- ACRONYMS AND DEFINITIONS
- ACE - ACE inhibitors
- ARB - Angiotensin receptor blockers
- CCB - Calcium channel blockers
- ENaC inhibitors - Epithelial sodium channel inhibitors
- ER - Extended-release
- GFR - Glomerular Filtration Rate
- HCTZ - Hydrochlorothiazide
- IR - Immediate-release
- P = Drugs with pediatric dosing
Chlorothiazide (Diuril®)
Dosage forms
Tablet
- 250 mg
- 500 mg
Suspension
- 250 mg/5 ml
- Comes in 237 ml bottle
- Store at room temperature
Dosing
Hypertension (adults)
- Starting: 500 - 1000 mg/day
- Maintenance: 500 - 1500 mg/day
- Max: 2000 mg/day
- May be given in one or two divided doses
- May take without regard to food
Hypertension and diuresis (< 2 years)
- Dosing: 10 - 20 mg/kg/day (max 375 mg/day)
- May be given once daily or in two divided doses
- In infants < 6 months of age, doses up to 30 mg/kg/day in two divided doses may be required
- May take without regard to food
Hypertension and diuresis (2 - 12 years)
- Dosing: 10 - 20 mg/kg/day (max 1000 mg/day)
- May be given once daily or in two divided doses
- May take without regard to food
Edema (adults)
- 500 - 1000 mg given 1 - 2 times a day
- Max: 2000 mg/day
- May take without regard to food
Generic / Price
- Tablet - YES/$
- Suspension - NO/$$
Chlorthalidone (Thalitone®)
Dosage forms
Tablet
- 15 mg
- 25 mg
- 50 mg
Dosing
Hypertension (adults)
- Starting: 12.5 - 25 mg once daily
- Maintenance: 12.5 - 100 mg once daily
- Max: 100 mg/day
- In hypertension trials, doses of 12.5 - 25 mg/day were typically used
- In general, a 12.5mg dose of chlorthalidone is equivalent to 25mg of hydrochlorothiazide. See HCTZ vs Chlorthalidone for more.
- Doses above 50 mg/day are rarely used and may lead to significant hypokalemia
- Take with food
Hypertension (pediatric)
- Starting: 0.3 mg/kg once daily
- Max: 2 mg/kg (max 50 mg) once daily
- AAP recommended dosing [2]
- Take with food
Edema (adults)
- Starting: 50 - 100 mg once daily or every other day
- Max: 200 mg/day
- Take with food
Generic / Price
- YES/$Hydrochlorothiazide (HCTZ)
Dosage forms
Tablet
- 12.5 mg
- 25 mg
- 50 mg
Capsule
- 12.5 mg
Dosing
Hypertension (adults)
- Starting: 25 mg/day (monotherapy)
- Maintenance: 25 - 50 mg/day
- Max: 50 mg/day
- May be given in one or two divided doses
- A starting dose of 12.5 mg may be appropriate when adding to other medications (ex. ACE inhibitors, ARBs etc.)
- Doses above 50 mg/day are rarely used
- May take without regard to food
Hypertension and diuresis (< 2 years)
- Dosing: 1 - 2 mg/kg/day (max 37.5 mg/day)
- May be given once daily or in two divided doses
- In infants < 6 months of age, doses up to 3 mg/kg/day in two divided doses may be required
- May take without regard to food
Hypertension and diuresis (2 - 12 years)
- Dosing: 1 - 2 mg/kg/day (max 100 mg/day)
- May be given once daily or in two divided doses
- May take without regard to food
Edema (adults)
- Maintenance: 25 - 100 mg/day
- Max: 100 mg/day
- May be given in one or two divided doses
- May take without regard to food
Generic / Price
- YES/$Indapamide (Lozol®)
Dosage forms
Tablet
- 1.25 mg
- 2.5 mg
Dosing
Hypertension (adults)
- Starting: 1.25 mg once daily
- Maintenance: 1.25 - 5 mg once daily
- Max: 5 mg/day
- May take without regard to food
Edema (adults)
- Starting: 2.5 mg once daily
- Maintenance: 2.5 - 5 mg once daily
- Max: 5 mg/day
- May take without regard to food
Generic / Price
- YES/$Metolazone (Zaroxolyn®)
Dosage forms
Tablet
- 2.5 mg
- 5 mg
- 10 mg
Dosing
Hypertension (adults)
- Typical range: 2.5 - 5 mg once daily
- Max: 20 mg/day
- May take without regard to food
Edema (adults)
- Typical range: 5 - 20 mg once daily
- Max: 20 mg/day
- May take without regard to food
- See combining loop and thiazide diuretics for information on adding to loop diuretics
Generic / Price
- YES/$Accuretic® (quinapril + HCTZ)
Dosage forms
Tablet
- Quinapril - HCTZ
- 10 mg - 12.5 mg
- 20 mg - 12.5 mg
- 20 mg - 25 mg
Dosing
Hypertension
- Dosing: 10/12.5 mg - 40/25 mg once daily
- Max: 40/25 mg once daily
- Increase dose at intervals of 2 - 3 weeks
- May take without regard to food
Generic / Price
- YES/$Capozide® (captopril + HCTZ)
Dosage forms
Tablet
- Captopril - HCTZ
- 25 mg - 15 mg
- 25 mg - 25 mg
- 50 mg - 15 mg
- 50 mg - 25 mg
Dosing
Hypertension
- Dosing: HCTZ 25 - 50 mg/day; Captopril 25 - 150 mg/day
- May be given once daily or in divided doses
- Take one hour before meals
Generic / Price
- YES/$Lotensin HCT® (benazepril + HCTZ)
Dosage forms
Tablet
- Benazepril - HCTZ
- 5 mg - 6.25 mg
- 10 mg - 12.5 mg
- 20 mg - 12.5 mg
- 20 mg - 25 mg
Dosing
Hypertension
- Starting: 10/12.5 mg once daily
- Maintenance: 5/6.25 - 20/25 mg once daily
- Max: 20/25 mg once daily
- Increase dose at intervals of every 2 - 3 weeks
- May take without regard to food
Generic / Price
- YES/$Monopril HCT® (fosinopril + HCTZ)
Dosage forms
Tablet
- Fosinopril - HCTZ
- 10 mg - 12.5 mg
- 20 mg - 12.5 mg
Dosing
Hypertension
- Dosing: HCTZ 12.5 - 50 mg once daily; Fosinopril 10 - 80 mg once daily
- In trials, the maximum dose used was 40/37.5 mg once daily
- May take without regard to food
Generic / Price
- YES/$Other
- On average, the effect of the combination of 10 mg of fosinopril with 12.5 mg of HCTZ was similar to the effect seen with monotherapy using either 40 mg of fosinopril or 37.5 mg of HCTZ
Uniretic® (moexipril + HCTZ)
Dosage forms
Tablet
- Moexipril - HCTZ
- 7.5 mg - 12.5 mg
- 15 mg - 12.5 mg
- 15 mg - 25 mg
Dosing
Hypertension
- Dosing: HCTZ 12.5 - 50 mg/day; Moexipril 7.5 - 30 mg/day
- May be given once daily or in divided doses
- Take one hour before a meal
Generic / Price
- YES/$Vaseretic® (enalapril + HCTZ)
Dosage forms
Tablet
- Enalapril - HCTZ
- 5 mg - 12.5 mg
- 10 mg - 25 mg
Dosing
Hypertension
- Starting: 10/25 mg/day given once daily or in two divided doses
- Max: 20/50 mg/day
- Increase dose at intervals of 2 - 3 weeks
- May take without regard to food
Generic / Price
- YES/$Zestoretic® | Prinzide® (lisinopril + HCTZ)
Dosage forms
Tablet
- Lisinopril - HCTZ
- 10 mg - 12.5 mg
- 20 mg - 12.5 mg
- 20 mg - 25 mg
Dosing
Hypertension
- Dosing: HCTZ 6.25 - 50 mg/day | Lisinopril 10 - 80 mg/day
- Typically dosed once daily
- Increase dose at intervals of 2 - 3 weeks
- May take without regard to food
Generic / Price
- YES/$Atacand HCT® (candesartan + HCTZ)
Dosage forms
Tablet
- Candesartan - HCTZ
- 16 mg - 12.5 mg
- 32 mg - 12.5 mg
- 32 mg - 25 mg
Dosing
Hypertension
- Dosing: HCTZ 12.5 - 50 mg/day | Candesartan 8 - 32 mg/day
- May be given once daily or divided into two doses
- May take without regard to food
Generic / Price
- YES/$-$$Other
- Maximal effect seen within 4 weeks
Avalide® (irbesartan + HCTZ)
Dosage forms
Tablet
- Irbesartan - HCTZ
- 150 mg - 12.5 mg
- 300 mg - 12.5 mg
Dosing
Hypertension
- Starting: 150/12.5 mg once daily
- Max: 300/25 mg once daily
- Titrate dose at intervals of 1 - 2 weeks
- May take without regard to food
Generic / Price
- YES/$Benicar HCT® (olmesartan + HCTZ)
Dosage forms
Tablet
- Olmesartan - HCTZ
- 20 mg - 12.5 mg
- 40 mg - 12.5 mg
- 40 mg - 25 mg
Dosing
Hypertension
- Starting: 20/12.5 - 40/12.5 mg once daily
- Max: 40/25 mg once daily
- May take without regard to food
Generic / Price
- YES/$Diovan HCT® (valsartan + HCTZ)
Dosage forms
Tablet
- Valsartan - HCTZ
- 80 mg - 12.5 mg
- 160 mg - 12.5 mg
- 160 mg - 25 mg
- 320 mg - 12.5 mg
- 320 mg - 25 mg
Dosing
Hypertension
- Starting: 160/12.5 mg once daily
- Max: 320/25 mg once daily
- Titrate dose at intervals of 1 - 2 weeks
- May take without regard to food
Generic / Price
- YES/$Other
- Maximum effect seen within 2 - 4 weeks
Edarbyclor® (azilsartan + chlorthalidone)
Dosage forms
Tablet
- Azilsartan - Chlorthalidone
- 40 mg - 12.5 mg
- 40 mg - 25 mg
Dosing
Hypertension
- Starting: 40/12.5 mg once daily
- Max: 40/25 mg once daily
- Increase dose if needed after 2 - 4 weeks
- May take without regard to food
Generic / Price
- NO/$$$$Other
- Most of the antihypertensive effect is seen within 1 - 2 weeks
Hyzaar® (losartan + HCTZ)
Dosage forms
Tablet
- Losartan - HCTZ
- 50 mg - 12.5 mg
- 100 mg - 12.5 mg
- 100 mg - 25 mg
Dosing
Hypertension
- Starting: 50/12.5 mg once daily
- Max: 100/25 mg once daily
- Increase dose at intervals of 3 weeks
- May take without regard to food
Hypertension with LVH to reduce the risk of stroke
- Starting: 50/12.5 mg once daily
- Max: 100/25 mg once daily
- May take without regard to food
Generic / Price
- YES/$Micardis HCT® (telmisartan + HCTZ)
Dosage forms
Tablet
- Telmisartan - HCTZ
- 40 mg - 12.5 mg
- 80 mg - 12.5 mg
- 80 mg - 25 mg
- Comes in sealed blister pack of 30 tablets
Dosing
Hypertension
- Starting: 80/12.5 mg once daily
- Max: 160/25 mg once daily
- Titrate dose at intervals of 2 - 4 weeks
- May take without regard to food
Generic / Price
- YES/$Other
- Do not remove tablet from blister pack until ready to take
Corzide® (nadolol + Bendroflumethiazide)
Dosage forms
Tablet
- Nadolol - Bendroflumethiazide
- 40 mg - 5 mg
- 80 mg - 5 mg
Dosing
Hypertension
- Starting: 40/5 mg once daily
- Maintenance: 40/5 - 80/5 mg once daily
- May take without regard to food
Generic / Price
- YES/$$Dutoprol® (metoprolol succinate ER + HCTZ)
Dosage forms
Tablet
- Metoprolol - HCTZ
- 25 mg - 12.5 mg
- 50 mg - 12.5 mg
- 100 mg - 12.5 mg
Dosing
Hypertension
- Starting: 25 mg/12.5 mg once daily
- Maintenance: 25 mg/12.5 mg - 200 mg/25 mg once daily
- Max: 200 mg/25 mg once daily
- Increase dose at intervals of 2 weeks
- May take without regard to food
Generic / Price
- NO/$$$$Inderide® (propranolol IR + HCTZ)
Dosage forms
Tablet
- Propranolol - HCTZ
- 40 mg - 25 mg
- 80 mg - 25 mg
Dosing
Hypertension
- Starting: 40 mg/25 mg twice a day
- Maintenance: 40 mg/25 mg - 80 mg/25 mg twice a day
- Max: 80 mg/25 mg twice a day
- May take without regard to food
Generic / Price
- YES/$Lopressor HCT® (metoprolol tartrate IR + HCTZ)
Dosage forms
Tablet
- Metoprolol - HCTZ
- 50 mg - 25 mg
- 100 mg - 25 mg
- 100 mg - 50 mg
Dosing
Hypertension
- Dosing: Metoprolol may be dosed up to 200 mg/day. HCTZ may be dosed up to 50 mg/day. Daily dose may be given once daily or divided and given twice a day.
- Metoprolol doses of ≤ 100 mg/day may be more effective if given in divided doses
- Take with or immediately following a meal
Generic / Price
- YES/$Tenoretic® (atenolol + chlorthalidone)
Dosage forms
Tablet
- Atenolol - Chlorthalidone
- 50 mg - 25 mg
- 100 mg - 25 mg
Dosing
Hypertension
- Starting: 50 mg/25 mg once daily
- Maintenance: 50 mg/25 mg - 100 mg/25 mg once daily
- May take without regard to food
Generic / Price
- YES/$Ziac® (bisoprolol + HCTZ)
Dosage forms
Tablet
- Bisoprolol - HCTZ
- 2.5 mg - 6.25 mg
- 5 mg - 6.25 mg
- 10 mg - 6.25 mg
Dosing
Hypertension
- Starting: 2.5 mg/6.25 mg once daily
- Maintenance: 2.5 mg/6.25 mg - 20 mg/12.5 mg once daily
- Max: 20 mg/12.5 mg once daily
- Titrate dose at intervals of 14 days
- May take without regard to food
Generic / Price
- YES/$Dyazide® (HCTZ + triamterene)
Dosage forms
Capsule
- HCTZ - Triamterene
- 25 mg - 37.5 mg
Dosing
Hypertension or Edema
- Dosing: 25/37.5 - 50/75 mg once daily
- Max: 50/75 mg once daily
- May take without regard to food
Generic / Price
- YES/$Other
- Triamterene helps prevent potassium loss from HCTZ but has no significant effect on blood pressure
- See ENaC inhibitors for more
Maxzide® (HCTZ + triamterene)
Dosage forms
Tablet
- HCTZ - Triamterene
- 25 mg - 37.5 mg
- 50 mg - 75 mg
Dosing
Hypertension or Edema
- Dosing: 25/37.5 - 50/75 mg once daily
- Max: 50/75 mg once daily
- May take without regard to food
Generic / Price
- YES/$Other
- Triamterene helps prevent potassium loss from HCTZ but has no significant effect on blood pressure
- See ENaC inhibitors for more
Moduretic® (HCTZ + amiloride)
Dosage forms
Tablet
- Amiloride - HCTZ
- 5 mg - 50 mg
Dosing
Hypertension or Edema
- Dosing: 5/50 mg - 10/100 mg/day
- May be given once daily or in divided doses
- Take with food
Generic / Price
- YES/$Other
- Amiloride helps prevent potassium loss from HCTZ but has no significant effect on blood pressure
- See ENaC inhibitors for more
Aldactazide® (HCTZ + spironolactone)
Dosage forms
Tablet
- HCTZ - Spironolactone
- 25 mg - 25 mg
- 50 mg - 50 mg
Dosing
Hypertension
- Dosing: 25/25 mg - 100/100 mg/day
- May be given once daily or in divided doses
- Food may increase the absorption of spironolactone. Manufacturer makes no specific recommendation.
Edema
- Dosing: 25/25 mg - 200/200 mg/day
- May be given once daily or in divided doses
- Food may increase the absorption of spironolactone. Manufacturer makes no specific recommendation.
Generic / Price
- 25/25 mg dose - YES/$
- 50/50 mg dose - NO/$$$$
Aldoril® (methyldopa + HCTZ)
Dosage forms
Tablet
- Methyldopa - HCTZ
- 250 mg - 15 mg
- 250 mg - 25 mg
Dosing
Hypertension
- Starting: 250/15 mg two to three times a day OR 250/25 mg twice a day
- Max: Methyldopa - 3000 mg/day; HCTZ 50 mg/day
- May take without regard to food
Generic / Price
- YES/$$Tekturna HCT® (aliskiren + HCTZ)
Dosage forms
Tablet
- Aliskiren - HCTZ
- 150 mg - 12.5 mg
- 150 mg - 25 mg
- 300 mg - 12.5 mg
- 300 mg - 25 mg
Dosing
Hypertension
- Starting: 150/12.5 mg once daily
- Maintenance: 150/12.5 - 300/25 mg once daily
- Max: 300/25 mg once daily
- The antihypertensive effect is largely manifested within 1 week with maximal effect seen within 4 weeks
- Patients should establish a routine pattern for taking Tekturna HCT with regard to meals. High-fat meals decrease absorption substantially.
Generic / Price
- NO/$$$$Exforge HCT® (amlodipine + valsartan + HCTZ)
Dosage forms
Tablet
- Amlodipine - Valsartan - HCTZ
- 5 mg - 160 mg - 12.5 mg
- 5 mg - 160 mg - 25 mg
- 10 mg - 160 mg - 12.5 mg
- 10 mg - 160 mg - 25 mg
- 10 mg - 320 mg - 25 mg
Dosing
Hypertension
- Starting: 5/160/12.5 once daily
- Maintenance: 5/160/12.5 mg - 10/320/25 mg once daily
- Max: 10/320/25 mg once daily
- Titrate dose at intervals of 2 weeks
- Full antihypertensive effect is seen after 2 weeks
- May take without regard to food
Generic / Price
- YES/$-$$Tribenzor® (amlodipine + olmesartan + HCTZ)
Dosage forms
Tablet
- Amlodipine - Olmesartan - HCTZ
- 5 mg - 20 mg - 12.5 mg
- 5 mg - 40 mg - 12.5 mg
- 5 mg - 40 mg - 25 mg
- 10 mg - 40 mg - 12.5 mg
- 10 mg - 40 mg - 25 mg
Dosing
Hypertension
- Starting: 5/20/12.5 mg once daily
- Maintenance: 5/20/12.5 mg - 10/40/25 mg once daily
- Max: 10/40/25 mg once daily
- Titrate dose at intervals of 2 weeks
- May take without regard to food
Generic / Price
- YES/$$- Kidney disease dosing
- Diuretics are often necessary to maintain urine output in patients with significant kidney disease. Professional guidelines state that thiazide diuretics may be adequate in patients with a CrCl > 30 ml/min. When CrCl falls below 30 ml/min, loop diuretics, which promote more sodium and fluid loss than thiazides, are preferred. Patients with severe kidney disease may still benefit from thiazides, as a small study (N=160) found that chlorthalidone significantly reduced blood pressure, natriuretic peptide, and proteinuria in patients with CrCl < 30 ml/min (see chlorthalidone in CKD).
- Thiazides may also be added to loop diuretics to overcome tolerance that can develop with loop diuretics (see combining thiazide and loop diuretics for more)
- Liver disease dosing
- Cirrhosis
- Patients with cirrhosis often need diuretics to alleviate and prevent fluid retention. Loop diuretics combined with spironolactone are preferred in these patients (see diuretic therapy in cirrhosis)
- Mild to moderate liver disease
- Dosage adjustments are not typically needed
- DRUG INTERACTIONS
- NOTE: The drug interactions presented here are NOT all-inclusive. Other interactions may exist. Drug interaction checkers provide the most efficient and practical way to check for interactions among multiple medications. A free interaction checker is available from Drugs.com (see Drugs.com interactions checker).
- All thiazide diuretics
- Bile acid sequestrants (Questran®, Welchol®, Colestid®) - Bile Acid Sequestrants can interfere with the absorption of thiazide and loop diuretics. Diuretics should be taken 1 hour before or 4 hours after bile acid sequestrants.
- Lithium - Thiazides may reduce the clearance of lithium. Thiazides should be avoided with lithium if possible. Lithium levels should be monitored closely in patients taking thiazides.
- NSAIDS (Advil®, ibuprofen, naprosyn, etc.) - NSAIDS can block the therapeutic effect of all diuretics. Patients should monitor for decreased effectiveness of diuretics when taking NSAIDS for extended periods.
- HCTZ
- Topiramate (Topamax®) - HCTZ may increase topiramate levels
- Metabolism and clearance
- Only indapamide undergoes significant liver metabolism
- Indapamide is a CYP3A4 substrate
- PRICE ($) INFO
Pricing legend
- $ = 0 - $50
- $$ = $51 - $100
- $$$ = $101 - $150
- $$$$ = > $151
- Pricing based on one month of therapy at standard dosing in an adult
- Pricing based on information from GoodRX.com®
- Pricing may vary by region and availability
- BIBLIOGRAPHY
- 1 - Manufacturer's Package Insert for each drug listed
- 2 - PMID 28827377 - Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents, Pediatrics (2017)