Hydrochlorothiazide Toxicity: A Broadview

What Is Hydrochlorothiazide?

Hydrochlorothiazide is the second most often prescribed anti-hypertensive drug in the United States. The Food and Drug Administration (FDA) authorized this medicine in 1959. Hydrochlorothiazide (HCTZ or HCT), is a prescription drug most frequently used to treat swelling brought on by edema or water retention, which is frequently linked to:

• Elevated blood pressure.

• Enlarged heart disease.

• Liver cirrhosis.

• Renal failure.

• Nephrotic syndrome.

• Prescriptions for corticosteroids.

This prescription is typically used with other medications that control blood pressure, cholesterol, arrhythmias, and other disorders to treat cardiac issues.

What Are the Side Effects of Hydrochlorothiazide?

Usually, a doctor can help manage the bothersome side effects of hydrochlorothiazide usage by changing the dose. Typical negative consequences include:

• Muscle sluggishness

• Thirst.

• Blurred vision.

• Lightheadedness.

• Constipation.

• Photosensitivity.

There are potentially severe adverse effects of HCTZ, including allergic reactions, that may call for immediate medical attention. Among the very dangerous adverse effects are the following:

• Severe abdominal discomfort.

• Persistent appetite loss.

• Stools or urine with a clay-like hue.

• Uncommon bleeding or bruising.

• A cutaneous rash that causes the skin to peel.

• A rapid or erratic pulse.

• Feeling tingly or numb.

• Eyes or skin that has become yellow (jaundice).

Can a Person Get High Using Hydrochlorothiazide?

To lessen swelling or edema, diuretic medications like Hydrochlorothiazide particularly increase the amount of urine the body generates. Unfortunately, even though few people intentionally seek this sensation as a high, there has been occasional drug abuse with this chemical. Of the 92,557 persons who reported negative side effects from using Hydrochlorothiazide, 112 said that abusing or becoming addicted to the drug was one of those unwanted effects. This happens most frequently in those taking the medication for more than ten years. It may be a sign of drug abuse in addition to taking Hydrochlorothiazide as directed or relapse behaviors from prior addictions.

Contrary to many prescription medicines, this drug was overused by more women than men; nevertheless, this could be because women are physiologically more susceptible to water retention than males. Various reports state:

• Women made up 57.8 percent of those who abused the substance, while males up to 42.2 percent.

• At least 29 percent of the population was over 60 years.

• Ages 40 to 49 made up about 28 percent.

Why Is the Drug Misused?

Athletes may abuse diuretics to lose weight within a short duration through dehydration to compete in a weight division or achieve certain weight standards. Diuretics can also remove residues of performance-enhancing substances from urine tests, such as stimulants or steroids. However, the World Anti-Doping Agency (WADA) lists several diuretics as prohibited during the competition. Diuretics were among the 7.9 percent of prohibited drugs discovered on testing in 2008. According to WADA laboratories, Hydrochlorothiazide, the most often discovered drug, was found in 137 instances (31.4 percent of positive cases). That year, Furosemide was surpassed by Hydrochlorothiazide as the most often abused diuretic medicine.

Although Hydrochlorothiazide has a relatively short half-life and is normally removed from the body within 24 to 48 hours after consumption, WADA routinely tests athletes during and between events. In rare cases, persistent activity for an hour or more might reduce its half-life. To detect cases of usage, regular drug testing is crucial.

What Are the Different Drug Interactions with Hydrochlorothiazide?

• As Hydrochlorothiazide affects blood pressure and edema linked to long-term health issues, it may interact with several other prescription treatments, and illegal substances may render Hydrochlorothiazide ineffective or create dangerous side effects.

• Drugs that dangerously increase heart rate, blood pressure, and breathing rate include Adderall, Ritalin, Cocaine, MDMA, and bath salts. They may also increase body temperature, which might harm the kidneys.

• Hydrochlorothiazide can worsen heart and renal damage, any present or previous abuse of these stimulant medicines has to be disclosed to a doctor if this prescription is recommended.

• Alcohol is one of the most harmful substances that affect Hydrochlorothiazide. In addition, despite being a legal intoxicant, alcohol is a sedative and negatively interacts with many prescription drugs. When alcohol and Hydrochlorothiazide are used together, blood pressure might drop quickly, which can cause fainting or very bad dizziness. Additionally, it may exacerbate other adverse consequences, such as impaired cognition or eyesight.

What Happens During Overdose of the Drug?

Hydrochlorothiazide overdose is uncommon, but it can happen when a person consumes too much of this medicine, whether intentionally, unintentionally, or by mixing it with another prescription that intensifies the effects of the first poisoning. Hydrochlorothiazide overdose symptoms include:

• Nausea.

• Weakened muscles.

• Thirst and very dry mouth

• Dizziness.

How to Manage the Overdose?

• Putting an end to drug usage.

• Maintaining an appropriate airway involves, if required, removing mucus secretions from the respiratory system and intubating an unconscious patient.

• Maintaining appropriate CO2 (carbon dioxide) elimination and oxygen consumption. Giving oxygen as needed to maintain sufficient arterial oxygenation if respiration is low, and ventilate the patient if cyanosis or CO2 retention is evident.

• Keeping blood pressure constant. Establishing an intravenous line, starting fluids (saline or Ringer's lactate), and putting the patient in the Trendelenburg position for hypovolemic shock.

• Dopamine or Norepinephrine should be administered if these precautions are insufficient.

• Keeping an eye on the hematocrit and whole blood count.

• Fluids must be cautiously administered to treat hemoconcentration (three liters intravenously or four liters orally in 24 hours).

• Hyponatraemia (low sodium concentration in the serum) and hypokalaemia (low potassium concentration in the serum) are urgent risks, and ECG (electrocardiogram) monitoring is necessary. In addition, electrolyte abnormalities should be assessed and addressed.

• ECG, pulse, and blood pressure should be monitored to determine how the heart functions.

• Observe renal function by measuring serum creatinine and urine output.

• The effects on the digestive system are often transient but may need symptomatic care.

Conclusion

Hydrochlorothiazide is the drug most frequently used to treat swelling due to water retention and hypertension. Clinicians should be informed of the negative effects of HCTZ before prescribing it. Although the medication is generally safe, the patient's electrolyte balance has to be checked often. According to more recent research Hydrochlorothiazide may not be as effective as some of the other thiazide diuretics.