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warnings
WARNINGS Hydrochlorothiazide, a sulfonamide, can cause an idiosyncratic reaction, resulting in acute transient myopia and acute angle-closure glaucoma. Symptoms include acute onset of decreased visual acuity or ocular pain and typically occur within hours to weeks of drug initiation. Untreated acute angle-closure glaucoma can lead to permanent vision loss. The primary treatment is to discontinue hydrochlorothiazide as rapidly as possible. Prompt medical or surgical treatments may need to be considered if the intraocular pressure remains uncontrolled. Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy. Acute Myopia and Secondary Angle-Closure Glaucoma: Latent diabetes mellitus may become manifest and diabetic patients given thiazides may require adjustment of their insulin dose. Diabetes and Hypoglycemia: Cumulative effects of the thiazides may develop in patients with impaired renal function. In such patients, thiazides may precipitate azotemia. Renal Disease:
ADVERSE REACTIONS The adverse reactions associated with hydrochlorothiazide have been shown to be dose related. In controlled clinical trials, the adverse events reported with doses of 12.5 mg hydrochlorothiazide once daily were comparable to placebo. The following adverse reactions have been reported for doses of hydrochlorothiazide 25 mg and greater and, within each category, are listed in the order of decreasing severity. Weakness. Body as a whole: Hypotension including orthostatic hypotension (may be aggravated by alcohol, barbiturates, narcotics or antihypertensive drugs). Cardiovascular: Pancreatitis, jaundice (intrahepatic cholestatic jaundice), diarrhea, vomiting, sialadenitis, cramping, constipation, gastric irritation, nausea, anorexia. Digestive: Aplastic anemia, agranulocytosis, leukopenia, hemolytic anemia, thrombocytopenia. Hematologic: Anaphylactic reactions, necrotizing angiitis (vasculitis and cutaneous vasculitis), respiratory distress including pneumonitis and pulmonary edema, photosensitivity, fever, urticaria, rash, purpura. Hypersensitivity: Electrolyte imbalance (see ), hyperglycemia, glycosuria, hyperuricemia. Metabolic: PRECAUTIONS Muscle Spasm. Musculoskeletal: Vertigo, paresthesia, dizziness, headache, restlessness. Nervous System/Psychiatric: Renal failure, renal dysfunction, interstitial nephritis (see ). Renal: WARNINGS Erythema multiforme including Stevens-Johnson syndrome, exfoliative dermatitis including toxic epidermal necrolysis, alopecia. Skin: Transient blurred vision, xanthopsia. Special Senses: Impotence. Urogenital: Whenever adverse reactions are moderate or severe, thiazide dosage should be reduced or therapy withdrawn.