Thiazide diuretics

(JASN 2017;28:3414)

• Drugs: hydrochlorothiazide (HCTZ), chlorothiazide (Diuril), metolazone (Zaroxolyn)

• Mech: inhib Na-Cl cotransporter in the distal convoluted tubule (DCT); 5% Na reabsorp

synergistic with loop diuretic, esp. if chronic loop use

↓ effect when GFR <30, except metolazone, which is still effective in renal insufficiency

• Dosing: give 30 min prior to loop diuretic

• Adverse effects: ↓ Na, ↓ K, ↓ Mg, ↑ Ca, HLD, pancreatitis, ↑ glc, hypersensitivity