Liz Oliphant. Approved by Clinical Practice Committee
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
Dose and Administration 1,2,3
- 10-20 mg/kg/dose 12-hourly PO.
- Control of pulmonary oedema in preterm infants with chronic lung
- Diuretic for long term control of mild to moderate oedema associated
with congestive heart failure (generally in combination with spironolactone).
- Known hypersensitivity to thiazides or sulphonamide derivatives.
- Severe renal or hepatic dysfunction
- Decreased renal or hepatic function.
- Electrolyte imbalances.
- Chlorothiazide causes increased urinary losses of sodium, chloride,
potassium, bicarbonate, magnesium and phosphate
- Chlorothiazide decreases renal excretion of calcium
- Neonates with significant jaundice (chlorothiazide competes with
bilirubin for available plasma albumin-binding sites).
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
Possible Adverse Effects1,3
- Gastrointestinal disturbance (nausea, vomiting, diarrhoea)
- Hypokalaemia, hypochloraemic alkalosis, hypomagnesaemia,
- Hypercalcaemia, hyperglycaemia, hyperuricaemia.
- Altered plasma-lipid concentrations
- Hypersensitivity reactions (skin reactions, photosensitivity, fever,
respiratory distress, blood dyscrasias).
- Possibly kernicterus in very jaundiced babies.
- Monitor sodium, potassium, calcium and glucose levels.
- Effects appear increased when used in combination with
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.
- 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
- Chronic administration can lead to significant urinary losses of
magnesium that can precipitate symptoms of magnesium deficiency.
- NSAIDs decrease antihypertensive response.
- Digoxin: increased risk of digitalis toxicity from thiazide-induced
- Diazoxide: increased antihypertensive, hyperglycaemic or hyperuricaemic