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Hydrochlorothiazide alternatives: What can I take instead of hydrochlorothiazide?

Hydrochlorothiazide doesn't work for everyone. Zestril, Diovan, Norvasc, Lasix, and Aldactone are some hydrochlorothiazide alternatives. Get the full list here.
By | Sep. 16, 2022
Rx pills: Top hydrochlorothiazide alternatives and how to switch your Rx

Key takeaways

  • Hydrochlorothiazide, though effective for hypertension and edema, can cause adverse effects such as frequent urination and electrolyte imbalance, leading patients to seek alternatives.

  • Alternatives to hydrochlorothiazide include ACE inhibitors like Zestril, ARBs like Diovan, calcium channel blockers like Norvasc, and diuretics such as Lasix or Aldactone, each with its own mechanism of action and side effect profile.

  • Natural alternatives and lifestyle adjustments, including the DASH diet, weight loss, and exercise, can also help manage hypertension and edema, though they may not entirely replace medication.

  • Consulting with a healthcare provider is crucial when considering switching from hydrochlorothiazide to an alternative medication or treatment plan to ensure the new approach suits the patient’s health needs and medical history.

Compare hydrochlorothiazide alternatives | Zestril | Diovan | Norvasc | Lasix | Aldactone | Natural alternatives | How to switch meds

Whether you are taking hydrochlorothiazide to lower your blood pressure or lessen leg swelling, you probably recognize its important role in your health. Unfortunately, you may also be noticing some of the downsides to hydrochlorothiazide therapy. Frequent urination, electrolyte imbalance, sun sensitivity, and muscle cramps are among the potential adverse effects of hydrochlorothiazide. A side effect or ineffectiveness are the most likely reasons for seeking an alternative, because the cost of this generic drug is usually quite low. You should know that there are plenty of other options that could avoid the same side effects and still be kind to your wallet.

What can I take in place of hydrochlorothiazide?

Hydrochlorothiazide, better known as HCTZ, is a thiazide diuretic or water pill. It inhibits reabsorption of sodium in the kidney, thereby allowing more sodium and water loss in the urine. The drug’s effectiveness has led to two indications for use from the Food and Drug Administration (FDA). HCTZ can be taken for hypertension (high blood pressure) or peripheral edema, which is most commonly experienced as lower leg swelling. If you have a contraindication to its use or if you are experiencing an adverse effect, either medical condition can be treated with alternatives to HCTZ. A member of the loop or potassium-sparing diuretic classes could help with peripheral edema. Hypertension could be treated with a multitude of different classes of antihypertensives, including diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers, and beta blockers.

Compare hydrochlorothiazide alternatives
Drug name Uses Dosage Coupons
Hydrochlorothiazide (HCTZ) Hypertension, peripheral edema (swelling) 12.5 to 50 mg once daily (higher doses up to 200 mg may used for edema) Get hydrochlorothiazide coupons
Zestril (lisinopril) Hypertension, CHF with low EF, acute MI 2.5 to 40 mg once daily Get Zestril coupons
Vasotec (enalapril) Hypertension, CHF with low EF, systolic dysfunction (reduced heart squeeze) without symptoms 2.5 to 20 mg once or twice daily Get Vasotec coupons
Lotensin (benazepril) Hypertension 5 to 40 mg once or twice daily Get Lotensin coupons
Zestoretic (combination lisinopril/hydrochlorothiazide) Hypertension 10 mg/12.5 mg, 20 mg/12.5 mg, or 20 mg/25 mg once daily Get Zestoretic coupons
Cozaar (losartan) Hypertension, diabetic nephropathy, stroke prevention 25 to 100 mg once daily Get Cozaar coupons
Diovan (valsartan) Hypertension, CHF with low EF, left ventricular dysfunction (reduced heart squeeze) after MI 80 to 320 mg once daily (or divided into two doses) Get Diovan coupons
Avapro (irbesartan) Hypertension, diabetic nephropathy 75 to 150 mg once daily Get Avapro coupons
Norvasc (amlodipine) Hypertension, coronary artery disease (CAD) 2.5 to 10 mg once daily Get Norvasc coupons
Lotrel (combination amlodipine/benazepril) Hypertension 2.5 mg/10 mg, 5 mg/10 mg, 5 mg/20 mg, 5 mg/40 mg, 10 mg/20 mg, or 10 mg/40 mg once daily Get Lotrel coupons
Cardizem CD (diltiazem extended release) Hypertension, angina 120 to 480 mg once daily Get Cardizem CD coupons
Toprol XL (metoprolol extended release) Hypertension, angina, CHF with low EF 25 to 400 mg once daily Get Toprol XL coupons
Coreg (carvedilol) Hypertension, CHF with low EF, left ventricular dysfunction after MI 3.125 to 25 mg twice daily Get Coreg coupons
Aldactone (spironolactone) Hypertension, CHF with low EF, edema, primary hyperaldosteronism (excess aldosterone from adrenal glands) 12.5 to 100 mg once daily for hypertension (or up to 200 to 400 mg daily for some indications) Get aldactone coupons
Lasix (furosemide) Hypertension, edema 10 to 40 mg twice daily for hypertension (or up to 600 mg per day for edema) Get Lasix coupons
Hydralazine Hypertension 10 to 50 mg four times daily Get hydralazine coupons
Cardura (doxazosin) Hypertension, benign prostatic hypertrophy (BPH, enlarged prostate) 1 to 16 mg once daily (or maximum of 8 mg for BPH) Get Cardura coupons

Other alternatives to hydrochlorothiazide

Top 5 hydrochlorothiazide alternatives

1. Zestril (lisinopril)

Zestril is an ACE inhibitor, as is Lotensin, Vasotec, quinapril, Altace, fosinopril, perindopril, and captopril. ACE inhibitors are a first-line choice for hypertension, particularly for those with diabetes mellitus. The members of the class are often low-priced generics that can be obtained at a cost similar to HCTZ. Get a SingleCare discount card for more savings at your local pharmacy. Lisinopril and benazepril can both be taken once daily, so they match the convenience of HCTZ. While they can help you avoid the urinary frequency and hypokalemia (low potassium) associated with thiazide diuretics, ACE inhibitors can cause hyperkalemia (high potassium) as well as cough and angioedema (sudden swelling of the lips or other body parts). 

Hypertension often requires more than one drug class, so combination pills are a nice option to combine multiple mechanisms in a single tablet. Concurrent use of ACE inhibitors and HCTZ produces a synergistic effect to more effectively lower blood pressure than either category could do alone. In other words, Zestoretic (lisinopril with HCTZ) could get your blood pressure down to goal if HCTZ and Zestril have failed individually.

2. Diovan (valsartan)

The ARB drug class includes Diovan. Cozaar, Benicar, Avapro, and Atacand. Like ACE inhibitors, they limit the blood pressure-raising effects of angiotensin II and have similar cardiovascular and renal benefits in aiding in the prevention of heart attacks and kidney disease. ARBs avoid the dry, tickling cough side effect that afflicts up to 35% of those taking ACE inhibitors, and they do not cause the urinary frequency and hypokalemia of HCTZ. The convenience of once daily dosing is another positive for Diovan. You may also like the sound of convenient combinations like Diovan HCT (with HCTZ), Exforge (with amlodipine), and Exforge HCT (with both HCTZ and amlodipine).

Either an ACE inhibitor like Zestril or an ARB like Diovan could be a good option to substitute for HCTZ if side effects are the issue. In addition, either could be a worthy substitute for or an add-on to HCTZ if the thiazide’s actions alone are insufficient to lower blood pressure in hypertensive patients.

3. Norvasc (amlodipine)

Norvasc is another great alternative to HCTZ for hypertension treatment. It is a dihydropyridine calcium channel blocker, like Nifedical XL, Felodipine XR, and isradipine. These drugs do not cause hypokalemia and, unlike HCTZ, ACE inhibitors, and ARBs, the calcium channel blockers do not alter renal function tests. They also avoid the increased risk of bradycardia (slow heartbeat) carried by beta blockers, like Toprol XL, and non-dihydropyridine calcium channel blockers, such as Cardizem CD. While all of this may sound great, you need to know that one of amlodipine’s common adverse effects is peripheral edema, so that experience could be a drastic change from HCTZ, which functions as a diuretic to limit edema.

4. Lasix (furosemide)

If you need to find another option for treating peripheral edema, then you may want to look outside the thiazide diuretic class. If HCTZ or a thiazide-like diuretic, such as chlorthalidone or indapamide, are not resolving your swelling, Lasix could be what you are looking for. Loop diuretics, like Lasix, bumetanide, and torsemide, increase sodium and fluid loss in the urine via a different mechanism, one that is much more potent than HCTZ. The result is more fluid loss and less edema. This makes brand name Lasix a more popular option than HCTZ for peripheral edema from causes such as congestive heart failure and cirrhosis. With more potency from Lasix may come more side effects; you may not like the more noticeably increased urination and potential dizziness.

5. Aldactone (spironolactone)

Aldactone provides a whole different diuretic action than HCTZ and Lasix for the treatment of edema or hypertension. Aldactone is categorized as a potassium-sparing diuretic, in the same group as amiloride, triamterene, and Inspra. By blocking aldosterone receptors in the kidney, Aldactone promotes sodium and fluid loss in the urine. The drug can be particularly helpful as an add-on to loop diuretics for congestive heart failure and cirrhosis. It has some advantages over HCTZ, namely it avoids hypokalemia. Unfortunately, Aldactone can make potassium levels rise too far, leading to hyperkalemia, which is more likely in those with kidney problems. It also has hormonal side effects that can lead to menstrual irregularity in women and gynecomastia (breast growth) in men. These potential adverse effects are a clear example of why it is important to consider all aspects when contemplating a change to your medication.

Natural alternatives to hydrochlorothiazide

There are many natural options that should also be considered when looking for hydrochlorothiazide alternatives.   Garlic, celery, ginseng, and black cumin are some dietary supplements that have been used for hypertension, and watermelon and other foods may have a diuretic effect. These foods typically do not have the proof of a clinical trial to support their use, and you may find that general dietary changes are safer and more impactful. The Dietary Approaches to Stop Hypertension (DASH) diet is a proven option to lower blood pressure. In addition, the DASH diet also aids in lowering cholesterol levels, which combined with high blood pressure is a risk factor that can lead to heart disease and stroke. Another component of the DASH diet is the intake of  low sodium.  This adjustment could pay off with both lower blood pressure and less edema. Weight loss and exercise can also be helpful. At least initially, these actions may not replace HCTZ, but they are worthy choices at least, and ideally, they could provide a foundation for better long term health.

How to switch to a hydrochlorothiazide alternative

Deciding to make a major dietary change or an adjustment to your medical regimen should not be done alone. Bring your healthcare provider into the conversation. Their medical advice will prove quite valuable. Talk to them about why you are interested in an alternative to hydrochlorothiazide and discuss the treatment options listed above that interest you. By listening to your input and reviewing your health history and list of other prescription drugs and over-the-counter medications, a healthcare professional can guide you to a decision that best suits your needs.