Polythiazide

Polythiazide is an antihypertensive agent belonging to Thiazide Diuretics.

Polythiazide is a thiazide diuretic used to treat hypertension and edema in congestive heart failure, hepatic cirrhosis, and corticosteroid and estrogen therapy.

Polythiazide is readily absorbed from the GI tract. Approximately >80% of Plasma protein binding. The plasma half-life of polythiazide is approximately 26 hours. After oral administration, Polythiazide is excreted via urine as an unchanged drug and feces.

Polythiazide shows common side effects like Low blood pressure, Increased blood sugar levels, Nausea and Vomiting, Diarrhoea, Stomach cramps, Dizziness, Fatigue, etc.

Polythiazide is available in the form of Oral Tablets.

Polythiazide is available in India, China, the US, Canada, the UK, and Hong Kong.

Polythiazide belonging to the Thiazide Diuretics, acts as an antihypertensive agent.

As a diuretic, Polythiazide inhibits active chloride reabsorption at the early distal tubule via the thiazide-sensitive Na-Cl cotransporter (TSC), resulting in an increase in the excretion of sodium, chloride, and water. Thiazides like polythiazide also inhibit sodium ion transport across the renal tubular epithelium through binding to the thiazide-sensitive sodium-chloride transporter. This results in an increase in potassium excretion via the sodium-potassium exchange mechanism. The antihypertensive mechanism of polythiazide may be mediated through its action on carbonic anhydrases in the smooth muscle or through its action on the large-conductance calcium-activated potassium (KCa) channel, also found in the smooth muscle.

The onset of action of Polythiazide occurs within 2 hours.

The Duration of Action for Polythiazide in the body is approximately 24-48 hours.

Polythiazide is available in the form of Oral Tablets taken by mouth usually once a day.

Polythiazide is a thiazide diuretic used to treat hypertension and edema in congestive heart failure, hepatic cirrhosis, and corticosteroid and estrogen therapy.

Polythiazide is an antihypertensive agent belonging to Thiazide Diuretics. Polythiazide inhibits active chloride reabsorption at the early distal tubule via the thiazide-sensitive Na-Cl cotransporter (TSC), resulting in an increase in the excretion of sodium, chloride, and water. Polythiazide is a thiazide diuretic used to treat fluid retention (edema) in people with congestive heart failure, cirrhosis of the liver, kidney disorders, or edema caused by taking steroids or estrogen.

Polythiazide is approved for use in the following clinical indications

• Edema

Polythiazide is indicated as adjunctive therapy in the edema associated with congestive heart failure, hepatic cirrhosis, and corticosteroid and estrogen therapy. Polythiazide has also been found useful in edema due to various forms of renal dysfunction as Nephrotic syndrome; Acute glomerulonephritis; and Chronic renal failure.

• Hypertension

Polythiazide is indicated in the management of hypertension either as the sole therapeutic agent or to enhance the effectiveness of other antihypertensive drugs in the more severe forms of hypertension.

• Edema

In the treatment of edema, the usual dose is 1 to 4 mg daily.

• Hypertension

In the treatment of hypertension, the usual dose is 2 to 4 mg daily.

Polythiazide is available in various strengths as 1mg, 2mg, and 4mg.

Polythiazide is available in the form of Oral Tablets.

Avoid consumption of a high-salt or high-sodium diet while taking Polythiazide.

Polythiazide is contraindicated in patients with

• Anuria
• Hypersensitivity to this or other sulfonamide-derived drugs.
• Renal decompensation
• Pregnancy

• Renal disease

Thiazides should be used with caution in severe renal disease. In patients with renal disease, thiazides may precipitate azotemia. Cumulative effects of the drug may develop in patients with impaired renal function.

• Liver disease

Thiazides should be used with caution in patients with impaired hepatic function or progressive liver disease, since minor alterations of fluid and electrolyte balance may precipitate hepatic coma.

• Allergy or bronchial asthma

Sensitivity reactions may occur in patients with a history of allergy or bronchial asthma. The possibility of exacerbation or activation of systemic lupus erythematosus has been reported.

• Fluid or electrolyte imbalance

Periodic determination of serum electrolytes to detect possible electrolyte imbalance should be performed at appropriate intervals. All patients receiving thiazide therapy should be observed for clinical signs of fluid or electrolyte imbalance; namely, hyponatremia, hypochloremic alkalosis, and hypokalemia. Serum and urine electrolyte determinations are particularly important when the patient is vomiting excessively or receiving parenteral fluids. Medication such as digitalis may also influence serum electrolytes. Warning signs, irrespective of cause, are dryness of mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, and gastrointestinal disturbances such as nausea and vomiting.

• Hypokalemia

Hypokalemia may develop with thiazides as with any other potent diuretic, especially with brisk diuresis, when severe cirrhosis is present, or during concomitant use of corticosteroids or ACTH. Interference with adequate oral electrolyte intake will also contribute to hypokalemia. Digitalis therapy may exaggerate the metabolic effects of hypokalemia, especially with reference to myocardial activity.

• Hyponatremia

Any chloride deficit is generally mild and usually does not require specific treatment except under extraordinary circumstances (as in liver disease or renal disease). Dilutional hyponatremia may occur in edematous patients in hot weather; appropriate therapy is water restriction, rather than administration of salt except in rare instances when the hyponatremia is life-threatening. In actual salt depletion, appropriate replacement is the therapy of choice.

• Hyperuricemia

Hyperuricemia may occur or frank gout may be precipitated in certain patients receiving thiazide therapy.

• In diabetic patients

Insulin requirements in diabetic patients may be increased, decreased, or unchanged. Latent diabetes mellitus may become manifest during thiazide administration.

Consumption of alcohol is not recommended while taking Polythiazide due to the increased risk of low blood pressure.

Thiazides appear in breast milk. If the use of the drug is deemed essential, the patient should stop nursing.

The routine use of diuretics in an otherwise healthy woman is inappropriate and exposes the mother and fetus to unnecessary hazards. Diuretics do not prevent the development of toxemia in pregnancy, and there is no satisfactory evidence that they are useful in the treatment of developed toxemia.

Avoid consumption of a high-salt or high-sodium diet while taking Polythiazide.

• Common Adverse effects

Weakness, Orthostatic hypotension, Pancreatitis, Jaundice, Nausea, vomiting, Sialadenitis, Abdominal cramping, Urticaria/erythema multiforme/exfoliative dermatitis, Purpura, Muscle spasm, Vertigo/dizziness, Paresthesias, Diarrhea/Constipation, Gastric irritation, Aplastic anemia, Agranulocytosis, Fever, Headache, Restlessness.

• Rare Adverse effects

Hypokalemia, hyponatremia, hypercalcemia, and/or hypomagnesemia, Necrotizing angiitis, Pneumonitis, and pulmonary edema, azotemia, acute transient myopia, and acute angle-closure glaucoma, Leukopenia, Hemolytic anemia, Photosensitivity, Transient blurred vision, Xanthopsia, Impotence, Hyperuricemia, Thrombocytopenia, Hyperglycemia.

• ACTH or Corticosteroids: Hypokalemia may develop with concomitant use of ACTH or Corticosteroids.
• Beta-blocker: Hyperglycemia may develop with concomitant treatment in Type 2 diabetes mellitus.
• Barbiturates or Narcotics: Orthostatic hypotension may be aggravated with Barbiturates or Narcotics.
• Cyclosporine: Avoid concurrent use of cyclosporine and thiazides may increase the risk of gout or renal toxicity.
• Digoxin: Metabolic effects of hypokalemia may be increased with concomitant digitalis therapy.
• Lithium: Lithium toxicity can occur with concomitant therapy which reduces renal excretion of lithium.
• NSAIDs: NSAIDs can decrease the efficacy of thiazides reducing the diuretic and antihypertensive effects.

The common side of Polythiazide includes the following

• Common

Low blood pressure, Increased blood sugar levels, Nausea and Vomiting, Diarrhoea, Stomach cramps, Dizziness, and Fatigue.

• Rare

Hemolytic anemia, Thrombocytopenia, Necrotizing angiitis, Pneumonitis, and pulmonary edema, Photosensitivity, Fever, Weight gain, Redness of the eye, sexual problems, Pancreatitis, Jaundice, Nausea/vomiting, Sialadenitis, Aplastic anemia, Agranulocytosis, Leukopenia.

• Pregnancy

Pregnancy Category D.

Thiazides cross the placental barrier and appear in cord blood. The use of thiazides in pregnant women requires that the anticipated benefit be weighed against possible hazards to the fetus. These hazards include fetal or neonatal jaundice, thrombocytopenia, and possibly other adverse reactions which have occurred in the adult.

• Nursing Mothers

Thiazides appear in breast milk. If the use of the drug is deemed essential, the patient should stop nursing.

• Pediatric Use

Safety and effectiveness in pediatric patients have not been established.

• Geriatric Use

Data is not available.

No information was available.

Pharmacodynamic

As a thiazide diuretic, Polythiazide inhibits the sodium-chloride symporter which decreases solute reabsorption leading to a retention of water in the urine, as water normally follows solutes. More frequent urination is due to the increased loss of water that has not been retained from the body as a result of a concomitant relationship with sodium loss from the convoluted tubule. The short-term anti-hypertensive action is based on the fact that thiazides decrease preload, decreasing blood pressure.

Pharmacokinetics

• Absorption

Readily absorbed from the GI tract.

• Distribution
  

Plasma protein binding: >80%.

• Metabolism and Excretion

Via urine (as unchanged drug) and feces. Elimination half-life: Approx 26 hr.

• https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=abd6ecf0-dc8e-41de-89f2-1e36ed9d6535&type=display
• https://go.drugbank.com/drugs/DB01324
• https://www.syrianclinic.com/med/en/ProfDrugs/Polythiazidepd.html#drug-interactions
• https://www.rxlist.com/renese-drug.htm