Hydrochlorothiazide and spironolactone

You should not use this medicine if you have kidney problems, Addison's disease, high blood levels of calcium or potassium, an allergy to sulfa drugs, or if you are unable to urinate.

Spironolactone has caused tumors in animals but it is not known whether this could occur in people. Do not use this medicine for any condition that has not been checked by your doctor.

Usual Adult Dose for Hypertension:

Hydrochlorothiazide 50 to 100 mg-Spironolactone 50 to 100 mg orally daily in 1 to 2 divided doses

Uses:
-Treatment of essential hypertension when other measures are considered inadequate or inappropriate.
-Treatment of diuretic-induced hypokalemia in hypertensive patients when other measures are considered inappropriate.
-Treatment of hypertension.

Usual Adult Dose for Edema:

Hydrochlorothiazide 25 to 200 mg-Spironolactone 25 to 200 mg orally daily in 1 to 2 divided doses

Usual Adult Dose for Congestive Heart Failure:

Hydrochlorothiazide 25 to 200 mg-Spironolactone 25 to 200 mg orally daily in 1 to 2 divided doses

Uses:
-Management of edema and sodium retention when the patient is only partially responsive to, or is intolerant of, other therapeutic measures.
-Treatment of diuretic-induced hypokalemia in patients with congestive heart failure (CHF) when other measures are considered inappropriate.
-Treatment of patients with CHF taking digitalis when other therapies are considered inadequate or inappropriate.

Usual Adult Dose for Ascites:

Hydrochlorothiazide 25 to 200 mg-Spironolactone 25 to 200 mg orally daily in 1 to 2 divided doses

Use: Maintenance therapy together with bed rest and fluid and sodium restriction for cirrhosis of the liver accompanied by edema and/or ascites.

Usual Adult Dose for Nephrotic Syndrome:

Hydrochlorothiazide 25 to 200 mg-Spironolactone 25 to 200 mg orally daily in 1 to 2 divided doses

Use: For nephrotic patients when treatment of the underlying disease, restriction of fluid and sodium intake, and the use of other diuretics do not provide an adequate response.

Taking this medicine with other drugs that make you dizzy or lower your blood pressure can worsen these effects. Ask your doctor before taking a sleeping pill, opioid pain medicine, a muscle relaxer, or medicine for anxiety, depression, or seizures.

Tell your doctor about all your current medicines and any you start or stop using, especially:

• cholestyramine;

• digoxin;

• lithium;

• heart or blood pressure medicine, especially another diuretic;

• insulin or oral diabetes medicine;

• medicine to prevent a blood clot;

• NSAIDs (nonsteroidal anti-inflammatory drugs)--aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others; or

• steroid medicine--dexamethasone, prednisone, or others.

This list is not complete. Other drugs may interact with hydrochlorothiazide and spironolactone, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

• If you have an allergy to hydrochlorothiazide, spironolactone, or any other part of hydrochlorothiazide and spironolactone.
• If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
• If you have any of these health problems: Addison's disease, high calcium levels, high potassium levels, kidney disease, or liver disease.
• If you are not able to pass urine.
• If you are taking any of these drugs: Amiloride, dofetilide, eplerenone, or triamterene.

This is not a list of all drugs or health problems that interact with this medicine.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take hydrochlorothiazide and spironolactone with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
• Signs of fluid and electrolyte problems like mood changes, confusion, muscle pain or weakness, a heartbeat that does not feel normal, very bad dizziness or passing out, fast heartbeat, more thirst, seizures, feeling very tired or weak, not hungry, unable to pass urine or change in the amount of urine produced, dry mouth, dry eyes, or very bad upset stomach or throwing up.
• Signs of liver problems like dark urine, feeling tired, not hungry, upset stomach or stomach pain, light-colored stools, throwing up, or yellow skin or eyes.
• Signs of a pancreas problem (pancreatitis) like very bad stomach pain, very bad back pain, or very bad upset stomach or throwing up.
• Signs of kidney problems like unable to pass urine, change in how much urine is passed, blood in the urine, or a big weight gain.
• Black, tarry, or bloody stools.
• Change in balance.
• Change in sex ability.
• Fever or chills.
• Sore throat.
• Throwing up blood or throw up that looks like coffee grounds.
• Slow heartbeat.
• A burning, numbness, or tingling feeling that is not normal.
• Shortness of breath.
• Any unexplained bruising or bleeding.
• For males, enlarged breasts.
• Period (menstrual) changes.
• This medicine can cause certain eye problems. If left untreated, this can lead to lasting eyesight loss. If eye problems happen, signs like change in eyesight or eye pain most often happen within hours to weeks of starting hydrochlorothiazide and spironolactone. Call your doctor right away if you have these signs.

• Store at room temperature.
• Store in a dry place. Do not store in a bathroom.
• Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
• Check with your pharmacist about how to throw out unused drugs.

There are no dosage adjustments provided in manufacturer’s labeling. Efficacy of hydrochlorothiazide is limited in patients with CrCl <30 mL/minute; use is contraindicated in patients with anuria, acute renal insufficiency, or significant impairment of renal excretory function. For additional considerations, also see individual agents.

There are no dosage adjustments provided in manufacturer’s labeling. Use is contraindicated in acute or severe hepatic failure.

An oral suspension containing hydrochlorothiazide 5 mg and spironolactone 5 mg per mL may be made with tablets. Crush twenty-four 25 mg hydrochlorothiazide and twenty-four 25 mg spironolactone tablets and reduce to a fine powder. Add small portions of a 1:1 mixture of Ora-Sweet and Ora-Plus and mix to a uniform paste; mix while adding the vehicle in equal proportions to almost 120 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add sufficient quantity of vehicle to make 120 mL. Label "shake well". Stable 60 days under refrigeration or at room temperature.

Hydrochlorothiazide 25 to 200 mg-Spironolactone 25 to 200 mg orally daily in 1 to 2 divided doses