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cardio:diuretics:chlorthalidone

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cardio:diuretics:chlorthalidone [2026/02/15 03:24] – andrew2393cnscardio:diuretics:chlorthalidone [2026/02/15 03:25] (current) – andrew2393cns
Line 59: Line 59:
 Often combined with: Often combined with:
   * [[cardio:raas:acei|ACE inhibitors]]     * [[cardio:raas:acei|ACE inhibitors]]  
-  * [[cardio:raas:arbs|ARBs]]  +  * [[cardio:raas:arb|ARBs]]  
   * [[cardio:beta_blockers:start|Beta-blockers]]     * [[cardio:beta_blockers:start|Beta-blockers]]  
  
Line 205: Line 205:
   * [[cardio:diuretics:hydrochlorothiazide|Hydrochlorothiazide]]   * [[cardio:diuretics:hydrochlorothiazide|Hydrochlorothiazide]]
   * [[cardio:hypertension:start|Hypertension]]   * [[cardio:hypertension:start|Hypertension]]
-  * [[cardio:raas:ace_inhibitors:start|ACE Inhibitors]]====== Chlorthalidone (Thalitone®) ====== +  * [[cardio:raas:acei|ACE Inhibitors]]
- +
-<WRAP right 340px> +
-<WRAP infobox> +
-| | {{ :cardio:diuretics:chlorthalidone.svg?180 |}} | +
-^ Chlorthalidone | +
-| Brand Name | Thalitone® | +
-| Drug Class | [[cardio:diuretics:start|Thiazide-like Diuretic]] | +
-| Primary Indication | Hypertension | +
-| Site of Action | Distal Convoluted Tubule | +
-| Mechanism | Na⁺/Cl⁻ Cotransporter Inhibition | +
-| Potassium Effect | ↓ (Hypokalemia risk) | +
-| Calcium Effect | ↑ Reabsorption | +
-| Half-Life | ~40–60 hours | +
-| Landmark Trial | ALLHAT | +
-| FDA Approval | 1960 | +
-</WRAP> +
-</WRAP> +
- +
-===== Overview ===== +
- +
-Chlorthalidone is a thiazide-like diuretic used primarily for the treatment of hypertension. +
- +
-Although often grouped with thiazides, chlorthalidone has a significantly longer half-life and stronger outcome data compared to [[cardio:diuretics:hydrochlorothiazide|Hydrochlorothiazide]]. +
- +
-It is frequently preferred in hypertension guidelines due to its durable 24-hour blood pressure control and cardiovascular outcome benefit. +
- +
-<WRAP clear></WRAP> +
- +
----- +
- +
-===== Mechanism of Action ===== +
- +
-**Site of Action** +
-  * Distal convoluted tubule   +
- +
-**Transporter Blocked** +
-  * Na⁺/Cl⁻ cotransporter (NCC)   +
- +
-**Physiologic Effects** +
-  * ↑ Sodium and water excretion   +
-  * ↑ Potassium excretion   +
-  * ↑ Calcium reabsorption   +
-  * ↓ Plasma volume   +
-  * ↓ Peripheral vascular resistance (long-term effect)   +
- +
-Net effect: +
-  * Sustained blood pressure reduction   +
- +
----- +
- +
-===== Indications ===== +
- +
-  * Primary hypertension   +
-  * Edema (less commonly)   +
- +
-Supported by: +
-  * ALLHAT trial — reduction in cardiovascular events   +
- +
-Often combined with: +
-  * [[cardio:raas:ace_inhibitors:start|ACE inhibitors]]   +
-  * [[cardio:raas:arbs:start|ARBs]]   +
-  * [[cardio:beta_blockers:start|Beta-blockers]]   +
- +
----- +
- +
-<WRAP contra> +
-===== Contraindications ===== +
- +
-Absolute: +
-  * Anuria   +
- +
-Relative / Caution: +
-  * Severe renal impairment (reduced efficacy when eGFR < 30)   +
-  * Gout   +
-  * Hyponatremia   +
-  * Hypokalemia   +
-  * Diabetes mellitus   +
- +
-</WRAP> +
- +
----- +
- +
-<WRAP details> +
-===== Dosing ===== +
- +
-Hypertension: +
-  * 12.5–25 mg once daily   +
- +
-Higher doses: +
-  * Increase metabolic side effects   +
-  * Provide minimal additional BP reduction   +
- +
-Long half-life supports once-daily dosing with sustained effect. +
- +
-</WRAP> +
- +
----- +
- +
-<WRAP details> +
-===== Pharmacokinetics ===== +
- +
-Absorption: +
-  * Oral   +
- +
-Half-life: +
-  * ~40–60 hours   +
- +
-Duration: +
-  * >24-hour BP control   +
- +
-Elimination: +
-  * Renal   +
- +
-Longer duration compared to hydrochlorothiazide. +
- +
-</WRAP> +
- +
----- +
- +
-<WRAP details> +
-===== Adverse Effects ===== +
- +
-Electrolyte: +
-  * Hypokalemia   +
-  * Hyponatremia   +
-  * Hypomagnesemia   +
-  * Hypercalcemia   +
- +
-Metabolic: +
-  * Hyperglycemia   +
-  * Hyperuricemia (gout)   +
-  * Mild dyslipidemia   +
- +
-Other: +
-  * Photosensitivity   +
- +
-Electrolyte abnormalities may be more pronounced than with HCTZ. +
- +
-</WRAP> +
- +
----- +
- +
-<WRAP details> +
-===== Drug Interactions ===== +
- +
-Lithium: +
-  * Increased lithium levels   +
- +
-RAAS inhibitors: +
-  * May blunt potassium loss   +
- +
-Loop diuretics: +
-  * Additive electrolyte depletion   +
- +
-</WRAP> +
- +
----- +
- +
-<WRAP monitoring> +
-===== Monitoring ===== +
- +
-  * Blood pressure   +
-  * Electrolytes (Na⁺, K⁺)   +
-  * Renal function   +
-  * Uric acid (if gout risk)   +
-  * Glucose (diabetics)   +
- +
-</WRAP> +
- +
----- +
- +
-<WRAP pearls> +
-===== Clinical Pearls ===== +
- +
-  * Longer half-life than hydrochlorothiazide.   +
-  * Strong cardiovascular outcome data (ALLHAT).   +
-  * Often preferred thiazide for hypertension.   +
-  * More sustained 24-hour BP control.   +
-  * Greater risk of electrolyte abnormalities than HCTZ.   +
- +
-</WRAP> +
- +
----- +
- +
-===== Comparison Within Class ===== +
- +
-Compared to [[cardio:diuretics:hydrochlorothiazide|Hydrochlorothiazide]]: +
-  * Longer half-life   +
-  * Better cardiovascular outcome data   +
-  * More potent   +
- +
-Compared to [[cardio:diuretics:indapamide|Indapamide]]: +
-  * Similar mechanism   +
-  * Slightly different metabolic profile   +
- +
-Compared to [[cardio:diuretics:furosemide|Furosemide]]: +
-  * Less potent diuretic   +
-  * Not effective in severe renal failure   +
- +
----- +
- +
-===== Related ===== +
- +
-  * [[cardio:diuretics:start|Diuretics]] +
-  * [[cardio:diuretics:hydrochlorothiazide|Hydrochlorothiazide]] +
-  * [[cardio:hypertension:start|Hypertension]] +
-  * [[cardio:raas:ace_inhibitors:start|ACE Inhibitors]]+
cardio/diuretics/chlorthalidone.txt · Last modified: by andrew2393cns