Bendroflumethiazide

CLINICAL USE

Thiazide diuretic:

  • Hypertension
  • Oedema

    DOSE IN NORMAL RENAL FUNCTION

    Oedema: 5–10 mg in the morning or alternate days

  • Maintenance: 5–10 mg, 1–3 times weekly
  • Hypertension: 2. 5 mg daily

    PHARMACOKINETICS

  • Molecular weight                           :421.4
  • %Protein binding                           :94
  • %Excreted unchanged in urine     : 30
  • Volume of distribution (L/kg)       :1.2–1.5
  • half-life – normal/ESRD (hrs)      :3–9/–

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Dose as in normal renal function
  • 10 to 20     : Dose as in normal renal function
  • <10           : Unlikely to work

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Unlikely to be dialysed. Unlikely to work.
  • HD                     :Not dialysed. Unlikely to work
  • HDF/high flux   :Unknown dialysability. Unlikely to work
  • CAV/VVHD      :Probably not dialysed. Unlikely to work

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs

  • Analgesics: increased risk of nephrotoxicity with NSAIDs; antagonism of diuretic effect
  • Anti-arrhythmics: hypokalaemia leads to increased cardiac toxicity; effects of lidocaine and mexiletine antagonised
  • Antibacterials: avoid administration with lymecycline
  • Antidepressants: increased risk of hypokalaemia with reboxetine; enhanced hypotensive effect with MAOIs; increased risk of postural hypotension with tricyclics
  • Anti-epileptics: increased risk of hyponatraemia with carbamazepine
  • Antifungals: increased risk of hypokalaemia with amphotericinAntihypertensives: enhanced hypotensive effect; increased risk of first dose hypotension with post-synaptic alpha-blockers like prazosin; hypokalaemia increases risk of ventricular arrhythmias with sotalol
  • Antipsychotics: hypokalaemia increases risk of ventricular arrhythmias with amisulpride or sertindole; enhanced hypotensive effect with phenothiazines; hypokalaemia increases risk of ventricular arrhythmias with pimozide – avoid concomitant use
  • Atomoxetine: hypokalaemia increases risk of ventricular arrhythmias
  • Cardiac glycosides: increased toxicity if hypokalaemia occurs
  • Ciclosporin: increased risk of nephrotoxicity and hypomagnesaemia
  • Lithium excretion reduced, increased toxicity

    ADMINISTRATION

    Reconstition

    Route

    Oral

    Rate of Administration

    Comments

    OTHER INFORMATION

    Monitor for hypokalaemia Thiazide diuretics are unlikely to be of use once GFR<30 mL/min

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