Hydroflumethiazide


Generic Medicine Info
Indications and Dosage
Oral
Oedema
Adult: In cases of cardiac, renal or hepatic origin, including iatrogenic oedema: Initially, 50-200 mg daily in 1 or 2 divided doses, preferably in the morning, may reduce to 25-50 mg on alternate days or intermittently according to patient’s response.
Child: >12 years Recommended dose: Initially, 1 mg/kg daily.
Elderly: Dose reduction may be required.

Oral
Hypertension
Adult: As monotherapy or in combination with other antihypertensive agents: Usual dose: 25-50 mg daily. Maintenance: 25-50 mg on alternate days.
Child: >12 years Recommended dose: Initially, 1 mg/kg daily.
Elderly: Dose reduction may be required.
Renal Impairment
Severe: Contraindicated.
Hepatic Impairment
Severe: Contraindicated.
Contraindications
Addison’s disease, hypercalcaemia, symptomatic hyperuricaemia, refractory hypokalaemia, hyponatraemia, anuria. Severe renal and hepatic impairment. Concomitant use with lithium.
Special Precautions
Patient with diabetes, gout, or SLE. Children and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: May aggravate diabetes, gout or SLE; hypokalaemia.
Blood and lymphatic system disorders: Blood dyscrasias
Gastrointestinal disorders: Pancreatitis, diarrhoea.
Hepatobiliary disorders: Intrahepatic cholestasis.
Immune system disorders: Hypersensitivity reactions.
Investigations: Altered plasma lipid concentrations.
Metabolism and nutrition disorders: Hyponatraemia, hypercalcaemia, hypochloraemic alkalosis, hyperuricaemia, hyperglycaemia.
Reproductive system and breast disorders: Impotence.
Skin and subcutaneous tissue disorders: Rash, photosensitivity.
Vascular disorders: Postural hypotension.
Monitoring Parameters
Monitor renal function; electrolyte levels and signs of blood dyscrasias (prolonged use, particularly in elderly).
Overdosage
Symptoms: Diuresis, lethargy (progressing to coma, with minimal cardiorespiratory depression and with or without significant serum electrolyte changes or dehydration), gastrointestinal irritation, hypermotility, transient elevation of BUN level. Management: Symptomatic and supportive treatment. Empty stomach by gastric lavage. Institute supportive measures as required to maintain hydration, electrolyte balance, respiration, and cardiovascular and renal function.
Drug Interactions
May increase sensitivity to and risk of toxicity of digitalis. May result in antagonistic effect with NSAIDs (e.g. indometacin, ketorolac), corticosteroids, estrogens and combined oral contraceptives. Enhanced hypotensive effect with ACE inhibitors, angiotensin II antagonists, β-blockers, Ca channel blockers, nitrates, adrenergic neurone blockers, general anaesthetics, anxiolytics, hypnotics, MAOI, phenothiazines, alprostadil, aldesleukin, levodopa, baclofen, moxisylyte, tizanidine, and α-blockers (e.g. prazosin). Increased risk of nephrotoxicity and ototoxicity with cisplatin. May exacerbate hypokalaemia with acetazolamide, corticosteroids, amphotericin, reboxetine, β2 sympathomimetics, theophylline, and loop diuretics. Increased risk of nephrotoxicity and hypermagnesaemia with ciclosporin. Increased cardiotoxicity with disopyramide, amiodarone, cardiac glycosides, flecainide, quinidine. Antagonise effects of lidocaine, mexiletine and antidiabetic agents. Increased risk of ventricular arrhythmias with amisulpride, sotalol, atomoxetine, sertindole, terfenadine. May increase risk of postural hypotension with TCAs. May increase the risk of hypersensitivity with allopurinol. May increase risk of lithium toxicity. May reduce absorption with colestipol and colestyramine. Increased risk of hyponatraemia with aminoglutethimide, carbamazepine, chlorpropamide. Increased the risk of hypercalcaemia with calcium salts, toremifene and vitamin D.
Food Interaction
Increased risk of postural hypotension with alcohol.
Action
Description: Hydroflumethiazide is a thiazide diuretic that acts mainly on the distal convoluted tubule to the thick segment of the end limb of the loop of Henle. It inhibits the distal tubular re-absorption of Na and Cl ions resulting in increased urinary loss of K and Mg. Additionally, it increases the renal tubular re-absorption of Ca.
Onset: Approx 2 hours.
Duration: Up to 24 hours.
Pharmacokinetics:
Absorption: Rapidly but incompletely absorbed from the gastrointestinal tract. Time to peak plasma concentration: Approx 1-4 hours.
Distribution: Volume of distribution: 6.4 L/kg. Plasma protein binding: Approx 75%.
Excretion: Via urine (40-80% as unchanged drug). Plasma elimination half-life: 12.4-26.9 hours.
Chemical Structure

Chemical Structure Image
Hydroflumethiazide

Source: National Center for Biotechnology Information. PubChem Database. Hydroflumethiazide, CID=3647, https://pubchem.ncbi.nlm.nih.gov/compound/3647#section=2D-Structure&fullscreen=true

Storage
Store below 25°C.
MIMS Class
Diuretics
ATC Classification
C03AA02 - hydroflumethiazide ; Belongs to the class of low-ceiling thiazide diuretics.
References
Buckingham R (ed). Hydroflumethiazide. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 09/06/2021.

Neo-Urizide Tablets (Chelonia Healthcare Limited). MHRA. https://products.mhra.gov.uk. Accessed 09/06/2021.

Saluron Tablet (Shire). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 22/06/2021.

Disclaimer: This information is independently developed by MIMS based on Hydroflumethiazide from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2022 MIMS. All rights reserved. Powered by MIMS.com
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