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Chlorthalidone
Overview
What is Chlorthalidone?
Chlorthalidone is an oral antihypertensive/diuretic. It is a monosulfamyl
diuretic that differs chemically from thiazide diuretics in that a double-ring
system is incorporated in its structure. It is 2-chloro-5(1-hydroxy-3-oxo-1-
isoindolinyl) benzenesulfonamide with the following structural formula:
Molecular Formula: CHClNOS
Molecular weight: 338.76
Chlorthalidone, USP is practically insoluble in water, in ether, and in
chloroform; soluble in methanol; slightly soluble in ethanol.
Chlorthalidone tablets are available containing 25 mg of
chlorthalidone USP and the following inactive ingredients: colloidal silicon
dioxide, microcrystalline cellulose, D and C Yellow No.10, sodium starch glycolate, pregelatinized starch, stearic acid and other inactive
ingredients.
What does Chlorthalidone look like?
What are the available doses of Chlorthalidone?
Sorry No records found.
What should I talk to my health care provider before I take Chlorthalidone?
Sorry No records found
How should I use Chlorthalidone?
Diuretics such as chlorthalidone are indicated in the management
of hypertension either as the sole therapeutic agent or to enhance the effect of
other antihypertensive drugs in the more severe forms of hypertension.
Chlorthalidone is indicated as adjunctive therapy in edema associated with
congestive heart failure, hepatic cirrhosis, and corticosteroid and estrogen
therapy.
Chlorthalidone has also been found useful in edema due to various forms of
renal dysfunction, such as nephrotic syndrome, acute glomerulonephritis, and
chronic renal failure.
Therapy should be initiated with the lowest possible dose. This
dose should be titrated according to individual patient response to gain maximal
therapeutic benefit while maintaining lowest dosage possible. A single dose
given in the morning with food is recommended; divided daily doses are
unnecessary.
Initiation:
Maintenance:
Initiation:
Maintenance:
What interacts with Chlorthalidone?
Anuria.
Known hypersensitivity to chlorthalidone or other sulfonamide-derived drugs.
What are the warnings of Chlorthalidone?
Sorry No Records found
What are the precautions of Chlorthalidone?
Sorry No Records found
What are the side effects of Chlorthalidone?
The following adverse reactions have been observed, but there is
not enough systematic collection of data to support an estimate of their
frequency.
Gastrointestinal System Reactions:
Central Nervous System Reactions:
Hematologic Reactions:
Dermatologic-Hypersensitivity Reactions:
Cardiovascular Reactions:
Other Adverse Reactions:
Whenever adverse reactions are moderate or severe, chlorthalidone dosage
should be reduced or therapy withdrawn.
What should I look out for while using Chlorthalidone?
Anuria.
Known hypersensitivity to chlorthalidone or other sulfonamide-derived drugs.
Chlorthalidone should be used with caution in severe renal
disease. In patients with renal disease, chlorthalidone or related drugs may
precipitate azotemia. Cumulative effects of the drug may develop in patients
with impaired renal function.
Chlorthalidone should be used with caution in patients with impaired hepatic
function or progressive liver disease, since minor alterations of fluid and
electrolyte balance may precipitate hepatic coma.
Sensitivity reactions may occur in patients with a history of allergy or
bronchial asthma.
The possibility of exacerbation or activation of systemic lupus erythematosus
has been reported with thiazide diuretics, which are structurally related to
chlorthalidone. However, systemic lupus erythematosus has not been reported
following chlorthalidone administration.
What might happen if I take too much Chlorthalidone?
Symptoms of acute overdosage include nausea, weakness, dizziness,
and disturbances of electrolyte balance. The oral LD of
the drug in the mouse and the rat is more than 25,000 mg/kg body weight. The
minimum lethal dose (MLD) in humans has not been established. There is no
specific antidote, but gastric lavage is recommended, followed by supportive
treatment. Where necessary, this may include intravenous dextrose-saline with
potassium, administered with caution.
How should I store and handle Chlorthalidone?
Store at controlled room temperature 20° to 25°C (68° to 77°F) [see USP] .Chlorthalidone Tablets, USP are available containing 25 mg USP.The 25 mg tablets are light yellow, round, unscored tablets debossed with on one side of the tablet and blank on the other side. They are available as follows:NDC 0179-0015-01bottles of 100 tabletsStore at 20° to 25°C (68° to 77°F). [See USP for Controlled Room Temperature.]Protect from light.Dispense in a tight, light-resistant container as defined in the USP using a child-resistant closure.Chlorthalidone Tablets, USP are available containing 25 mg USP.The 25 mg tablets are light yellow, round, unscored tablets debossed with on one side of the tablet and blank on the other side. They are available as follows:NDC 0179-0015-01bottles of 100 tabletsStore at 20° to 25°C (68° to 77°F). [See USP for Controlled Room Temperature.]Protect from light.Dispense in a tight, light-resistant container as defined in the USP using a child-resistant closure.Chlorthalidone Tablets, USP are available containing 25 mg USP.The 25 mg tablets are light yellow, round, unscored tablets debossed with on one side of the tablet and blank on the other side. They are available as follows:NDC 0179-0015-01bottles of 100 tabletsStore at 20° to 25°C (68° to 77°F). [See USP for Controlled Room Temperature.]Protect from light.Dispense in a tight, light-resistant container as defined in the USP using a child-resistant closure.Chlorthalidone Tablets, USP are available containing 25 mg USP.The 25 mg tablets are light yellow, round, unscored tablets debossed with on one side of the tablet and blank on the other side. They are available as follows:NDC 0179-0015-01bottles of 100 tabletsStore at 20° to 25°C (68° to 77°F). [See USP for Controlled Room Temperature.]Protect from light.Dispense in a tight, light-resistant container as defined in the USP using a child-resistant closure.Chlorthalidone Tablets, USP are available containing 25 mg USP.The 25 mg tablets are light yellow, round, unscored tablets debossed with on one side of the tablet and blank on the other side. They are available as follows:NDC 0179-0015-01bottles of 100 tabletsStore at 20° to 25°C (68° to 77°F). [See USP for Controlled Room Temperature.]Protect from light.Dispense in a tight, light-resistant container as defined in the USP using a child-resistant closure.Chlorthalidone Tablets, USP are available containing 25 mg USP.The 25 mg tablets are light yellow, round, unscored tablets debossed with on one side of the tablet and blank on the other side. They are available as follows:NDC 0179-0015-01bottles of 100 tabletsStore at 20° to 25°C (68° to 77°F). [See USP for Controlled Room Temperature.]Protect from light.Dispense in a tight, light-resistant container as defined in the USP using a child-resistant closure.
Clinical Information
Chemical Structure
No Image foundClinical Pharmacology
Chlorthalidone is an oral diuretic with prolonged action (48–72
hours) and low toxicity. The major portion of the drug is excreted unchanged by
the kidneys. The diuretic effect of the drug occurs in approximately 2.6 hours
and continues for up to 72 hours. The mean half-life following a 50 to 200 mg
dose is 40 hours. In the first order of absorption, the elimination half-life is
53 hours following a 50 mg dose, and 60 hours following a 100 mg dose.
Approximately 75 percent of the drug is bound to plasma proteins, 58 percent of
the drug being bound to albumin. This is caused by an increased affinity of the
drug to erythrocyte carbonic anhydrase. Nonrenal routes of elimination have yet
to be clarified. Data are not available regarding percentage of dose as
unchanged drug and metabolites, concentration of the drug in body fluids, degree
of uptake by a particular organ or in the fetus, or passage across the
blood-brain barrier.
The drug produces copious diuresis with greatly increased excretion of sodium
and chloride. At maximal therapeutic dosage, chlorthalidone is approximately
equal in its diuretic effect to comparable maximal therapeutic doses of
benzothiadiazine diuretics. The site of action appears to be the cortical
diluting segment of the ascending limb of Henle's loop of the nephron.
Non-Clinical Toxicology
Anuria.Known hypersensitivity to chlorthalidone or other sulfonamide-derived drugs.
Chlorthalidone should be used with caution in severe renal disease. In patients with renal disease, chlorthalidone or related drugs may precipitate azotemia. Cumulative effects of the drug may develop in patients with impaired renal function.
Chlorthalidone should be used with caution in patients with impaired hepatic function or progressive liver disease, since minor alterations of fluid and electrolyte balance may precipitate hepatic coma.
Sensitivity reactions may occur in patients with a history of allergy or bronchial asthma.
The possibility of exacerbation or activation of systemic lupus erythematosus has been reported with thiazide diuretics, which are structurally related to chlorthalidone. However, systemic lupus erythematosus has not been reported following chlorthalidone administration.
Ranitidine has been reported to affect the bioavailability of other drugs through several different mechanisms such as competition for renal tubular secretion, alteration of gastric pH, and inhibition of cytochrome P450 enzymes.
Procainamide:Ranitidine, a substrate of the renal organic cation transport system, may affect the clearance of other drugs eliminated by this route. High doses of ranitidine (e.g., such as those used in the treatment of Zollinger-Ellison syndrome) have been shown to reduce the renal excretion of procainamide and N-acetylprocainamide resulting in increased plasma levels of these drugs. Although this interaction is unlikely to be clinically relevant at usual ranitidine doses, it may be prudent to monitor for procainamide toxicity when administered with oral ranitidine at a dose exceeding 300 mg per day.
Warfarin:There have been reports of altered prothrombin time among patients on concomitant warfarin and ranitidine therapy. Due to the narrow therapeutic index, close monitoring of increased or decreased prothrombin time is recommended during concurrent treatment with ranitidine.
Ranitidine may alter the absorption of drugs in which gastric pH is an important determinant of bioavailability. This can result in either an increase in absorption (e.g., triazolam, midazolam, glipizide) or a decrease in absorption (e.g., ketoconazole, atazanavir, delavirdine, gefitinib). Appropriate clinical monitoring is recommended.
Atazanavir:Atazanavir absorption may be impaired based on known interactions with other agents that increase gastric pH. Use with caution. See atazanavir label for specific recommendations.
Delavirdine:Delavirdine absorption may be impaired based on known interactions with other agents that increase gastric pH. Chronic use of H-receptor antagonists with delavirdine is not recommended.
Gefitinib: Gefitinib exposure was reduced by 44% with the coadministration of ranitidine and sodium bicarbonate (dosed to maintain gastric pH above 5.0). Use with caution.
Glipizide:In diabetic patients, glipizide exposure was increased by 34% following a single 150-mg dose of oral ranitidine. Use appropriate clinical monitoring when initiating or discontinuing ranitidine.
Ketoconazole:Oral ketoconazole exposure was reduced by up to 95% when oral ranitidine was coadministered in a regimen to maintain a gastric pH of 6 or above. The degree of interaction with usual dose of ranitidine (150 mg twice daily) is unknown.
Midazolam:Oral midazolam exposure in 5 healthy volunteers was increased by up to 65% when administered with oral ranitidine at a dose of 150 mg twice daily. However, in another interaction study in 8 volunteers receiving IV midazolam, a 300 mg oral dose of ranitidine increased midazolam exposure by about 9%. Monitor patients for excessive or prolonged sedation when ranitidine is coadministered with oral midazolam.
Triazolam:Triazolam exposure in healthy volunteers was increased by approximately 30% when administered with oral ranitidine at a dose of 150 mg twice daily. Monitor patients for excessive or prolonged sedation.
Hypokalemia may develop with chlorthalidone as with any other diuretic, especially with brisk diuresis when severe cirrhosis is present or during concomitant use of corticosteroids or ACTH.
Interference with adequate oral electrolyte intake will also contribute to hypokalemia. Digitalis therapy may exaggerate metabolic effects of hypokalemia especially with reference to myocardial activity.
Any chloride deficit is generally mild and usually does not require specific treatment except under extraordinary circumstances (as in liver disease or renal disease). Dilutional hyponatremia may occur in edematous patients in hot weather, appropriate therapy is water restriction, rather than administration of salt except in rare instances when the hyponatremia is life threatening. In actual salt depletion, appropriate replacement is the therapy of choice.
Hyperuricemia may occur or frank gout may be precipitated in certain patients receiving chlorthalidone. Thiazide-like diuretics have been shown to increase the urinary excretion of magnesium; this may result in hypomagnesemia.
The antihypertensive effects of the drug may be enhanced in the post-sympathectomy patient.
If progressive renal impairment becomes evident, as indicated by a rising nonprotein nitrogen or blood urea nitrogen, a careful reappraisal of therapy is necessary with consideration given to withholding or discontinuing diuretic therapy.
Calcium excretion is decreased by thiazide-like drugs. Pathological changes in the parathyroid gland with hypercalcemia and hypophosphatemia have been observed in few patients on thiazide therapy. The common complications of hyperparathyroidism such as renal lithiasis, bone resorption and peptic ulceration have not been seen.
The following adverse reactions have been observed, but there is not enough systematic collection of data to support an estimate of their frequency.
Gastrointestinal System Reactions:
Central Nervous System Reactions:
Hematologic Reactions:
Dermatologic-Hypersensitivity Reactions:
Cardiovascular Reactions:
Other Adverse Reactions:
Whenever adverse reactions are moderate or severe, chlorthalidone dosage should be reduced or therapy withdrawn.
Reference
This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"
While we update our database periodically, we cannot guarantee it is always updated to the latest version.
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Interactions
Interactions
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