ADVERSE EFFECTS

The major adverse effects of thiazide diuretics include:

• Hypokalemia
  
• Hyponatremia. By inhibiting solute reabsorption in the distal nephron, thiazides prevent maximal urine dilution. In addition, significant fluid losses can trigger release of antidiuretic hormone (see Plate 3-17).
  
• Hypercalcemia
  
• Hypomagnesemia (with long-term use)
  
• Hyperuricemia, which may precipitate gout attacks
  
• Metabolic alkalosis, resulting from aldosterone release secondary to volume losses and, if hypokalemia is present, an increase in proximal tubular ammoniagenesis
  
• Impaired glucose tolerance or diabetes mellitus secondary to multiple mechanisms, including catecholamine release (secondary to activation of the sympathetic nervous system resulting from volume depletion), as well as reduced insulin secretion (secondary to hypokalemia)
  
• Hyperlipidemia, through mostly unknown mechanisms
  
• Nausea and vomiting
  
• Photosensitivity
  
• Erectile dysfunction