Hydrochlorothiazide: Difference between revisions

{{Short description|Diuretic medication}}

{{Use dmy dates|date=July 2022}}

{{cs1 config |name-list-style=vanc |display-authors=6}}

| Verifiedfields = changed

| Watchedfields = changed

| verifiedrevid = 443860485

| image = Hydrochlorothiazide.svg

| width = 200

| alt =

| width2 =

| alt2 =

| caption =

<!-- Clinical data -->

| pronounce =

| tradename = Hydrodiuril, others

| Drugs.com = {{drugs.com|monograph|hydrochlorothiazide}}

| DailyMedID = Hydrochlorothiazide

| pregnancy_AU = C

| pregnancy_AU_comment = <ref name="Drugs.com pregnancy">{{cite web | title=Hydrochlorothiazide Use During Pregnancy | website=Drugs.com | date=30 July 2019 | url=https://www.drugs.com/pregnancy/hydrochlorothiazide.html | access-date=19 January 2020}}</ref>

| pregnancy_category =

| routes_of_administration = [[By mouth]]

| class =

| ATC_prefix = C03

| ATC_suffix = AA03

| ATC_supplemental = {{ATC|C03|AB03}} {{ATC|C03|AX01}} {{ATC|C03|EA01}} {{ATC|C09|BX03}} {{ATC|C09|DX01}} {{ATC|C09|DX03}} {{ATC|C09|DX06}} {{ATC|C09|DX07}} {{ATC|C09|XA52}} {{ATC|C09|XA54}}

<!-- Legal status -->

| legal_AU = <!-- S2, S3, S4, S5, S6, S7, S8, S9 or Unscheduled-->

| legal_AU_comment =

| legal_BR = <!-- OTC, A1, A2, A3, B1, B2, C1, C2, C3, C4, C5, D1, D2, E, F-->

| legal_BR_comment =

| legal_CA = <!-- OTC, Rx-only, Schedule I, II, III, IV, V, VI, VII, VIII -->

| legal_CA_comment =

| legal_DE = <!-- Anlage I, II, III or Unscheduled-->

| legal_DE_comment =

| legal_NZ = <!-- Class A, B, C -->

| legal_NZ_comment =

| legal_UK = <!-- GSL, P, POM, CD, CD Lic, CD POM, CD No Reg POM, CD (Benz) POM, CD (Anab) POM or CD Inv POM / Class A, B, C -->

| legal_UK_comment =

| legal_US = Rx-only

| legal_US_comment =

| legal_UN = <!-- N I, II, III, IV / P I, II, III, IV-->

| legal_UN_comment =

| legal_status = Rx-only

<!-- Pharmacokinetic data -->

| bioavailability = Variable (~70% on average)

| protein_bound =

| metabolism = Not significant<ref>{{cite journal | vauthors = Beermann B, Groschinsky-Grind M, Rosén A | title = Absorption, metabolism, and excretion of hydrochlorothiazide | journal = Clinical Pharmacology and Therapeutics | volume = 19 | issue = 5 Pt 1 | pages = 531–537 | date = May 1976 | pmid = 1277708 | doi = 10.1002/cpt1976195part1531 | s2cid = 22159706 }}</ref>

| metabolites =

| onset =

| elimination_half-life = 5.6–14.8&nbsp;h

| duration_of_action =

| excretion = Primarily [[kidney]] (>95% as unchanged drug)

<!-- Identifiers -->

| CAS_number_Ref = {{cascite|correct|??}}

| CAS_number = 58-93-5

| CAS_supplemental =

| PubChem = 3639

| IUPHAR_ligand = 4836

| DrugBank_Ref = {{drugbankcite|correct|drugbank}}

| DrugBank = DB00999

| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}

| ChemSpiderID = 3513

| KEGG_Ref = {{keggcite|correct|kegg}}

| KEGG = D00340

| KEGG2_Ref = {{keggcite|correct|kegg}}

| KEGG2 = C07041

| ChEBI_Ref = {{ebicite|changed|EBI}}

| ChEBI = 5778

| NIAID_ChemDB =

| PDB_ligand =

| synonyms = HCTZ, HCT

<!-- Chemical and physical data -->

| IUPAC_name = 6-chloro-1,1-dioxo-3,4-dihydro-2''H''-1,2,4-benzothiadiazine-7-sulfonamide

| C=7 | H=8 | Cl=1 | N=3 | O=4 | S=2

| SMILES = O=S(=O)(N)c1c(Cl)cc2c(c1)S(=O)(=O)NCN2

| StdInChI_comment =

| density =

| density_notes =

| melting_point =

| melting_high =

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| specific_rotation =

<!-- Definition and uses -->

'''Hydrochlorothiazide''', sold under the brand name '''Hydrodiuril''' among others, is a [[diuretic]] medication used to treat [[hypertension]] and [[edema|swelling due to fluid build-up]].<ref name=AHFS2015/> Other uses include treating [[diabetes insipidus]] and [[renal tubular acidosis]] and to decrease the risk of [[kidney stone]]s in those with a [[hypercalciuria|high calcium level in the urine]].<ref name=AHFS2015/> Hydrochlorothiazide is taken by mouth and may be combined with other [[blood pressure medication]]s as a single pill to increase effectiveness.<ref name="AHFS2015">{{cite web| title=Hydrochlorothiazide| url=https://www.drugs.com/monograph/hydrochlorothiazide.html| publisher=Drugs.com| access-date=31 May 2023| date=15 November 2022}}</ref> Hydrochlorothiazide is a [[thiazide]] medication which inhibits reabsorption of [[sodium]] and [[chloride]] ions from the [[distal convoluted tubule]]s of the kidneys, causing a [[natriuresis]].<ref name=AHFS2015/><ref name=wright/> This initially increases [[urine]] volume and lowers [[blood]] volume.<ref name=Du2010/> It is believed to reduce [[Vascular resistance|peripheral vascular resistance]].<ref name=Du2010>{{cite journal | vauthors = Duarte JD, Cooper-DeHoff RM | title = Mechanisms for blood pressure lowering and metabolic effects of thiazide and thiazide-like diuretics | journal = Expert Review of Cardiovascular Therapy | volume = 8 | issue = 6 | pages = 793–802 | date = June 2010 | pmid = 20528637 | pmc = 2904515 | doi = 10.1586/erc.10.27 | id = NIHMSID: NIHMS215063 }}</ref>

<!-- Side effects -->

Potential side effects include poor kidney function, [[electrolyte imbalance]]s, including [[hypokalemia|low blood potassium]], and, less commonly, [[hyponatremia|low blood sodium]], [[gout]], [[hyperglycemia|high blood sugar]], and [[orthostatic hypotension|feeling lightheaded with standing]].<ref name=AHFS2015/>

<!-- History, society and culture -->

Two companies, [[Merck & Co.]] and [[Ciba Specialty Chemicals]], state they discovered the medication which became commercially available in 1959.<ref>{{cite book| vauthors = Ravina E |title=The evolution of drug discovery: from traditional medicines to modern drugs|date=2011|publisher=Wiley-VCH |location=Weinheim |isbn=9783527326693 |page=74|edition=1st |url=https://books.google.com/books?id=iDNy0XxGqT8C&pg=PA74|url-status=live|archive-url=https://web.archive.org/web/20150110034441/https://books.google.ca/books?id=iDNy0XxGqT8C&pg=PA74|archive-date=10 January 2015}}</ref> It is on the [[WHO Model List of Essential Medicines|World Health Organization's List of Essential Medicines]].<ref name="WHO23rd">{{cite book | vauthors = ((World Health Organization)) | title = The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023) | year = 2023 | hdl = 10665/371090 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MHP/HPS/EML/2023.02 | hdl-access=free }}</ref> It is available as a [[generic drug]]<ref name=AHFS2015/> and is relatively affordable.<ref>{{cite web|title=Best drugs to treat high blood pressure The least expensive medications may be the best for many people|url=http://www.consumerreports.org/cro/2011/03/best-drugs-to-treat-high-blood-pressure/index.htm|access-date=10 January 2015|date=November 2014|url-status=live|archive-url=https://web.archive.org/web/20150103054653/http://www.consumerreports.org/cro/2011/03/best-drugs-to-treat-high-blood-pressure/index.htm|archive-date=3 January 2015}}</ref> In 2022, it was the twelfth most commonly prescribed medication in the United States, with more than 38{{nbsp}}million prescriptions.<ref>{{cite web | title=The Top 300 of 2022 | url=https://clincalc.com/DrugStats/Top300Drugs.aspx | website=ClinCalc | access-date=30 August 2024 | archive-date=30 August 2024 | archive-url=https://web.archive.org/web/20240830202410/https://clincalc.com/DrugStats/Top300Drugs.aspx | url-status=live }}</ref><ref>{{cite web | title = Hydrochlorothiazide Drug Usage Statistics, United States, 2013 - 2022 | website = ClinCalc | url = https://clincalc.com/DrugStats/Drugs/Hydrochlorothiazide | access-date = 30 August 2024 }}</ref>

Hydrochlorothiazide is used for the treatment of [[hypertension]], [[congestive heart failure]], symptomatic [[edema]], [[diabetes insipidus]], [[renal tubular acidosis]].<ref name=AHFS2015/> It is also used for the prevention of kidney stones in those who have high levels of calcium in their urine.<ref name=AHFS2015/>

Multiple studies suggest hydrochlorothiazide could be used as initial monotherapy in people with primary hypertension; however, the decision should be weighed against the consequence of long-term adverse metabolic abnormalities.<ref name="Suchard_2019">{{cite journal | vauthors = Suchard MA, Schuemie MJ, Krumholz HM, You SC, Chen R, Pratt N, Reich CG, Duke J, Madigan D, Hripcsak G, Ryan PB | display-authors = 6 | title = Comprehensive comparative effectiveness and safety of first-line antihypertensive drug classes: a systematic, multinational, large-scale analysis | journal = Lancet | volume = 394 | issue = 10211 | pages = 1816–1826 | date = November 2019 | pmid = 31668726 | pmc = 6924620 | doi = 10.1016/S0140-6736(19)32317-7 }}</ref><ref>{{cite journal | vauthors = Musini VM, Gueyffier F, Puil L, Salzwedel DM, Wright JM | title = Pharmacotherapy for hypertension in adults aged 18 to 59 years | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 8 | pages = CD008276 | date = August 2017 | pmid = 28813123 | pmc = 6483466 | doi = 10.1002/14651858.CD008276.pub2 | collaboration = Cochrane Hypertension Group }}</ref> Doses of hydrochlorothiazide of 50&nbsp;mg or less over four years reduced mortality and development of cardiovascular diseases better than high-dose hydrochlorothiazide (50&nbsp;mg or more) and beta-blockers.<ref name=wright/> A 2019 review supported equivalence between drug classes for initiating monotherapy in hypertension, although thiazide or thiazide-like diuretics showed better primary effectiveness and safety profiles than angiotensin-converting enzyme inhibitors and non-dihydropyridine calcium channel blockers.<ref name="Suchard_2019" />

Low doses (50&nbsp;mg or less) of hydrochlorothiazide as first‐line therapy for hypertension were found to reduce total mortality and cardiovascular disease events over a four-year study.<ref name="wright">{{cite journal |vauthors=Wright JM, Musini VM, Gill R |title=First-line drugs for hypertension |journal=The Cochrane Database of Systematic Reviews |volume=2018 |issue=4 |pages=CD001841 |date=April 2018 |pmid=29667175 |pmc=6513559 |doi=10.1002/14651858.CD001841.pub3}}</ref> Hydrochlorothiazide appears be more effective than [[chlorthalidone]] in preventing heart attacks and strokes.<ref name="hrip">{{cite journal | vauthors = Hripcsak G, Suchard MA, Shea S, Chen R, You SC, Pratt N, Madigan D, Krumholz HM, Ryan PB, Schuemie MJ | display-authors = 6 | title = Comparison of Cardiovascular and Safety Outcomes of Chlorthalidone vs Hydrochlorothiazide to Treat Hypertension | journal = JAMA Internal Medicine | volume = 180 | issue = 4 | pages = 542–551 | date = April 2020 | pmid = 32065600 | pmc = 7042845 | doi = 10.1001/jamainternmed.2019.7454 }}</ref> Hydrochlorothiazide is less potent but may be more effective than chlorthalidone in reducing blood pressure.<ref name=hrip/><ref name="Peterzan_2012">{{cite journal | vauthors = Peterzan MA, Hardy R, Chaturvedi N, Hughes AD | title = Meta-analysis of dose-response relationships for hydrochlorothiazide, chlorthalidone, and bendroflumethiazide on blood pressure, serum potassium, and urate | journal = Hypertension | volume = 59 | issue = 6 | pages = 1104–1109 | date = June 2012 | pmid = 22547443 | pmc = 4930655 | doi = 10.1161/HYPERTENSIONAHA.111.190637 }}</ref> More robust studies are required to confirm which drug is superior in reducing cardiovascular events.<ref name="Dorsch_2011">{{cite journal | vauthors = Dorsch MP, Gillespie BW, Erickson SR, Bleske BE, Weder AB | title = Chlorthalidone reduces cardiovascular events compared with hydrochlorothiazide: a retrospective cohort analysis | journal = Hypertension | volume = 57 | issue = 4 | pages = 689–694 | date = April 2011 | pmid = 21383313 | doi = 10.1161/HYPERTENSIONAHA.110.161505 | s2cid = 13017777 | doi-access = free }}</ref> Side effect profile for both drugs appear similar and are dose dependent.<ref name=hrip/>

Hydrochlorothiazide is also sometimes used to prevent [[osteopenia]] and treat [[hypoparathyroidism]],<ref>{{cite journal | vauthors = Mitchell DM, Regan S, Cooley MR, Lauter KB, Vrla MC, Becker CB, Burnett-Bowie SA, Mannstadt M | display-authors = 6 | title = Long-term follow-up of patients with hypoparathyroidism | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 97 | issue = 12 | pages = 4507–4514 | date = December 2012 | pmid = 23043192 | pmc = 3513540 | doi = 10.1210/jc.2012-1808 }}</ref> [[hypercalciuria]], [[Dent's disease]], and [[Ménière's disease]].

A low level of evidence, predominantly from observational studies, suggests that thiazide diuretics have a modest beneficial effect on bone mineral density and are associated with a decreased fracture risk when compared with people not taking thiazides.<ref>{{cite journal | vauthors = Aung K, Htay T | title = Thiazide diuretics and the risk of hip fracture | journal = The Cochrane Database of Systematic Reviews | issue = 10 | pages = CD005185 | date = October 2011 | pmid = 21975748 | doi = 10.1002/14651858.CD005185.pub2 | collaboration = Cochrane Hypertension Group}}</ref><ref>{{cite journal | vauthors = Xiao X, Xu Y, Wu Q | title = Thiazide diuretic usage and risk of fracture: a meta-analysis of cohort studies | journal = Osteoporosis International | volume = 29 | issue = 7 | pages = 1515–1524 | date = July 2018 | pmid = 29574519 | doi = 10.1007/s00198-018-4486-9 | s2cid = 4322516}}</ref><ref>{{cite journal | vauthors = Solomon DH, Ruppert K, Zhao Z, Lian YJ, Kuo IH, Greendale GA, Finkelstein JS | title = Bone mineral density changes among women initiating blood pressure lowering drugs: a SWAN cohort study | journal = Osteoporosis International | volume = 27 | issue = 3 | pages = 1181–1189 | date = March 2016 | pmid = 26449354 | pmc = 4813302 | doi = 10.1007/s00198-015-3332-6 }}</ref> Thiazides decrease mineral bone loss by promoting calcium retention in the kidney, and by directly stimulating [[osteoblast]] differentiation and bone mineral formation.<ref name="pmid17656470">{{cite journal | vauthors = Dvorak MM, De Joussineau C, Carter DH, Pisitkun T, Knepper MA, Gamba G, Kemp PJ, Riccardi D | display-authors = 6 | title = Thiazide diuretics directly induce osteoblast differentiation and mineralized nodule formation by interacting with a sodium chloride co-transporter in bone | journal = Journal of the American Society of Nephrology | volume = 18 | issue = 9 | pages = 2509–2516 | date = September 2007 | pmid = 17656470 | pmc = 2216427 | doi = 10.1681/ASN.2007030348}}</ref>

The combination of fixed-dose preparation such as losartan/hydrochlorothiazide has added advantages of a more potent antihypertensive effect with additional antihypertensive efficacy at the dose of 100&nbsp;mg/25&nbsp;mg when compared to monotherapy.<ref>{{cite journal | vauthors = Lacourcière Y, Poirier L | title = Antihypertensive effects of two fixed-dose combinations of losartan and hydrochlorothiazide versus hydrochlorothiazide monotherapy in subjects with ambulatory systolic hypertension | journal = American Journal of Hypertension | volume = 16 | issue = 12 | pages = 1036–1042 | date = December 2003 | pmid = 14643578 | doi = 10.1016/j.amjhyper.2003.07.014 | s2cid = 26447230 | doi-access = free }}</ref><ref name="Musini_2014">{{cite journal | vauthors = Musini VM, Nazer M, Bassett K, Wright JM | title = Blood pressure-lowering efficacy of monotherapy with thiazide diuretics for primary hypertension | journal = The Cochrane Database of Systematic Reviews | issue = 5 | pages = CD003824 | date = May 2014 | volume = 2014 | pmid = 24869750 | doi = 10.1002/14651858.cd003824.pub2| pmc = 10612990 }}</ref>

* [[Hypokalemia]], or low blood levels of potassium are an occasional side effect. It can be usually prevented by [[potassium]] supplements or by combining hydrochlorothiazide with a [[potassium-sparing diuretic]]

* Other disturbances in the levels of serum electrolytes, including [[hypomagnesemia]] (low magnesium), [[hyponatremia]] (low sodium), and [[hypercalcemia]] (high calcium)

* [[Hyperuricemia]] (high levels of [[uric acid]] in the blood). All thiazide diuretics including hydrochlorothiazide can inhibit excretion of uric acid by the kidneys, thereby increasing serum concentrations of uric acid. This may increase the incidence of gout in doses of ≥ 25&nbsp;mg per day and in more susceptible patients such as male gender of <60 years old.<ref name="Musini_2014" /><ref>{{cite journal | vauthors = Hueskes BA, Roovers EA, Mantel-Teeuwisse AK, Janssens HJ, van de Lisdonk EH, Janssen M | title = Use of diuretics and the risk of gouty arthritis: a systematic review | journal = Seminars in Arthritis and Rheumatism | volume = 41 | issue = 6 | pages = 879–889 | date = June 2012 | pmid = 22221907 | doi = 10.1016/j.semarthrit.2011.11.008 }}</ref><ref>{{cite journal | vauthors = Wilson L, Nair KV, Saseen JJ | title = Comparison of new-onset gout in adults prescribed chlorthalidone vs. hydrochlorothiazide for hypertension | journal = Journal of Clinical Hypertension | volume = 16 | issue = 12 | pages = 864–868 | date = December 2014 | pmid = 25258088 | pmc = 8031516 | doi = 10.1111/jch.12413 | doi-access = free}}</ref>

* [[Hyperglycemia]], high blood sugar

* [[Hyperlipidemia]], high cholesterol and triglycerides

* [[Nausea]]/[[vomiting]]

* [[Weight gain]]

* [[Pancreatitis]]

Package inserts contain vague and inconsistent data surrounding the use of thiazide diuretics in patients with allergies to sulfa drugs, with little evidence to support these statements.<ref>{{cite journal | vauthors = Johnson KK, Green DL, Rife JP, Limon L | title = Sulfonamide cross-reactivity: fact or fiction? | journal = The Annals of Pharmacotherapy | volume = 39 | issue = 2 | pages = 290–301 | date = February 2005 | pmid = 15644481 | doi = 10.1345/aph.1E350 | s2cid = 10642527}}</ref> A retrospective cohort study conducted by Strom et al. concluded that there is an increased risk of an allergic reaction occurring in patients with a predisposition to allergic reactions in general rather than cross reactivity from structural components of the sulfonamide-based drug.<ref>{{cite journal | vauthors = Strom BL, Schinnar R, Apter AJ, Margolis DJ, Lautenbach E, Hennessy S, Bilker WB, Pettitt D | display-authors = 6 | title = Absence of cross-reactivity between sulfonamide antibiotics and sulfonamide nonantibiotics | journal = The New England Journal of Medicine | volume = 349 | issue = 17 | pages = 1628–1635 | date = October 2003 | pmid = 14573734 | doi = 10.1056/NEJMoa022963| doi-access = free }}</ref> Prescribers should examine the evidence carefully and assess each patient individually, paying particular attention to their prior history of sulfonamide hypersensitivity rather than relying on drug monograph information.<ref>{{cite journal | vauthors = Ghimire S, Kyung E, Lee JH, Kim JW, Kang W, Kim E | title = An evidence-based approach for providing cautionary recommendations to sulfonamide-allergic patients and determining cross-reactivity among sulfonamide-containing medications | journal = Journal of Clinical Pharmacy and Therapeutics | volume = 38 | issue = 3 | pages = 196–202 | date = June 2013 | pmid = 23489131 | doi = 10.1111/jcpt.12048 | doi-access = free}}</ref>

There is an increased risk of non-melanoma skin cancer.<ref>{{cite journal | vauthors = Pedersen SA, Gaist D, Schmidt SA, Hölmich LR, Friis S, Pottegård A | title = Hydrochlorothiazide use and risk of nonmelanoma skin cancer: A nationwide case-control study from Denmark | journal = Journal of the American Academy of Dermatology | volume = 78 | issue = 4 | pages = 673–681.e9 | date = April 2018 | pmid = 29217346 | doi = 10.1016/j.jaad.2017.11.042 | doi-access = free }}</ref> In August 2020, the Australian [[Therapeutic Goods Administration]] required the Product Information (PI) and Consumer Medicine Information (CMI) for medicines containing hydrochlorothiazide to be updated to include details about an increased risk of non-melanoma skin cancer.<ref>{{cite web | title=Hydrochlorothiazide | website=[[Therapeutic Goods Administration]] (TGA) | date=24 August 2020 | url=https://www.tga.gov.au/alert/hydrochlorothiazide | access-date=22 September 2020}}</ref> In August 2020, the U.S. [[Food and Drug Administration]] (FDA) updated the drug label about an increased risk of non-melanoma skin cancer (basal cell skin cancer or squamous cell skin cancer).<ref>{{cite web | title=FDA approves label changes to hydrochlorothiazide | website=U.S. [[Food and Drug Administration]] (FDA) | date=20 August 2020 | url=https://www.fda.gov/drugs/drug-safety-and-availability/fda-approves-label-changes-hydrochlorothiazide-describe-small-risk-non-melanoma-skin-cancer | access-date=28 August 2020}} {{PD-notice}}</ref>

==Society and culture==

[[File:Two boxes and a blister pack of Co-Diovan (Valsartan and hydrochlorothiazide), Singapore - 20150210.jpg|thumb|Co-Diovan ([[Valsartan/hydrochlorothiazide|valsartan and hydrochlorothiazide]])]]

[[File:001850277lg Benazepril hydrochloride 20 MG Hydrochlorothiazide 25 MG Oral Tablet.jpg|right|thumb|Two generic [[Benazepril|benazepril HCl]] 20&nbsp;mg and hydrochlorothiazide 25&nbsp;mg oral tablets]]

===Brand names===

Hydrochlorothiazide is available as a [[generic drug]] under a large number of brand names, including Apo-Hydro, Aquazide, BPZide, Dichlotride, Esidrex, Hydrochlorot, Hydrodiuril, HydroSaluric, Hypothiazid, Microzide, Oretic and many others.{{medcn|date=January 2020}}

To reduce [[Polypharmacy#Pill burden|pill burden]] and in order to reduce side effects, hydrochlorothiazide is often used in [[Combination drug|fixed-dose combinations]] with many other classes of antihypertensive drugs such as:

* [[ACE inhibitor]]s – e.g. Prinzide or Zestoretic ([[Lisinopril/hydrochlorothiazide|with lisinopril]]), Co-Renitec (with [[enalapril]]), Capozide (with [[captopril]]), Accuretic (with [[quinapril]]), Monopril HCT (with [[fosinopril]]), Lotensin HCT (with [[benazepril]]), etc.

* [[Angiotensin II receptor antagonist|Angiotensin receptor blocker]]s – e.g. Hyzaar ([[Losartan/hydrochlorothiazide|with losartan]]), Co-Diovan or Diovan HCT ([[Valsartan/hydrochlorothiazide|with valsartan]]), Teveten Plus (with [[eprosartan]]), Avalide or CoAprovel (with [[irbesartan]]), Atacand HCT or Atacand Plus (with [[candesartan]]), etc.

* [[Beta blocker]]s – e.g. Ziac or Lodoz (with [[bisoprolol]]),<ref>{{cite web|url=https://www.ema.europa.eu/documents/psusa/bisoprolol/hydrochlorothiazide-list-nationally-authorised-medicinal-products-psusa/00000420/202111_en.pdf|title=List of nationally authorised medicinal products : Active substance: bisoprolol / hydrochlorothiazide Procedure no.: PSUSA/00000420/202111|website=Ema.europa.eu|access-date=16 July 2022}}</ref> Nebilet Plus or Nebilet HCT (with [[nebivolol]]), Dutoprol or Lopressor HCT (with [[metoprolol]]), etc.

* Direct [[renin inhibitor]]s – e.g. Co-Rasilez or Tekturna HCT (with [[aliskiren]])

* [[Potassium sparing diuretics]] – Dyazide and Maxzide [[triamterene]]<ref>{{cite web | title=Triamterene and Hydrochlorothiazide | website=MedlinePlus | date=1 January 2020 | url=https://medlineplus.gov/druginfo/meds/a601125.html | archive-url=https://web.archive.org/web/20200102052553/https://medlineplus.gov/druginfo/meds/a601125.html | archive-date=2 January 2020 | url-status=live | access-date=1 January 2020}}</ref>

===Sport===

Use of hydrochlorothiazide is prohibited by the [[World Anti-Doping Agency]] for its ability to mask the use of performance-enhancing drugs.<ref>{{cite web | url = https://www.wada-ama.org/sites/default/files/prohibited_list_2018_en.pdf | title = Prohibited List | date = January 2018 | publisher = [[World Anti-Doping Agency]]}}</ref>

== References ==

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