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Thiazide (/ ˈ θ aɪ ə z aɪ d /) refers to both a class of sulfur-containing organic molecules [1] and a class of diuretics based on the chemical structure of benzothiadiazine. [2] The thiazide drug class was discovered and developed at Merck and Co. in the 1950s. [ 3 ]
Hydrochlorothiazide, sold under the brand name Hydrodiuril among others, is a diuretic medication used to treat hypertension and swelling due to fluid build-up. [4] Other uses include treating diabetes insipidus and renal tubular acidosis and to decrease the risk of kidney stones in those with a high calcium level in the urine. [4]
Thiazide diuretics increase the excretion of sodium and potassium ions and decrease the excretion of calcium ions and uric acid so they are contraindicated in patients with hyponatraemia, hypokalaemia, hypercalcaemia and hyperuricaemia. They are also contraindicated in patients with Addison's disease.
As with other thiazide diuretics, chlortalidone crosses the placenta and is excreted in breast milk. [49] Chlortalidone may suppress lactation, and has been used for this indication. Due to its long half-life, chlortalidone may accumulate in newborns via breast milk, despite receiving only about 6% of the maternal weight-adjusted dose. [50]
The thiazides and potassium-sparing diuretics are considered to be calcium-sparing diuretics. [6] The thiazides cause a net decrease in calcium lost in urine. [7] The potassium-sparing diuretics cause a net increase in calcium lost in urine, but the increase is much smaller than the increase associated with other diuretic classes. [7]
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The thiazide diuretics also deplete circulating potassium unless combined with a potassium-sparing diuretic or supplemental potassium. Some authors have challenged thiazides as first line treatment. [55] [56] [57] However, as the Merck Manual of Geriatrics notes, "thiazide-type diuretics are especially safe and effective in the elderly." [58]
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