lRENAL IMPAIRMENTThiazides and related diuretics should
be used with caution because they can further reduce renal
function. They are ineffective if estimated glomerular
filtration rate is less than^30 mL/minute/^1.^73 m
(^2) and
should be avoided. Metolazone remains effective if
estimated glomerularfiltration rate is less than
30 mL/minute/ 1. 73 m^2 but is associated with a risk of
excessive diuresis.
MonitoringElectrolytes should be monitored in renal
impairment.
lMONITORING REQUIREMENTSElectrolytes should be
monitored, particularly with high doses and long-term
use.
eiiiiF 110
Bendroflumethiazide
(Bendrofluazide)
lINDICATIONS AND DOSE
Hypertension
▶BY MOUTH
▶Child 1 month–1 year: 50 – 100 micrograms/kg daily,
adjusted according to response
▶Child 2–11 years:Initially 50 – 400 micrograms/kg daily
(max. per dose 10 mg), then maintenance
50 – 100 micrograms/kg daily, adjusted according to
response; maximum 10 mg per day
▶Child 12–17 years: 2. 5 mg once daily, dose to be taken as
a single dose in the morning, higher doses are rarely
necessary
Oedema in heart failure, renal disease and hepatic
disease|Pulmonary oedema
▶BY MOUTH
▶Child 1 month–1 year: 50 – 100 micrograms/kg daily,
adjusted according to response
▶Child 2–11 years:Initially 50 – 400 micrograms/kg daily
(max. per dose 10 mg), then maintenance
50 – 100 micrograms/kg daily, adjusted according to
response; maximum 10 mg per day
▶Child 12–17 years:Initially 5 – 10 mg once daily or on
alternate days, adjusted according to response, dose to
be taken as a single dose in the morning; maximum
10 mg per day
lINTERACTIONS→Appendix 1 : thiazide diuretics
lSIDE-EFFECTSAgranulocytosis.alkalosis hypochloraemic
.aplastic anaemia.blood disorder.cholestasis.diarrhoea.
electrolyte imbalance.erectile dysfunction.
gastrointestinal disorder.gout.hyperglycaemia.
hyperuricaemia.neutropenia.pancreatitis.
photosensitivity reaction.pneumonitis.pulmonary
oedema
lBREAST FEEDINGThe amount present in milk is too small
to be harmful. Large doses may suppress lactation.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Tablet
▶Bendroflumethiazide (Non-proprietary)
Bendroflumethiazide 2.5 mgBendroflumethiazide 2. 5 mg tablets|
28 tabletP£ 3. 68 DT = £ 0. 28 | 500 tabletP£ 5. 00 – £ 21. 85
Bendroflumethiazide 5 mgBendroflumethiazide 5 mg tablets|
28 tabletP£ 9. 80 DT = £ 0. 34
▶Aprinox(AMCo)
Bendroflumethiazide 2.5 mgAprinox 2. 5 mg tablets|
500 tabletP£ 27. 31
▶Neo-Naclex(AMCo)
Bendroflumethiazide 2.5 mgNeo-Naclex 2. 5 mg tablets|
28 tabletP£ 0. 33 DT = £ 0. 28
eiiiiF 110
Chlorothiazide
lINDICATIONS AND DOSE
Heart failure|Hypertension|Ascites
▶BY MOUTH
▶Neonate: 10 – 20 mg/kg twice daily.
▶Child 1–5 months: 10 – 20 mg/kg twice daily
▶Child 6 months–11 years: 10 mg/kg twice daily; maximum
1 g per day
▶Child 12–17 years: 0. 25 – 1 g once daily, alternatively
125 – 500 mg twice daily
Reduction of diazoxide-induced sodium and water
retention in the management of chronic hypoglycaemia|
Potentiating the glyacaemic effect of diazoxide in the
management of chronic hypoglycaemia
▶BY MOUTH
▶Child: 3 – 5 mg/kg twice daily
Nephrogenic and partial pituitary diabetes insipidus
▶BY MOUTH
▶Child: 10 – 20 mg/kg twice daily (max. per dose 500 mg)
lUNLICENSED USENot licensed.
lCAUTIONSNeonate (theoretical risk of kernicterus if very
jaundiced)
lINTERACTIONS→Appendix 1 : chlorothiazide
lBREAST FEEDINGThe amount present in milk is too small
to be harmful. Large doses may suppress lactation.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: tablet, oral suspension, oral solution
Tablet
▶Diuril (Imported (United States))
Chlorothiazide 250 mgDiuril 250 mg tablets| 100 tabletPs
DRUGS ACTING ON THE RENIN-ANGIOTENSIN
SYSTEM›ACE INHIBITORS
Angiotensin-converting enzyme f
inhibitors
lCONTRA-INDICATIONSBilateral renovascular disease
lCAUTIONSAfro-Caribbean patients (may respond less well
to ACE inhibitors).concomitant diuretics.diabetes (may
lower blood glucose).first dose hypotension (especially in
patients taking high doses of diuretics, on a low-sodium
diet, on dialysis, dehydrated, or with heart failure).
neonates (in neonates).primary aldosteronism (patients
may respond less well to ACE inhibitors).the risk of
agranulocytosis is possibly increased in collagen vascular
disease (blood counts recommended).use with care (or
avoid) in those with a history of idiopathic or hereditary
angioedema.use with care in patients with hypertrophic
cardiomyopathy.use with care in patients with severe or
symptomatic aortic stenosis (risk of hypotension)
CAUTIONS, FURTHER INFORMATION
▶Anaphylactoid reactionsTo prevent anaphylactoid reactions,
ACE inhibitors should be avoided during dialysis with
high-flux polyacrylonitrile membranes and during low-
density lipoprotein apheresis with dextran sulfate; they
should also be withheld before desensitisation with wasp
or bee venom.
lSIDE-EFFECTS
▶Common or very commonAlopecia.angina pectoris.
angioedema (may be delayed; more common in Afro-
Caribbean patients).arrhythmias.asthenia.chest pain.
constipation.cough.diarrhoea.dizziness.drowsiness.
BNFC 2018 – 2019 Hypertension 111
Cardiovascular system
2