Diuzid Special Precautions

Hydrochlorothiazide should be used with caution in patients with renal impairment since it can further reduce renal function. It should also be used with caution in patients with existing fluid and electrolyte disturbances or who are at risk from changes in fluid and electrolyte balance such as the elderly. Hyponatremia may occur in patients with severe heart failure who are very oedematous, particularly with large doses of thiazide in conjunction with restricted salt in the diet. Patients should be carefully observed for signs of fluid and electrolyte imbalance, especially in the presence of vomiting or during parenteral fluid therapy. Thiazide may precipitate attacks of gout in susceptible patients. It may also cause hyperglycemia and aggravate or unmask diabetes mellitus. Blood glucose concentrations should be monitored in patients taking antidiabetics since requirements may change. An increased risk of non-melanoma skin cancer (NMSC), basal cell carcinoma and squamous cell carcinoma, with increasing cumulative dose of hydrochlorothiazide exposure has been observed in 2 epidemiological studies based on the Danish National Cancer Registry. Photosensitizing actions of hydrochlorothiazide could act as a possible mechanism of NMSC. Patients taking Hydrochlorothiazide should be informed of the risk of NMSC and advised to regularly check their skin for any new lesions and promptly report any suspicious skin lesions. Possible preventive measures such as limited exposure to sunlight and UV rays and, in case of exposure, adequate protection should be advised to the patients in order to minimize the risk of skin cancer. Suspicious skin lesions should be promptly examined potentially including histological examinations of biopsies. The use of hydrochlorothiazide may also need to be reconsidered in patients who have experienced previous NMSC.