Does Hctz Affect The Enzymes In The Liver?

Hydrochlorothiazide is a medication used to treat fluid retention caused by various conditions such as congestive heart failure, severe liver disease (cirrhosis), kidney disease, or treatment with a steroid or diuretic. It is considered a first-line drug for initial therapy in uncomplicated arterial hypertension. However, it can increase the risk of electrolyte problems in people with liver problems.

Hepatotoxicity, or liver damage, can occur when taking hydrochlorothiazide. This is an uncommon adverse event rarely described and only clinically. There are 11 disease interactions with hydrochlorothiazide, including anuria, electrolyte losses, liver disease, Lupus erythematosus, renal function disorders, and asthma.

Various case studies have shown that patients on hydrochlorothiazide show altered liver function tests indicative of drug interference with normal liver function. Drug-induced liver affection is not rare, but cases with liver damage, also known as hepatotoxicity, should be immediately reported to a healthcare provider.

Liver failure symptoms may include yellowing of skin or eyes, increased liver enzymes, fatigue, and increased liver enzymes. Hydrochlorothiazide is also used to treat fluid retention caused by congestive heart failure, severe liver disease (cirrhosis), kidney disease, or treatment with a steroid or diuretic.

Can diuretics affect the liver?

Hepatotoxicity. Use of the loop diuretics has not been associated with an increased rate of serum aminotransferase elevations. There have been only rare, reported cases of clinically apparent liver injury associated with loop diuretics and most of these reports were not very convincing. Interestingly, furosemide causes a direct hepatotoxicity in mice and has been used as an animal model of drug induced liver injury. This injury does not appear to occur in humans. Instances of liver injury in patients on furosemide usually present with ischemic hepatitis (shock liver) caused by heart failure with diuretic induced dehydration and hypotension. Thus, idiosyncratic, clinically apparent liver injury from the loop diuretics must be exceeding rare, if it occurs at all.

Likelihood score, all loop diuretics: E (unlikely causes of clinically apparent liver injury).

Mechanism of Injury. The cause of the rare occurrence of clinically apparent liver injury associated with the loop diuretics is not known. These agents are metabolized minimally by the liver and generally have rapid renal excretion.

Is hydrochlorothiazide toxic to kidneys?

Hydrochlorothiazide is contraindicated in patients with Kidney diseases due to its effect of leading stress on Kidneys. The drug should be avoided in patients with a history of Liver diseases, Diabetes, Lower blood potassium, and lower blood sodium levels.

Hydrochlorothiazide is a thiazide class of diuretic that targets Kidneys for increasing urine output and bringing in a decrease in swelling and blood pressure.

ACE inhibitors are more specific in action, which is brought by blocking of Angiotensin-Converting Enzymes, which inhibits the conversion of angiotensin I to angiotensin II. Decreased angiotensin II enzyme leads to the dilation of blood vessels which in turn leads to a decrease in blood pressure.

2. Is Hydrochlorothiazide a Potassium Sparing Diuretic?

Does hydrochlorothiazide affect potassium levels?

Serious side effects. Hydrochlorothiazide affects electrolyte and fluid balance in the body, which can have serious side effects. This medication may cause low sodium levels (hyponatremia), low potassium levels (hypokalemia), and low magnesium levels (hypomagnesemia). Electrolyte imbalances can cause dry mouth, irregular heartbeats (arrhythmias), muscle aches, nausea, thirst, tiredness, vomiting, and weakness. In some cases, these conditions can be dangerous and even life-threatening (DailyMed, 2014). If you experience any electrolyte imbalance symptoms such as dry mouth, weakness, restlessness, confusion, or muscle pains, seek medical help right away ( NIH, 2019 ).

Some people can have an allergic reaction to HCTZ ( FDA, 2011 ). This diuretic is a sulfonamide, a medication that uses sulfa, so people with an allergy to sulfa drugs should not take hydrochlorothiazide. An allergic reaction may cause hives, shortness of breath, trouble breathing, wheezing, skin rash, or swelling of the face, tongue, or throat. Seek medical attention immediately if you experience any of these signs of an allergic reaction.

Talk to your healthcare provider about any other prescription drugs, over-the-counter medications, and supplements that you are taking before starting hydrochlorothiazide.

Is triamterene HCTZ safe?

Talk to your care team about your risk of skin cancer. You may be more at risk for skin cancer if you take this medication.

This medication can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds/booths.

What side effects may I notice from receiving this medication?. Side effects that you should report to your care team as soon as possible:

• Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
• Dehydration—increased thirst, dry mouth, feeling faint or lightheaded, headache, dark yellow or brown urine
• Gout—severe pain, redness, warmth, or swelling in joints such as the big toe
• High potassium level—muscle weakness, fast or irregular heartbeat
• Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
• Kidney stones—blood in the urine, pain or trouble passing urine, pain in the lower back or sides
• Low blood pressure—dizziness, feeling faint or lightheaded, blurry vision
• Sudden eye pain or change in vision, such as blurry vision, seeing halos around lights, vision loss

Does HCTZ lower creatinine levels?

Abstract. Benzothiadiazines, potent oral diuretics, also inhibit carbonic anhydrase, although to a lesser degree than acetazolamide (Diamox). The latter has little effect on urinary calcium but causes hypocitriuria which predisposes to nephrolithiasis. The effect of benzothiadiazines on urinary calcium/citrate balance is less well known. In this study, the fall of urinary calcium and citrate was roughly 50% and 30%, respectively, in normal and hypertensive subjects during the prolonged administration of hydrochlorothiazide, a member of the benzothiadiazine family. Hence, in contradistinction to acetazolamide, this drug produces hypocalciuria but depresses the urinary citrate less. Consequently, the benzothiadiazines would not be expected to predispose to nephrolithiasis. In addition, hydrochlorothiazide was found to produce a 10-20% fall in creatinine clearance and an initial rise of roughly 0. 7 mg./100 ml. in serum calcium concentration. There are indications that the benzothiadiazines affect the overall metabolism of calcium and citrate.

EFFECT OF ACETAZOLAMIDE AND TRIPLE SULFONAMIDE ON CITRATE AND CALCIUM EXCRETION.

MCINTOSH HW, SERAGLIA M, UHLEMANN I, KORE R. MCINTOSH HW, et al. Can Med Assoc J. 1963 Dec 28;89:1332-3. Can Med Assoc J. 1963. PMID: 14101455 Free PMC article.

Can triamterene HCTZ damage the liver?

Liver damage, also called hepatotoxicity, can happen when taking triamterene/hydrochlorothiazide. Call your healthcare provider right away if you have any of the following symptoms of liver damage. Severely Low Platelet Levels.

What is triamterene/hydrochlorothiazide used for?. Triamterene/hydrochlorothiazide is a diuretic, also called a water pill, commonly used to treat high blood pressure ( hypertension ).

Triamterene/hydrochlorothiazide is also commonly used to reduce fluid retention ( edema ) caused by the following conditions.

• Congestive heart failure, which is a condition where the heart is not pumping as well as it should
• Liver disease, such as cirrhosis, which can lead to a buildup of fluid in the abdomen (ascites)
• Kidney disease, including protein in the urine ( nephrotic syndrome )
• Fluid caused by the use of hormones, such as estrogen or other steroids

Does HCTZ damage kidneys?

Hydrochlorothiazide is contraindicated in patients with Kidney diseases due to its effect of leading stress on Kidneys. The drug should be avoided in patients with a history of Liver diseases, Diabetes, Lower blood potassium, and lower blood sodium levels.

Hydrochlorothiazide is a thiazide class of diuretic that targets Kidneys for increasing urine output and bringing in a decrease in swelling and blood pressure.

ACE inhibitors are more specific in action, which is brought by blocking of Angiotensin-Converting Enzymes, which inhibits the conversion of angiotensin I to angiotensin II. Decreased angiotensin II enzyme leads to the dilation of blood vessels which in turn leads to a decrease in blood pressure.

2. Is Hydrochlorothiazide a Potassium Sparing Diuretic?

Does HCTZ affect liver enzymes?

Hepatotoxicity. The thiazide diuretics have not been shown to cause serum aminotransferase elevations to an appreciable extent, and are often used as a control group in assessing adverse events including serum aminotransferase elevations of newer antihypertensive medications. Despite their widespread use, the thiazide diuretics have only rarely been implicated in cases of clinically apparent acute liver injury. No clear signature or clinical pattern has been demonstrated in the rare case reports and in some instances other potentially hepatotoxic medications were being used and other possible diagnoses were present. The usual latency period to onset has been short (few days to several weeks) and the pattern of serum enzyme elevations has ranged from hepatocellular, to mixed and cholestatic (Cases 1 and 2). Immunoallergic features were uncommon as was autoantibody formation. Recovery was usually rapid upon stopping. At present, only hydrochlorothiazide has been implicated in more than 3 instances, while chlorothiazide, indapamide, metolazone and polythiazide have been implicated in one or two instances in causing drug induced liver injury. Hydrochlorothiazide is the most commonly used thiazide diuretic and it is not surprising that it has been implicated most commonly. Regardless, liver injury from thiazide diuretics is exceedingly rare. The similarity in chemical structure among the thiazide diuretics suggests that liver injury might be a class effect.

Hydrochlorothiazide likelihood score: C (probable rare cause of clinically apparent liver injury).

Chlorothiazide, indapamide, metolazone and polythiazide likelihood score: D (possible rare causes of clinically apparent liver injury).

What is the most common side effect of hydrochlorothiazide?

• Frequent urination
• Headache
• Nausea
• Dizziness
• Lightheadedness
• Electrolyte imbalances
• Hair loss

More severe side effects of hydrochlorothiazide use can include:

• Vision changes
• Difficulty breathing
• Signs of dehydration like lightheadedness, weakness, confusion, fast heartbeat, or cramps
• Swelling
• Chest pain
• Yellowing of the skin or eyes
• Slow or irregular heartbeat
• Unusual bleeding or bruising
• Fever, sore throat, or chills
• Joint pain
• Gout attacks
• Skin sensitivity to the sun

What are the metabolic side effects of HCTZ?

Hyperglycemia: Hydrochlorothiazide has been associated with higher levels of fasting blood glucose. Although the exact mechanism behind HCTZ-induced hyperglycemia is not well understood, it is hypothesized that decreased potassium levels may reduce insulin secretion by the pancreas. Caution is advised when prescribing hydrochlorothiazide to patients with a preexisting history of diabetes mellitus or impaired glucose metabolism.

Gout: Gout flares may be precipitated by hyperuricemia caused by hydrochlorothiazide, especially in susceptible individuals. The mechanism is related to volume contraction caused by diuresis and increased uric acid reabsorption in the proximal convoluted tubule. Increased uric acid levels and gout flares will often occur within the first weeks of initiating hydrochlorothiazide therapy.

Dyslipidemia: Although the precise mechanism is not well understood, hypercholesterolemia has been associated with hydrochlorothiazide use.

What is the best diuretic for liver failure?

5. 5. 1 Spironolactone. Spironolactone is an aldosterone antagonist, acting mainly on the distal tubules to increase natriuresis and conserve potassium. Spironolactone is the drug of choice in the initial treatment of ascites due to cirrhosis. 66 The initial daily dose of 100 mg may have to be progressively increased up to 400 mg to achieve adequate natriuresis. There is a lag of 3–5 days between the beginning of spironolactone treatment and the onset of the natriuretic effect. 67 Controlled studies have found that spironolactone achieves a better natriuresis and diuresis than a “loop diuretic” such as frusemide. 68, 69, 70, 71 Most frequent side effects of spironolactone in cirrhotics are those related to its antiandrogenic activity, such as decreased libido, impotence, and gynaecomastia in men and menstrual irregularity in women (although most women with ascites do not menstruate anyway). Gynaecomastia can be significantly reduced when the hydrophilic derivative potassium canrenoate is used, 72 but this is not readily available in the UK. Tamoxifen at a dose 20 mg twice a day has been shown to be useful in the management of gynaecomastia. 73 Hyperkalaemia is a significant complication that frequently limits the use of spironolactone in the treatment of ascites. 74.

Serum sodium 126–135 mmol/l, normal serum creatinine. Continue diuretic therapy but observe serum electrolytes. Do not water restrict.

Serum sodium 121–125 mmol/l, normal serum creatinine. International opinion is to continue diuretic therapy, our opinion is to stop diuretic therapy or adopt a more cautious approach.