Talk:Thiazide

Wiki Education Foundation-supported course assignment
This article was the subject of a Wiki Education Foundation-supported course assignment, between 8 July 2019 and 3 August 2019. Further details are available on the course page. Student editor(s): DrCupino. Peer reviewers: Hbultra.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 11:17, 17 January 2022 (UTC)

Thiazides in Chronic Kidney Disease
Thiazide are recommended in patients with hypertension & Chronic kidney disease when GFR >= 30 ml/min (Stages 1-3) according to the National Kidney Foundation KDOQI Guidelines. — Preceding unsigned comment added by Regarr (talk • contribs) 23:13, 28 January 2016 (UTC)

Thiazides raise homocysteine levels, cite specifics for folate supplementation
The article says that thiazides raise homocysteine levels (for which there is reasonable evidence), and goes on to say "It is recommended that patients receiving long-term thiazide treatments also receive folic acid supplements to combat the risk" without any citation. I can't find any source for this in treatment guidelines, drug labelling, or a couple of pharmacology reference books. Recommendations would probably differ by country according to how much folate fortification was in ordinary foods. 216.254.24.205 19:14, 4 July 2007 (UTC)

hyponatremia
i read it quickly but i don't think the hyponatremia effect from taking thiazides was explained. Please add this information. -- lose ability to dilute urine. —Preceding unsigned comment added by Tkjazzer (talk • contribs) 06:58, 11 October 2007 (UTC)

Thiazide-induced diabetes
This article cites a new issue of Hypertension (journal), specifically LeadSongDog (talk) 20:50, 25 November 2008 (UTC)

I would add this to the main article in my opinion. 78.133.21.188 (talk) 13:32, 29 January 2011 (UTC)

allergy
can you have sulfa allergy to this? shouldn't each drug have an allergy sub-section. thanks. —Preceding unsigned comment added by 207.151.243.70 (talk) 23:42, 13 December 2008 (UTC)

hypokalemia???
as far as I know there is the exact opposite SE- hyperkalemia. Am I wrong? —Preceding unsigned comment added by Yonigros (talk • contribs) 06:18, 3 April 2009 (UTC)


 * Not unless you wreck the renal function somewhere along the way. JFW | T@lk  22:30, 9 November 2009 (UTC)

Moser
http://archinte.ama-assn.org/cgi/content/full/169/20/1851 - review by Marvin Moser, historical. JFW | T@lk  22:30, 9 November 2009 (UTC)

Efficacy in reducing cardiovascular diseases?
No mention of heart attacks or strokes. Imagine Reason (talk) 12:33, 7 December 2009 (UTC)
 * ? "The thiazides and thiazide-like diuretics reduce the risk of death, stroke, heart attack and heart failure due to hypertension, and, as of 2009, the best available evidence favors them as the first choice of treatment for high blood pressure when drugs are necessary." Fvasconcellos (t·c) 12:38, 7 December 2009 (UTC)

Article should mention how long thiazides typically take to become effective.
What is the expected response curve, in terms of results in the first days, weeks, etc.

Article should mention JNC7 "first line" recommendation.
The JNC7 "first line" recommendation should at least be mentioned. — Preceding unsigned comment added by 99.190.133.143 (talk) 21:48, 12 February 2012 (UTC)

Definition missing
I don't see a definition of what "thiazide" means. The lede describes qualities of it, but not what it actually is (is it a certain substructure, or biochemical target, or natural origin, or...?). DMacks (talk) 04:44, 19 December 2015 (UTC)

Proposed Workplan for Updates to Thiazide
This month the following updates to the thiazide page are under consideration, following the outline of Benzodiazepine. Comments and suggestions are welcome!

MEDICAL USES

done 1.1 Possible minor edits to Hypertension - rearrange guidelines section by region, break down long sentences to more readable form, summarized long quotes, moved mechanism of action information to MECHANISM OF ACTION section, now renamed PHARMACOLOGY

done 1.2 Reorganize the Other section to pull out and expand a new heading entitled Calcium balance in which hypocalcemia (low blood calcium, Idiopathic) and hypercalcenuria (high urine calcium, Idiopathic and Dent's disease) are more thoroughly discussed in the context of thiazides (First-level priority)

CONTRAINDICATIONS

2.1 Add a section for Renal disease and discuss the relationship of thiazides and prostaglandin, as well as the effect of diminished renal function on the efficacy of thiazides

ADVERSE EFFECTS

3.0 Move information about about mechanism from this section down into Pharmacology

3.1 Add a section for Sulfa allergy and discuss signs and symptoms of allergic reaction

3.2 Add a section for Lactating mothers that contains the information of Breast milk (see below)

INTERACTIONS (New Section)

4.0 Summarize interactions in an initial list

4.1 Add a section for Diabetes and discuss the Beta-blockers and thiazide diuretics (Third-level priority)

MECHANISM OF ACTION (Reworked into a section called PHARMACOLOGY)

1.0 Write an initial paragraph summarizing the use of thiazides to regulate water balance and electrolytes, especially calcium (Second-level priority)

5.1 Add a Pharmacodynamics section. Include a brief discussion of the speed of onset for various thiazide diuretics

5.2 Maybe add a Pharmacokinetics section. Include a table with a list of the thiazide diuretics

BREAST MILK (Moved into ADVERSE EFFECTS section)

done DENOMINATION (Moved into the lead paragraph)

HISTORY

6.0 Possibly expand this section to include additional drugs from this class — Preceding unsigned comment added by DrCupino (talk • contribs) 07:20, 11 July 2019 (UTC)

Peer review of thiazide 7/26/2019
Thank you to all the wikipedians who have contributed here thus far. Thanks for the work you've done as well, DrCupino. After reading the article and your proposed plan (based on this talk page), I think you're developing a stronger article. I think the additions of the pharmacokinetics, developing the diabetes discussion, and other suggestions will really round out this article and make it very comprehensive for medical professionals and patients. Thank you for such a thorough and well thought out plan.

Below please find my thoughts for specific improvement and some questions.

Lead: The main point is buried. I recommend restructuring the intro lead paragraph for more succinct clarity: Thiazides are medications that act as diuretics to treat hypertension. The indication, drug class, medical info are likely more releavant info to people than organic chemistry information


 * -The first mention of hypertension is in regards to how they are inexpensive all over the world.
 * The reader must make the leap from diuretics to hypertension, which probably not obvious to most people
 * History, organic chemistry, and naming confusion are probably best in a second paragraph, away from the information about primary indication and mechanism of action. This should improve clarity and organization.
 * The organic chem/compound information makes more sense in the second paragraph because it helps the reader understand the distinction from thiazide and thiazide like

Water Balance/Hypertension:
The intro paragraph about hypertension may be important for a reader to understand, but it may be best if it's linked to the internal wiki article instead of written out explicitly here. Why? Two reasons: one is that the HTN page will be updated if/when new research is published and the understanding of HTN causes, pathophys, or treatments develops because it will be closely and directly monitored for HTN science changes; secondly, an encyclopedic discussion of a HTN drug should focus on the drug more so than the disease it treats. I think it's appropriate to link to hypertension, but I think it doesn't add much to spell out HTN explicitly here. Second paragraph: "decades as a cornerstone..." this sentence reads not neutral, and difficult to verify. Decades as standard practice is not evidence for correctness or optimal treatment approach (consider any number of mainstay medical procedures that are by the wayside despite decades+ of use (ie surgery without anesthesia).

Good discussion about clinical guidelines globally; this paragraph is pretty well written and could be moved up in this section. It's important information. The discussion about thiazides vs low dose thiazides is not entirely clear and forces a reader to make some leaps. I think some people will get lost in the process, so a sentence explicitly stating the differences and why each would be used would benefit greatly.
 * Recommendation: World Health Organization's recommendations or inputs. Which diuretics are on the essential medicines list?

Water Balance/Diabetes Insipidous
When you click to read about DI, there is a paragraph describing thiazide's MOA for treating the disease. The discussion there, however, does not have any citations. I think the thiazide article would benefit from discussion about how thiazides accomplish a paradoxical increase in urine output.

Calcium Balance
urinary stones, second sentence has an unnecessary comma Dent's Disease, the use of a case study as a reference makes me pause. It may be worth linking to case study because most people may not understand the limitations of conclusions you can draw from n=2, n=7, etc. While it's addressed in the next sentence because Dent's is rare, the whole paragraph/section could be moved to the bottom of this list. More people suffer from osteoporosis than Dent's disease. recommendation: move to bottom of medical uses.

Other uses

 * Recommend removing capitalization of Loop diuretics --> loop diuretics
 * Add Hyperkalemia?

Adverse effects

 * hypokalemia -- long, wordy paragraph about a pathway. Got me thinking a picture of the pathway for the mechanism of action may help clarify things.

Mechanism of Action

 * Would benefit greatly from supplementation of a diagram, picture, or flow chart.

Breast Milk
Are all thiazides safe in pregnancy? Which ones? I think this section could be improved by expanding to discussion concerns for pregnant patients Consider linking to the association mentioned (wiki article about them or their external site).

Other thoughts and overall impressions

 * Consider adding a pictures of pathways to help people understand the physiology
 * Consider adding picture(s) of the more popularly prescribed drug (realizing there are many, this may not actually be helpful)
 * The organization of information in each paragraph could be reordered, and the strength of the article could be improved. If you're writing for people who take this drug or prescribe this drug, front load the pertinent info.
 * Include discussion about HTN treatment/management in pregnancy
 * May benefit by listing several trade/generic names of common thiazides for US or elsewhere
 * Consider adding World Health Organization references/discussion

Hbultra (talk) 19:27, 26 July 2019 (UTC)

This sentence: "Also, thiazides are preferred because they are less expensive than low-dose thiazides." is probably an error.
From Water Balance ( Hypertension ) referencing the Cochrane systematic review. It should be ... well I'd fix it if I had that figured out, but thiazides are not cheaper than thiazides. Cited source says, "No other drug class improved health outcomes better than low‐dose thiazides." and "High‐quality evidence supported that low‐dose thiazides should be used first for most patients with elevated blood pressure. Fortunately, thiazides are also very inexpensive." Oh, and finally, "First‐line low‐dose thiazides reduced all morbidity and mortality outcomes in adult patients with moderate to severe primary hypertension. First‐line ACE inhibitors and calcium channel blockers may be similarly effective, but the evidence was of lower quality. First‐line high‐dose thiazides and first‐line beta‐blockers were inferior to first‐line low‐dose thiazides." I think I will go delete the problem sentence as a quick fix. 108.26.17.17 (talk) 05:23, 15 September 2019 (UTC)