Hydrochlorothiazide has possible interactions with alcohol, other drugs, and certain supplements. Examples include other blood pressure drugs and nonsteroidal anti-inflammatory drugs (NSAIDs). Talk with your doctor to avoid potentially harmful effects from hydrochlorothiazide interactions.
Hydrochlorothiazide oral tablet is a generic drug prescribed for high blood pressure and certain types of edema (swelling caused by fluid retention) in adults and children.
Hydrochlorothiazide (also known as HCTZ) is not available in a brand-name version.
An interaction occurs when one substance causes another substance to have a different effect than expected.
Hydrochlorothiazide comes in different forms, and they have the same interactions. The forms are:
- oral tablets
- oral capsules
This article will focus on interactions for the oral tablet form of hydrochlorothiazide.
By learning about possible hydrochlorothiazide interactions, you can work with your doctor to ensure that hydrochlorothiazide will be safe and effective for you to take. For additional information about hydrochlorothiazide, including details about its uses, see this hydrochlorothiazide overview article.
Before you start treatment with hydrochlorothiazide, tell your doctor and pharmacist about any prescription, over-the-counter (OTC), and other medications you take. By sharing this information with them, you may help prevent possible interactions.
To learn whether hydrochlorothiazide interacts with supplements, herbs, or vitamins, see the “Hydrochlorothiazide and other interactions” section.
If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.
Here’s a table of drugs that can interact with hydrochlorothiazide. Keep in mind that this table doesn’t include all drugs that may interact with hydrochlorothiazide. Some of these interactions are described in detail in “Drug interactions in depth.”
| Drug class or drug name | Drug examples | Interaction result with hydrochlorothiazide |
|---|---|---|
| barbiturates | • phenobarbital • secobarbital | can increase the risk of orthostatic hypotension (a drop in blood pressure when changing positions) |
| opioids | • morphine (MS Contin, others) • oxycodone /acetaminophen (Percocet) | can increase the risk of orthostatic hypotension and make hydrochlorothiazide less effective |
| diabetes medications | • insulin degludec (Tresiba) • glimepiride (Amaryl) | can make the diabetes drug less effective |
| other blood pressure drugs | • lisinopril (Zestril, others) • losartan (Cozaar) | may increase the risk of low blood pressure |
| certain cholesterol-lowering drugs | • cholestyramine (Prevalite) • colestipol (Colestid) | can make hydrochlorothiazide less effective |
| corticosteroids | • prednisone • methylprednisolone (Medrol) | can increase your risk of side effects from both drugs |
| nonsteroidal anti-inflammatory drugs (NSAIDs) | • ibuprofen (Motrin, Advil) • naproxen (Aleve, Naprosyn) | can make hydrochlorothiazide less effective and increase the risk of side effects from both drugs |
| certain adrenergic drugs | • norepinephrine • epinephrine | can make the adrenergic drug less effective |
| lithium (Lithobid) | — | can increase the risk of side effects of lithium |
In some cases, factors or conditions could prevent your doctor from prescribing hydrochlorothiazide due to the risk of harm. These are known as contraindications. Below are the contraindications of hydrochlorothiazide.
Note: Before you start treatment with hydrochlorothiazide, it’s important to tell your doctor if these contraindications apply to you. They can determine whether to prescribe the drug.
Having anuria
Doctors typically will not prescribe hydrochlorothiazide for people with anuria (a condition in which your body makes very little or no urine). This is because hydrochlorothiazide works by clearing excess salt and water from your body through your urine. If your body cannot produce urine, hydrochlorothiazide may not work properly. Hydrochlorothiazide may also worsen your condition.
If you have anuria, talk with your doctor before taking hydrochlorothiazide. They’ll likely prescribe a treatment other than hydrochlorothiazide for your condition.
Having had an allergic reaction to hydrochlorothiazide or any of its ingredients
If you have had an allergic reaction to hydrochlorothiazide, any of its ingredients, or drugs with sulfonamide, your doctor will likely not prescribe hydrochlorothiazide. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.
Your doctor will likely recommend that you do not drink alcohol while taking hydrochlorothiazide. They’ll also usually advise you not to take any prescription or OTC drugs that contain alcohol during hydrochlorothiazide treatment.
Consuming alcohol and taking hydrochlorothiazide (which is prescribed to reduce blood pressure) may cause your blood pressure to drop too low. This can lead to dizziness, falls, and fainting.
If you have concerns about avoiding alcohol while you’re taking hydrochlorothiazide, talk with your doctor before starting treatment.
Here’s a closer look at certain drug interactions of hydrochlorothiazide tablet.
Diabetes medications
Taking hydrochlorothiazide with diabetes medications can make the diabetes drugs less effective. This is because hydrochlorothiazide can increase your blood sugar level. (Diabetes drugs are used to lower your blood sugar level.)
Here are some diabetes drugs that may interact with hydrochlorothiazide:
Steps you or your doctor may take
Before starting hydrochlorothiazide, tell your doctor if you take diabetes drugs. They may adjust the dosage of your diabetes medication. They’ll also likely monitor your blood sugar levels closely.
Opioids
Taking hydrochlorothiazide with opioids can increase the risk of orthostatic hypotension. This is because both drugs can cause low blood pressure. Therefore, you may be more likely to experience this side effect if you combine hydrochlorothiazide and opioids.
Taking these drugs together may also make hydrochlorothiazide less effective. This is because opioids cause the release of antidiuretic hormone, a hormone that tells your body to hold on to more fluid (salt and water). Hydrochlorothiazide works by clearing excess fluid from your body through your urine. So combining these medications can reduce the effect of hydrochlorothiazide on your fluid level.
Here are some opioids that may interact with hydrochlorothiazide:
- oxycodone/acetaminophen (Percocet)
- oxycodone (Oxycontin, others)
- codeine
- morphine (MS Contin, others)
Steps you or your doctor may take
Let your doctor know if you take opioids. They can help determine whether it’s safe for you to combine hydrochlorothiazide and an opioid. If you’re taking these drugs together, your doctor may monitor your blood pressure more closely.
NSAIDs
NSAIDs, such as ibuprofen and naproxen, may interfere with how well hydrochlorothiazide works. Specifically, NSAIDs can reduce the drug’s ability to remove extra fluid from your body and lower your blood pressure. This may make hydrochlorothiazide less effective at treating high blood pressure or swelling.
Combining an NSAID and hydrochlorothiazide may also increase your risk of kidney problems. Because kidney problems are a possible side effect of either drug, taking them together can raise your risk of this side effect.
Here are some NSAIDs that may interact with hydrochlorothiazide:
Steps you or your doctor may take
If you’re taking hydrochlorothiazide, ask your doctor or pharmacist before taking an NSAID. They can help determine whether the drugs are safe to combine.
If you need to take an NSAID while taking hydrochlorothiazide, talk with your doctor about how to monitor your blood pressure and kidney function. For instance, your doctor may order kidney function tests if you take these medications together.
Hydrochlorothiazide may have other interactions, such as with supplements, foods, vaccines, or lab tests.
Here are some potential interactions with hydrochlorothiazide. Keep in mind that the following information does not include all other possible hydrochlorothiazide interactions.
Hydrochlorothiazide interactions with supplements
Before you start treatment with hydrochlorothiazide, tell your doctor and pharmacist about any supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.
Hydrochlorothiazide may interact with fish oil and omega-3 fatty acid supplements. These supplements are believed to help prevent heart disease and support brain and eye health. However, they may also lower blood pressure. As a result, combining them with hydrochlorothiazide may increase your risk of low blood pressure.
If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.
Hydrochlorothiazide interactions with herbs
There are no specific reports of herbs interacting with hydrochlorothiazide. However, that doesn’t mean herbal interactions won’t occur or be recognized in the future. Because of this, it’s important to check with your doctor or pharmacist before taking any of these products during hydrochlorothiazide treatment.
Hydrochlorothiazide interactions with vitamins and minerals
Calcium and vitamin D may interact with hydrochlorothiazide. Combining either of these products with hydrochlorothiazide could increase your risk of hypercalcemia (high blood calcium levels).
If you take hydrochlorothiazide, your doctor may advise you to take a lower dose of calcium or vitamin D.
Before you start treatment with hydrochlorothiazide, tell your doctor and pharmacist about any vitamins or minerals you take. They can advise you on whether hydrochlorothiazide may interact with any of them.
Hydrochlorothiazide interactions with food
There were no reports of food interactions with hydrochlorothiazide. If you have questions about eating certain foods or what foods to avoid with hydrochlorothiazide, talk with your doctor.
Hydrochlorothiazide interactions with vaccines
There aren’t any known interactions between hydrochlorothiazide and vaccines. Talk with your doctor or pharmacist to check whether you’re due for any vaccines.
Hydrochlorothiazide interactions with lab tests
Hydrochlorothiazide may interfere with the results of certain lab tests, such as tests for parathyroid function. Taking the medication can increase your blood calcium levels. High calcium levels may be a sign of hyperparathyroidism (a condition in which your parathyroid glands make too much parathyroid hormone). So taking this drug can make it seem like you have hyperparathyroidism even if you do not.
Because of this, it’s important to tell the person giving you the test that you’re taking hydrochlorothiazide.
For additional information, talk with your doctor.
HYDROCHLOROTHIAZIDE INTERACTION WITH CANNABIS OR CBDCannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with hydrochlorothiazide tablet. However, as with any drug or supplement, talk with your doctor before using cannabis in combination with hydrochlorothiazide. The impact of cannabis may affect how well you stick to your hydrochlorothiazide treatment plan.
Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.
Certain medical conditions and other factors may increase the risk of interactions with hydrochlorothiazide. Before you take this drug, be sure to talk with your doctor about your health history. Hydrochlorothiazide may not be the right treatment option if you have certain medical conditions or other factors affecting your health.
Health conditions or factors that might interact with hydrochlorothiazide include:
- Diabetes: Hydrochlorothiazide can increase your blood sugar levels. If you have diabetes, this can worsen your condition. Tell your doctor if you have diabetes before starting hydrochlorothiazide. They may monitor your blood sugar levels more closely once you start hydrochlorothiazide treatment.
- Gout: Hydrochlorothiazide can increase the uric acid levels in your blood. If you have gout, this may worsen your condition. Let your doctor know if you have gout before taking hydrochlorothiazide. They can discuss whether it’s safe for you to take this drug.
- Liver problems: If you have liver problems, taking hydrochlorothiazide may increase your risk of electrolyte problems. Tell your doctor if you have liver problems before you start hydrochlorothiazide. They’ll determine whether the drug is safe for you to take.
- Kidney problems: Your kidneys help clear hydrochlorothiazide from your body. If you have kidney problems, you may not be able to clear the drug as usual. This can cause hydrochlorothiazide to build up in your body, increasing your risk of the drug’s side effects. Hydrochlorothiazide can also worsen kidney problems. Tell your doctor if you have kidney problems. They can help determine whether the drug is safe for you.
- Lupus: Hydrochlorothiazide can cause lupus flare-ups (a worsening of lupus symptoms). If you have lupus, tell your doctor before starting treatment. They may prescribe a different medication instead.
- Allergic reaction: If you’ve had an allergic reaction to hydrochlorothiazide, any of its ingredients, or drugs with sulfonamides, your doctor will likely not prescribe hydrochlorothiazide. Taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be a better option for you.
- Breastfeeding: It’s usually not recommended to take hydrochlorothiazide while breastfeeding. The drug passes into breast milk and can cause side effects in a child who is breastfed. If you’re breastfeeding or planning to, talk with your doctor before taking hydrochlorothiazide. They can talk with you about treatment options and ways to feed a child other than breastfeeding.
- Pregnancy: There haven’t been enough clinical trials to determine whether hydrochlorothiazide is safe to take while pregnant. If you’re pregnant or planning to become pregnant, tell your doctor before starting hydrochlorothiazide. They can advise you on the right treatment plan for you.
Here are some frequently asked questions about hydrochlorothiazide tablet and possible interactions.
Can I drink coffee with hydrochlorothiazide?
Maybe. There are no known interactions between coffee and hydrochlorothiazide. However, caffeine may increase blood pressure by narrowing your blood vessels. Hydrochlorothiazide is sometimes used to treat high blood pressure. As a result, drinking coffee may counteract the drug’s effect on lowering your blood pressure.
Additionally, coffee can have diuretic effects. (Diuretics are substances that increase the amount of urine your body makes.) Because hydrochlorothiazide is also a diuretic, consuming coffee with the drug might increase the risk of dehydration.
If you have concerns about drinking coffee with hydrochlorothiazide, talk with your doctor or pharmacist.
Is hydrochlorothiazide safe to take with acetaminophen (Tylenol)?
In most cases, yes. There are no known interactions between acetaminophen and hydrochlorothiazide.
However, sometimes acetaminophen is used in a combination product, such as Tylenol 3 (acetaminophen/codeine) or Percocet (oxycodone/acetaminophen). In these cases, acetaminophen is combined with an opioid. Opioids and hydrochlorothiazide can interact.
Taking these drugs together can increase your risk of low blood pressure and make hydrochlorothiazide less effective. For details about this interaction, see the “Drug interactions in depth” section.
Before starting any new medications with hydrochlorothiazide, talk with your doctor or pharmacist about potential interactions.
You can take certain steps to help prevent interactions with hydrochlorothiazide. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:
- Let them know if you drink alcohol or use cannabis.
- Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
- Create a
medication list , which your doctor and pharmacist can help you fill out.
It’s also important to read the hydrochlorothiazide label and other
If hydrochlorothiazide doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.
You can also help prevent interactions with hydrochlorothiazide by taking it exactly as your doctor prescribes.
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.