Thiazide diuretics, drug reaction

Additional adverse reactions of these drugs are listed in tiie Summary Drug Table Diuretics. When a potassium-sparing diuretic and a thiazide diuretic are given together, tiie adverse reactions associated with both drugp may be seen. 

Acute drug-related hypersensitivity reactions (allergic responses) may cause tubulointerstitial nephritis, which will damage the tubules and interstitium. These reactions are most commonly observed with administration of methicillin and other synthetic antibiotics as well as furosemide and the thiazide diuretics. The onset of symptoms occurs in about 15 days. Symptoms include fever, eosinophilia, hematuria (blood in the urine), and proteinuria (proteins in the urine). Signs and symptoms of acute renal failure develop in about 50% of the cases. Discontinued use of the drug usually results in complete recovery however, some patients, especially the elderly, may experience permanent renal damage. 

Drug-induced photosensitivity reactions are divided into phototoxicity (a nonimmunologic reaction) and photoallergic reactions (an immunologic reaction). The latter form is far less common. Medications associated with photosensitivity reactions include fluoroquinolones, nonsteroidal antiinflammatory drugs, phenothiazines, antihistamines, estrogens, progestins, sulfonamides, sulfonylureas, thiazide diuretics, and tricyclic antidepressants. 

Exanthematic/maculopapular reactions are the most frequent unlike a viral exanthem the eruption typically starts on the trunk the face is relatively spared. Continued use of the drug may lead to erythroderma. They commonly occur at about the ninth day of treatment (or day 2-3 in previously exposed patients), although onset may be delayed until after treatment is completed causes include antimicrobials, especially ampicillin, sulphonamides and derivatives (sulphonylureas, frusemide (furosemide) and thiazide diuretics). Morbilliform (measles-like) eruptions typically recur on rechallenge. 

Photoallergic reactions may occur as a result of exposure to systemically administered drugs such as griseofulvin, NSAIDs, phenothiazines, quinidine, sulfonamides, sulfonylureas, and thiazide diuretics as well as to external agents such as para-aminobenzoic acid (found in sunscreens), bithionol (used in soaps and cosmetics), paraphenylenediamine, and others. 

Administration of thiazides and related diuretics may be associated with numerous adverse reactions. However, many patients take these drug s without... 

Furo.semide and bumetanide are similar to the CA inhibilm. thiazides, and thiazide-like diuretics in possessing a. sulfanHnl moiety. This functional group has been associated with h)pei. sensitivity reactions such as urtic-aria. drug fever, bloixldyvt. sios. and interstitial nephritis. 

The development of an acute interstitial inflammatory reaction in the kidney related to the administration of certain classes of drugs and leading to renal failure has been recognized for almost a century [42]. Antibiotics, in particular the sulfonamides [43] and semisynthetic penicillins [44, 45], were recognized as etio-logically associated in many instances. A retrospective review of 1068 kidney biopsies from 1%8 to 1997 by Schwarz et al. yielded acute interstitial nephritis in 6.5% of cases. In the majority of instances (85%) acute interstitial nephritis was drug related. Diuretics were implicated in 7.8 % of these cases [46]. Lyons et al. noted that four patients with proliferative glomerulonephritis and nephrotic syndrome treated with sulfonamide-derivative diuretics (furosemide or thiazides) developed severe renal failure, which reversed when the diuretic was withdrawn and prednisone was adminis-... 

Theophylline, asthma, 17.2, 18.1, 18.2 Thiazides, see Diuretics Thiazolidinediones cardiovascular reactions, 31.697 musculoskeletal reactions, 32.779 peripheral edema, 29.531 Thiomersal, in vaccines, 28.357 Thiopurines, genetic susceptibility, 31.634 Thyroid hormones, 29.464 Thyroxine, drug interactions, 24.484 Tiaprofenic acid, cystitis, 18.106 TNF, see tumor necrosis factor Tolcapone, 32.289... 

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