히드로클로로티아지드

Hydrochlorothiazide

6-chloro-3,4-dihydro-2H-1,2,4-benzothiadiazine-7-sulfonamide 1,1-dioxide

다른 이름: HydroDIURIL · Microzide · Aldactazide · Hydro-Par · Ezide · Co-amilozide · Moduretic · HCTZ · hidroclorotiazida · hydrochlorothiazidum

VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료

2 mg/kg PO twice daily with a low sodium dietPO· twice daily

체중— 🐕

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

동물 종별 용량

🌎 NA — North America🌍 EU — Europe

개

적응증	용량	경로	빈도	기간	지역
Treatment of nephrogenic diabetes insipidus	2 mg/kg PO twice daily with a low sodium diet	PO	twice daily	—	🌎 NA
Treatment of nephrogenic diabetes insipidus	2.5-5 mg/kg PO twice daily	PO	twice daily	—	🌎 NA
Treatment of systemic hypertension	1 mg/kg PO q12-24h	PO	q12-24h	—	🌎 NA
Prevention of recurrent calcium oxalate uroliths with renal hypercalcuria	2 mg/kg q12h PO	PO	q12h	—	🌎 NA
Prevention of recurrent calcium oxalate uroliths with renal hypercalcuria	2.2 mg/kg PO q12h	PO	q12h	—	🌎 NA
Prevention of recurrent calcium oxalate uroliths with renal hypercalcuria	2-4 mg/kg PO q12h	PO	q12h	—	🌎 NA
Diuretic for heart failure (refractory to furosemide alone)	2-4 mg/kg PO q12h	PO	q12h	—	🌎 NA
Adjunctive treatment of heart failure	2 mg/kg PO q12h	PO	q12h	—	🌎 NA
Ascites secondary to right-sided heart failure	2 mg/kg initially on an every other day bases	PO	every other day	—	🌎 NA
Ascites in patients with liver disease	0.5-1 mg/kg PO twice daily	PO	twice daily	—	🌎 NA
As a diuretic (general)	1-4 mg/kg PO q12h	PO	q12h	—	🌎 NA
Refractory congestive heart failure / Calcium oxalate urolithiasis prevention / Hypertension	0.5-4 mg/kg	PO	q12-24h	Long-term	🌍 EU

Treatment of nephrogenic diabetes insipidus: Based on a case report
Treatment of systemic hypertension: As a second choice agent; may combine with spironolactone (1-2 mg/kg PO q12 hours) to reduce potassium loss
Prevention of recurrent calcium oxalate uroliths with renal hypercalcuria: Usually added when dietary therapy does not adequately control calcium oxalate crystalluria
Prevention of recurrent calcium oxalate uroliths with renal hypercalcuria: Repeat urinalysis q2-4 weeks and monitor serum electrolytes within several weeks of initial dose and within 2 weeks of dosage adjustment
Diuretic for heart failure (refractory to furosemide alone): In combination with furosemide
Adjunctive treatment of heart failure: When a dog requires 4-5 mg/kg PO q8h of furosemide and continues to exhibit clinical signs of congestion, reduce the furosemide dose by 50% and add hydrochlorothiazide
Ascites secondary to right-sided heart failure: In addition to furosemide, spironolactone, ACE inhibitors, dietary sodium restriction; monitor electrolytes and renal function
Ascites in patients with liver disease: Using the fixed-dose combination with spironolactone (Aldactazide); dosed empirically based on the spironolactone content
Refractory congestive heart failure / Calcium oxalate urolithiasis prevention / Hypertension: Start at low dose and titrate upwards every 5-10 days, to effect. Monitor urea, creatinine, electrolytes and blood pressure before increasing dose.

고양이

적응증	용량	경로	빈도	기간	지역
Treatment of systemic hypertension	1 mg/kg PO q12-24h	PO	q12-24h	—	🌎 NA
Treatment of systemic hypertension	2-4 mg/kg PO q12h	PO	q12h	—	🌎 NA
Diuretic for heart failure	1-2 mg/kg PO q12h	PO	q12h	—	🌎 NA
Ascites in patients with liver disease	0.5-1 mg/kg PO twice daily	PO	twice daily	—	🌎 NA
To reduce calcium oxalate saturation in urine	1 mg/kg PO q12h	PO	q12h	—	🌎 NA
Refractory congestive heart failure / Calcium oxalate urolithiasis prevention / Hypertension	1-2 mg/kg	PO	q12-24h	Long-term	🌍 EU

Treatment of systemic hypertension: As a second choice agent; may combine with spironolactone (1-2 mg/kg PO q12 hours) to reduce potassium loss
Treatment of systemic hypertension: Not effective as a single agent in cats, and may be contraindicated (e.g., chronic renal failure). Possibly helpful acutely with retinal detachment.
Diuretic for heart failure: In combination with furosemide in patients who have become refractory to furosemide alone
Ascites in patients with liver disease: Using the fixed-dose combination with spironolactone (Aldactazide); dosed empirically based on the spironolactone content
To reduce calcium oxalate saturation in urine: Study done in normal cats, unknown what effect HCTZ will have in cats with spontaneously occurring calcium oxalate urolithiasis
Refractory congestive heart failure / Calcium oxalate urolithiasis prevention / Hypertension: Start at low dose and titrate upwards cautiously. Monitor urea, creatinine, electrolytes and blood pressure.

말

적응증	용량	경로	빈도	기간	지역
Adjunctive therapy of hyperkalemic periodic paralysis (HyPP)	0.5-1 mg/kg PO q12h	PO	q12h	—	🌎 NA

Adjunctive therapy of hyperkalemic periodic paralysis (HyPP): When diet adjustment does not control episodes. Note: ARCI UCGFS Class 4 Drug

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개요

히드로클로로티아지드(HCTZ)는 중간 정도의 효능을 가진 티아지드계 이뇨제입니다. 수의학에서 일반적인 부종 치료용으로는 루프 이뇨제(예: 푸로세미드)로 대체되었으나, 특정 적응증에는 여전히 매우 유용합니다.

주요 임상 용도:

칼슘 옥살레이트 요석증: 소변으로의 칼슘 배설을 감소시키는 독특한 능력(저칼슘뇨 효과)으로 인해 개(및 잠재적으로 고양이)의 재발 방지에 사용됩니다.
전신성 고혈압: 보조적 또는 2차 항고혈압제로 자주 사용됩니다.
신성 요붕증(DI): 요붕증 환자에서 역설적으로 소변량을 감소시키며, 신성 요붕증의 일차적인 약물 치료제입니다.
불응성 심부전: 이뇨제 내성을 극복하기 위해 루프 이뇨제와 순차적으로 사용됩니다(순차적 네프론 차단).
고칼륨혈성 주기성 마비(HyPP): 식이 관리만으로 조절되지 않는 말에서 아세타졸아마이드의 대안으로 사용됩니다.

임상 팁: 처방 요약에는 "저혈당증"이 언급되어 있으나, 티아지드계 약물은 인슐린 분비와 말초 포도당 이용을 감소시켜 실제로는 고혈당증을 유발하거나 악화시키는 것으로 알려져 있습니다. 인슐린종과 같은 고인슐린성 저혈당증 관리에 간혹 사용되지만, 디아족사이드(diazoxide)가 더 일반적입니다.

작용 기전

Hydrochlorothiazide acts primarily on the distal convoluted tubule (DCT) (cortical diluting segment) of the nephron.

Diuretic Effect: It competitively antagonizes the Na⁺/Cl⁻ cotransporter (NCC) → inhibits sodium and chloride reabsorption → enhances excretion of Na⁺, Cl⁻, and water.
Electrolyte Alterations: Increased distal delivery of Na⁺ stimulates the renin-angiotensin-aldosterone system (RAAS) → increased aldosterone → enhanced secretion of K⁺ and H⁺ (leading to hypokalemia and metabolic alkalosis). It also increases excretion of magnesium, phosphate, iodide, and bromide.
Calcium Sparing: Unlike loop diuretics, thiazides decrease calcium excretion. By depleting intracellular Na⁺ in the DCT, they enhance the activity of the basolateral Na⁺/Ca²⁺ exchanger → increased calcium reabsorption into the blood.
Paradoxical Effect in Diabetes Insipidus: Mild volume depletion induced by the diuretic → compensatory increase in proximal tubule reabsorption of Na⁺ and water → decreased delivery of water to the distal nephron → overall reduction in polyuria.

안전성·주의사항

금기사항

Hypersensitivity to thiazides or sulfonamides
Anuria
Pregnancy (relative contraindication in otherwise healthy patients with mild edema)
Dogs with absorptive (intestinal) hypercalciuria (may result in hypercalcemia)
Renal impairment (due to reduction in GFR)
Severe electrolyte imbalances (e.g., severe hypokalaemia or hyponatraemia)

부작용

Hypokalemia (most common)
Hypochloremic alkalosis
Dilutional hyponatremia
Hypomagnesemia
Hypercalcemia (hyperparathyroid-like effects)
Hypophosphatemia
Hyperuricemia
Gastrointestinal reactions (vomiting, diarrhea)
Polyuria
Hyperglycemia
Hyperlipidemias
Orthostatic hypotension
Hypersensitivity/dermatologic reactions
Hypokalaemia
Hyponatraemia
Hypochloraemia
Hyperglycaemia
Volume contraction (dehydration)
Activation of the renin-angiotensin-aldosterone system (RAAS)

주의

Extreme Caution/Avoid: Severe renal disease, preexisting electrolyte (including hypercalcemia) or water balance abnormalities, impaired hepatic function (may precipitate hepatic coma), hyperuricemia, systemic lupus erythematosus (SLE), or diabetes mellitus.

Monitoring: Patients with conditions that may lead to electrolyte or water balance abnormalities (e.g., vomiting, diarrhea) should be monitored carefully. Chronic therapy requires monitoring of serum potassium.

Laboratory Test Interferences: May increase serum amylase, decrease renal excretion of cortisol, falsely decrease total urinary estrogen, cause false-negative histamine tests for pheochromocytoma, elevate serum calcium (discontinue prior to parathyroid testing), compete for PSP secretion, cause false-negative phentolamine tests, decrease protein-bound iodine, slightly reduce T3 resin uptake, and cause false-negative tyramine tests.

약물 상호작용

Amphotericin B

Increased risk for severe hypokalemia

Corticosteroids, Corticotropin

Increased risk for severe hypokalemia

Diazoxide

Increased risk for hyperglycemia, hyperuricemia, and hypotension

DigoxinMajor

Thiazide-induced hypokalemia, hypomagnesemia, and/or hypercalcemia may increase the likelihood of digitalis toxicity

Insulin

Thiazides may increase insulin requirements

Lithium

Thiazides can increase serum lithium concentrations

Methenamine

Thiazides can alkalinize urine and reduce methenamine effectiveness

NSAIDs

Thiazides may increase risk for renal toxicity and NSAIDs may reduce diuretic actions of thiazides

Neuromuscular Blocking Agents

Tubocurarine or other nondepolarizing neuromuscular blocking agents response or duration of effect may be increased

Probenecid

Blocks thiazide-induced uric acid retention (used to therapeutic advantage)

Quinidine

Half-life may be prolonged by thiazides (thiazides can alkalinize the urine)

Vitamin D or Calcium Salts

Hypercalcemia may be exacerbated if thiazides are concurrently administered

CorticosteroidsModerate

Increased risk of developing hypokalaemia.

Loop diuretics (e.g., furosemide, torasemide)Major

Synergistic diuresis (sequential nephron blockade) but significantly increased risk of hypokalaemia and dehydration.

Vitamin DModerate

Concurrent administration may exacerbate hypercalcaemia.

Calcium saltsModerate

Concurrent administration may exacerbate hypercalcaemia.

모니터링

Serum electrolytes (especially potassium, sodium, chloride, calcium, magnesium)
Renal function (BUN, Creatinine)
Hydration status and body weight
Blood pressure (if treating hypertension)
Urine output and clinical signs of congestion (if treating heart failure)
Blood Urea Nitrogen (BUN)
Serum Creatinine
Serum Electrolytes (Potassium, Sodium, Chloride, Calcium)

약동학

반감기

고양이Unknown개Approximately 2 to 4 hours

흡수

In humans, hydrochlorothiazide is about 65-75% absorbed after oral administration. Onset of diuretic activity occurs in 2 hours; peaks at 4-6 hours.

분포

Not specifically described in domestic animals.

대사

The drug is apparently not metabolized.

배설

Excreted unchanged into the urine. In humans, the serum half-life is approximately 5.6-14.8 hours and duration of activity is 6-12 hours.

과다투여

Acute overdosage may cause:

Electrolyte and water balance problems (hypokalemia, hyponatremia, dehydration)
CNS effects (ranging from lethargy to coma and seizures)
GI effects (hypermotility, GI distress)
Transient increases in BUN

Treatment:

Empty the gut after recent oral ingestion using standard protocols.
Avoid concomitant cathartics as they may exacerbate fluid and electrolyte imbalances.
Monitor and treat electrolyte and water balance abnormalities supportively.
Monitor respiratory, CNS, and cardiovascular status; treat supportively and symptomatically if required.

제품

제형

Oral Tablets
Oral Capsules
Oral Suspension (Compounded)
25 mg hydrochlorothiazide / 2.5 mg amiloride tablets
50 mg hydrochlorothiazide / 5 mg amiloride tablets

동물용의약품

None (ARCI Class 4 substance)

인용의약품

Hydrochlorothiazide Oral Tablets: 25 mg, 50 mg, & 100 mg (HydroDIURIL, Hydro-Par, Ezide, generic)
Hydrochlorothiazide Oral Capsules: 12.5 mg (Microzide, generic)
Spironolactone/Hydrochlorothiazide Oral Tablets: 25 mg/25 mg & 50 mg/50 mg (Aldactazide, generic)
Co-amilozide tablets (25 mg hydrochlorothiazide / 2.5 mg amiloride)
Co-amilozide tablets (50 mg hydrochlorothiazide / 5 mg amiloride)
Moduretic

규제 현황

European Union✓ 승인됨처방전의약품EMA

Available as human generic (Co-amilozide) or branded products. Used under the cascade.

United Kingdom✓ 승인됨처방전의약품VMD

POM (Prescription Only Medicine). Used under the prescribing cascade.

규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

보관·안정성

Capsules and tablets should be stored at room temperature in well-closed containers. Compounded liquid preparations should be protected from light. A compounded suspension with spironolactone in Ora-Plus/Ora-Sweet retains >90% potency for 60 days at 5°C and 25°C.

보호자 정보

히드로클로로티아지드(HCTZ)는 체액 저류, 고혈압, 특정 유형의 신장 결석(칼슘 옥살레이트) 및 요붕증이라는 수분 균형 장애를 치료하는 데 사용되는 "이뇨제"입니다.

배뇨 증가: 반려동물이 더 자주, 더 많은 양의 소변을 볼 가능성이 높습니다. 수의사가 특별히 제한하지 않는 한 항상 신선하고 깨끗한 식수를 마실 수 있도록 해주세요.
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