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Polythiazide Side Effects

Applies to polythiazide: oral tablet.

Serious side effects of polythiazide

Along with its needed effects, polythiazide may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking polythiazide:

Incidence not known

  • abdominal or stomach pain
  • black, tarry stools
  • bleeding gums
  • bloating
  • blood in urine or stools
  • blurred vision
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • chest pain
  • chills
  • clay-colored stools
  • cold sweats
  • confusion
  • constipation
  • cough or hoarseness
  • coughing up blood
  • darkened urine
  • diarrhea
  • difficulty breathing
  • dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
  • dry mouth
  • fever
  • flushed, dry skin
  • fruit-like breath odor
  • general feeling of discomfort or illness
  • general feeling of tiredness or weakness
  • headache
  • increased hunger
  • increased thirst
  • increased urination
  • indigestion
  • irregular heartbeat
  • itching
  • joint pain, stiffness, or swelling
  • loss of appetite
  • lower back or side pain
  • muscle cramps or pain
  • nausea or vomiting
  • nosebleeds
  • numbness, tingling, pain, or weakness in hands or feet
  • painful or difficult urination
  • pains in stomach, side, or abdomen, possibly radiating to the back
  • pale skin
  • pinpoint red spots on skin
  • rash
  • redness, soreness, or itching skin
  • seizures
  • shortness of breath
  • sores, welting, or blisters
  • sugar in the urine
  • swelling of feet or lower legs
  • swollen or painful glands
  • tenderness of salivary glands
  • tightness in chest
  • trembling
  • troubled breathing
  • unpleasant breath odor
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • unusual weight loss
  • vomiting of blood
  • weakness and heaviness of legs
  • wheezing
  • yellow eyes or skin

Other side effects of polythiazide

Some side effects of polythiazide may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Incidence not known

  • cramping
  • difficulty having a bowel movement (stool)
  • feeling of constant movement of self or surroundings
  • hair loss, thinning of hair
  • increased sensitivity of skin to sunlight
  • muscle spasm
  • pinpoint red or purple spots on skin
  • redness or other discoloration of skin
  • restlessness
  • sensation of spinning
  • severe sunburn
  • weakness

For healthcare professionals

Applies to polythiazide: oral tablet.

Metabolic adverse events

The metabolic side effects of polythiazide, as with other thiazide diuretics, include hypokalemia, hyponatremia, hypochloremia, hypercalcemia, hypercholesterolemia, and hyperuricemia. Significant reductions in the serum potassium (decreases of 0.5 mEq/L or more) have been observed in up to 50% of patients who are taking moderate doses of thiazide diuretics. This can predispose some patients to develop cardiac arrhythmias.[Ref]

Some of the metabolic changes associated with thiazide diuretics may be significant in patients with underlying cardiac arrhythmias (hypokalemia), coronary artery disease (hypercholesterolemia), gout (hyperuricemia), or liver disease (hyponatremia and hypokalemia).[Ref]

Hypersensitivity

Hypersensitivity reactions to thiazide diuretics have been reported in less than 1% of patients. While most allergic reactions present as rash with nausea and vomiting, rare cases of acute pulmonary edema, interstitial cystitis, interstitial nephritis, and anaphylaxis have been associated with some thiazide diuretics.[Ref]

Dermatologic

Dermatologic reactions to thiazides include erythema annular centrifugum, acute eczematous dermatitis, morbilliform and leukocytoclastic vasculitis. Thiazides may induce phototoxic dermatitis. In addition, a rare, distinct entity with clinical and laboratory features indistinguishable from those of subacute cutaneous lupus erythematosus has been associated with a related drug, hydrochlorothiazide.[Ref]

Renal

Renal side effects including new or worsened renal insufficiency may occur due to polythiazide-induced intravascular volume depletion. Rare cases of interstitial nephritis have been associated with some thiazide diuretics.[Ref]

Cardiovascular

Cardiovascular side effects are generally limited to palpitations. Orthostatic hypotension may occur and may rarely be associated with syncope, particularly in the elderly.[Ref]

Cardiac arrhythmias, including ventricular ectopy and complete AV heart block, have been associated with thiazide-induced hypokalemia. (Potassium supplementation is not an uncommon requirement.)[Ref]

Endocrine

Endocrinologic problems associated with thiazide diuretics include glucose intolerance and a potentially deleterious effect on the lipid profile. This may be important in some patients with or who are at risk for diabetes or coronary artery disease.[Ref]

A prospective study of 34 patients who received oral thiazide diuretics for 14 years without interruption revealed an increased mean fasting blood glucose level after treatment. Withdrawal of thiazide therapy for 7 months in 10 of the patients resulted in mean reductions of 10% in fasting blood glucose and 25% in the 2-hour glucose tolerance test value. A control group was not reported.[Ref]

Hematologic

Hematologic side effects are rare. Cases of immune-complex hemolytic anemia, aplastic anemia, and thrombocytopenia have been associated with polythiazide or related thiazide agents.[Ref]

A 2.5-year-old male with anasarca developed cyanosis and oral ulcerations associated with laboratory evidence of pancytopenia 15 days after beginning polythiazide (dose not available). A bone marrow aspiration revealed general hypoplasia with absence of megakaryocytes and blast cells. The child died from persistent hemorrhaging and infections despite prednisolone and antimicrobial therapy.[Ref]

Gastrointestinal

Gastrointestinal side effects are unusual. The most common complaint is "dry mouth". There have been rare cases of pancreatitis and acute cholecystitis associated with thiazide diuretics.[Ref]

Thiazide diuretics may increase serum cholesterol and triglycerides, resulting in increased risk of cholesterol gallstone formation. Reports of bowel strictures associated with thiazide ingestion have been reported in the 1960's, although these patients were on a combination hydrochlorothiazide-potassium product.[Ref]

Psychiatric

Limited data suggest an association between psychiatric depression and thiazide diuretics. These data are uncontrolled observations and have not been substantiated.[Ref]

References

1. Rosenberg L, Shapiro S, Slone D, Kaufman DW, Miettinen OS, Stolley PD (1980) "Thiazides and acute cholecystitis." N Engl J Med, 303, p. 546-8

2. Papademetriou V, Fletcher R, Khatri IM, Freis ED (1983) "Diuretic-induced hypokalemia in uncomplicated systemic hypertension: effect of plasma potassium correction on cardiac arrhythmias." Am J Cardiol, 52, p. 1017-22

3. Kuller L, Farrier N, Caggiula A, Borhani N, Dunkle S (1985) "Relationship of diuretic therapy and serum magnesium levels among participants in the Multiple Risk Factor Intervention Trial." Am J Epidemiol, 122, p. 1045-59

4. Fichman MP, Vorherr H, Kleeman CR, Telfer N (1971) "Diuretic-induced hyponatremia." Ann Intern Med, 75, p. 853-63

5. Ragnarsson J, Hardarson T, Snorrason SP (1987) "Ventricular dysrhythmias in middle-aged hypertensive men treated either with a diuretic agent or a beta-blocker." Acta Med Scand, 221, p. 143-8

6. Hollifield JW, Slaton PE (1981) "Thiazide diuretics, hypokalemia and cardiac arrhythmias." Acta Med Scand Suppl, 647, p. 67-73

7. Papademetriou V, Price M, Notargiacomo A, Gottdiener J, Fletcher RD, Freis ED (1985) "Effect of diuretic therapy on ventricular arrhythmias in hypertensive patients with or without left ventricular hypertrophy." Am Heart J, 110, p. 595-9

8. Krishna GG, Narins RG (1988) "Hemodynamic consequences of diuretic-induced hypokalemia." Am J Kidney Dis, 12, p. 329-31

9. Mahabir RN, Laufer ST (1969) "Clinical evaluation of diuretics in congestive heart failure. A detailed study in four patients." Arch Intern Med, 124, p. 1-7

10. Polanska AI, Baron DN (1978) "Hyponatraemia associated with hydrochlorothiazide treatment ." Br Med J, 1, p. 175-6

11. Pinnock CA (1978) "Hyponatraemia associated with hydrochlorothiazide treatment ." Br Med J, 1, p. 48

12. Hakim R, Tolis G, Goltzman D, Meltzer S, Friedman R (1979) "Severe hypercalcemia associated with hydrochlorothiazide and calcium carbonate therapy." Can Med Assoc J, 121, p. 591-4

13. Byatt CM, Millard PH, Levin GE (1990) "Diuretics and electrolyte disturbances in 1000 consecutive geriatric admissions." J R Soc Med, 83, p. 704-8

14. Bain PG, Egner W, Walker PR (1986) "Thiazide-induced dilutional hyponatraemia masquerading as subarachnoid haemorrhage ." Lancet, 2, p. 634

15. Benfield GF, Haffner C, Harris P, Stableforth DE (1986) "Dilutional hyponatraemia masquerading as subarachnoid haemorrhage in patient on hydrochlorothiazide/amiloride/timolol combined drug ." Lancet, 2, p. 341

16. Duarte CG, Winnacker JL, Becker KL, Pace A (1971) "Thiazide-induced hypercalcemia." N Engl J Med, 284, p. 828-30

17. Gould L, Reddy CV, Zen B, Singh BK (1980) "Life-threatening reaction to thiazides." N Y State J Med, 80, p. 1975-6

18. Diamond MT (1972) "Hyperglycemic hyperosmolar coma associated with hydrochlorothiazide and pancreatitis." N Y State J Med, 72, p. 1741-2

19. Klimiuk PS, Davies M, Adams PH (1981) "Primary hyperparathyroidism and thiazide diuretics." Postgrad Med J, 57, p. 80-3

20. Seelig CB (1990) "Magnesium deficiency in two hypertensive patient groups." South Med J, 83, p. 739-42

21. Peters RW, Hamilton J, Hamilton BP (1989) "Incidence of cardiac arrhythmias associated with mild hypokalemia induced by low-dose diuretic therapy for hypertension." South Med J, 82, 966-9,

22. Kone B, Gimenez L, Watson AJ (1986) "Thiazide-induced hyponatremia." South Med J, 79, p. 1456-7

23. Holland OB, Kuhnert L, Pollard J, Padia M, Anderson RJ, Blomqvist G (1988) "Ventricular ectopic activity with diuretic therapy." Am J Hypertens, 1, p. 380-5

24. Fager G, Berglund G, Bondjers G, Elmfeldt D, Lager I, Olofsson SO, Smith U, Wiklund O (1983) "Effects of anti-hypertensive therapy on serum lipoproteins. Treatment with metoprolol, propranolol and hydrochlorothiazide." Artery, 11, p. 283-96

25. Mouallem M, Friedman E, Shemesh Y, Mayan H, Pauzner R, Farfel Z (1991) "Cardiac conduction defects associated with hyponatremia." Clin Cardiol, 14, p. 165-8

26. Jones IG, Pickens PT (1967) "Diabetes mellitus following oral diuretics." Practitioner, 199, p. 209-10

27. Kaur J, Wahi PL (1967) "Polythiazide as a diuretic. A clinical trial." J Indian Med Assoc, 48, p. 13-7

28. Murphy MB, Kohner E, Lewis PJ, Schumer B, Dollery CT (1982) "Glucose intolerance in hypertensive patients treated with diuretics: a fourteen-year follow-up." Lancet, 2, p. 1293-5

29. Bell DS (1993) "Insulin resistance. An often unrecognized problem accompanying chronic medical disorders." Postgrad Med, 93, 99-103,

30. Berlin I (1993) "Prazosin, diuretics, and glucose intolerance." Ann Intern Med, 119, p. 860

31. O'Brien ET, MacKinnon J (1972) "Propranolol and polythiazide in treatment of hypertension." Br Heart J, 34, p. 1042-4

32. Ghose RR (1977) "Reset osmostat after diuretic treatment." Br Med J, 2, p. 1063

33. Smith WM (1979) "Diuretics and cholesterol elevation." JAMA, 242, p. 1612

34. Ghose RR (1975) "Letter: Hyponatraemia and diuretics." Lancet, 1, p. 578-9

35. Larson E, Dominguez CJ, Scheib R (1965) "Thiazide therapy: experience with parenteral administration." Curr Ther Res Clin Exp, 7, p. 617-24

36. Ramirez EA, Tristani FE (1965) "Clinical evaluation of parenteral polythiazide (P-2525) administration." Curr Ther Res Clin Exp, 7, p. 528-35

37. Pickkers P, Schachter M, Hughes AD, Feher MD, Sever PS (1996) "Thiazide-induced hyperglycaemia: a role for calcium-activated potassium channels?" Diabetologia, 39, p. 861-4

38. Magil AB, Ballon HS, Cameron EC, Rae A (1980) "Acute interstitial nephritis associated with thiazide diuretics. Clinical and pathologic observations in three cases." Am J Med, 69, p. 939-43

39. Hoss DM, Nierenberg DW (1988) "Severe shaking chills and fever following hydrochlorothiazide administration." Am J Med, 85, p. 747

40. Klein MD (1987) "Noncardiogenic pulmonary edema following hydrochlorothiazide ingestion." Ann Emerg Med, 16, p. 901-3

41. Beaudry C, Laplante L (1973) "Severe allergic pneumonitis from hydrochlorothiazide." Ann Intern Med, 78, p. 251-3

42. Hoegholm A, Rasmussen SW, Kristensen KS (1990) "Pulmonary oedema with shock induced by hydrochlorothiazide: a rare side effect mimicking myocardial infarction." Br Heart J, 63, p. 186

43. Biron P, Dessureault J, Napke E (1991) "Acute allergic interstitial pneumonitis induced by hydrochlorothiazide [published erratum appears in Can Med Assoc J 1991 Sep 1;145(5):391]." Can Med Assoc J, 145, p. 28-34

44. Dorn MR, Walker BK (1981) "Noncardiogenic pulmonary edema associated with hydrochlorothiazide therapy." Chest, 79, p. 482-3

45. Magil AB (1983) "Drug-induced acute interstitial nephritis with granulomas." Hum Pathol, 14, p. 36-41

46. Prupas HM, Brown D (1983) "Acute idiosyncratic reaction to hydrochlorothiazide ingestion." West J Med, 138, p. 101-2

47. Grace AA, Morgan AD, Strickland NH (1989) "Hydrochlorothiazide causing unexplained pulmonary oedema." Br J Clin Pract, 43, p. 79-81

48. Levay ID (1984) "Hydrochlorothiazide-induced pulmonary edema." Drug Intell Clin Pharm, 18, p. 238-9

49. Goette DK, Beatrice E (1988) "Erythema annulare centrifugum caused by hydrochlorothiazide-induced interstitial nephritis." Int J Dermatol, 27, p. 129-30

50. Alted E, Navarro M, Cantalapiedra JA, Alvarez JA, Blasco MA, Nunez A (1987) "Non-cardiogenic pulmonary edema after oral ingestion of hydrochlorothiazide ." Intensive Care Med, 13, p. 364-5

51. Grunwald MH, Halevy S, Livni E (1989) "Allergic vasculitis induced by hydrochlorothiazide: confirmation by mast cell degranulation test." Isr J Med Sci, 25, p. 572-4

52. Bjornberg A, Gisslen H (1965) "Thiazides: A cause of necrotising vasculitis?" Lancet, 2, p. 982-3

53. Reed BR, Huff JC, Jones SK, Orton PW, Lee LA, Norris DA (1985) "Subacute cutaneous lupus erythematosus associated with hydrochlorothiazide therapy." Ann Intern Med, 103, p. 49-51

54. Diffey BL, Langtry J (1989) "Phototoxic potential of thiazide diuretics in normal subjects." Arch Dermatol, 125, p. 1355-8

55. Robinson HN, Morison WL, Hood AF (1985) "Thiazide diuretic therapy and chronic photosensitivity." Arch Dermatol, 121, p. 522-4

56. Parodi A, Romagnoli M, Rebora A (1989) "Subacute cutaneous lupus erythematosus-like eruption caused by hydrochlorothiazide." Photodermatol, 6, p. 100-2

57. Goodrich AL, Kohn SR (1993) "Hydrochlorothiazide-induced lupus erythematosus: a new variant?" J Am Acad Dermatol, 28, p. 1001-2

58. Delevett AF, Recalde M (1973) "Diuretic-induced renal colic." JAMA, 225, p. 992

59. Pitkajarvi T, Kyostila S, Kontro J (1977) "Antihypertensive action of drug combination: polythiazide, prazosin and tolamolol." Curr Ther Res Clin Exp, 21, p. 169-76

60. Marinkovic M, Vrhovac B, Kuzmanic D, Radonic M (1979) "Comparative study with prazosin, methyldopa and polythiazide in arterial hypertension." Int J Clin Pharmacol Biopharm, 17, p. 38-47

61. Paloyan E, Farland M, Pickleman JR (1969) "Hyperparathyroidism coexisting with hypertension and prolonged thiazide administration." JAMA, 210, p. 1243-5

62. Balizet L (1973) "Recurrent parathyroid adenoma. Association with prolonged thiazide administration." JAMA, 225, p. 1238-9

63. Garratty G, Houston M, Petz LD, Webb M (1981) "Acute immune intravascular hemolysis due to hydrochlorothiazide." Am J Clin Pathol, 76, p. 73-8

64. Eisner EV, Crowell EB (1971) "Hydrochlorothiazide-dependent thrombocytopenia due to IgM antibody." JAMA, 215, p. 480-2

65. Srivastava G, Agarwal KN (1967) "Thiazide-induced bone-marrow aplasia. Report of a case." Indian J Pediatr, 34, p. 407-9

66. Dietz MW (1967) "Iatrogenic jejunal ulcer." Am J Roentgenol Radium Ther Nucl Med, 99, p. 136-8

67. Reinus FZ, Weinberger HA, Fischer WW (1966) "Medication-induced ulceration of the small bowel." Am J Surg, 112, p. 97-101

68. Wagner W, Longerbeam JK, Smith LL, Feikes HL (1967) "Drug-induced ulcers of the small bowel causing intestinal obstruction or perforation." Am Surg, 33, p. 7-11

69. Campbell JR, Knapp RW (1966) "Small bowel ulceration associated with thiazide and potassium therapy: review of 13 cases." Ann Surg, 163, p. 291-6

70. Smith BL, Tedeschi A, Lane CD (1988) "Pancreatitis with a twist." Hosp Pract (Off Ed), 23, 150,

71. Holland GW (1965) "Stenosing ulcers of the small bowel associated with thiazide and potassium therapy." N Z Med J, 64, p. 383-5

72. Okada F (1985) "Depression after treatment with thiazide diuretics for hypertension." Am J Psychiatry, 142, p. 1101-2

Further information

Polythiazide side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.