Usual Adult Dose for Edema

Usual dose: 25 mg to 100 mg orally once or twice daily

Comments:

• Some patients respond to intermittent therapy, (i.e., administration on alternate days or on 3 to 5 days each week). Excessive response and undesirable electrolyte imbalance are less likely to occur with intermittent dosing.

Usual Adult Dose for Hypertension

Initial dose: 25 mg orally once daily
Maintenance dose: May increase to 50 mg orally daily, as a single or 2 divided doses

Comments:

• Patients usually do not require doses in excess of 50 mg daily when used concomitantly with other antihypertensive agents.

Usual Adult Dose for Nephrocalcinosis

Initial: 25 mg orally once daily
Maintenance dose: May increase to 50 mg twice daily

Usual Adult Dose for Osteoporosis

Initial: 25 mg orally once daily
Maintenance dose: May increase to 50 mg daily

Usual Adult Dose for Diabetes Insipidus

Initial: 50 mg orally once daily
Maintenance dose: May increase to 100 mg orally daily

Usual Pediatric Dose for Edema

Less than 6 months: Up to 3 mg/kg/day (up to 1.5 mg/pound) orally in 2 divided doses

Less than 2 years: 1 to 2 mg/kg/day (0.5 to 1 mg/pound) orally daily as a single dose or in 2 divided doses
Maximum dose 37.5 mg per day

2 to 12 years: 1 to 2 mg/kg/day (0.5 to 1 mg/pound) orally daily as a single dose or in 2 divided doses
Maximum dose 100 mg per day

Usual Pediatric Dose for Hypertension

Less than 6 months: Up to 3 mg/kg/day (up to 1.5 mg/pound) orally in 2 divided doses

Less than 2 years: 1 to 2 mg/kg/day (0.5 to 1 mg/pound) orally daily as a single dose or in 2 divided doses
Maximum dose 37.5 mg per day

2 to 12 years: 1 to 2 mg/kg/day (0.5 to 1 mg/pound) orally daily as a single dose or in 2 divided doses
Maximum dose 100 mg per day

Renal Dose Adjustments

CrCl less than 30 mL/min: Not recommended; thiazide diuretics are considered ineffective below this level.

Liver Dose Adjustments

Thiazides 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.

Dose Adjustments

Many patients with edema respond to intermittent therapy by giving doses on alternate days or 3 to 5 days/week. Patients usually do not require more than 50 mg/day when combined with other antihypertensives.

Precautions

There are no well-controlled clinical trials in pediatric patients. Information on dosing in this age group is supported by evidence from empiric use in pediatric patients and published literature regarding the treatment of hypertension in children.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Periodic monitoring of electrolytes is recommended, particularly in elderly patients and in patients receiving a high dose.

Hydrochlorothiazide doses should be administered in the morning; if patients are on a twice daily dosing schedule, the second dose should be given before 6 PM.

If hydrochlorothiazide is used concomitantly with other antihypertensive agents, the dose of the latter may need to be reduced so as to minimize the risk of an excessive fall in blood pressure.

Diuretics, including hydrochlorothiazide, should be discontinued for 2 to 3 days before the start of angiotensin converting enzyme (ACE) inhibitor therapy so as to reduce the risk of first dose hypotension.

Frequently asked questions

• What is the best time of day to take blood pressure medication?
• How long does hydrochlorothiazide stay in your system?
• Should you use a diuretic with diazoxide?