Contents

Search

drug adverse effects of thiazide diuretics

Adverse effects: 1) hypercalcemia [5] - hyperparathyroidism present in 34-43% of patients with thiazide-associated hypercalcemia [5] 2) hyperuricemia 3) hyperglycemia* [1] - increased risk of diabetes, relative risk 1.2-1.5 [2] - mean increase in fasting blood glucose = 3.6 mg/dL [6] 4) hypokalemia* 5) hypomagnesemia 6) hyponatremia - incidence may be higher than that indicated on drug labeling - 2 year cumulative risk for serum sodium < 130 meq/L is < 4% [10] 7) glucose intolerance 8) hypochloremic metabolic alkalosis 9) increased low-density lipoprotein (LDL) 10) increased triglycerides 11) 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] 12) pancreatitis 13) hepatitis 14) vasculitis 15) impotence [1] 16) 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]

Properties

DRUGS: thiazide diuretic FORM: drug adverse effects thiazide diuretic

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 16. American College of Physicians, Philadelphia 1998, 2012
  2. Taylor EN et al, Antihypertensive medications and the risk of incident type 2 diabetes. Diabetes Care 2006; 29:1065 PMID: 16644638
  3. Palmer BF, Naderi AS. Metabolic complications associated with use of thiazide diuretics. J Am Soc Hypertens. 2007 Nov-Dec;1(6):381-92 PMID: 20409871
  4. Makam AN et al. Risk of thiazide-induced metabolic adverse events in older adults. J Am Geriatr Soc 2014 Jun; 62:1039 PMID: 24823661 http://onlinelibrary.wiley.com/doi/10.1111/jgs.12839/abstract
  5. Griebeler ML et al. Thiazide-associated hypercalcemia: Incidence and association with primary hyperparathyroidism over two decades. J Clin Endocrinol Metab 2016 Mar; 101:1166. PMID: 26751196 http://press.endocrine.org/doi/10.1210/jc.2015-3964
  6. 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: 32157653 Review. https://link.springer.com/article/10.1007/s11606-020-05731-3
  7. 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: 33609289
  8. 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: 33846199 Free article. https://www.cmaj.ca/content/193/15/E508
  9. 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: 33974908 https://www.amjmed.com/article/S0002-9343(21)00289-8/fulltext
  10. 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: 38109740 https://www.acpjournals.org/doi/full/10.7326/M23-1989
  11. NEJM Knowledge+