Drug and Alcohol - Dual Diagnosis

Everything You Wanted to Know About Hydrochlorothiazide Abuse

What is Hydrochlorothiazide Abuse?

Even drugs like hydrochlorothiazide can be abused. A diuretic often abused by athletes, learn more about hydrochlorothiazide abuse in our blog.

Written by

brian-mooreBrian Moore

Content Writer

Reviewed by

jeremy-arztJeremy Arzt

Chief Clinical Officer

Drug and Alcohol

Dual Diagnosis

March 24, 2023

Hydrochlorothiazide (frequently abbreviated to HCTZ) is one of the many medications that are involved in prescription drug abuse in the country. Hydrochlorothiazide itself is not considered addictive. However, when abused and consumed in more than the prescribed dosage, there is a risk of developing a psychological dependency on the drug.

Hydrochlorothiazide has also been in the limelight because of its use by athletes. Many athletes use such medications for non-medical reasons to qualify for an event, to cut weight, or to maintain their performance.

While it is helpful as a means to control hypertension on its own, the side effects of hydrochlorothiazide abuse can include weight changes and extreme electrolyte imbalance. People might also show signs of hair loss upon abusing hydrochlorothiazide. Finally, it's possible to develop a psychological dependence on even non-addictive drugs like hydrochlorothiazide.

Let's learn more about this poorly-understood form of addiction

Hydrochlorothiazide Abuse: What Is Hydrochlorothiazide?

As a prescription drug, hydrochlorothiazide was approved by the Food and Drug Administration in 1959. Hydrochlorothiazide is one of the most commonly prescribed anti-hypertensive medications and is used by people with edema (swelling caused by fluid retention) or who need to manage their blood pressure. Hydrochlorothiazide is used to treat:

Hydrochlorothiazide prescription is also found among people diagnosed with ascites. In people already on corticosteroids or using estrogen, prescribing hydrochlorothiazide is done more carefully. Many people refer to hydrochlorothiazide as Microzide., its most popular brand name.

Also called a thiazide diuretic, or a water pill, hydrochlorothiazide increases the rate and degree of water elimination. This is what often attracts athletes to the drug. When water is excreted from the body, it carries salts, too, such as those found in urine. This helps to reduce blood pressure—the desired effect of hydrochlorothiazide as a medication and not as an abused drug.

Hydrochlorothiazide Abuse Potential

Unlike other prescriptions such as opioid painkillers, hydrochlorothiazide is not addictive in the ways we usually consider addiction. Usually, painkillers and prescription drugs like benzodiazepines present a higher risk of addiction as they provide a feeling of euphoria. Hydrochlorothiazide does not produce a high.

Instead, it's abused because it helps the body lose fluids. For some athletes, this is attractive. Casting off water weight before an event or contest is an advantage. For example, a bodybuilder who suddenly loses a lot of water weight can have more defined muscles, an advantage in a bodybuilding competition. For a jockey, boxer, or wrestler, losing a few extra pounds before a weigh-in means they're able to participate in an event.

Also, diuretics like hydrochlorothiazide can flush out steroids and other so-called performance-enhancing drugs from the body. This allows someone to beat a urine drug test because it' flushes out drugs in a person's system. This is why HCTZ and other diuretics are banned by organizations such as the World Anti-Doping Agency (WADA).

Drug abuse and addiction aren't always about a high. A drug like HCTZ can create an intense psychological dependence on it, fueling a person's sense of body image. If a person comes to believe they need hydrochlorothiazide to reach their true potential, they can be addicted to it every bit as severely as someone who's addicted to painkillers, alcohol, or stimulants. Given that high doses of hydrochlorothiazide can create harmful side effects, it's important to treat HCTZ abuse professionally.

Let's learn more about athletes and HCTZ abuse.

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Hydrochlorothiazide Abuse: Diuretic Abuse Among Athletes

Diuretics can help athletes using performance-enhancing drugs that sport governing bodies have not approved. Hydrochlorothiazide works by increasing the expulsion of urine from the body. When doing so, the person also loses more water from the body along with many salts and metabolic traces of many substances, including banned drugs.

Again, professional athletes are regularly tested for banned substances. A urine test is the preferred method, and hydrochlorothiazide can be helpful to dilute the urine and escape the test without testing positive for such prohibited drugs.

This is why hydrochlorothiazide is called a masking agent. The diuretic medication might not help beat the doping controls for all types of performance-boosting drugs, but yes, it does help conceal doping across many such substances.

Many similar masking agents work similarly. For instance, plasma expanders also help athletes come out clean after submitting doping samples. However, such masking agents tend to affect how organs like the kidneys function. This means that when abused without a prescription-based requirement, they can take a toll on the person's kidneys.

Repeatedly abusing hydrochlorothiazide can alter how it maintains its fluid and salt balance. This creates the risk of over-expulsing electrolytes like potassium or sodium; for some athletes qualifying for a specific athletic benchmark means cutting body weight. Again, masking and cutting agents like hydrochlorothiazide help to gain the desired body weight range relatively quickly, but people ignore the long-term damages of abusing hydrochlorothiazide.

Prescription Drug Abuse of Hydrochlorothiazide Among Athletes

Using prescription drugs wrongfully to boot on-track or in-ring performance or to ensure that the physical conditioning meets the performance standards has spread to nearly every type of professional sport. This includes diuretics that can raise the urine flow quickly, helping sportspersons drop weight within a short period. In addition, such tactics have often been spoken about in combat sports, where professionally trained competitors usually jump a weight division using such manipulative methods.

This is often referred to as doping with diuretics, where athletes intentionally overdose on Hydrochlorothiazide to ensure that illegally sourced and unethically consumed performance-enhancing steroids or stimulants are harder to catch in the urine tests. For such drug abuse needs, Hydrochlorothiazide is a great choice as it has a uniquely short half-life. Hydrochlorothiazide can be quickly eliminated within 24 hours to 48 hours after consumption. The more seasoned hydrochlorothiazide abusers know that the half-life can be further shortened if some heavy-duty exercise is combined with high hydrochlorothiazide dosage. 

Hydrochlorothiazide is not the only diuretic that is abused in this way. There are many variations in this drug class. Every diuretic presents different physicochemical properties. Some can be threatening to urinary tract functions. Others might permanently damage the kidneys. Some diuretics are fast acting, and some take time to build up in the body. 

Some anti-doping laboratories are trying to bring in new testing methods that can trace the use of diuretics like hydrochlorothiazide to escape drug testing. While the pharmacology of all diuretics can be different, their application in sports is a dangerous choice.

As we've said, drug abuse isn't always about chasing a high. Drug abuse is more about behaviors and less about an individual substance. The following behaviors are all types of drug abuse:

  • Taking more of a prescription than advised

  • Using another person's prescription

  • Taking a prescription drug for recreational purposes

  • Taking a prescription drug for a reason other than the one the drug was prescribed for

  • Obtaining additional prescription drugs illegally

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Understanding Hydrochlorothiazide Abuse 

Hydrochlorothiazide might not be looked upon as a typical, addiction-causing illegal drug but as a prescription drug that can be abused. However, it is related to a certain degree of dependence.

A history of hydrochlorothiazide abuse can be closely associated with maintaining a certain level of bodily aesthetics despite realizing the harms of continuing Hydrochlorothiazide dosing. Even when the side effects of hydrochlorothiazide become apparent, the person might continue to use the medicine to keep up with the performance or aesthetic standards.

This problem indicates a psychological need to use a substance despite realizing its harm, like any other drug addiction problem.

Hydrochlorothiazide Overdose Symptoms

It takes a large amount of hydrochlorothiazide to overdose, but yes, it can happen. Usually, Hydrochlorothiazide side effects show up due to consistently taking the prescription drug in a high dose. As the excessive dosage of the medication is maintained, it starts reacting in many ways, including interacting with other medicines and turning the drug's desired effects into unwanted symptoms that look like hydrochlorothiazide overdosing.

The more controllable signs of a Hydrochlorothiazide overdose include the following:

  • Vomiting

  • Dizziness

  • Headaches

  • Muscle weakness

  • Parched mouth

  • Excessive thirst

  • Physical weakness

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Common Side Effects of Hydrochlorothiazide Abuse

Hydrochlorothiazide side effects develop with deficient potassium levels. This is expected with Hydrochlorothiazide being an effective diuretic. People abusing hydrochlorothiazide will eventually develop highly inadequate potassium levels. As the person continues to use hydrochlorothiazide, more non-addictive symptoms are likely to surface, such as:

  • Elevated blood sugar

  • Elevated cholesterol 

  • Elevated uric acid levels

  • Elevated calcium levels

  • Orthostatic hypotension 

  • Diarrhea

  • Abdominal pain

  • Hair loss

  • Rashes

  • Low sodium levels

  • Low magnesium levels

  • Low chloride levels

Hydrochlorothiazide Abuse and Weight Changes

Hydrochlorothiazide is not a preferred way to lose weight, even among people who seem obsessed with a certain body image. However, the body aesthetics created by abusing Hydrochlorothiazide might just become irresistible for some people. As the person further uses hydrochlorothiazide, the body weight can dangerously decrease.

This also makes hydrochlorothiazide a poor choice for anyone serious about physical training and maintaining the desired weight since as soon a user stops hydrochlorothiazide, the water weight will not take a long time to accumulate again.

More Dangers of Hydrochlorothiazide Abuse

Hydrochlorothiazide has been continuously linked with raising the risk of certain skin cancers. The medication indeed increases the sensitivity to the sun, a common side effect of abusing hydrochlorothiazide. This is why someone on hydrochlorothiazide is asked to stay away from the sun and avoid tanning beds.

Skin damage is also closely associated with Hydrochlorothiazide, as some people can develop a severe allergic reaction. This could be in the form of swelling, inflammation, hives, or difficulty breathing. In addition, the skin could start peeling and be very slow to heal.

More Hydrochlorothiazide Abuse Symptoms

There are many other types of hydrochlorothiazide abuse-related problems, ranging from joint pain to hair loss. Arthritic people should be made aware of the chances of hydrochlorothiazide worsening their symptoms, just like anyone unnecessarily using hydrochlorothiazide should know that the sustained use of this prescription medication can even cause hair thinning and hair loss.

Hydrochlorothiazide Interactions with Medical Conditions

Hydrochlorothiazide can be a bigger threat among seniors as the low sodium levels can interact with other medications the aged are likely to consume. Among people with a white complexion, abuse of hydrochlorothiazide has been associated with increasing the risk of non-melanoma skin cancer.

Hydrochlorothiazide abuse can also worsen certain medical conditions, including gout and pancreatitis. Some other physical conditions that can be further exacerbated by abusing hydrochlorothiazide are:

  • Dehydration

  • Diabetes

  • Seizures

  • Lupus

  • Electrolyte problems

  • Liver problems 

  • Kidney problems

  • A history of gout

  • Swollen pancreas

  • Irregular heartbeats

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Hydrochlorothiazide Abuse Is Serious. Get Treated for Prescription Drug Abuse at The Edge Treatment Center

Someone with a prescription drug addiction needs professional help. Attempting drug detox at home or suddenly going off the abused medication (aka "cold turkey") creates the threat of suffering from a side effect serious enough to take the person to the ER.

In comparison, an accredited drug rehab facility like The Edge Treatment Center will provide a more structured plan to reduce, stop, and detox from hydrochlorothiazide, handle the withdrawal symptoms of an addicted substance, and help the affected person understand the roots of their addiction. Abuse of drugs like hydrochlorothiazide is often accompanied by mental disorders like body dysmorphia. We'll help you find a way out of a dual diagnosis.

The Edge Treatment Center uses the latest drug rehab therapies and evidence-backed treatments to help people with substance abuse disorders. Want to learn more about our prescription drug abuse treatment program? Reach out to us today.

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