Thiazide diuretic prescription and electrolyte abnormalities in primary care

Br J Clin Pharmacol. 2006 Jan;61(1):87-95. doi: 10.1111/j.1365-2125.2005.02531.x.


Aims: Thiazide diuretics have a number of well-documented metabolic adverse effects. The aim of this study was to estimate the frequency of hyponatraemia and hypokalaemia amongst patients taking a thiazide diuretic in primary care.

Methods: A computerized search of the electronic prescribing and laboratory records of six UK general practices was performed. Of the 32 218 adult patients identified, 3773 had received at least one prescription for a thiazide between the years 1990 and 2002.

Results: Detailed prescribing data were available for 2942 patients of whom 951 (32.3%) had a recorded check of their electrolytes. One hundred and ninety-six (20.6%) had a sodium and/or potassium concentration below the normal range. The sodium distribution had a negative skew (-1.8) and in 130 (13.7%) patients was within the hyponatraemic range. Hypokalaemia was less common, occurring in 79 (8.5%) patients. Hyponatraemia was significantly associated with increased age; the odds ratio for developing hyponatraemia in patients over 70 years was 3.87 compared with those of < or = 70 years. Hypokalaemia was significantly associated with increased thiazide dose.

Conclusions: Prescription of a thiazide diuretic in primary care is associated with a high frequency of hyponatraemia and hypokalaemia. Thiazides should be prescribed at low dose and the risk of hyponatraemia, especially in the elderly, should be considered and monitored for when prescribing these agents.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Bendroflumethiazide / adverse effects
  • Cross-Sectional Studies
  • Family Practice
  • Female
  • Humans
  • Hypokalemia / chemically induced*
  • Hypokalemia / metabolism
  • Hyponatremia / chemically induced*
  • Hyponatremia / metabolism
  • Male
  • Middle Aged
  • Odds Ratio
  • Potassium / blood
  • Potassium / metabolism
  • Sex Factors
  • Sodium / blood
  • Sodium / metabolism
  • Sodium Chloride Symporter Inhibitors / adverse effects*


  • Sodium Chloride Symporter Inhibitors
  • Bendroflumethiazide
  • Sodium
  • Potassium