CHLOROTHIAZIDE

Chlorothiazide

Reviewed by Liz Oliphant. Approved by Clinical Practice Committee
 
May 2013
Administration Newborn Drug Protocol Index Newborn Services Home Page

This is NOT hydrochlorothiazide. Check doses carefully.

From July 2013, NICU has changed from using hydrochlorothiazide to chlorothiazide to bring us in line with Pharmac requirements and the remainder of Starship. Hydrochlorothiazide is no longer available anywhere in ADHB. Dosages are 10-fold different between these two drugs – please double check doses carefully.
 

Dose and Administration 1,2,3

  1. 10-20 mg/kg/dose 12-hourly PO.

Indications1

  1. Control of pulmonary oedema in preterm infants with chronic lung disease.
  2. Diuretic for long term control of mild to moderate oedema associated with congestive heart failure (generally in combination with spironolactone).

Contraindications2

  1. Known hypersensitivity to thiazides or sulphonamide derivatives.
  2. Anuria.
  3. Severe renal or hepatic dysfunction

Precautions2

  1. Decreased renal or hepatic function.
  2. Electrolyte imbalances.
  3. Neonates with significant jaundice (chlorothiazide competes with bilirubin for available plasma albumin-binding sites).

Clinical Pharmacology1 

Chlorothiazide is a thiazide diuretic - a moderately potent diuretic which acts at the proximal end of the distal tubule to cause a decrease in reabsorption of electrolytes and an increase in excretion of sodium and chloride ions with accompanying water loss.

For further information see Reference Viewer.

Possible Adverse Effects1,3

  1. Gastrointestinal disturbance (nausea, vomiting, diarrhoea)
  2. Hypokalaemia, hypochloraemic alkalosis, hypomagnesaemia, hypophosphotaemia, hyponatraemia.
  3. Hypercalcaemia, hyperglycaemia, hyperuricaemia.
  4. Altered plasma-lipid concentrations
  5. Hypersensitivity reactions (skin reactions, photosensitivity, fever, respiratory distress, blood dyscrasias).
  6. Possibly kernicterus in very jaundiced babies.

Special Considerations1

  1. Monitor sodium, potassium, calcium and glucose levels.
  2. Effects appear increased when used in combination with furosemide or spironolactone. Combined use with spironolactone, however, causes urinary calcium loss of a magnitude similar to that caused by furosemide, possibly resulting in bone demineralization in the pre-term infant.
  3. Distal diuretics (eg. chlorothiazide) improve pulmonary mechanics in preterm infants, aged greater than 3 weeks, with chronic lung disease. The use of distal diuretics reduces the need for furosemide .
  4. Chronic administration can lead to significant urinary losses of magnesium that can precipitate symptoms of magnesium deficiency.
  5. NSAIDs decrease antihypertensive response.
  6. Digoxin: increased risk of digitalis toxicity from thiazide-induced hypokalaemia.
  7. Diazoxide: increased antihypertensive, hyperglycaemic or hyperuricaemic effects.