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Pronunciation:

(ben droe floo meth EYE a zide)

U.S. Brand Names:

Naturetin® [DSC]

Generic Available:

Use:

Management of mild to moderate hypertension, edema associated with congestive heart failure, pregnancy, or nephrotic syndrome; reportedly does not alter serum electrolyte concentrations appreciably at recommended doses

Pregnancy Risk Factor:

Contraindications:

Hypersensitivity to bendroflumethiazide, any component of the formulation, thiazides, or sulfonamide-derived drugs; anuria; renal decompensation; pregnancy

Warnings/Precautions:

Use with caution in severe renal disease. Electrolyte disturbances (hypokalemia, hypochloremic alkalosis, hyponatremia) can occur. Use with caution in severe hepatic dysfunction; hepatic encephalopathy can be caused by electrolyte disturbances. Gout can be precipitate in certain patients with a history of gout, a familial predisposition to gout, or chronic renal failure. Cautious use in diabetics; may see a change in glucose control. Hypersensitivity reactions can occur. Can cause SLE exacerbation or activation. Use with caution in patients with moderate or high cholesterol concentrations. Photosensitization may occur.

Chemical similarities are present among sulfonamides, sulfonylureas, carbonic anhydrase inhibitors, thiazides, and loop diuretics (except ethacrynic acid). Use in patients with thiazide or sulfonamide allergy is specifically contraindicated in product labeling, however, a risk of cross-reaction exists in patients with allergy to any of these compounds; avoid use when previous reaction has been severe.

Adverse Reactions:

1% to 10%:

Cardiovascular: Orthostatic hypotension

Endocrine & metabolic: Hyponatremia, hypokalemia

Gastrointestinal: Anorexia, upset stomach, diarrhea

<1% (Limited to important or life-threatening): Agranulocytosis, allergic reactions, aplastic anemia, drowsiness, hemolytic anemia, hepatic function impairment, hepatitis, hypercalcemia, hyperuricemia, leukopenia, nausea, pancreatitis, paresthesia, polyuria, thrombocytopenia, uremia, vomiting

Drug Interactions:

ACE inhibitors: Increased hypotension if aggressively diuresed with a thiazide diuretic.

Beta-blockers increase hyperglycemic effects in type 2 diabetes mellitus (noninsulin dependent, NIDDM)

Cyclosporine and thiazides can increase the risk of gout or renal toxicity; avoid concurrent use.

Digoxin toxicity can be exacerbated if a thiazide induces hypokalemia or hypomagnesemia.

Lithium toxicity can occur by reducing renal excretion of lithium; monitor lithium concentration and adjust as needed.

Neuromuscular blocking agents can prolong blockade; monitor serum potassium and neuromuscular status.

NSAIDs can decrease the efficacy of thiazides reducing the diuretic and antihypertensive effects.

Mechanism of Action:

Like other thiazide diuretics, it inhibits sodium, chloride, and water reabsorption in the renal distal tubules, thereby producing diuresis with a resultant reduction in plasma volume; hypothetically may reduce peripheral resistance through increased prostacyclin synthesis

Dosage:

Oral:

Children: Initial: 0.1-0.4 mg/kg/day in 1-2 doses; maintenance dose: 0.05-0.1 mg/kg/day in 1-2 doses; maximum dose: 20 mg/day

Adults: 2.5-20 mg/day or twice daily in divided doses

Patient Education:

May be taken with food or milk; take early in day to avoid nocturia; take the last dose of multiple doses no later than 6 PM unless instructed otherwise. A few people who take this medication become more sensitive to sunlight and may experience skin rash, redness, itching, or severe sunburn, especially if sunblock SPF 15 is not used on exposed skin areas.

Nursing Implications:

Assess weight, I & O reports daily to determine fluid loss

Cardiovascular Considerations:

Thiazide diuretics are effective first-line therapeutic agents in the management of hypertension and have proven to be of benefit in terms of cardiovascular outcome. They may act synergistically to lower blood pressure when combined with an ACE inhibitor or beta-blocker. The initial concern about thiazide diuretic-induced hypokalemia, glucose intolerance, and lipid profiles does not appear to be of substantial clinical consequence in the treatment of hypertension. The benefits of this class of agents in the treatment of hypertension is established and compares well with other first-line therapeutic agents.

Diuretics are standard therapy for the management of edema in patients with heart failure.

Dental Health: Effects on Dental Treatment:

Key adverse event(s) related to dental treatment: Orthostatic hypotension.

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

No information available to require special precautions

Mental Health: Effects on Mental Status:

May cause drowsiness

Mental Health: Effects on Psychiatric Treatment:

May produce orthostatic hypotension; use caution with concurrent psychotropic use; rare reports of agranulocytosis; caution with clozapine and carbamazepine; may decrease lithium clearance resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels

Dosage Forms:

Tablet: 5 mg

International Brand Names:

Aprinox® (AU, EG, GB, HK); Bendroflumethiazide® (GB); Centyl® (DK, IE, NO); Low Centyl K® (IE); Neo-NaClex® (GB); Neo-Naclex® (NZ); Salures® (SE); Urizid® (IL)

References

Chobanian AV, Bakris GL, Black HR, et al, "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report,"JAMA, 2003, 289(19):2560-71.

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