氯噻嗪
Chlorothiazide
Chlorothiazide / Chlorothiazide Sodium
別名: Diuril · Azide · Chlorzide · Chlotride · Diachlor · Diurigen · Pahtlisan · Saluric · chlorothiazidum · clorotiazida
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Treatment of nephrogenic diabetes insipidus | 20-40 mg/kg | PO | q12h | — | 🌎 NA |
| Treatment of systemic hypertension | 20-40 mg/kg | PO | q12-24h | — | 🌎 NA |
| As a diuretic | 20-40 mg/kg | PO | q12h | — | 🌎 NA |
- Treatment of systemic hypertension: Use with dietary salt restriction
- As a diuretic: Twice daily
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Treatment of diabetes insipidus | 20-40 mg/kg | PO | q12h | — | 🌎 NA |
| As a diuretic | 20-40 mg/kg | PO | q12h | — | 🌎 NA |
- Treatment of diabetes insipidus: May be tried
- As a diuretic: Twice daily
牛
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| General dosing for adult cattle | 4-8 mg/kg | PO | once or twice daily | — | 🌎 NA |
| General dosing | 2 g | PO | once to twice daily | — | 🌎 NA |
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
氯噻嗪是一種噻嗪類利尿劑，在獸醫學中主要用於治療犬的腎性尿崩症、全身性高血壓，以及預防草酸鈣尿結石。
雖然在治療一般水腫方面已很大程度上被袢利尿劑（如呋塞米）所取代，但它仍然是一種重要的輔助療法。
臨床要點： 噻嗪類藥物在尿崩症患者中會反常地減少尿量。它們會引起輕度的體液流失，從而導致近端腎小管對鈉和水的重吸收代償性增加，最終減少到達遠端腎單位的濾液量。
作用機制
Chlorothiazide acts primarily on the distal convoluted tubule (DCT) of the nephron.
- Primary Mechanism: Inhibits the Na⁺/Cl⁻ symporter in the luminal membrane of the DCT → prevents reabsorption of sodium and chloride → promotes osmotic diuresis.
- Electrolyte Effects: Enhances excretion of sodium, chloride, potassium, magnesium, phosphate, iodide, and bromide.
- Calcium Sparing: Unlike loop diuretics, thiazides decrease urinary calcium excretion with chronic use, making them useful for preventing calcium oxalate uroliths.
- Hemodynamic Effects: Decreases glomerular filtration rate (GFR). The resulting volume depletion activates the renin-angiotensin-aldosterone system (RAAS), which contributes to downstream potassium wasting (hypokalemia).
安全性與警告
禁忌症
- Hypersensitivity to thiazides or sulfonamides
- Anuria
- Pregnancy in otherwise healthy females with only mild edema (relative contraindication)
不良反應
- Hypokalemia
- Hypochloremic alkalosis
- Dilutional hyponatremia
- Hypomagnesemia
- Hypercalcemia
- Hypophosphatemia
- Hyperuricemia
- Gastrointestinal distress (vomiting, diarrhea)
- Pancreatitis
- Hypersensitivity / dermatologic reactions
- Polyuria
- Hematologic toxicity
- Hyperglycemia
- Hyperlipidemias
- Orthostatic hypotension
注意事項
Use with extreme caution or avoid in patients with severe renal disease, preexisting electrolyte or water balance abnormalities, impaired hepatic function (may precipitate hepatic coma), hyperuricemia, systemic lupus erythematosus (SLE), or diabetes mellitus. Monitor patients with conditions that may lead to fluid/electrolyte loss (e.g., vomiting, diarrhea) very carefully.
藥物相互作用
Increased risk for severe hypokalemia
Increased risk for severe hypokalemia
Increased risk for hyperglycemia, hyperuricemia, and hypotension
Thiazide-induced hypokalemia, hypomagnesemia, and/or hypercalcemia may increase the likelihood of digitalis toxicity
Thiazides may increase insulin requirements
Thiazides can increase serum lithium concentrations
Thiazides can alkalinize urine and reduce methenamine effectiveness
May increase risk for renal toxicity; NSAIDs may reduce diuretic actions of thiazides
Response or duration of nondepolarizing agents (e.g., tubocurarine) may be increased
Blocks thiazide-induced uric acid retention
Half-life may be prolonged by thiazides due to urine alkalinization
Hypercalcemia may be exacerbated
監測
- Serum electrolytes (especially potassium)
- BUN and Creatinine
- Blood glucose
- Hydration status
- Blood pressure (if indicated)
- Hemograms (if indicated)
藥物動力學
吸收
In humans, only 10-21% absorbed after oral administration. Onset of diuretic activity occurs in 1-2 hours and peaks at about 4 hours.
分佈
Enters maternal milk.
代謝
Pharmacokinetics have apparently not been studied in domestic animals.
排除
Duration of activity is from 6-12 hours (in humans).
過量
Acute overdosage may cause electrolyte and water balance problems, CNS effects (ranging from lethargy to coma and seizures), and GI effects (hypermotility, GI distress). Transient increases in BUN have also been reported.
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; provide symptomatic and supportive care as required.
可用產品
劑型
- Tablets
- Oral suspension
- Powder for injection (lyophilized)
人用標示
- Chlorothiazide Tablets: 250 mg & 500 mg (Diuril®, Diurigen®, generic)
- Chlorothiazide Oral Suspension: 50 mg/mL in 237 mL (Diuril®)
- Chlorothiazide Sodium Powder for Injection (lyophilized): 500 mg in 20 mL vials (Diuril®)
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Tablets should be stored at room temperature. The oral suspension should be protected from freezing. The injectable preparation is stable for 24 hours after reconstitution. If the pH of the reconstituted solution is less than 7.4, precipitation will occur in less than 24 hours.
飼主須知
- 提供飲水： 除非獸醫特別指示，否則請確保您的寵物隨時可以喝到新鮮的水。
- 監測脫水/電解質失衡： 如果您發現寵物出現水分或電解質失衡的跡象，例如過度口渴、嚴重嗜睡、虛弱、焦躁不安、排尿減少、嘔吐、腹瀉或心跳過快，請立即聯繫您的獸醫。
- 給藥方式： 如果引起腸胃不適，可以與食物一起餵食。
- 持續用藥： 未經獸醫同意，請勿突然停藥，特別是當該藥物用於控制血壓或尿崩症時。
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