氫氯噻嗪
Hydrochlorothiazide
6-chloro-3,4-dihydro-2H-1,2,4-benzothiadiazine-7-sulfonamide 1,1-dioxide
別名: HydroDIURIL · Microzide · Aldactazide · Hydro-Par · Ezide · Co-amilozide · Moduretic · HCTZ · hidroclorotiazida · hydrochlorothiazidum
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 | 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.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
馬
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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
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
氫氯噻嗪 (Hydrochlorothiazide, HCTZ) 是一種中等效力的噻嗪類利尿劑。在獸醫學中，雖然它在一般水腫治療上已大多被環利尿劑（如呋塞米）取代，但對於特定適應症仍具有高度價值。
主要臨床用途包括：
- 草酸鈣尿石症：用於預防犬（及潛在的貓）結石復發，因其具有降低尿鈣排泄的獨特能力（低鈣尿效應）。
- 全身性高血壓：常作為輔助或二線抗高血壓藥物。
- 腎性尿崩症 (DI)：在尿崩症患者中能反常地減少尿量，是腎性尿崩症的主要藥物療法。
- 難治性心臟衰竭：與環利尿劑依序使用，以克服利尿劑抗性（連續性腎單位阻斷）。
- 高血鉀性週期性麻痺 (HyPP)：當飲食管理不足時，在馬匹中作為乙醯唑胺 (acetazolamide) 的替代藥物。
臨床要點：雖然處方摘要中提到「低血糖」，但實際上噻嗪類藥物會減少胰島素釋放和周邊葡萄糖利用，已知會引起或加重高血糖。它們偶爾被用於治療高胰島素性低血糖（例如胰島素瘤），儘管二氮嗪 (diazoxide) 更為常用。
作用機制
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.
安全性與警告
禁忌症
- 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)
不良反應
- 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)
注意事項
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.
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
Thiazides may increase risk for renal toxicity and NSAIDs may reduce diuretic actions of thiazides
Tubocurarine or other nondepolarizing neuromuscular blocking agents response or duration of effect may be increased
Blocks thiazide-induced uric acid retention (used to therapeutic advantage)
Half-life may be prolonged by thiazides (thiazides can alkalinize the urine)
Hypercalcemia may be exacerbated if thiazides are concurrently administered
Increased risk of developing hypokalaemia.
Synergistic diuresis (sequential nephron blockade) but significantly increased risk of hypokalaemia and dehydration.
Concurrent administration may exacerbate hypercalcaemia.
Concurrent administration may exacerbate hypercalcaemia.
監測
- 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)
藥物動力學
半衰期
吸收
In humans, hydrochlorothiazide is about 65-75% absorbed after oral administration. Onset of diuretic activity occurs in 2 hours; peaks at 4-6 hours.
分佈
Not specifically described in domestic animals.
代謝
The drug is apparently not metabolized.
排除
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.
過量
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.
可用產品
劑型
- Oral Tablets
- Oral Capsules
- Oral Suspension (Compounded)
- 25 mg hydrochlorothiazide / 2.5 mg amiloride tablets
- 50 mg hydrochlorothiazide / 5 mg amiloride tablets
獸醫用
- None (ARCI Class 4 substance)
人用標示
- 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
各地核准狀態
Available as human generic (Co-amilozide) or branded products. Used under the cascade.
POM (Prescription Only Medicine). Used under the prescribing cascade.
暫無法規資料: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
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.
飼主須知
氫氯噻嗪 (HCTZ) 是一種「水丸」（利尿劑），用於治療體液滯留、高血壓、特定類型的腎結石（草酸鈣結石），以及一種稱為尿崩症的水分平衡障礙。
- 排尿增加：您的寵物可能會更頻繁地排尿，且尿量增加。除非獸醫特別限制，否則請確保牠們隨時有乾淨的飲用水。
- 如廁需求：狗狗需要更常到室外排尿以避免在室內發生意外。請確保貓咪的貓砂盆保持清潔。
- 注意電解質失衡：因為此藥物會從體內排除水分和鹽分，請注意脫水或低血鉀的跡象。如果您注意到以下情況，請立即聯繫獸醫：
- 過度口渴或極度嗜睡/虛弱
- 焦躁不安或意識混亂
- 嘔吐或腹瀉（這會加重水分流失）
- 排尿量突然減少
- 與食物同服：如果藥物引起寵物腸胃不適，可以嘗試與少量食物或零食一起餵食。
- 請勿突然停藥：如果是用於治療心臟衰竭或高血壓，未經獸醫同意請勿自行停藥，否則症狀可能會迅速復發。
VetSheet 藥物參考供持牌獸醫專業人員作臨床決策輔助之用，不能取代專業判斷或廠方最新藥品說明書。