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Thiazide (/ ˈ θ aɪ ə z aɪ d /) refers to both a class of sulfur-containing organic molecules [1] and a class of diuretics based on the chemical structure of benzothiadiazine. [2] The thiazide drug class was discovered and developed at Merck and Co. in the 1950s. [ 3 ]
Hydrochlorothiazide, sold under the brand name Hydrodiuril among others, is a diuretic medication used to treat hypertension and swelling due to fluid build-up. [4] Other uses include treating diabetes insipidus and renal tubular acidosis and to decrease the risk of kidney stones in those with a high calcium level in the urine. [4]
[2] [3] Other serious side effects may include high blood potassium. [2] [3] Use in pregnancy and breastfeeding is not generally recommended. [2] [3] Use in those with significant kidney problems is not recommended. [2] [3] It decreases blood pressure mainly by hydrochlorothiazide while triamterene decreases the amount of potassium lost. [2] [3]
The thiazide diuretics also deplete circulating potassium unless combined with a potassium-sparing diuretic or supplemental potassium. Some authors have challenged thiazides as first line treatment. [55] [56] [57] However, as the Merck Manual of Geriatrics notes, "thiazide-type diuretics are especially safe and effective in the elderly." [58]
The thiazides and potassium-sparing diuretics are considered to be calcium-sparing diuretics. [6] The thiazides cause a net decrease in calcium lost in urine. [7] The potassium-sparing diuretics cause a net increase in calcium lost in urine, but the increase is much smaller than the increase associated with other diuretic classes. [7]
Triamterene directly blocks the epithelial sodium channel [4] (ENaC) on the lumen side of the kidney collecting tubule. [5]: 127 Other diuretics cause a decrease in the sodium concentration of the forming urine due to the entry of sodium into the cell via the ENaC, and the concomitant exit of potassium from the principal cell into the forming urine.
Potassium-sparing diuretics or antikaliuretics [1] refer to drugs that cause diuresis without causing potassium loss in the urine. [2] They are typically used as an adjunct in management of hypertension , cirrhosis , and congestive heart failure . [ 3 ]
For loop diuretics, thiazide diuretics and thiazide-like diuretics, their common side effects include hypokalemia, hyponatremia, metabolic alkalosis and hyperglycaemia. [4] For potassium-sparing diuretics, its common side effects include hyponatremia, hyperkalemia, metabolic acidosis and sexual dysfunction specifically for spironolactone. [4] [5]