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

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Route

Oral

Rate of Administration

–

Comments

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OTHER INFORMATION

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

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