Intended for healthcare professionals

Letters Chlortalidone for hypertension

UK supply of chlortalidone for hypertension must be restored

BMJ 2013; 346 doi: (Published 15 May 2013) Cite this as: BMJ 2013;346:f3076
  1. Emma E Morrison, specialist trainee year 3, clinical pharmacology1,
  2. Emma J Turtle, McKenzie lecturer in clinical pharmacology1,
  3. David J Webb, Christison professor of therapeutics and clinical pharmacology1
  1. 1Pharmacology, Toxicology and Therapeutics, BHF Centre for Research Excellence University of Edinburgh, Queen’s Medical Research Institute, Edinburgh EH16 4TJ, UK
  1. emma.morrison{at}

In 2011 the National Institute for Health and Care Excellence (NICE) updated UK hypertension guidance.1 Bendroflumethiazide 2.5 mg, still the most commonly prescribed UK antihypertensive,2 was replaced by chlortalidone (12.5-50 mg) as the recommended thiazide-like diuretic, because of its much stronger evidence base. The only UK licensed preparation available is Hygroton 50 mg, which is hard to halve and unrealistic to quarter. The situation is set to worsen substantially because Hygroton is no longer reliably available in the UK. A scored 25 mg preparation of chlortalidone is available in many EU countries but is not licensed in the UK. NICE recommends indapamide as an alternative diuretic, but others have argued that there are no data from a primary prevention trial in which it has met its primary endpoint.3 An alternative might be bendroflumethiazide, but at a higher dose (5-10 mg).4

We accept NICE’s evidence in favour of chlortalidone, which we believe needs to be made available in the UK. However, NICE, the Medicines and Healthcare Products Regulatory Agency (the independent regulator), and the Department of Health cannot mandate a drug’s manufacture or importation. While we cannot prescribe chlortalidone for hypertension—a major risk factor for ill health5—UK patients and their doctors are seriously disadvantaged.


Cite this as: BMJ 2013;346:f3076


  • Competing interests: None declared.


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