Do you routinely transition patients with recurrent calcium based kidney stones off of hydrochlorothiazide and onto chlorthalidone or indapamide for optimal control of hypercalciuria?

Yes, I do as they are longer acting thiazides and thus have better control over hypercalciuria. I generally start with Indapamide 1.25 mg daily and will titrate up if necessary. I prefer that as opposed to Chlorthalidone as to start with 12.5 mg Chlorthalidone, you need to cut it in half, which is n...

Typically, I start with hydrochlorothiazide 25 mg daily (the NoStone Study showed that 12.5 mg per day is equivalent to placebo) and then recheck a 24 hour urine. If calciuria is more than 200 mg/24 hours— the level that separates stone formers from non-stone formers— I either increase hydrochloroth...

I would only exchange a thiazide diuretic drug for therapy in the same category, if there was some reason for doing so, such as insurance coverage or patient preference (once a day medication vs twice daily for maximum benefit). If the drug was ineffective, I don't think that a change in thiazide cl...