 mg/day, otherwise may use while breastfeeding; no known risk of infant harm based on limited human data and drug properties; decr. milk production with high-dose use based on limited human data
Pharmacology .
Metabolism: for hydrochlorothiazide: none; CYP450: none
Excretion: for hydrochlorothiazide: urine (>61% unchanged); Half-life: 5.6-14.8h
Subclass: Diuretics, Thiazides ; Nephrolithiasis
Mechanism of Action
for hydrochlorothiazide: inhibits distal convoluted tubule sodium and chloride reabsorption
Formulary .
No Formulary Selected
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