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thiazide diuretic
Increases the elimination of water and salt by the kidneys and lowers blood pressure. This molecule appears in 5 of the medicines we have indexed.
We do not make a formula for this treatment. Talk to your doctor or pharmacist about this active ingredient.
See the detailsBy the Layer Nutrition editorial teamHow the atlas classifies the 664 molecules
Pharmacologically, this molecule belongs to the “thiazide diuretic (antihypertensive)” category. Diuretics help the kidneys eliminate water and salt, which lowers blood pressure and relieves edema.
In practice: Increases the elimination of water and salt by the kidneys and lowers blood pressure. It is generally taken over the long term, with regular follow-up, and it is not stopped on one’s own initiative.
These names come from the public registers of 32 countries: the ANSM for France, the AEMPS for Spain, the AIFA for Italy, the HPRA for Ireland, Swissmedic for Switzerland, and the European Medicines Agency for the others.
Most widespread
The atlas gives each molecule one of these three answers. Most call for nothing.
Diuretics can lower blood magnesium. Diet is the first lever for getting it, and the easiest to keep up day after day. Potassium, for its part, is monitored by blood test and managed with your doctor.
Magnesium comes mainly from leafy green vegetables such as spinach, nuts such as almonds and walnuts, pumpkin seeds, pulses, whole grains and dark chocolate. Spreading them across your meals covers a good share of your needs, on top of your treatment.
Altizide is a thiazide diuretic. It acts in the kidney, at the distal convoluted tubule of the nephron, where it blocks the sodium-chloride cotransporter, also called the Na-Cl symporter or NCC protein (SLC12A3 gene). This transporter is the main gateway for sodium at this point in the tubule. By blocking it, altizide prevents the reabsorption of sodium and chloride.
The sodium and chloride thus retained in the tubule draw water along with them: the elimination of salt and water in the urine increases. Blood volume falls, and blood pressure drops. Its chemical formula is C11H14ClN3O4S3 and its common name is althiazide.
Altizide is not marketed on its own: it exists only as a fixed combination with spironolactone, notably under the name Aldactazine. Spironolactone is a mineralocorticoid receptor antagonist, in other words an antialdosterone agent. It counters the action of aldosterone on the distal tubule and the collecting duct, which spares potassium.
The combination follows an electrolyte logic. The thiazide causes potassium loss, while spironolactone retains it: the fall in blood potassium caused by the diuretic alone is thereby limited. The two molecules also have complementary durations of action: spironolactone has a short half-life, about 1.4 hours, but its effect is prolonged by active metabolites, including canrenone, whose half-life reaches about 16.5 hours.
Thiazide diuretics such as altizide are prescribed first and foremost for high blood pressure. By lowering blood volume, then reducing the pressure the blood exerts on the artery walls, they bring blood pressure down to lower values.
They are also used to treat oedema, these accumulations of water in the tissues linked to heart failure, cirrhosis of the liver or kidney disease. By increasing the elimination of salt and water, the diuretic helps to clear this retention. Adding spironolactone then combines two actions on the kidney while sparing potassium.
A thiazide diuretic is taken in the morning, with food. Since it makes you urinate more, taking it in the morning avoids waking at night to go to the toilet. The half-life of thiazides varies from one molecule to another, from a few hours to about fifteen hours (for example 5.6 to 14.8 hours for hydrochlorothiazide), which justifies once-daily dosing.
Regularity comes first: the treatment is taken every day, preferably at a fixed time, to maintain a stable blood pressure. You do not stop it on your own initiative, even if blood pressure seems to have returned to normal, because hypertension comes back once it is stopped. Any change in dose is decided with the doctor, based on blood pressure measurement and blood tests.
The thiazide side alters the electrolytes in the blood. The most common effect is hypokalaemia, a fall in blood potassium; there may also be hyponatraemia (a fall in sodium), hypomagnesaemia (a fall in magnesium), hyperuricaemia that can trigger a gout attack, hypercalcaemia and hyperglycaemia. Hypokalaemia results from two mechanisms: inhibition of the Na-Cl cotransporter and stimulation of aldosterone, which activates the Na+/K+-ATPase pump of the collecting duct and drives potassium into the urine. Unlike many medicines, the thiazide reduces the urinary elimination of calcium: it retains calcium rather than demineralising.
The spironolactone side has other effects. The most characteristic is hyperkalaemia, a rise in potassium: among treated cardiac patients, 10 to 15% develop one, and 6% a severe form. Since spironolactone also acts on androgen and progestogen receptors, it can cause gynaecomastia in men, a dose-dependent development of breast tissue: in the RALES trial, at 25 mg per day, it occurred in 9.1% of men compared with 1.3% on placebo. In women, it can lead to menstrual disturbances and breast tenderness.
Several medicines interact with this treatment. Thiazides reduce the renal elimination of lithium and increase the risk of toxicity: the combination is not advised. They also decrease the elimination of uric acid, with which they compete on the same transporter, which explains the hyperuricaemia. The hypokalaemia they cause increases the heart’s sensitivity to digitalis and can promote serious arrhythmias. NSAIDs and salicylates such as aspirin reduce the diuretic effect and increase the risk of acute kidney failure. Because of spironolactone, combining an ACE inhibitor, an ARB or a potassium supplement raises the risk of hyperkalaemia.
Monitoring relies on regular blood tests. They check blood sodium, blood potassium, blood uric acid, blood calcium and kidney function, because the treatment shifts these parameters. Blood potassium requires particular attention: the thiazide tends to lower it, spironolactone to raise it, and other medicines such as beta-blockers, ACE inhibitors and ARBs can worsen hyperkalaemia. Finally, thiazides are contraindicated in cases of anuria, the absence of urine output, and of allergy to sulphonamides, because they contain a sulphonamide group.
Beyond the plate, a single isolated nutrient can be worth discussing, to confirm with your doctor or pharmacist. Here is which one and in which form.
Magnesium is a mineral involved in many enzymatic reactions. Supplements differ mainly by their salt: organic forms such as bisglycinate and citrate are better tolerated digestively and better absorbed than oxide.
Preferred formbisglycinate or citrate rather than oxide
To be confirmed with your doctor or pharmacist.
Type the name written on the box. The atlas gives you its answer.
For example Panadol, Doliprane or paracetamol.
Altizide is a thiazide diuretic prescribed for high blood pressure and certain types of oedema. In France it is almost always combined with spironolactone, a potassium-sparing diuretic, within a single medicine. For the indication that applies to you, refer to the package leaflet and to your doctor or pharmacist.
The package leaflet notably lists imbalances in water and in mineral salts such as sodium and potassium, dizziness or a drop in blood pressure. The effects experienced vary from one person to another. Read the full package leaflet and report any symptom to your doctor or pharmacist.
Thiazide diuretics can lower blood potassium, but combining them with spironolactone is designed to limit that loss, and may instead raise it. Monitoring your blood potassium is your doctor’s responsibility. Do not change anything on your own.
Diuretics are generally not recommended during pregnancy, and the package leaflet states this. Only your doctor can assess your situation. Report any current or planned pregnancy, as well as breastfeeding.
The package leaflet flags interactions, notably with lithium, certain anti-inflammatory drugs and potassium intake, and alcohol can worsen the drop in blood pressure. Give your pharmacist the list of your treatments and read the interactions section of the package leaflet.
Research links thiazide diuretics to a fall in blood magnesium and to increased urinary loss of this mineral. The active substance to consider is magnesium, preferably in a well-tolerated, well-absorbed form such as bisglycinate. Potassium, on the other hand, is not something to supplement freely here: combining altizide with spironolactone can raise it, so any blood test and any supplementation are decided together with your doctor.
These answers draw on the patient leaflet and on the published literature. For any question about your medicine, the patient leaflet and your doctor or pharmacist are the reference.
We will write to you the day your formula becomes available.