Would you support a modified chlorthalidone treatment regimen involving a drug holiday of two days per week for patients with recurrent calcium based nephrolithiasis who have less erectile dysfunction side effects when temporarily off of the thiazide diuretic?

I know of no study data to answer the question. The half-life of chlorthalidone is approximately 40–60 hours. Whether the drug would wear off enough during a 24 hour drug holiday to achieve an erection would be the first question to answer. The second is a risk benefit question: an increased risk of stone formation versus an improved chance of sexual activity, which the patient would need to answer with your guidance.

Stephen B Erickson, MD