Adult: Alone or in combination with other antihypertensives: Initially, 2.5 mg once daily in the morning. Doses above 2.5 mg are rarely necessary. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines). Elderly: Dose reduction may be needed. Child: <12 years 0.05-0.1 mg/kg daily; ≥12 years 2.5 mg once daily. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines).
Oral Oedema
Adult: In cases associated with heart failure, nephrotic syndrome, liver cirrhosis: Initially, 5-10 mg once daily or on alternate days, in the morning. Maintenance dose: 2.5-10 mg 1-3 times weekly. Premenstrual oedema: 2.5 mg once daily for 7 days before the onset of menstruation. Dosage and treatment recommendations may vary among countries and between individual products (refer to specific product guidelines). Elderly: Dose reduction may be needed. Child: In cases associated with heart failure, nephrotic syndrome, liver cirrhosis: <12 years Initially, up to 0.4 mg/kg daily. Max: 10 mg daily. Maintenance: 0.05 to 0.1 mg/kg daily. Max: 10 mg daily; ≥12 years Same as adult dose. Dosage recommendations may vary among countries and between individual products (refer to specific product guidelines).
Renal Impairment
Severe: Contraindicated.
Hepatic Impairment
Severe: Contraindicated.
Administration
Bendroflumethiazide May be taken with or without food.
Contraindications
Hypersensitivity to sulfonamide-derived drugs, thiazide. Hypercalcaemia, refractory hypokalaemia, hyponatraemia, symptomatic hyperuricaemia, primary adrenal insufficiency (Addison's disease). Severe renal and hepatic impairment.
Special Precautions
Patient with diabetes mellitus, gout, hypercholesterolaemia, hypokalaemia, alcoholic cirrhosis, SLE, severe heart failure with oedema. Mild to moderate renal and hepatic impairment. Children and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Electrolyte disturbances (e.g. hypokalaemia, hypomagnesaemia, hypercalcaemia, hypophosphataemia), choroidal effusion with visual field defect, transient myopia, and acute angle-closure glaucoma, photosensitisation, pancreatitis, increased serum uric acid levels, exacerbation of gout or SLE, altered serum lipid levels, impaired glycaemic control; may precipitate diabetes mellitus. Blood and lymphatic system disorders: Aplastic anaemia, agranulocytosis, leucopenia, thrombocytopenia, neutropenia. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, constipation, gastric irritation, dry mouth, cholecystitis. General disorders and administration site conditions: Fatigue, thirst. Hepatobiliary disorders: Cholestasis. Nervous system disorders: Headache, dizziness, drowsiness, paraesthesia. Renal and urinary disorders: Acute interstitial nephritis. Reproductive system and breast disorders: Erectile dysfunction. Skin and subcutaneous tissue disorders: Rashes, erythema multiforme, exfoliative dermatitis, skin eruptions resembling lichen planus and subacute cutaneous lupus erythematous). Vascular disorders: Postural hypotension, vasculitis. Potentially Fatal: Hyponatraemia.
PO: C (FDA Pregnancy Category C applies to bendroflumethiazide in combination w/ nadolol.)
Patient Counseling Information
Avoid exposure to sunlight; use sunscreen or wear protective clothing when going outdoors.
Monitoring Parameters
Correct hypokalaemia before treatment initiation. Monitor weight, blood pressure, serum electrolytes (particularly with high doses and long-term use), renal function; input and output records daily to determine fluid loss.
Overdosage
Symptoms: Anorexia, nausea, vomiting, diarrhoea, dehydration, dizziness, hypotension, weakness, muscle cramps, convulsions, paraesthesia, tetany, and increased frequency of micturition with polyuria and thirst. In severe cases, depletion of intravascular volume, hypotension, and peripheral circulatory failure may occur. Hypokalaemia may develop, particularly in patients with pre-existing cardiac disease. Hyponatraemia, hypomagnesaemia, hypercalcaemia, hypoglycaemia, hyperglycaemia, and metabolic alkalosis may occur, potentially leading to arrhythmias. CNS depression (e.g. drowsiness, lethargy, coma) may manifest without CV or respiratory depression.
Management: Supportive and symptomatic treatment. Correct fluid and electrolyte imbalance and monitor blood pressure, blood glucose, ECGs, and renal function. Avoid the use of cathartics.
Drug Interactions
Enhanced hypotensive effect with aldesleukin, alprostadil, levodopa, tizanidine, general anaesthetics, nitrates, MAOIs, and other antihypertensives (e.g. ACE inhibitors, angiotensin II antagonists, calcium channel blockers, α-blockers, β-blockers, hydralazine, diazoxide), moxisylyte. May cause severe hyponatraemia with trimethoprim. Increased risk of postural hypotension with opioids, TCAs, and barbiturates. Increased risk of hypokalaemia with reboxetine, amphotericin, ACTH, xanthines (e.g. theophylline), naturally occurring corticosteroids (e.g. cortisone, hydrocortisone), other diuretics (e.g. acetazolamide, loop diuretics), and high doses of β2-sympathomimetics. Increased risk of hypercalcaemia with toremifene, calcium salts, and vitamin D. May cause a synergistic effect with chlorpropamide, leading to an increased risk of hyponatraemia. Increased risk of developing milk-alkali syndrome when given concomitantly in patients receiving large doses of calcium or vitamin D. May cause severe hypokalaemia with carbenoxolone. Decreased absorption with colestipol and colestyramine. May increase serum concentration and risk of toxicity of lithium. Increased risk of arrhythmias with QT-prolonging agents (e.g. pimozide, sertindole, thioridazine, astemizole, terfenadine, halofanthrine). May antagonise the action of allopurinol. May antagonise the hypoglycaemic effects of antidiabetics (e.g. sulfonylureas, insulin). Increased risk of nephrotoxicity and ototoxicity with cisplatin. Increased risk of hypermagnasaemia and/or nephrotoxicity with ciclosporin. NSAIDs (e.g. indomethacin, ketorolac), estrogen, and progestogens may antagonise the diuretic effect of bendroflumethiazide. Increased risk of nephrotoxicity with NSAIDs. May enhance the cardiotoxic effects of disopyramide, amiodarone, flecainide, and quinidine if hypokalaemia occurs. May increase the toxic effects of cardiac glycosides (e.g. digoxin). May enhanced the neuromuscular blocking effect of non-depolarising muscle relaxants (e.g. tubocurarine, gallamine, alcuronium, pancuronium).
Food Interaction
May potentiate orthostatic hypotension with alcohol.
Lab Interference
May interfere with parathyroid function tests. May result in false-negative aldosterone/renin ratio.
Action
Description: Overview: Bendroflumethiazide is a thiazide diuretic. Mechanism of Action: Bendroflumethiazide inhibits sodium and chloride transport in the distal convoluted tubules, resulting in the reduction of sodium and chloride reabsorption. Synonym(s): Bendrofluazide. Pharmacodynamics: The diuretic effect of bendroflumethiazide causes little or no disturbance to acid-base equilibrium; sodium and chloride ions are excreted in equivalent proportions. While its blood pressure-lowering mechanism has not been clearly established, it is attributed mainly to the reduction of peripheral vascular resistance. Bendroflumethiazide may also enhance the effects of other antihypertensive agents. Onset: Diuresis: 2 hours (peak effect: 3-6 hours). Blood pressure reduction: 3-4 days. Duration: Diuresis: 12-24 hours. Pharmacokinetics: Absorption: Completely absorbed from the gastrointestinal tract. Time to peak plasma concentration: 2 hours. Distribution: Crosses the placenta and enters breast milk. Plasma protein binding: >90%. Metabolism: Fairly extensively metabolised. Excretion: Via urine (30% as unchanged drug). Elimination half-life: 3-8.5 hours.
Chemical Structure
Bendroflumethiazide Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 2315, Bendroflumethiazide. https://pubchem.ncbi.nlm.nih.gov/compound/Bendroflumethiazide. Accessed Oct. 27, 2025.
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