Table 11-6

*Table 11-6.* Antihypertensive drugs: diuretics.
Drug	Proprietary Name	Initial Dosage	Dosage Range	Cost per Unit	Cost of 30 Days Treatment¹ (Average Dosage)	Adverse Effects	Comments
THIAZIDES AND RELATED DIURETICS
Hydrochlorothiazide	Esidrix, Hydro-Diuril	12.5 or 25 mg once daily	12.5-50 mg once daily	$0.08/25 mg	$2.40	K⁺, Mg²⁺, Ca²⁺, Na⁺, uric acid, glucose, LDL cholesterol, triglycerides; rash, erectile dysfunction.	Low dosages effective in many patients without associated metabolic abnormalities; metolazone more effective with concurrent renal insufficiency; indapamide does not alter serum lipid levels.
Chlorthalidone	Hygroton, Thaliton	12.5 or 25 mg once daily	12.5-50 mg once daily	$0.23/25 mg	$6.90
Metolazone	Zaroxolyn	1.25 or 2.5 mg once daily	1.25-5 mg once daily	$1.48/5 mg	$44.40
Mykrox	0.5 mg once daily	0.5-1 mg once daily	$1.24/0.5 mg	$37.20
Indapamide	Lozol	2.5 mg once daily	2.5-5 mg once daily	$0.83/2.5 mg	$24.90
LOOP DIURETICS
Furosemide	Lasix	20 mg twice daily	40-320 mg in 2 or 3 doses	$0.16/40 mg	$9.60	Same as thiazides, but higher risk of excessive diuresis and electrolyte imbalance. Increases calcium excretion.	Furosemide: Short duration of action a disadvantage; should be reserved for patients with renal insufficiency or fluid retention. Poor anti-hypertensive. Torsemide: Effective blood pressure medication at low dosage.
Ethacrynic acid	Edecrin	50 mg once daily	50-100 mg once or twice daily	$0.37/25 mg	$44.40
Bumetanide	Bumex	0.25 mg twice daily	0.5-10 mg in 2 or 3 doses	$0.52/1 mg	$31.20
Torsemide	Demadex	2.5 mg once daily	5-10 mg once daily	$0.70/10 mg	$21.00
ALDOSTERONE RECEPTOR BLOCKERS
Spironolactone	Aldactone	12.5 or 25 mg once daily	12.5-100 mg once daily	$0.46/25 mg	$13.80	Hyperkalemia, metabolic acidosis, gynecomastia.	Can be useful add-on therapy in patients with refractory hypertension.
Amiloride	Midamor	5 mg once daily	5-10 mg once daily	$0.48/5 mg	$14.40
Eplerenone	Inspra	25 mg once daily	25-100 mg once daily	$3.78/25 mg	$113.40
COMBINATION PRODUCTS
Hydrochlorothiazide and triamterene	Dyazide (25/50 mg); Maxzide (25/37.5 mg)	1 tab once daily	1 or 2 tabs once daily	$0.36	$10.80	Same as thiazides plus GI disturbances, hyperkalemia rather than hypokalemia, headache; triamterene can cause kidney stones and renal dysfunction; spironolactone causes gynecomastia. Hyperkalemia can occur if this combination is used in patients with renal failure or those taking ACE inhibitors.	Use should be limited to patients with demonstrable need for a potassium-sparing agent.
Hydrochlorothiazide and amiloride	Moduretic (50/5 mg)	1/2 tab once daily	1 or 2 tabs once daily	$0.33	$9.90
Hydrochlorothiazide and spironolactone	Aldactazide (25/25 mg)	1 tab once daily	1 or 2 tabs once daily	$0.50	$15.00
¹Average wholesale price (AWP, for AB-rated generic when available) for quantity listed. Source: Red Book Update, Vol. 25, No. 1, January 2006. AWP may not accurately represent the actual pharmacy cost because wide contractual variations exist among institutions.LDL = low-density lipoprotein; GI = gastrointestinal; ACE = angiotensin-converting enzyme.

Table 11-6

*Table 11-6.* Antihypertensive drugs: diuretics.
Drug	Proprietary Name	Initial Dosage	Dosage Range	Cost per Unit	Cost of 30 Days Treatment¹ (Average Dosage)	Adverse Effects	Comments
THIAZIDES AND RELATED DIURETICS
Hydrochlorothiazide	Esidrix, Hydro-Diuril	12.5 or 25 mg once daily	12.5-50 mg once daily	$0.08/25 mg	$2.40	K⁺, Mg²⁺, Ca²⁺, Na⁺, uric acid, glucose, LDL cholesterol, triglycerides; rash, erectile dysfunction.	Low dosages effective in many patients without associated metabolic abnormalities; metolazone more effective with concurrent renal insufficiency; indapamide does not alter serum lipid levels.
Chlorthalidone	Hygroton, Thaliton	12.5 or 25 mg once daily	12.5-50 mg once daily	$0.23/25 mg	$6.90
Metolazone	Zaroxolyn	1.25 or 2.5 mg once daily	1.25-5 mg once daily	$1.48/5 mg	$44.40
Mykrox	0.5 mg once daily	0.5-1 mg once daily	$1.24/0.5 mg	$37.20
Indapamide	Lozol	2.5 mg once daily	2.5-5 mg once daily	$0.83/2.5 mg	$24.90
LOOP DIURETICS
Furosemide	Lasix	20 mg twice daily	40-320 mg in 2 or 3 doses	$0.16/40 mg	$9.60	Same as thiazides, but higher risk of excessive diuresis and electrolyte imbalance. Increases calcium excretion.	Furosemide: Short duration of action a disadvantage; should be reserved for patients with renal insufficiency or fluid retention. Poor anti-hypertensive. Torsemide: Effective blood pressure medication at low dosage.
Ethacrynic acid	Edecrin	50 mg once daily	50-100 mg once or twice daily	$0.37/25 mg	$44.40
Bumetanide	Bumex	0.25 mg twice daily	0.5-10 mg in 2 or 3 doses	$0.52/1 mg	$31.20
Torsemide	Demadex	2.5 mg once daily	5-10 mg once daily	$0.70/10 mg	$21.00
ALDOSTERONE RECEPTOR BLOCKERS
Spironolactone	Aldactone	12.5 or 25 mg once daily	12.5-100 mg once daily	$0.46/25 mg	$13.80	Hyperkalemia, metabolic acidosis, gynecomastia.	Can be useful add-on therapy in patients with refractory hypertension.
Amiloride	Midamor	5 mg once daily	5-10 mg once daily	$0.48/5 mg	$14.40
Eplerenone	Inspra	25 mg once daily	25-100 mg once daily	$3.78/25 mg	$113.40
COMBINATION PRODUCTS
Hydrochlorothiazide and triamterene	Dyazide (25/50 mg); Maxzide (25/37.5 mg)	1 tab once daily	1 or 2 tabs once daily	$0.36	$10.80	Same as thiazides plus GI disturbances, hyperkalemia rather than hypokalemia, headache; triamterene can cause kidney stones and renal dysfunction; spironolactone causes gynecomastia. Hyperkalemia can occur if this combination is used in patients with renal failure or those taking ACE inhibitors.	Use should be limited to patients with demonstrable need for a potassium-sparing agent.
Hydrochlorothiazide and amiloride	Moduretic (50/5 mg)	1/2 tab once daily	1 or 2 tabs once daily	$0.33	$9.90
Hydrochlorothiazide and spironolactone	Aldactazide (25/25 mg)	1 tab once daily	1 or 2 tabs once daily	$0.50	$15.00
¹Average wholesale price (AWP, for AB-rated generic when available) for quantity listed. Source: Red Book Update, Vol. 25, No. 1, January 2006. AWP may not accurately represent the actual pharmacy cost because wide contractual variations exist among institutions.LDL = low-density lipoprotein; GI = gastrointestinal; ACE = angiotensin-converting enzyme.