Precaution
Severe renal disease, impaired hepatic, allergy or bronchial asthma, systemic lupus erythematosus, acute gout, diabetes mellitus, elderly, collagen vascular diseases, should be discontinued before carrying out tests for parathyroid function. Pregnancy and lactation.
Side Effect
Pancreatitis, jaundice, diarrhoea, nausea, vomiting, cramps, constipation, gastric irritation, anorexia, aplastic anaemia, agranulocytosis, leukopaenia, haemolytic anaemia, thrombocytopaenia, vasculitis, resp distress, including pneumonitis and pulmonary oedema, photosensitivity, fever, urticaria, rash, hyperglycaemia, glycosuria, hyperuricaemia, muscle spasm, vertigo, paraesthesias, dizziness, headache, restlessness, renal failure, renal dysfunction, interstitial nephritis, erythema multiforme including Stevens-Johnson syndrome, exfoliative dermatitis including toxic epidermal necrolysis, alopoecia, transient blurred vision, xanthopsia, impotence, dizziness, fatigue, headache, abdominal pain, cough, rarely symptomatic hypotension, angioneurotic oedema of face, lips, tongue, glottis and larynx, syncope, renal impairment, hypersensitivity reactions.
Potentially Fatal: Anaphylactic reactions, electrolyte imbalance, hypotension.
Interaction
Hydrochlorthiazide in combination with alcohol, barbiturates, or narcotics potentiates orthostatic hypotension. When coadministered with other antihypertensive gives additive effect. Absorption is reduced with cholestyramine and colestipol resins. Hypokalemia is observed with corticosteroids, tubocurarine responsiveness to the muscle relaxant is increased. It decreases the renal clearance of lithium and increases the risk of lithium toxicity. Non-steroidal anti-inflammatory agents can reduce the diuretic and natriuretic effect of hydrochlorthiazide.
Ramipril with potassium-sparing diuretics results in severe hyperkaelemia. May increase serum lithium concentration, NSAIDs may reduce the effect of the drug and cause deterioration of renal function.