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warnings
WARNINGS Thiazides should be used with caution in severe renal disease. In patients with renal disease, thiazides may precipitate azotemia. Cumulative effects of the drug may develop in patients with impaired renal function. 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. Thiazides may add to or potentiate the action of other antihypertensive drugs. Potentiation occurs with ganglionic or peripheral adrenergic blocking drugs. Sensitivity reactions may occur in patients with a history of allergy or bronchial asthma. The possibility of exacerbation or activation of systemic lupus erythematosus has been reported. Usage in Pregnancy Thiazides cross the placental barrier and appear in cord blood. The use of thiazides in pregnant women requires that the anticipated benefit be weighed against possible hazards to the fetus. These hazards include fetal or neonatal jaundice, thrombocytopenia, and possibly other adverse reactions which have occurred in the adult. Nursing Mothers Thiazides appear in breast milk. If use of the drug is deemed essential, the patient should stop nursing.
ADVERSE REACTIONS A. GASTROINTESTINAL SYSTEM REACTIONS anorexia gastric irritation nausea vomiting cramping diarrhea constipation jaundice (intrahepatic cholestatic jaundice) pancreatitis B. CENTRAL NERVOUS SYSTEM REACTIONS dizziness vertigo paresthesias headache xanthopsia C. HEMATOLOGIC REACTIONS leukopenia agranulocytosis thrombocytopenia aplastic anemia D. DERMATOLOGIC—HYPERSENSITIVITY REACTIONS purpura photosensitivity rash urticaria necrotizing angiitis (vasculitis) (cutaneous vasculitis) E. CARDIOVASCULAR REACTION Orthostatic hypotension may occur and may be aggravated by alcohol, barbiturates or narcotics. F. OTHER hyperglycemia glycosuria hyperuricemia muscle spasm weakness restlessness Whenever adverse reactions are moderate or severe, thiazide dosage should be reduced or therapy withdrawn.