Chlortalidone oral
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral formulations of chlortalidone.
Drugs List
Therapeutic Indications
Uses
Ascites and oedema associated with hepatic cirrhosis
Heart failure - chronic mild to moderate
Hypertension
Nephrogenic diabetes insipidus
Oedema due to nephrotic syndrome
Dosage
Adults
Hypertension
Initial dose: 25mg once daily. Increase to 50mg daily if necessary.
Additional hypertensive therapy maybe added to the dosage regime, where necessary.
Stable, chronic heart failure
Initial dose: 25mg to 50mg once daily. Increase up to a maximum of 200mg daily if necessary.
The usual maintenance dose is the lowest effective dose, e.g. 25mg to 50mg daily or every other day.
Oedema
The lowest effective dose identified by titration and administered over a limited period.
Doses should not exceed 50mg daily.
Diabetes insipidus
Initial dose: 100mg twice daily. Reduce to maintenance dose of 50mg daily if possible.
Children
Use the lowest effective dose.
0.5mg/kg to 1mg/kg every 48 hours (up to a maximum of 1.7mg/kg every 48 hours).
The following alternative dosing schedule may be suitable:
Hypertension
Children aged 12 to 18 years
25mg daily in the morning, increased to 50mg daily if necessary.
Children aged 5 to 12 years
0.5mg/kg to 1mg/kg in the morning every 48 hours (up to a maximum of 1.7mg/kg every 48 hours).
Stable heart failure
Children aged 12 to 18 years
25mg to 50mg daily in the morning (up to a maximum of 200mg daily if necessary).
Children aged 5 to 12 years
0.5mg/kg to 1mg/kg in the morning every 48 hours (up to a maximum of maximum 1.7mg/kg every 48 hours).
Ascites, oedema in nephrotic syndrome
Children aged 12 to 18 years
Up to 50mg daily.
Children aged 5 to 12 years
0.5mg/kg to 1mg/kg in the morning every 48 hours (up to a maximum of 1.7mg/kg every 48 hours).
Contraindications
Addison's disease
Anuria
Breastfeeding
Galactosaemia
Hypercalcaemia
Hyponatraemia
Pregnancy
Refractory hypokalaemia
Renal impairment - creatinine clearance below 30 ml/minute
Severe hepatic impairment
Symptomatic hyperuricaemia
Precautions and Warnings
Elderly
Diabetes mellitus
Glucose-galactose malabsorption syndrome
Gout
Hepatic cirrhosis
Hepatic impairment
Lactose intolerance
Nephrotic syndrome
Renal impairment
Severe arteriosclerosis
Systemic lupus erythematosus
Adjustment of hypoglycaemic therapy may be necessary in diabetes mellitus
May decrease glucose tolerance in patients with diabetes mellitus
Nephrotic syndrome:only for normokalaemic, normovolaemic patients
Not for long term/first line use in diabetes mellitus
Not for long term/first line use in hypercholesterolaemia
Advise ability to drive/operate machinery may be affected by side effects
Contains lactose
Consider the addition of a potassium sparing agent to correct hypokalaemia
Monitor fluid and electrolyte status
Excess consumption of liquorice may increase the risk of hypokalaemia
May precipitate diabetes mellitus
May precipitate gout
Reduce dose/withdraw 2-3 days prior to ACE inhibitors
Discontinue if hypokalaemia with clinical signs occur (paresis,ECG changes)
Maintain treatment at the lowest effective dose
Advise patient not to take NSAIDs unless advised by clinician
Monitor serum electrolytes in elderly patients, patients with ascites due to liver cirrhosis and in patients with oedema due to nephrotic syndrome. Hyponatraemia with neurological symptoms such as nausea, debility, progressive disorientation and apathy have been reported following thiazide treatment.
Idiosyncratic reactions resulting in choroidal effusion with visual field defect, transient myopia and acute angle-closure glaucoma may be caused by sulfonamide, or sulfonamide derivative drugs. Untreated acute angle-closure glaucoma can lead to permanent vision loss, prompt medical or surgical treatments may need to be considered if the intraocular pressure remains uncontrolled.
Pregnancy and Lactation
Pregnancy
Chlortalidone is contraindicated during pregnancy.
The manufacturer does not recommend using chlortalidone during pregnancy as it may be associated with hypovolaemia, increased blood viscosity and reduced placental perfusion. Available reports suggest foetal bone marrow depression, thrombocytopenia and foetal and neonatal jaundice are associated with the use of thiazide diuretics.
Lactation
Chlortalidone is contraindicated during breastfeeding.
The manufacturer does not recommend breastfeeding whilst taking chlortalidone. Chlortalidone is present in human breast milk. Effects on exposed infants are unknown.
Side Effects
Agranulocytosis
Arrhythmias
Choroidal effusion
Constipation
Decreased appetite
Diarrhoea
Dizziness
Eosinophilia
Gastric discomfort
Gastric pain
Glycosuria
Gout
Headache
Hypercalcaemia
Hyperglycaemia
Hyperuricaemia
Hypochloraemic alkalosis
Hypokalaemia
Hypomagnesaemia
Hyponatraemia
Impotence
Increase in plasma cholesterol
Interstitial nephritis
Intrahepatic cholestasis
Jaundice
Leucopenia
Myopia
Narrow angle glaucoma
Nausea
Pancreatitis
Paraesthesia
Photosensitivity
Postural hypotension
Pulmonary oedema
Rash
Reduced visual acuity
Reduction in glucose tolerance - may cause worsening of diabetic control
Thrombocytopenia
Urticaria
Vomiting
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: May 2021
Reference Sources
Summary of Product Characteristics: Hylaton 12.5mg tablets. Morningside Healthcare Limited. Revised November 2020.
Summary of Product Characteristics: Hylaton 50mg tablets. Morningside Healthcare Limited. Revised November 2020.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 06 May 2021
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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