Existing electrolyte disturbances, hepatic cirrhosis, severe heart failure, oedema, elderly, renal impairment. Observe signs of fluid and electrolyte disturbances. Hepatic impairment, diabetes, gout, hyperlipidaemia; hyperuricaemia; ECG: LVH and/or ventricular ectopics (extrasystoles). Hypovalaemia, hyperkalaemia, collagen vascular disease, valvular stenosis; before, during or immediately after anaesthesia, renal impairment, preexisting renal insufficiency, unilateral renal artery stenosis. Childn <6yrs. Assess renal function and insufficiency. Renovascular hypertension; surgery; anaesthesia. In severe CCF, it may cause oliguria and/or progressive azotemia and rarely acute renal failure.
Potentially Life-threatening
Adverse Drug Reactions
Volume depletion and electrolyte imbalance, dry mouth, thirst, lethargy, drowsiness, muscle pain and cramps, hypotension, hypersensitivity reactions eg, rashes, photosensitivity, thrombocytopaenia, jaundice, pancreatitis; fatigue, weakness; may precipitate an attack of gout; impotence, hyperglycaemia; anorexia, gastric irritation, nausea, vomiting, constipation, diarrhoea, sialadenititssialadenitis, dizziness, raised Ca concentration, headache, fatigue, cough, chest pain or angioneurotic oedema. Occasional increase in liver enzymes and serum bilirubin. Sudden hypotension.
Adverse Drug Reactions
Seizures, may unmask diabetes mellitus. Hyponatraemia and idiosyncratic, hypersensitivity reactions. Severe hypotension, angioedema.
Interactions
Hydrochlorothiazide: Symptomatic hyponatraemia when combined with carbamazepine. Predisposes to allopurinol sensitivity reactions and impaired renal function. Potentiates hypotensive effect of a-blockers and ACE inhibitors; these also reduce diuretic-induced hypokalaemia. Lisinopril: Antacids may decrease the bioavailability of ACE inhibitors. Inhibit tachycardia produced by vasodilators. Co-administration of cyclooxygenase inhibitors may cause sharp reduction in renal function.
