Duretic , Enduron
Classifications: thiazide diuretic; antihypertensive agent; Therapeutic: antihypertensive; thiazide diuretic
Pregnancy Category: D first trimester; C second and third trimester
2.5 mg, 5 mg tablets
Thiazide diuretic similar to hydrochlorothiazide. Diuretic effect results from a drug-induced inhibition of the renal tubular
reabsorption of electrolytes. The excretion of sodium and chloride is enhanced. There is also a loss of potassium ions via
the kidney. BP is lowered, probably by the loss of sodium, chloride and water, and, consequently, blood volume. Edema is
also decreased in CHF patients by the same mechanism.
Antihypertensive effect as well as enhanced excretion of sodium and water.
Antihypertensive treatment and adjunctively in the management of edema associated with CHF, renal pathology, and hepatic
Hypersensitivity to thiazides, and sulfonamide derivatives; anuria, hypokalemia, pregnancy (category D) in first trimester
and pregnancy (category C second and third trimester), lactation.
Renal disease; impaired kidney or liver function; older adults; gout; SLE; hypercalcemia; diabetes mellitus, children.
Route & Dosage
Adult: PO 2.510 mg once/d or 35 times/wk
Adult: PO 2.510 mg/d
Child: PO 0.050.2 mg/kg/d
- Give early in a.m. after eating (reduces gastric irritation) to prevent sleep interruption because of diuresis. If 2 doses
are ordered, administer second dose no later than 3 p.m.
- Store at 15°30° C (59°86° F) unless otherwise instructed.
Adverse Effects (≥1%)Body as a Whole:
Postural hypotension, sialadenitis, unusual fatigue
, dizziness, paresthesias. Skin:
Photosensitivity. Special Senses:
Yellow vision. Metabolic: Hypokalemia. Hematologic: Agranulocytosis.
InteractionsDrug: Amphotericin B, corticosteroids
increase hypokalemic effects; may antagonize hypoglycemic effects of insulin, sulfonylureas
; cholestyramine, colestipol
decrease thiazide absorption; intensifies hypoglycemic and hypotensive effects of diazoxide;
increased potassium and magnesium loss may cause digoxin toxicity
; decreases lithium
excretion, increasing its toxicity
s may attenuate diuresis, and risk of nsaid
-induced kidney failure increased.
Incompletely absorbed. Onset:
2 h. Peak:
6 h. Duration:
>24 h. Distribution:
Distributed throughout extracellular tissue
; concentrates in kidney; crosses placenta; distributed in breast milk. Metabolism:
Does not appear to be metabolized. Elimination:
Assessment & Drug Effects
- Expect antihypertensive effects in 34 d; maximal effects may require 34 wk.
- Monitor BP and I&O ratio during first phase of antihypertensive therapy. Report a sudden fall in BP, which may initiate severe
postural hypotension and potentially dangerous perfusion problems, especially in the extremities.
- Lab tests: Periodic serum electrolytes and CBC with differential.
- Monitor patient for S&S of hypokalemia (see Appendix F). Report promptly. Physician may change dose and institute replacement
Patient & Family Education
- Eat a balanced diet to protect against hypokalemia; generally not severe even with long-term therapy. Prevent onset by eating
potassium-rich foods including a banana (about 370 mg potassium) and at least 180 mL (6 oz) orange juice (about 330 mg potassium)
- Watch carefully for loss of glycemic control (diabetics) and early signs of hyperglycemia (see Appendix F). Symptoms are
slow to develop.
- Avoid OTC drugs unless the physician approves them. Many preparations contain both potassium and sodium, and may induce electrolyte
imbalance adverse effects.
- Older adults are more responsive to excessive diuresis; orthostatic hypotension may be a problem.
- Change positions slowly and in stages from lying down to upright positions; avoid hot baths or showers, extended exposure
to sunlight, and standing still. Accept assistance as necessary to prevent falling.
- Do not drive or engage in potentially hazardous activities until adjustment to the hypotensive effects of drug has been made.