Bendroflumetiazid Alternova
Thiazide Diuretic for High Blood Pressure, Oedema and Kidney Stone Prevention
Quick Facts About Bendroflumetiazid Alternova
Key Takeaways About Bendroflumetiazid Alternova
- Effective first-line treatment for hypertension: At low doses (2.5 mg), bendroflumethiazide effectively lowers blood pressure primarily through vasodilation, with minimal diuretic effect
- Take in the morning: Because of its diuretic action, the tablet should be taken in the morning to avoid night-time urination
- Monitor potassium levels: Long-term use may lower blood potassium, which can cause muscle cramps, fatigue, and heart rhythm disturbances – regular blood tests are recommended
- Not suitable for gout: Bendroflumethiazide can raise uric acid levels and trigger gout attacks, so it should not be used in patients with gout
- Do not stop abruptly: Always consult your doctor before stopping treatment, as sudden discontinuation may cause a rebound increase in blood pressure and fluid retention
What Is Bendroflumetiazid Alternova and What Is It Used For?
Bendroflumetiazid Alternova is a thiazide diuretic (water tablet) that helps the body eliminate excess fluid and sodium through the kidneys. It is primarily prescribed to treat high blood pressure (hypertension), oedema (swelling caused by fluid retention), and to prevent the recurrence of calcium-based kidney stones.
Bendroflumetiazid Alternova contains the active substance bendroflumethiazide, which belongs to a well-established group of medicines called thiazide diuretics. These drugs have been used in clinical practice since the late 1950s and remain one of the most widely prescribed classes of antihypertensive medications worldwide. The European Society of Cardiology (ESC), the American Heart Association (AHA), and the National Institute for Health and Care Excellence (NICE) all include thiazide diuretics among their recommended first-line treatments for hypertension.
The blood pressure-lowering effect of bendroflumethiazide at low doses (2.5 mg daily) is primarily due to relaxation and widening of the small arteries (arterioles), rather than through its diuretic action. This vasodilatory effect reduces peripheral vascular resistance, meaning the heart does not have to work as hard to pump blood through the body. At higher doses (5–10 mg), the diuretic effect becomes more prominent, leading to increased excretion of sodium and water by the kidneys. This dual mechanism makes bendroflumethiazide a versatile cardiovascular medication.
For the treatment of oedema (swelling), bendroflumethiazide acts on the distal convoluted tubule in the kidney, inhibiting the reabsorption of sodium and chloride ions. This results in increased urine production and the removal of excess fluid from the body. Oedema can be caused by a range of conditions, including heart failure, liver disease, kidney disease, and certain medications. Premenstrual fluid retention is another condition for which bendroflumethiazide may be prescribed, typically at a dose of 2.5 mg daily for 7–10 days before the onset of menstruation.
In the prevention of kidney stones (nephrolithiasis), bendroflumethiazide works by reducing the amount of calcium excreted in the urine (hypercalciuria). Elevated urinary calcium is one of the most common risk factors for calcium oxalate and calcium phosphate kidney stones. By lowering urinary calcium levels, bendroflumethiazide decreases the likelihood of stone formation. This preventive approach is supported by multiple randomised controlled trials and is recommended by the European Association of Urology (EAU) for patients with recurrent calcium-based kidney stones.
Bendroflumethiazide is one of the most commonly prescribed antihypertensive medications, particularly in countries such as the United Kingdom, Denmark, and the Nordic region. It is often the first medication tried when a patient is diagnosed with high blood pressure, due to its well-established efficacy, favourable safety profile at low doses, and affordability. A single daily dose of 2.5 mg is usually sufficient to achieve meaningful blood pressure reduction.
What Should You Know Before Taking Bendroflumetiazid Alternova?
Before starting bendroflumethiazide, inform your doctor about all your medical conditions, especially gout, diabetes, liver or kidney disease, and electrolyte imbalances. You should also disclose all medications you are taking, as several important drug interactions exist. Bendroflumethiazide is contraindicated in severe liver or kidney disease and in patients with gout.
Contraindications
You should not take Bendroflumetiazid Alternova if any of the following apply to you:
- Allergy to bendroflumethiazide or to any of the other ingredients in the tablet (including lactose) – see the ingredients section for a full list
- Allergy to other thiazide diuretics – cross-reactivity exists between different thiazide compounds
- Allergy to sulfonamide antibiotics – there is a potential for cross-sensitivity because thiazides share a structural similarity with sulfonamides, although the actual clinical risk is debated
- Severe liver disease – thiazides can precipitate hepatic encephalopathy in patients with severe hepatic impairment
- Severe kidney disease – thiazide diuretics become ineffective when glomerular filtration rate (GFR) falls below approximately 30 mL/min; loop diuretics are preferred in this setting
- Gout – bendroflumethiazide increases uric acid levels in the blood and can trigger acute gout attacks
Warnings and Precautions
Talk to your doctor or pharmacist before taking Bendroflumetiazid Alternova if you have or have had any of the following conditions:
- Diabetes mellitus – thiazides can impair glucose tolerance and increase blood sugar levels, potentially worsening diabetic control. Regular monitoring of blood glucose is essential
- Previous adverse reaction to thiazides or thiazide-like diuretics – you may be at higher risk of similar reactions with bendroflumethiazide
- Concurrent treatment with digitalis glycosides (e.g., digoxin) – thiazide-induced potassium depletion increases the risk of potentially dangerous digitalis toxicity and cardiac arrhythmias
- Electrolyte imbalances – pre-existing low potassium (hypokalaemia), low sodium (hyponatraemia), or high calcium (hypercalcaemia) may be worsened by bendroflumethiazide
- Visual changes or eye pain – in rare cases, thiazides have been associated with acute angle-closure glaucoma and choroidal effusion (fluid accumulation behind the retina). If you experience sudden vision changes, eye pain, or redness, seek immediate medical attention, as untreated acute glaucoma can lead to permanent vision loss
- History of penicillin allergy – patients with a history of allergy to penicillin or sulfonamide antibiotics may have a slightly higher risk of developing hypersensitivity reactions to thiazides
If you develop blurred vision, eye pain, or redness within hours to weeks of starting Bendroflumetiazid Alternova, seek medical attention immediately. These may be signs of acute angle-closure glaucoma or choroidal effusion, which can cause permanent vision loss if not treated promptly. Stop taking the medication and contact your doctor or go to the nearest emergency department.
Use in Children and Adolescents
Bendroflumetiazid Alternova is not recommended for use in children and adolescents. There is insufficient clinical data regarding the safety and efficacy of bendroflumethiazide in the paediatric population. If a child or adolescent requires diuretic therapy or antihypertensive treatment, the prescribing doctor will select an appropriate alternative medication with an established paediatric safety profile.
Pregnancy and Breastfeeding
Bendroflumethiazide should generally be avoided during pregnancy. There is a risk that the drug may affect the developing foetus. Thiazide diuretics can cross the placental barrier and may cause electrolyte disturbances and reduced platelet counts in the newborn. They may also reduce placental blood flow by decreasing maternal blood volume. If you are pregnant, think you might be pregnant, or are planning to become pregnant, always consult your doctor before using Bendroflumetiazid Alternova.
It is not known whether bendroflumethiazide passes into breast milk in clinically significant amounts. Because thiazide diuretics may suppress lactation, and because of the potential for adverse effects in the nursing infant, you should consult your doctor before using this medication regularly during breastfeeding. Your doctor will assess whether the benefits of treatment outweigh the potential risks.
Driving and Operating Machinery
Bendroflumethiazide can occasionally cause dizziness, particularly at the start of treatment or when the dose is increased. This dizziness is often related to a drop in blood pressure, especially when standing up quickly from a sitting or lying position (orthostatic hypotension). If you experience dizziness, you should not drive or operate machinery until the symptoms resolve. This effect is more common in elderly patients and in those taking multiple blood pressure-lowering medications. You are responsible for assessing whether you are fit to drive; discuss with your doctor if you are uncertain.
Lactose Content
Bendroflumetiazid Alternova tablets contain lactose as an inactive ingredient. If you have been told by your doctor that you have an intolerance to certain sugars, contact your doctor before taking this medicine. Patients with rare hereditary problems of galactose intolerance, total lactase deficiency, or glucose-galactose malabsorption should not take this medicine.
How Does Bendroflumetiazid Alternova Interact with Other Drugs?
Bendroflumethiazide can interact with several important medications, including digitalis glycosides, lithium, NSAIDs, ACE inhibitors, and cholesterol-lowering resins. These interactions can affect the efficacy or safety of either drug. Always inform your doctor about all medications you are taking, including over-the-counter products and herbal supplements.
Drug interactions with bendroflumethiazide are clinically significant because the medication affects electrolyte balance, blood pressure, and kidney function. Changes in potassium, sodium, or calcium levels caused by the diuretic can enhance or diminish the effects of other medications. The following tables summarise the most important interactions.
Major Interactions
| Drug | Category | Effect | Recommendation |
|---|---|---|---|
| Digoxin / Digitalis glycosides | Cardiac glycoside | Thiazide-induced hypokalaemia (low potassium) significantly increases the risk of digitalis toxicity, which can cause life-threatening arrhythmias | Monitor potassium levels frequently; consider potassium supplementation or potassium-sparing diuretic |
| Lithium | Mood stabiliser | Thiazides reduce renal lithium clearance, leading to increased lithium blood levels and risk of lithium toxicity (tremor, confusion, kidney damage) | Avoid combination if possible; if co-administration is essential, monitor lithium levels closely and reduce lithium dose |
| Sotalol | Beta-blocker / antiarrhythmic | Hypokalaemia from thiazides increases the risk of QT prolongation and torsades de pointes when combined with sotalol | Monitor potassium and magnesium levels; correct electrolyte imbalances before starting combination |
| ACE inhibitors (e.g., enalapril, ramipril) | Antihypertensive | Risk of severe first-dose hypotension (dangerously low blood pressure), especially in volume-depleted patients | Start ACE inhibitor at low dose; consider temporarily stopping thiazide before initiating ACE inhibitor |
Moderate Interactions
| Drug | Category | Effect | Recommendation |
|---|---|---|---|
| NSAIDs (e.g., ibuprofen, naproxen, indometacin) | Anti-inflammatory / analgesic | NSAIDs reduce the diuretic and antihypertensive effect of thiazides by inhibiting renal prostaglandin synthesis; may also worsen kidney function | Monitor blood pressure and kidney function; use the lowest effective NSAID dose for the shortest duration |
| Cholestyramine / Colestipol | Bile acid sequestrant (cholesterol-lowering) | These drugs bind to thiazides in the gastrointestinal tract, significantly reducing their absorption | Take bendroflumethiazide at least 1–2 hours before or 4–6 hours after cholestyramine or colestipol |
| Corticosteroids (e.g., prednisolone) | Anti-inflammatory | Corticosteroids can cause sodium and fluid retention, counteracting the diuretic effect; both drugs deplete potassium | Monitor potassium levels; increased potassium supplementation may be required |
| Antidiabetic agents (insulin, metformin, sulfonylureas) | Hypoglycaemic agents | Thiazides can impair glucose tolerance and raise blood sugar, reducing the effectiveness of antidiabetic treatment | Monitor blood glucose more frequently; antidiabetic dose adjustment may be needed |
What Is the Correct Dosage of Bendroflumetiazid Alternova?
The typical dose of bendroflumethiazide for high blood pressure is 2.5 mg once daily in the morning. For oedema, doses of 2.5–10 mg daily may be used. For kidney stone prevention, the usual dose is 2.5 mg twice daily. Always follow your doctor's individual dosing instructions.
Always take Bendroflumetiazid Alternova exactly as your doctor has told you. The dose is individualised based on your condition, response to treatment, and any other medications you are taking. The tablet should be swallowed whole with a glass of water. It is recommended to take the tablet in the morning to minimise the need for night-time urination.
Adults
| Condition | Dose | Frequency | Notes |
|---|---|---|---|
| High blood pressure (hypertension) | 2.5–5 mg | Once daily in the morning | Start with 2.5 mg; blood pressure response usually seen within 1–2 weeks |
| Oedema (fluid retention) | 2.5–10 mg | Once daily in the morning | Higher doses increase diuretic effect but also increase risk of electrolyte imbalances |
| Premenstrual oedema | 2.5 mg | Once daily for 7–10 days before menstruation | Short-term cyclic use; discontinue at onset of menstruation |
| Kidney stone prevention | 2.5 mg | Twice daily (morning and evening) | Reduces urinary calcium excretion; maintain adequate fluid intake |
Children
Bendroflumetiazid Alternova is not recommended for children and adolescents. There are no established paediatric dosing guidelines for this medication. If a child requires diuretic or antihypertensive therapy, the treating doctor will select an appropriate alternative with documented safety in the paediatric population.
Elderly Patients
Elderly patients may be more susceptible to the blood pressure-lowering effects of bendroflumethiazide, particularly orthostatic hypotension (dizziness when standing up). Doctors typically start with the lowest effective dose (2.5 mg daily) and increase cautiously if needed. Regular monitoring of electrolytes (particularly potassium and sodium), kidney function, and blood pressure is especially important in this age group, as elderly patients are at greater risk of electrolyte depletion and its consequences.
Missed Dose
If you forget to take a dose, take it as soon as you remember on the same day. If it is already afternoon or evening, skip the missed dose entirely to avoid night-time urination and take your next dose the following morning as usual. Do not take a double dose to make up for a forgotten dose, as this increases the risk of excessive blood pressure reduction and electrolyte disturbances.
Overdose
If you take more Bendroflumetiazid Alternova than prescribed, or if a child accidentally ingests the tablets, seek immediate medical attention by contacting your local poison control centre or going to the nearest emergency department. Symptoms of overdose may include severe dizziness, extreme thirst, nausea, vomiting, muscle cramps, confusion, and dangerously low blood pressure. Treatment is supportive and focuses on correcting fluid and electrolyte imbalances.
Do not stop taking Bendroflumetiazid Alternova without consulting your doctor. Abrupt discontinuation, particularly in patients taking the medication for hypertension, may lead to a rebound increase in blood pressure and worsening fluid retention. Your doctor will advise you on how to gradually reduce the dose if treatment needs to be stopped.
What Are the Side Effects of Bendroflumetiazid Alternova?
Like all medicines, bendroflumethiazide can cause side effects, although not everyone will experience them. Common side effects include dizziness, headache, and electrolyte imbalances (particularly low potassium). Most side effects are mild and dose-dependent, meaning they are less likely to occur at lower doses (2.5 mg).
Side effects of bendroflumethiazide are largely related to its effects on electrolyte and fluid balance. Low-dose therapy (2.5 mg daily for hypertension) is associated with significantly fewer metabolic side effects compared to higher doses. If you notice any side effects not listed here, or if any side effect becomes severe, contact your doctor or pharmacist.
Common
May affect up to 1 in 10 people
- Dizziness and headache, particularly at the start of treatment (usually transient)
- Low potassium levels in the blood (hypokalaemia) with long-term use – may cause muscle weakness, cramps, or fatigue
- Increased blood sugar levels – particularly relevant for patients with diabetes or pre-diabetes
- Elevated uric acid levels in the blood (hyperuricaemia) – may trigger gout attacks in susceptible individuals
Uncommon
May affect up to 1 in 100 people
- Orthostatic hypotension (blood pressure drop when standing up) – more common in elderly patients, causing dizziness or fainting
- Increased urinary excretion of magnesium (hypomagnesaemia)
- Elevated calcium levels in the blood (hypercalcaemia)
- Low sodium levels in the blood (hyponatraemia) – may cause confusion, headache, and nausea
- Increased sensitivity to sunlight (photosensitivity) – skin may burn more easily when exposed to ultraviolet light
Rare
May affect up to 1 in 1,000 people
- Skin rash, itching, or hives (urticaria)
- Vasculitis (inflammation of blood vessel walls)
- Reduced platelet count (thrombocytopenia) – may cause easy bruising or bleeding
- Reduced white blood cell count (leukopenia) – may increase susceptibility to infections
- Acid-base balance disturbances (metabolic alkalosis)
Not Known
Frequency cannot be estimated from available data
- Blurred vision or eye pain due to elevated intraocular pressure (possible sign of acute angle-closure glaucoma or choroidal effusion)
- Erectile dysfunction (impotence) – isolated cases have been reported
Contact your doctor promptly if you experience persistent muscle cramps, extreme fatigue, irregular heartbeat, severe dizziness, sudden vision changes, eye pain, unexplained bruising or bleeding, or signs of infection such as fever and sore throat. These may indicate a serious side effect requiring medical evaluation and possible adjustment of your treatment.
How Should You Store Bendroflumetiazid Alternova?
Store Bendroflumetiazid Alternova at room temperature, out of sight and reach of children. No special storage conditions are required. Do not use after the expiry date printed on the packaging.
There are no special temperature or humidity requirements for storing Bendroflumetiazid Alternova. Keep the tablets in their original packaging (blister or container) until you are ready to take them. Store the medicine in a location where children cannot see or reach it. Do not use any tablets after the expiry date (marked “EXP” on the carton), which refers to the last day of the stated month.
Do not dispose of unused or expired tablets by flushing them down the toilet or putting them in household rubbish. Return any unwanted medication to your local pharmacy for safe disposal. This helps protect the environment by preventing pharmaceutical substances from entering waterways and soil.
What Does Bendroflumetiazid Alternova Contain?
Each Bendroflumetiazid Alternova tablet contains bendroflumethiazide as the active substance, along with inactive ingredients including anhydrous lactose, pregelatinised maize starch, stearic acid, and talc.
Bendroflumetiazid Alternova 2.5 mg Tablets
- Active substance: Bendroflumethiazide 2.5 mg
- Other ingredients: Anhydrous lactose, pregelatinised maize starch, stearic acid, talc
- Appearance: Round, flat, white to off-white biconvex tablets, approximately 5.5 mm in diameter
Bendroflumetiazid Alternova 5 mg Tablets
- Active substance: Bendroflumethiazide 5 mg
- Other ingredients: Anhydrous lactose, pregelatinised maize starch, stearic acid, talc
- Appearance: Round, flat, white to off-white tablets with bevelled edges, marked with “5” on one side, approximately 7 mm in diameter
Pack Sizes
Bendroflumetiazid Alternova is available in the following pack sizes:
- Blister packs: 98 tablets
- Plastic containers (HDPE): 100, 105, 200, 250, 300, and 500 tablets
Not all pack sizes may be marketed in all countries.
Marketing Authorisation Holder: Alternova A/S, Energivej 15, 5260 Odense S, Denmark.
Manufacturer: Orifarm Generics A/S, Energivej 15, 5260 Odense S, Denmark.
Frequently Asked Questions About Bendroflumetiazid Alternova
Bendroflumethiazide is a thiazide diuretic primarily used to treat high blood pressure (hypertension), reduce swelling caused by fluid retention (oedema), and prevent calcium-based kidney stones. At low doses (2.5 mg), it is one of the most commonly prescribed first-line treatments for hypertension, as recommended by major international guidelines including the European Society of Cardiology, the American Heart Association, and NICE.
The most common side effects are dizziness and headache at the start of treatment (usually transient), low potassium levels with long-term use (which can cause muscle cramps and fatigue), elevated blood sugar levels (particularly relevant for diabetic patients), and increased uric acid levels (which may provoke gout attacks). At the standard low dose of 2.5 mg for blood pressure, these metabolic side effects are significantly less common than at higher doses.
Bendroflumethiazide should be taken in the morning. Because it increases urine production, taking it in the afternoon or evening may cause you to wake up during the night to urinate. The blood pressure-lowering effect of bendroflumethiazide lasts throughout the day even with a single morning dose. Take the tablet with a glass of water, and it can be taken with or without food.
While there is no absolute contraindication, alcohol should be consumed with caution when taking bendroflumethiazide. Alcohol can enhance the blood pressure-lowering effect of the medication, increasing the risk of dizziness, lightheadedness, and fainting, particularly when standing up. Alcohol also acts as a diuretic itself, which may worsen dehydration and electrolyte imbalances. If you choose to drink alcohol, do so in moderation and be aware of these potential effects.
Bendroflumethiazide should generally be avoided during pregnancy. Thiazide diuretics can cross the placenta and may cause electrolyte disturbances and reduced platelet counts in the newborn. They may also reduce placental blood flow. If you are pregnant or planning to become pregnant, consult your doctor who will recommend a safer alternative blood pressure medication, such as labetalol or methyldopa, which have better-established safety profiles during pregnancy.
Bendroflumethiazide may cause a small initial reduction in body weight due to the loss of excess fluid, particularly in patients with oedema. However, this is water weight and not fat loss. The weight loss effect typically stabilises after the first few weeks of treatment. Bendroflumethiazide should never be used as a weight loss medication. If you experience significant or unexpected weight changes while taking this medication, inform your doctor.
References
- Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal. 2018;39(33):3021–3104. doi:10.1093/eurheartj/ehy339
- Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Journal of the American College of Cardiology. 2018;71(19):e127–e248. doi:10.1016/j.jacc.2017.11.006
- National Institute for Health and Care Excellence (NICE). Hypertension in adults: diagnosis and management [NG136]. Updated 2022. nice.org.uk/guidance/ng136
- Musini VM, Nazer M, Bassett K, Wright JM. Blood pressure-lowering efficacy of monotherapy with thiazide diuretics for primary hypertension. Cochrane Database of Systematic Reviews. 2014;(5):CD003824. doi:10.1002/14651858.CD003824.pub2
- European Association of Urology (EAU). Guidelines on Urolithiasis. 2023. uroweb.org/guidelines/urolithiasis
- World Health Organization. WHO Model List of Essential Medicines – 23rd List. 2023. who.int
- British National Formulary (BNF). Bendroflumethiazide: Indications, dose, contraindications, side-effects, interactions. bnf.nice.org.uk
- Borghi L, Meschi T, Guerra A, Nouvenne A, Allegri F. Randomized prospective study of a nonthiazide diuretic, indapamide, in preventing calcium stone recurrences. Journal of Cardiovascular Pharmacology. 2012;59(2):187–193.
Editorial Team
This article has been written and reviewed by the iMedic Medical Editorial Team, which includes licensed physicians specialising in cardiology, nephrology, and clinical pharmacology. Our editorial process follows the GRADE evidence framework, ensuring that all medical information is based on the highest available level of evidence.
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We prioritise Level 1A evidence from systematic reviews and meta-analyses of randomised controlled trials. All drug information is cross-referenced with the BNF, EMA, and WHO Essential Medicines List.
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