Pharmacotherapy Newsletter

Volume 2, Issue 17, 04/27/2010

Question

How does the diuretic, hydrochlorothiazide (HCTZ), increase uric acid levels thereby increasing the risk for hyperuricemia or acute gout exacerbation in some patients?

Answer

Hydrochlorothiazide (HCTZ) is a thiazide diuretic that, at least initially, exerts its antihypertensive effect by inhibiting the Na⁺-Cl^- cotransporter on the luminal (apical) side of the distal tubule in the kidney.¹  Numerous clinical trials and practice guidelines support the use of thiazide diuretics as first line or add-on therapy for hypertension in a broad range of patients.^2,3  In addition to its demonstrated benefit, HCTZ is well tolerated and contraindications or warnings against its use are few.  As such, HCTZ remains one of the most widely prescribed antihypertensives available in the United States.  One clinical scenario in which the use of HCTZ must be carefully considered is the patient with hyperuricemia or gout.

What is the mechanism by which HCTZ impairs uric acid excretion?
Serum uric acid concentration is largely controlled by... 

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