Bendroflumethiazide (Bendrofluazide): Uses, Side effects

Chemical Structure:

Class of drug: Thiazide diuretic

Mode of action:

Enhances diuresis by decreasing sodium (Na+) reabsorption at the distal convoluted tubule (DCT) of the nephron

Medicinal forms available:

Tablets and ‘on-request’ oral suspensions

Some brands available:

Naturetin, Aprinox

Indications and dose:

Oedema

Adult

Initially 5–10 mg once daily or on alternate days, dose to be taken in the morning, then maintenance 5–10 mg 1–3 times a week 

Hypertension

Adult

2.5 mg daily, dose to be taken in the morning, higher doses are rarely necessary 

Contraindications:

·      Anuria

·      Addison’s disease

·      Hypercalcemia

·      Hyponatremia

·      Symptomatic hyperuricemia

·      Refractory hypokalemia

Cautions:

·      Diabetes

·      Gout

·      Systemic lupus erythematosus

·      Risk of hypokalemia

·      Hypotension

Interactions:

Aceclofenac – risk of acute renal failure

Allopurinol – risk of hypersensitivity reactions

Amiodarone – causes hypokalemia with increased risk of torsade de pointes

Artemether – causes hypokalemia with increased risk of torsade de pointes

Aspirin – risk of acute renal failure

Calcium – risk of hypercalcemia

Celecoxib – risk of acute renal failure

Chlorpromazine – causes hypokalemia with increased risk of torsade de pointes

Citalopram – causes hypokalemia with increased risk of torsade de pointes

Clarithromycin – causes hypokalemia with increased risk of torsade de pointes

Clomipramine – causes hypokalemia with increased risk of torsade de pointes

Diclofenac – risk of acute renal failure

Digoxin – risk of hypokalemia increase digoxin toxicity

Erythromycin – causes hypokalemia with increased risk of torsade de pointes

Fluconazole – causes hypokalemia with increased risk of torsade de pointes

Haloperidol – causes hypokalemia with increased risk of torsade de pointes

Ibuprofen – risk of acute renal failure

Mefenamic acid – risk of acute renal failure

Naproxen – risk of acute renal failure

Piroxicam – risk of acute renal failure

Quinine – causes hypokalemia with increased risk of torsade de pointes

Risperidone – causes hypokalemia with increased risk of torsade de pointes

Sildenafil – risk of hypotension and also causes hypokalemia with increased risk of torsade de pointes

Side effects/adverse effects:

·      Hypercalcemia

·      Electrolyte imbalance

·      Hyperglycemia

·      Erectile dysfunction

·      Nausea

·      Postural hypotension

·      Dizziness

·      Dry mouth

·      Skin reactions

·      Diarrhea

·      Constipation

·      Headache

·      Fatigue

Pregnancy:

Thiazide and thiazide-like diuretics should not be used in pregnancy to treat gestational hypertension.

Breastfeeding:

Amount present in milk is too small to be harmful; however, large doses may suppress lactation.

Hepatic impairment:

Use with caution in mild-to-moderate impairment; avoid in severe impairment.

Renal impairment:

Avoid if eGFR is less than 30 mL/minute/1.73m²

Monitoring requirements:

Monitor electrolytes

Other drugs in class:

·      Chlorothiazide

·      Chlorthalidone

·      Hydrochlorothiazide

·      Indapamide

·      Metolazone