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Hydrochlorothiazide & Weight Loss: How Much To Expect?

Hydrochlorothiazide is a diuretic medication prescribed for the treatment of hypertension and edema (fluid accumulation and retention in bodily tissues) resulting from various medical conditions and prescription medications (e.g. corticosteroids).  Other medical conditions for which hydrochlorothiazide is sometimes prescribed to treat include: congestive heart failure, diabetes insipidus, renal tubular acidosis, and kidney stones (as a prophylactic for patients with high calcium in urine).

As a diuretic, hydrochlorothiazide functions by interfering with the transport of sodium (Na+) in the distal convoluted tubule of the kidneys.  Interference with sodium (Na+) transport in the distal convoluted tubule of the kidneys: prevents sodium reabsorption, induces natriuresis (sodium excretion in the urine), and promotes water loss.

Despite the fact that the diuretic action of hydrochlorothiazide can effectively reduce blood pressure (to counteract hypertensive states) and enhance urinary excretion of sodium (to mitigate excessive water retention), some users are curious about its side effect profile.  A side effect that many hydrochlorothiazide users want to know about is weight loss – specifically whether the medication causes weight loss, and if so, how much.

Does Hydrochlorothiazide cause weight loss? (If so, how much?)

Yes.  All data from trials in which the effect of hydrochlorothiazide on body weight was evaluated suggest that the medication causes clinically significant weight loss as a side effect.  The fact that hydrochlorothiazide causes weight loss shouldn’t be very surprising given that it functions as a diuretic – causing the body to excrete sodium and water stores.

Average weight loss: 1.01 lbs. to 14.77 lbs.

  • Monotherapy: 2.31 lbs. to 6.92 lbs.
  • Polytherapy: 1.01 lbs. to 14.77 lbs.
  • Dose effect: Greater average weight loss is observed at doses of 200 mg/day vs. 100 mg/day and 50 mg/day.

The amount of weight loss reported in studies of hydrochlorothiazide ranges from 1.01 lbs. to 14.77 lbs.  However, the amount of weight loss that you experience during hydrochlorothiazide treatment will likely be contingent upon variables such as: preexisting water retention, medical diagnoses, concurrent medication use, hydrochlorothiazide dose, and duration of hydrochlorothiazide treatment.

It is logical to expect that patients with a history of edema-related weight gain (increased body weight as a result of edema) will be most likely to experience significant weight loss while using hydrochlorothiazide – relative to those using hydrochlorothiazide for other conditions (e.g. hypertension).  Additionally, the greater the amount of weight gain that a person incurred as a result of edema – the more weight loss he/she should experience while using hydrochlorothiazide (due to its antiemetic effect).

In a study by Freis et al. (1988) with 683 veterans with hypertension (mild-to-moderate), hydrochlorothiazide was shown to induce significant weight loss when administered over a 10-week span.  Among hydrochlorothiazide responders (i.e. patients who attained target blood pressure reduction), average weight losses were: 3.48 lbs. (50 mg users); 3.59 lbs. (100 mg users); and 6.92 lbs. (200 mg users).

Among hydrochlorothiazide non-responders (i.e. patients who failed to attain target blood pressure reduction), average weight losses were: 2.31 lbs. (50 mg users); 2.71 lbs. (100 mg users); and 3.65 lbs. (200 mg users).  This suggests that hydrochlorothiazide induces weight loss among patients with hypertension – and that weight reduction is greater among responders (patients who derive sufficient blood pressure reduction) versus non-responders.

Another study by Slotkoff (1983) in which hydrochlorothiazide (100 mg) was administered to 74 patients with edema for 12 weeks reported an average weight loss of 5.51 lbs. to 5.95 lbs. – over a 12-week period.  In this study, it was noted that a majority of the weight loss and edema reduction were observed within the first week of treatment.

Other studies have reported weight loss from the administration of hydrochlorothiazide as an adjunct or combination therapy.  For example, a study by Damian et al. (2016) documented an average weight loss of 1.01 lbs. after 1 year and an additional 0.5 lbs. after 2 years – among 4396 elderly individuals with hypertension receiving a daily combination of hydrochlorothiazide and amiloride.

Additionally, a short-term study by Dormans and Gerlag (1996) in 20 patients with congestive heart failure and renal impairment documented an average weight loss of 14.77 lbs. per patient – after the administration of hydrochlorothiazide (25-100 mg) plus high-dose furosemide (250 mg) for 3 to 12 days.  A study by Maxwell et al. (1985) reported weight losses of 1.9 lbs. and 3.2 lbs. in patients with hypertension who had received hydrochlorothiazide plus triamterene OR hydrochlorothiazide plus amiloride, respectively, for 6 weeks.

To summarize, all data hydrochlorothiazide trials indicate that the medication causes weight loss when administered as a monotherapy and polytherapy – regardless of the specific medical condition for which it is administered.  As a monotherapy, hydrochlorothiazide induces weight loss of 2.31 lbs. to 6.92 lbs. – and as a polytherapy, hydrochlorothiazide induces weight loss of 1.01 lbs. to 14.77 lbs. (with variance depending on the concomitant medication).

Hydrochlorothiazide & Weight Loss (Why It Occurs)

It is understood that hydrochlorothiazide causes rapid and significant weight loss in a majority of users – regardless of the specific purpose for which it is prescribed.  Most hydrochlorothiazide users understand that the medication functions as a diuretic by enhancing the elimination of sodium and water via the kidneys.

The elimination of sodium and water via the kidneys is the primary mechanism by which hydrochlorothiazide causes weight loss.  Essentially, hydrochlorothiazide helps the body eliminate excess sodium and water stores, and by doing so, the body loses “water weight.”

A common misconception among a subset of hydrochlorothiazide users is that the medication somehow induces body fat loss – this is not true.  Hydrochlorothiazide merely interferes with water retention such that the body carries less total water weight during treatment than it did before – causing users to notice a bit of [water] weight loss.

  1. Sodium & water depletion

Hydrochlorothiazide and other thiazide diuretics cause weight loss principally by inhibiting the sodium-chloride (Na+/Cl-) symporter, a cotransporter in the kidneys which is responsible for facilitating reabsorption of sodium and chloride ions from the tubular fluid into the cells of the distal convoluted tubule of the nephron.  Inhibition of the sodium-chloride symporter by hydrochlorothiazide prevents sodium reabsorption, induces natriuresis (sodium excretion), increases urinary flow, and promotes water loss.

As a result, bodily tissues end up losing a significant amount of water.  After the sodium and water loss occurs, anyone who steps on a scale and weighs themselves will notice that they’ve lost weight.  Some sources suggest that with diuretics like hydrochlorothiazide, some individuals can lose between 10 lbs. and 20 lbs. of water weight in less than 1 week.

Among persons with preexisting edema as a result of a medical condition or medication side effect – the water weight loss that results from hydrochlorothiazide use may be substantial.  While hydrochlorothiazide-mediated water depletion may yield rapid and substantial weight loss – it is important to remember that this is not body fat loss; bodily tissues are simply storing less water than before treatment.

  1. Side effects (Appetite loss, diarrhea, nausea)

The second way by which hydrochlorothiazide can cause weight loss is through side effects.  Several common side effects associated with hydrochlorothiazide include: appetite loss (or suppression); diarrhea; and nausea (which could lead to vomiting).  If you experience any of these side effects, there’s a chance that you may extra weight loss – in addition to the water weight loss resulting from hydrochlorothiazide’s diuretic effect.

Appetite loss: If you experience appetite loss (or suppression) while taking hydrochlorothiazide, it’s logical to suspect that this side effect might lead you to consume fewer calories than you did before treatment.  Consuming fewer calories than your body is accustomed to receiving (i.e. your maintenance calories) will yield a state of negative energy balance (i.e. calorie deficit).

As a result of the calorie deficit, your body will burn fat stores for energy such that you’ll end up losing weight (in the form of body fat).  Although appetite loss probably won’t be a primary driver of weight loss in most hydrochlorothiazide users, it is a possibility to consider for a subset of users – especially if the appetite loss is severe.

Diarrhea: If you experience diarrhea (frequent and/or rapid bowel movements), this could be another means by which you lose weight while using hydrochlorothiazide.  Diarrhea depletes water weight (and dehydrates the body), which could expedite and/or enhance the weight loss you experience from the diuretic action of hydrochlorothiazide.

Moreover, diarrhea may interfere with calorie absorption by inducing rapid movement of food through the digestive tract.  Poor calorie absorption means that the body may not receive as much energy to store as fat as it did before treatment – which could lead to weight loss via negative energy balance.

It is also understood that diarrhea might interfere with one’s appetite or desire to eat.  Someone with uncontrollable (moderate-to-severe) diarrhea may experience appetite loss and/or might eat less than usual in fear of another rapid bowel movement and upset stomach.

Nausea: Nausea is generally defined as a feeling of sickness with an inclination to vomit.  If you experience nausea while using hydrochlorothiazide, the nausea might be severe enough to: (1) interfere with your appetite (such that you consume fewer calories than usual) and/or (2) provoke vomiting (which can dehydrate the body and interfere with calorie absorption).

Consuming fewer calories than usual (due to nausea-related appetite loss) and/or vomiting (due to severe nausea) may cause a hydrochlorothiazide user to exhibit a state of negative energy balance – such that body fat loss occurs.  Additionally, frequent vomiting may augment the diuretic effect of hydrochlorothiazide such that the body ends up losing a more substantial amount of water weight than it otherwise would’ve.

Note:  It’s possible that there may be other mechanisms by which hydrochlorothiazide leads to weight loss.  Nevertheless, it is important to underscore that body water depletion is the primary means by which weight loss occurs among hydrochlorothiazide users – NOT fat loss.

Why Hydrochlorothiazide might cause fat gain…

When administered for a long-term, hydrochlorothiazide may induce unfavorable metabolic changes – which could lead to body fat gain (and weight gain), despite preexisting water depletion.  In addition to potentially unfavorable metabolic changes resulting from hydrochlorothiazide use, some individuals may experience substantial weight gain as a rebound effect following its discontinuation.

Metabolic changes

Research by Price et al. (2013) suggests that the use of hydrochlorothiazide could induce deleterious metabolic changes.  Specifically, Price et al. discovered that hydrochlorothiazide treatment significantly increased hepatic triglycerides (by approximately ~57%) and simultaneously reduced insulin sensitivity.

Although having high triglycerides might not directly cause weight gain, reduced insulin sensitivity could certainly lead to weight gain and/or increased body fat.  When insulin sensitivity decreases, this affects hormone signaling (e.g. leptin, ghrelin, etc.) to the brain, which can trigger an exaggerated appetite.

Furthermore, decreased insulin sensitivity may increase estrogen concentrations, an established risk factor for obesity.  The combination of increased appetite and elevated estrogen could lead to overconsumption of calories, fat gain, and/or muscle loss.  Some speculate that hydrochlorothiazide may increase visceral and subcutaneous body fat when administered over a long-term.

Rebound effect (Regained water weight after stopping)

Hydrochlorothiazide and other diuretics help decrease water weight and bloating, however, this effect is temporary – the medication must be administered regularly to maintain the water weight loss.  When hydrochlorothiazide treatment is discontinued, kidney function will normalize such that sodium and water are reabsorbed at standard quantities.

Normalization of sodium and water reabsorption means that all of water weight that was lost throughout treatment will be regained.  Furthermore, some have suggested that long-term diuretic usage might trigger excessive rebound weight gain in the aftermath of diuretic discontinuation due to transient renal adaptations induced by treatment.

In other words, it is thought that sodium reabsorption and water retention may substantially increase (above homeostatic baseline) for an unspecified duration after hydrochlorothiazide discontinuation – as a “rebound effect.”  This substantial increase [in sodium and water retention] might cause a former hydrochlorothiazide user to temporarily weigh more (in terms of water) than they did before treatment.

Hydrochlorothiazide & Weight Loss (The Research)

Listed below are studies in which the effect of hydrochlorothiazide on body weight was documented.  All data generated by studies examining the effect of hydrochlorothiazide are consistent in suggesting that hydrochlorothiazide causes weight loss.

There are no data suggesting that hydrochlorothiazide causes weight gain.  (For additional information about a study listed below, click the hyperlink citation listed beneath the summary).  Understand that, because hydrochlorothiazide is a diuretic (often prescribed to persons with edema), most medical professionals expect the medication to induce some degree of weight loss via decreasing water retention.

2016: Changes in selected metabolic parameters in patients over 65 receiving hydrochlorothiazide plus amiloride, atenolol or placebo in the MRC elderly trial.

Damian et al. noted that there was limited information regarding how antihypertensive medications affect: body weight; electrolyte concentrations; cholesterol; and glucose concentrations.  For this reason, Damian et al. conducted a retrospective analysis examining the effect of antihypertensive agents on body weight, electrolyte concentrations, cholesterol, and glucose – in 4396 elderly patients participating in the MRC (Medical Research Council) hypertension trial.

The 4396 trial participants examined by Damian et al. had been assigned to receive: hydrochlorothiazide plus amiloride; atenolol; or a placebo – for a long-term.  Measures of body weight, electrolytes, cholesterol, glucose, etc. were documented: at baseline (pre-trial); after 1 year; and after 2 years.

Results of the trial indicated that recipients of hydrochlorothiazide plus amiloride exhibited significantly greater average decreases in body weight – compared to placebo recipients at the end of one year.  Average weight loss among hydrochlorothiazide plus amiloride recipients after one year was 1.01 lbs. (0.46 kg).

After 2 years of treatment, recipients of hydrochlorothiazide plus amiloride exhibited an additional average weight loss of 0.5 lbs. (0.23 kg).  This observation indicates that most weight loss will occur within the first year of administering hydrochlorothiazide plus amiloride – and a less substantial weight reduction may occur thereafter.

Based on the results of this large-scale trial, it appears as though hydrochlorothiazide causes modest weight loss (1-1.5 lbs.) in elderly patients when administered with amiloride for 1-2 years [for the management of hypertension].  That said, it is unknown as to whether hydrochlorothiazide might’ve induced greater weight loss than amiloride (or vice-versa).

Because hydrochlorothiazide is a diuretic, the modest weight loss observed was likely attributable to a loss of water weight (rather than fat loss).  Moreover, because hydrochlorothiazide was being used to treat hypertension (rather than edema), it’s reasonable to expect that greater weight loss might’ve occurred in a trial of hydrochlorothiazide in patients with edema (due to edema-associated weight increases).

1996: Combination of high-dose furosemide and hydrochlorothiazide in the treatment of refractory congestive heart failure.

Dormans and Gerlag sought to determine the synergistic effect of hydrochlorothiazide with furosemide among patients with severe congestive heart failure and renal impairment.  The aforementioned researchers conducted an open-label trial in which 20 patients with congestive heart failure (stage 3-4) and diuretic resistance to high-dose furosemide (250 mg/day) – received hydrochlorothiazide (25-100 mg per day) for 3 to 12 days.

Results indicated that short-term treatment with hydrochlorothiazide led to an average body weight reduction of 14.77 lbs. (6.7 kg) per patient.  This study supports the idea that hydrochlorothiazide can cause significant weight loss (i.e. reduction in water weight) when administered for a short-term (up to 12 days) with high-dose furosemide.

1988: Volume (weight) loss and blood pressure response following thiazide diuretics.

Freis et al. conducted a study assessing the relationship between body weight change and blood pressure reduction among patients using hydrochlorothiazide.  The study involved 906 male veterans with diastolic blood pressure readings between 95 mm Hg and 114 mm Hg.

Following an initial 8-week placebo run-in phase, 683 of the participants who met entry criteria (i.e. exhibiting mild-to-moderate hypertension) were assigned at random to receive either hydrochlorothiazide (343 participants) OR propranolol (340 participants) for the treatment of hypertension.  Dosages of hydrochlorothiazide and propranolol were titrated over a 10-week duration until diastolic blood pressure was reduced below 90 mm Hg.

The dosages of hydrochlorothiazide administered throughout the study were: 25 mg (b.i.d.); 50 mg (b.i.d.); and 100 mg (b.i.d.).  Results indicated that 103 of the patients who responded to hydrochlorothiazide (~52%) [such that diastolic blood pressure dropped below 90 mm Hg] utilized the lowest dose of 50 mg per day (25 mg, b.i.d.) and exhibited an average weight loss of 3.48 lbs. (1.58 kg) over 10 weeks.

Compared to 202 patients who didn’t respond to hydrochlorothiazide at the same dose (50 mg per day), the 103 responders exhibited an average of ~2.66 lbs. (1.21 kg) greater body weight reduction.  In an additional 58 patients who responded to hydrochlorothiazide (29%), a dosage of 100 mg per day was required to attain target diastolic blood pressure reduction.

Responders to the 100 mg per day dose exhibited an average weight loss of 3.59 lbs. (1.63 kg) over 10 weeks; this amount was similar to the 50 mg per day responders.  When the 58 patients who responded to the 100 mg per day dose received the 50 mg per day dose, body weight reduction was less than at the 100 mg dose (but not statistically significant).

Another 38 patients who responded to hydrochlorothiazide (19%) required a dosage of 200 mg per day to attain target diastolic blood pressure reduction.  Responders to the 200 mg per day dose exhibited an average weight loss of 6.92 lbs. (3.14 kg) – a significantly greater amount than responders to lower doses.

In the 106 non-responders (i.e. patients who were unable to attain sufficient diastolic blood pressure reduction), weight loss amounts relative to daily dose were as follows: 2.31 lbs. (50 mg); 2.71 lbs. (100 mg); and 3.65 lbs. (200 mg).  Overall, this study supports the idea that hydrochlorothiazide induces significant weight loss over a 10-week period.

It seems as though persons who respond to hydrochlorothiazide for the treatment of hypertension exhibit greater weight loss (i.e. volume loss) than non-responders.  Additionally, the results of this study indicate that greater doses of hydrochlorothiazide are associated with more substantial weight loss than smaller doses.

1985: Blood pressure lowering and potassium conservation by triamterene-hydrochlorothiazide and amiloride-hydrochlorothiazide in hypertension.

Maxwell et al. conducted a randomized controlled trial examined the effect of combination therapies “hydrochlorothiazide (25 mg) plus triamterene (50 mg)” and “hydrochlorothiazide (50 mg) plus amiloride (5 mg)” in 84 adults with mild-to-moderate hypertension.  The trial began with a 3-week placebo run-in phase, followed by a 6-week treatment phase.

The 2 combination therapies were evaluated based upon blood pressure reduction and electrolyte changes (potassium and magnesium) during the final week of therapy.  Results indicated that both combination therapies substantially decreased supine blood pressure (systolic and diastolic); no significant differences were observed between groups in the magnitude of blood pressure reduction.

Body weight reduction was observed in each of the treatment groups relative to baseline.  In the hydrochlorothiazide plus triamterene group – weight decreased from 180 lbs. to 178.1 lbs. by Week 9.  In the hydrochlorothiazide plus amiloride group – weight decreased from 166.9 lbs. to 163.7 lbs. by Week 9.

Although it’s unknown as to how significant hydrochlorothiazide impacted body weight compared to concurrently administered medications (triamterene and amiloride), it’s reasonable to suspect that hydrochlorothiazide treatment led to weight reduction.  While this was a relatively small-scale study, it showed that treatment with: hydrochlorothiazide (25 mg) led to weight loss of: 1.9 lbs. (when combined with 50 mg triamterene) and hydrochlorothiazide (50 mg) led to a weight loss of 3.2 lbs. (when combined with 5 mg amiloride) – over a 9-week period.

Considering the results of this study, one might hypothesize that a lower body weight at treatment onset might lead to greater weight loss while using hydrochlorothiazide – than a higher body weight.  Moreover, because recipients of 50 mg hydrochlorothiazide lost more weight than recipients of 25 mg hydrochlorothiazide, it’s fair to speculate that larger hydrochlorothiazide doses yield greater weight reduction (than smaller ones).

1983: Clinical efficacy and safety of indapamide in the treatment of edema.

Slotkoff organized a double-blind study to compare the antiemetic efficacy of the medications hydrochlorothiazide (100 mg) and indapamide (2.5 mg, 5 mg, or 10 mg) – each administered once per day.  The respective antiemetic efficacies of each medication were determined based upon weight change and swelling (i.e. pitting) change within the lower extremities – over a 12-week period.

It was reported that 219 patients (129 females, 90 males) underwent body weight evaluations at baseline and after the 12-week treatment phase.  A total of 45 patients received hydrochlorothiazide (100 mg), and 174 patients received indapamide (2.5 mg, 5 mg, or 10 mg).

The average body weight of patients at baseline was 195.1 lbs. (88.5 kg).  After the 12-week trial, average weight loss of patients ranged from 5.51 lbs. (2.5 kg) to 5.95 lbs. (2.7 kg) – and did not differ between treatments (hydrochlorothiazide and indapamide).

Results of this study indicate that standalone hydrochlorothiazide (100 mg/day) induces significant weight loss over a 12-week span among patients with edema.  In many patients, both body weight and edema significantly decreased in less than 1 week of hydrochlorothiazide treatment.  Only one patient discontinued hydrochlorothiazide treatment due to a combination of frequent urination and unwanted weight loss.

Variables that influence Hydrochlorothiazide weight loss

There are a variety of variables that may influence how much weight loss occurs on hydrochlorothiazide.  Variables that likely will impact the magnitude of hydrochlorothiazide-induced weight loss include: (1) preexisting water retention; (2) hydrochlorothiazide dose; (3) duration of treatment; (4) concomitant substance use; and (5) attributes of the specific hydrochlorothiazide user.  It is the combination of these variables that will account for differences in weight change among users.

  1. Preexisting water retention

Because hydrochlorothiazide induces water weight loss by altering kidney function (inhibiting sodium reabsorption and increasing urinary output), the amount of preexisting water retention that a user exhibits (before treatment) will probably determine the amount of weight that is lost during treatment.  As a hypothetical example, let’s say that one hydrochlorothiazide user is carrying 20 lbs. of excess water weight due to untreated severe edema – and another user is carrying 10 lbs. of excess water due to edema.

In this example, it should be expected that the person carrying more edema-related water weight (20 lbs.) will experience greater weight loss while using hydrochlorothiazide than the person carrying less edema-related water weight (10 lbs.) – mostly because he/she had more water weight to lose.  In the event that a hydrochlorothiazide user doesn’t have much water weight to lose (such as an underweight individual who consumes a low sodium diet) – weight loss from hydrochlorothiazide may be less significant than expected.

  1. Hydrochlorothiazide dose

The dosage of hydrochlorothiazide that you take may impact the amount of weight loss that you experience.  Most research indicates that there’s a dose-dependent effect of hydrochlorothiazide on weight such that greater weight loss occurs at high doses (than low doses).

For example, in a study by Freis et al. (1988) reported average weight losses of 3.48 lbs., 3.59 lbs., and 6.92 lbs. – in responders to hydrochlorothiazide at 50 mg/day, 100 mg/day, and 200 mg/day, respectively, over a 10-week duration.  Although the differences in weight loss between 50 mg/day and 100 mg/day users weren’t significant, there was still greater weight loss with the 100 mg/day dose.

Furthermore, users of the 200 mg/day dose exhibited significantly greater weight loss than the 50 mg/day and 100 mg/day users.  Even among the non-responders to hydrochlorothiazide in the same study (by Freis et al.), the average weight loss increased in accordance with dosage: 2.31 lbs. (50 mg/day); 2.71 lbs. (100 mg/day); and 3.65 lbs. (200 mg/day).

Because larger doses of hydrochlorothiazide will modulate kidney function to a greater extent than smaller doses – more substantial sodium and water depletion should be expected with larger doses.  Generally speaking, the larger the dose of hydrochlorothiazide that you administer, the more significant your [water] weight loss is likely to be.

  1. Duration of hydrochlorothiazide use

The total duration over which a person uses hydrochlorothiazide might also influence the amount of weight loss that occurs.  It is understood that weight loss resulting from hydrochlorothiazide administration is generally rapid, such that a significant amount of weight can be lost within the initial 1-2 weeks of treatment.

One study reported that the addition of hydrochlorothiazide (25-100 mg/day) treatment to high-dose furosemide (250 mg/day) induced an average weight loss of 14.77 lbs. in 20 patients with congestive heart failure over the span of 3 to 12 days.  In most cases, a substantial amount of water weight will be lost in the first 2 weeks of treatment – and less weight (if any weight) thereafter.

The rapid water weight loss resulting from hydrochlorothiazide makes it one of the most commonly utilized diuretics among athletes in attempt to “make weight” (i.e. meet weight class requirements) for competitions – as has been reported by WADA (the World Anti-Doping Agency).  Although additional weight may be lost with longer-term hydrochlorothiazide use (in excess of 1-2 weeks), it is most common for water weight loss to peak within several weeks.

If the dosage of hydrochlorothiazide is titrated such that a user initiates treatment at a low dose (e.g. 25 mg/day) and increases to a higher dose (e.g. 100 mg/day) over a longer-term (e.g. several months), then water weight loss might require time to peak.  Nevertheless, once sodium and water stores have been fully depleted – extra weight loss should not be expected over the long-term.

The only way long-term hydrochlorothiazide treatment will lead to additional weight loss (beyond water weight) is if it somehow induces appetite reduction or loss (over a long-term) such that the user remains in a long-term calorie deficit.  If a long-term calorie deficit is sustained (due to appetite suppression), then weight loss may end up more significant with longer-term hydrochlorothiazide use.

Still, one must acknowledge research indicating that hydrochlorothiazide may induce deleterious metabolic changes over a long-term (reducing insulin sensitivity, increasing triglycerides, etc.).  If you incur deleterious metabolic changes from hydrochlorothiazide over a long-term, there’s a chance that you may lose water weight in the short-term, and gain some body fat in the long-term.

  1. Concurrent substance use

Any substances (prescription drugs, over-the-counter medications, supplements, etc.) that are administered with hydrochlorothiazide could influence the amount of weight loss is experienced during treatment.  Certain substances (e.g. other diuretics) will act synergistically with hydrochlorothiazide to enhance water weight loss, whereas other substances (e.g. antidiuretics) might oppose the action of hydrochlorothiazide to prevent water weight loss.

For example, if you’re using the diuretic furosemide along with hydrochlorothiazide, you may lose significantly more water weight with the combination than with standalone hydrochlorothiazide – due to the synergistic diuretic actions.  Oppositely, if you administer an estrogenic birth control medication, this might slightly counteract the diuretic action of hydrochlorothiazide – and yield less significant water weight loss (if hydrochlorothiazide was administered as a standalone).

Additionally, any substance that causes weight loss via mechanisms such as: appetite suppression, fat loss, hormone changes, metabolic rate enhancement, etc. – could increase the amount of weight loss that occurs from hydrochlorothiazide.  Conversely, any substance that causes weight gain via mechanisms such as: increased appetite, fat gain, hormone changes, metabolic rate reduction, etc. – could interfere with the amount of weight loss that occurs with hydrochlorothiazide.

For example, if you’re using a psychostimulant that suppresses appetite and promotes fat loss, you might notice weight loss in addition to the water loss incurred from hydrochlorothiazide.  On the other hand, if you’re using an antipsychotic or mood stabilizer that increases appetite and promotes fat gain, you may experience weight gain (in the form of fat) – despite losing water weight with hydrochlorothiazide.

  1. Individual Hydrochlorothiazide user

The specific person using hydrochlorothiazide could impact the amount of weight loss that occurs during treatment.  User-specific factors that might impact magnitude of hydrochlorothiazide-induced weight loss include: age; body composition; gene expression; lifestyle; medical conditions; prior substance use; and sex.

  • Age: Kidney function and urinary output may change slightly in older and/or elderly adults compared to middle aged adults and younger populations. Due to potential age-related changes in kidney function, it’s possible that hydrochlorothiazide will prove more efficacious in depleting sodium and water stores in younger users (compared to older individuals) – assuming the dose is equal.
  • Body size: The body size and composition of hydrochlorothiazide users might influence how much weight is lost during treatment. A larger-sized hydrochlorothiazide user probably carries more fat and muscle than a smaller-sized user.  Because muscle contains ~75% water and fat contains ~10% water – the larger user will probably carry more water weight before using hydrochlorothiazide than a smaller user.  Due to carrying more water weight at baseline, larger individuals should expect to lose more water weight than smaller persons.
  • Genetics: It’s unclear as to whether certain genes influence the amount of weight loss that occurs with hydrochlorothiazide and other diuretics. It’s possible that expression or non-expression of certain genes might yield greater water weight loss with hydrochlorothiazide administration – than the general population.
  • Lifestyle: The lifestyle of a hydrochlorothiazide user could determine the amount of weight that is lost throughout treatment. Someone who consumes a high-sodium diet and never exercises might lose less water weight than someone who consumes a low-sodium diet and exercises frequently.  Additionally, things like sleep quality and environmental stress can affect hormone production, which could influence water retention and possibly total weight loss from diuretics.
  • Medical conditions: Any preexisting medical conditions with which you’ve been diagnosed could determine the amount of weight loss that you experience on hydrochlorothiazide. If you have a medical condition that causes edema or water retention, and/or a condition that impacts renal function – there’s a chance that you may lose a different amount of weight than a healthy individual using hydrochlorothiazide for non-medical purposes.
  • Prior substance use: Any substances that you used prior to hydrochlorothiazide could have altered your body weight from homeostasis such that you experience a different amount of weight loss (more or less significant) than if you hadn’t used a substance just prior to initiating hydrochlorothiazide. If you discontinued a substance just prior to hydrochlorothiazide that had caused weight gain – you might notice major weight loss during treatment due to a combination of rebound weight loss (from discontinuing the agent that caused weight gain) and the diuretic effect of hydrochlorothiazide; the opposite holds for a recent discontinuation of a substance that had caused weight loss (such that you may experience weight gain following its discontinuation).
  • Sex: At this time, it’s unclear as to whether there are sex-specific differences in average weight loss from hydrochlorothiazide. However, because males generally carry more water weight in their bodies than females due to lower body fat (55-65% water for men and 45-50% water for women) – greater water weight loss may occur in men using hydrochlorothiazide than women.  Moreover, because men tend to have larger body sizes compared to women, total weight loss from hydrochlorothiazide is probably greater among men than women.

Dissatisfied with hydrochlorothiazide-induced weight loss?

Most individuals who use hydrochlorothiazide understand that it’s a diuretic and are prepared to lose a bit of water weight.  In fact, the primary purpose for utilizing hydrochlorothiazide in some cases is to treat edema (water retention) and counteract edema-related weight gain.

That said, not everyone is taking hydrochlorothiazide to treat edema – the medication is used for a variety of medical conditions (including hypertension).  If for whatever reason you dislike the water weight loss that occurs from hydrochlorothiazide – share your dissatisfaction with a medical doctor.

A medical doctor may be able to recommend alternative medications and/or therapies for your specific medical condition.  After hydrochlorothiazide is discontinued, it’s relatively effortless for most people to regain the water weight that was lost during treatment.

Note: By using the “minimal effective dose” during treatment (or lowest dose needed to achieve a therapeutic effect – it may be possible to minimize excessive water weight loss on hydrochlorothiazide.  (Using doses under 100 mg per day are associated with less significant weight loss – compared to doses of 200 mg per day).

Have you lost weight on Hydrochlorothiazide?

If you’ve lost weight with hydrochlorothiazide, feel free to leave a comment below sharing the amount of weight that you lost.  To help others get a better understanding of your situation, provide details such as: the dose that you used; how quickly you noticed weight loss; the amount of time it took for your weight loss to peak; and whether you used other substances (medications, supplements, etc.) with hydrochlorothiazide.

In your experience, was most of the weight that you lost purely water? Or was some of the weight that you lost also fat (due to appetite suppression and a calorie deficit)?  Overall, was the loss of water weight from hydrochlorothiazide considered favorable (such that it helped improve edema or your blood pressure) – or unfavorable (such that it wasn’t the primary aim of treatment).

What was the medical condition for which you were prescribed hydrochlorothiazide?  Do you believe that concomitant substance use might’ve influenced (enhanced or counteracted) the amount of weight loss that resulted from hydrochlorothiazide?  If you’re a long-term hydrochlorothiazide user – how has your weight changed over time while using the medication?

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