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As is the case with any other medication, there may be some instances where hydrochlorothiazide interactions with drugs, food, and medical conditions can occur. In such cases, use is not recommended or usage will have to be adjusted in order to prevent or reduce the risk of negative interactions occurring from other drugs, medical conditions, or even food and drink.

Drug Interactions

According to the FDA, drugs that may interact with this medication include the following:

  • Alcohol, barbiturates, or narcotics, as they can cause unsafe drops in blood pressure
  • Insulin or other diabetes drugs
  • Other blood pressure-lowering drugs, as they may cause an unsafe drop in blood pressure
  • The cholesterol-lowering drugs cholestyramine (Prevalite) and colestipol (Colestipol) resins, as they may prevent the body from absorbing hydrochlorothiazide
  • Corticosteroids and ACTH (adrenocorticotropic hormone), which treat a wide variety of conditions, including asthma, arthritis, skin conditions and autoimmune diseases; taking hydrochlorothiazide with these drugs can decrease electrolytes, which are important minerals in the body
  • Medications that increase blood pressure, known as pressor amines
  • Certain skeletal muscle relaxants, as hydrochlorothiazide can increase the body’s responsiveness to the muscle relaxant
  • Lithium, as diuretic agents like hydrochlorothiazide can reduce the amount of lithium the body expels in urine, which can allow lithium to reach toxic levels
  • Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil), as these pain relievers can reduce the effects of hydrochlorothiazide

Please note that this list may not be complete, and other interactions with drugs not listed here may occur.


Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID), which can decrease the blood pressure-lowering effects of hydrochlorothiazide. Many stores sell it under the brand name Advil.


Amlodipine (Norvasc) is another medication that lowers blood pressure, known as an antihypertensive; medical providers can prescribe amlodipine along with hydrochlorothiazide to lower extremely high blood pressure that does not respond to other treatments. Although taking amlodipine with hydrochlorothiazide can lower blood pressure too much, leading to a condition known as hypotension.


Losartan (Cozaar) is another antihypertensive that may work in combination with hydrochlorothiazide to treat hypertension and lower the risk of stroke; taking losartan with other blood pressure-lowering drugs like hydrochlorothiazide can drop blood pressure too much.


Metformin is a diabetes medication that helps lower blood sugar levels; taking hydrochlorothiazide with metformin can increase blood sugar levels. Many pharmacies sell this drug under the trade names Glucophage, Riomet, and Glumetza.

Lexapro (Escitalopram)

Lexapro, also known as escitalopram, is an antidepressant; using this drug with hydrochlorothiazide can cause the amount of sodium (salt) in the bloodstream to dip too low (hyponatremia).


Spironolactone is another type of diuretic, or water pill, which prevents the body from absorbing too much salt; medical providers sometimes give spironolactone alongside hydrochlorothiazide because spironolactone is “potassium sparing,” which means it keeps potassium levels from going too low. That said, the combination may not be right for some patients. It is available under the trade names CaroSpir and Aldactone.


Hydrochlorothiazide can lower potassium in the blood; taking potassium pills can help prevent low potassium levels, but the combination may not be right for some patients.


Lisinopril (Qbrelis, Zestril, Prinivil) reduces blood pressure and decreases the risk of stroke; medical providers sometimes prescribe lisinopril with hydrochlorothiazide, but the two together may not be right for some people.

Food Interactions

Sometimes the foods we eat and the beverages we drink can also interact with our medications. According to the FDA, no known foods and drinks are known to interact with hydrochlorothiazide. Please note that this list may not be complete, and foods and beverages may interact with this drug.

Hydrochlorothiazide and Alcohol

For more information, please visit our page on hydrochlorothiazide and alcohol interactions.


Experts have not recorded major interactions between hydrochlorothiazide and vitamins.

Grapefruit and Grapefruit Juice

Grapefruit and grapefruit juice can interact with many types of medications including some types of antihypertensive drugs, according to the FDA. However, hydrochlorothiazide is not on the FDA’s list of medications affected by eating grapefruit or drinking grapefruit juice.

Disease & Conditions Interactions

Some diseases and conditions can make a drug act differently than expected, and some medications can worsen certain health conditions.

Sometimes certain medications can increase the risk of negative side effects for patients with certain diseases or other medical conditions. According to the FDA, diseases and medical conditions known to negatively interact with hydrochlorothiazide include:

  • Anuria, a condition in which the kidneys cannot produce urine
  • Kidney disease
  • Liver disease
  • Glaucoma
  • Asthma
  • Gout
  • Diabetes

Please note that this list may not be complete, and there may be other diseases and medical conditions where patients should not take this medication.

Hydrochlorothiazide and Pregnancy

For more information, please visit our page on hydrochlorothiazide and pregnancy risks.


Diuretics like hydrochlorothiazide can increase the risk of gout, a type of arthritis that causes severe pain, redness and tenderness in joints, particularly the joint at the base of the big toe.


Hydrochlorothiazide can cause sudden increases in blood sugar levels in people with diabetes.

Sulfa Allergy

Hydrochlorothiazide is a sulfonamide, commonly known as a “sulfa drug.” As such, patients who are allergic to sulfonamides should avoid taking hydrochlorothiazide.


People with high blood pressure might be at an increased risk for severe illness from SARS-CoV-2, the virus that causes COVID-19, according to the Centers for Disease Control and Prevention (CDC). So. it is important that patients prescribed hydrochlorothiazide take their medications as directed.

Disclaimer: this article does not constitute or replace medical advice. If you have an emergency or a serious medical question, please contact a medical professional or call 911 immediately. To see our full medical disclaimer, visit our Terms of Use page.

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