Since each person is different, there have not been a sufficient number of studies to fully address this particular question. The response above was developed by doctors at Weill Cornell Medicine in consultation with experts in the field.
Chlorthalidone has a long elimination half-life of approximately 40-60 hours.1-3 Most of the circulating chlorthalidone is bound to erythrocyte carbonic anhydrase, which allows chlorthalidone to slowly re-enter the plasma over time and exert its effects.2,4 The duration of action of chlorthalidone has been reported to range from 24-72 hours.1,5 Studies using ambulatory blood pressure monitoring have demonstrated that the antihypertensive effects of chlorthalidone persist throughout the day and night.6,7 This long duration of action may benefit patients who miss a dose. In their study of the effect of different doses of chlorthalidone on blood pressure, Bengtsson et al. showed that 50 mg every other day versus every day maintained mean and diastolic blood pressure though there was a moderate increase in systolic blood pressure.8
The pharmacology registry, Micromedex, recommends that if patients miss a dose they should take it as soon as they can. However, if it is almost time for the next dose, skip the missed dose and take the next dose at the scheduled time. They caution against using extra medicine to make up for a missed dose.9
References
- Carter BL, Ernst ME, Cohen JD. Hydrochlorothiazide versus chlorthalidone: evidence supporting their interchangeability. Hypertension. 2004;43(1):4-9.
- Riess W, Dubach UC, Burckhardt D, Theobald W, Vuillard P, Zimmerli M. Pharmacokinetic studies with chlorthalidone (Hygroton) in man. Eur J Clin Pharmacol. 1977;12(5):375-382.
- Fleuren HL, Thien TA, Verwey-van Wissen CP, van Rossum JM. Absolute bioavailability of chlorthalidone in man: a cross-over study after intravenous and oral administration. Eur J Clin Pharmacol. 1979;15(1):35-50.
- Dieterle W, Wagner J, Faigle JW. Binding of chlorthalidone (Hygroton®) to blood components in man. European Journal of Clinical Pharmacology. 1976;10(1):37-42.
- Roush GC, Sica DA. Diuretics for Hypertension: A Review and Update. Am J Hypertens. 2016;29(10):1130-1137.
- Pareek AK, Messerli FH, Chandurkar NB, et al. Efficacy of Low-Dose Chlorthalidone and Hydrochlorothiazide as Assessed by 24-h Ambulatory Blood Pressure Monitoring. J Am Coll Cardiol. 2016;67(4):379-389.
- Ernst ME, Carter BL, Goerdt CJ, et al. Comparative antihypertensive effects of hydrochlorothiazide and chlorthalidone on ambulatory and office blood pressure. Hypertension. 2006;47(3):352-358.
- Bengtsson C, Johnsson G, Sannerstedt R, Werko L. Effect of different doses of chlorthalidone on blood pressure, serum potassium, and serum urate. Br Med J. 1975;1(5951):197-199.
- Chlorthalidone. Truven Health Analytics. http://www.micromedexsolutions.com. Accessed 7/1/16.