Chlorthalidone
Chlorthalidone
Thalitone; mostly prescribed generically
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Summary
Pharmacy
Starting dose
12.5-25 mg PO once daily; titrate to 50 mg
Preparations
15 mg, 25 mg, 50 mg tablets
US FDA Max
100 mg/d (rarely used)
Pharmacology
Routes
Oral
Onset
Diuresis at 2-3 hours; BP effect over weeks
Duration
48-72 hours per dose (much longer than hydrochlorothiazide)
Half-life
40-60 hours (notable for the thiazide class)[1]
Bioavailability
~65% (oral)[1]
Pregnancy
Avoided where possible; same class concerns as HCTZ.[citation needed]
Legal status
Rx-only in US
Purported mechanism
Chlorthalidone inhibits the Na+/Cl- cotransporter (NCC) in the distal convoluted tubule, producing the same natriuretic and vasodilatory effects as hydrochlorothiazide but with a substantially longer half-life that yields more sustained 24-hour BP control and modest evidence of better cardiovascular outcomes (ALLHAT, SHEP).0 Despite the favorable trial data, hydrochlorothiazide remains the dominant US thiazide prescription due to pricing and habit. Hyponatremia, hypokalemia, hypomagnesemia, hyperuricemia, hyperglycemia, and erectile dysfunction are characteristic class effects[1].
References
- ↑ 1.0 1.1 1.2 FDA Prescribing Information, chlorthalidone tablets, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/012109s015lbl.pdf