drug adverse effects of thiazide diuretics
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Adverse effects
- hypercalcemia[5]
- hyperparathyroidism present in 34-43% of patients with thiazide-associated hypercalcemia[5]
- hyperuricemia
- hyperglycemia*[1]
- increased risk of diabetes, relative risk 1.2-1.5[2]
- mean increase in fasting blood glucose = 3.6 mg/dL[6]
- hypokalemia*
- hypomagnesemia
- hyponatremia
- incidence may be higher than that indicated on drug labeling
- 2 year cumulative risk for serum sodium < 130 meq/L is < 4%[10]
- early hyponatremia after starting thiazide diuretic associated with increased mortality risk[12]
- glucose intolerance
- hypochloremic metabolic alkalosis
- increased low-density lipoprotein (LDL)
- increased triglycerides
- rash & photosensitivity
- increased risk of squamous cell carcinoma skin[7]
- increased risk of keratinocyte carcinoma (40%) basal cell carcinoma & squamous cell carcinoma skin & cutaneous melanoma (60%)[8]
- pancreatitis
- hepatitis
- vasculitis
- impotence[1]
- thiazide users more likely to present to an emergency department with
- acute kidney injury (21% vs 7%)
- hyponatremia (22% vs 10%)
- hypokalemia (19% vs 11%)
- recent falls (21% vs 7%)
- recent syncope (6% vs 3%)[9]
* thiazides & beta-blockers may cause glucose intolerance
* older patients are especially vulnerable to the adverse effects of thiazide diuretics, including renal-electrolyte disturbances, gout, hyperglycemia, & hypotension[4]
* do not change loop diuretic to thiazide diuretic for hyperkalemia in patients with systolic heart failure[5]
More general terms
References
- ↑ Jump up to: 1.0 1.1 1.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 16. American College of Physicians, Philadelphia 1998, 2012
- ↑ Jump up to: 2.0 2.1 Taylor EN et al, Antihypertensive medications and the risk of incident type 2 diabetes. Diabetes Care 2006; 29:1065 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16644638
- ↑ Palmer BF, Naderi AS. Metabolic complications associated with use of thiazide diuretics. J Am Soc Hypertens. 2007 Nov-Dec;1(6):381-92 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20409871
- ↑ Jump up to: 4.0 4.1 Makam AN et al. Risk of thiazide-induced metabolic adverse events in older adults. J Am Geriatr Soc 2014 Jun; 62:1039 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24823661 <Internet> http://onlinelibrary.wiley.com/doi/10.1111/jgs.12839/abstract
- ↑ Jump up to: 5.0 5.1 5.2 5.3 Griebeler ML, Kearns AE, Ryu E, et al. Thiazide-associated hypercalcemia: Incidence and association with primary hyperparathyroidism over two decades. J Clin Endocrinol Metab 2016 Mar; 101:1166-1173. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26751196 PMCID: PMC480317 Free PMC article <Internet> http://press.endocrine.org/doi/10.1210/jc.2015-3964
- ↑ Jump up to: 6.0 6.1 Hall JJ et al. Thiazide diuretic-induced change in fasting plasma glucose: A meta-analysis of randomized clinical trials. J Gen Intern Med 2020 Jun; 35:1849. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32157653 Review. https://link.springer.com/article/10.1007/s11606-020-05731-3
- ↑ Jump up to: 7.0 7.1 Schneider R, Reinau D, Stoffel S et al Risk of skin cancer in new users of thiazides and thiazide-like diuretics: a cohort study using an active comparator group. Br J Dermatol. Published online February 20, 2021 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33609289
- ↑ Jump up to: 8.0 8.1 Carroll L Common Blood Pressure Medications Linked to Increased Skin Cancer Risk. Medscape cites Reuters Health Information April 13, 2021 https://www.medscape.com/viewarticle/949153
Drucker AM, Hollestein L, Na Y et al Association between antihypertensive medications and risk of skin cancer in people older than 65 years: a population-based study. CMAJ. 2021 Apr 12;193(15):E508-E516. Apr 12 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33846199 Free article. https://www.cmaj.ca/content/193/15/E508 - ↑ Jump up to: 9.0 9.1 Ravioli S et al. Risk of electrolyte disorders, syncope, and falls in patients taking thiazide diuretics: Results of a cross-sectional study. Am J Med 2021 Sep; 134:1148. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33974908 https://www.amjmed.com/article/S0002-9343(21)00289-8/fulltext
- ↑ Jump up to: 10.0 10.1 Andersson NW, Wohlfahrt J, Feenstra B, Hviid A, Melbye M, Lund M. Cumulative Incidence of Thiazide-Induced Hyponatremia. A Population-Based Cohort Study. Ann Inter Med 2023. Dec 19. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38109740 https://www.acpjournals.org/doi/full/10.7326/M23-1989
- ↑ NEJM Knowledge+
- ↑ Jump up to: 12.0 12.1 Achinger SG, Ayus JC, Kumar A, Tsalatsanis A. Thiazide-Associated Hyponatremia and Mortality Risk: A Cohort Study. Kidney Med. 2024 Dec 9;7(2):100941. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39866296 Free PMC article. PMCID: PMC11759562 https://www.kidneymedicinejournal.org/article/S2590-0595(24)00152-3/fulltext