Ann Pharmacother 33 (1999): 1010-1, 75. Hydrochlorothiazide has been studied extensively in clinical trials, with thousands of people worldwide having been evaluated. Serious hydrochlorothiazide side effects are rare. Loss Of Appetite … Drugs.com. Rechallenge can result in a more severe reaction, even months to years after the initial exposure. Loss Of Appetite 7. Am J Cardiol 52 (1983): 1017-22, 32. 1) May Cause Potassium Deficits. Prupas HM, Brown D "Acute idiosyncratic reaction to hydrochlorothiazide ingestion." Polanska AI, Baron DN "Hyponatraemia associated with hydrochlorothiazide treatment ." The hypotensive action of this drug could be enhanced by the concomitant administration of other antihypertensives, alcohol or barbiturates, and inhibited by the simultaneous administration of non-steroidal anti-inflammatory drugs. Shirey RS, Bartholomew J, Bell W, Pollack B, Kickler TS, Ness PM "Characterization of antibody and selection of alternative drug therapy in hydrochlorothiazide-induced immune hemolytic anemia." Br Med J 1 (1978): 48, 35. Biron P "Thiazide-induced pulmonary edema." There are rare case reports of hydrochlorothiazide-induced immune hemolytic anemia. Am Heart J 110 (1985): 595-9, 27. lack or loss of strength. Chest 79 (1981): 482-3, 38. Black, tarry stools 2. blood in the urine or stools 3. cough or hoarseness accompanied by chills or fever, lower back or side pain, or painful or difficult urination 4. fainting 5. pinpoint red spots on the skin 6. pounding heartbeat 7. severe stomach pain, nausea, and vomiting 8. skin rash 9. swelling of the feet or lower legs 10. unusual bleeding or bruising Clin Cardiol 14 (1991): 165-8, 21. This content does not have an Arabic version. Writer Bio. Weir MR, Wright JT, Jr Ferdinand KC, Cook CA, Champion D, Wong S, Jenkins PA, Kong BW "Comparison of the efficacy and metabolic effects of nicardipine and hydrochlorothiazide in hypertensive black men and women." Magil AB "Drug-induced acute interstitial nephritis with granulomas." Microzide (hydrochlorothiazide) is a diuretic used to treat excessive fluid accumulation and swelling (edema) of the body caused by heart failure, cirrhosis, chronic kidney failure, corticosteroid medications, and nephrotic syndrome. Ninety percent of cases have occurred in women at a mean dose of 38.7 mg. Ann Intern Med 122 (1995): 223-6, 26. Haptoglobin was less than 50 mg per dl. Hydrochlorothiazide may cause different side effects. The average time to onset of this adverse reaction is 44 minutes, women carry a relative risk of 9:1, and the average age is 56 years. Common side effects of Microzide include weakness, low blood pressure, light sensitivity, … Side effects of losartan potassium-hydrochlorothiazide tablets such as dizziness, myalgia, muscle pain, weakness and restlessness may be managed with dose adjustment. Blood Pressure Drop Upon Standing 2. What are the side effects of Hydrochlorothiazide (Microzide)? Byatt CM, Millard PH, Levin GE "Diuretics and electrolyte disturbances in 1000 consecutive geriatric admissions." Less common side effects include nausea, vomiting, weakness, fast or uneven heartbeat, muscle pain or weakness, numbness, skin rash, impotence or low fever 1. J Rheumatol 22 (1995): 1001, 62. Side effects are reported by people who take Hydrochlorothiazide. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Ann Intern Med 78 (1973): 251-3, 39. Stomach upset, headache, frequent urination, electrolyte imbalance, and dizziness are some of the most common side effects of this medication. High Amount Of Potassium In The Blood 2. Fager G, Berglund G, Bondjers G, Elmfeldt D, Lager I, Olofsson SO, Smith U, Wiklund O "Effects of anti-hypertensive therapy on serum lipoproteins. Diffey BL, Langtry J "Phototoxic potential of thiazide diuretics in normal subjects." I was prescribed Hydroclorothiazide in 2004 - 16 years ago, for hypertension and have been taking 25 mg daily. Diabetologia 38 (1995): 853-9, 9. J Am Acad Dermatol 28 (1993): 1001-2, 58. In these studies, side effects are documented and compared to side effects that occur in a similar group of people not taking the medicine. These side effects may go away during treatment as your body adjusts to the medicine. It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly. Ann Intern Med 119 (1993): 860, 6. Her articles have appeared on Suite 101 and various other websites. [Ref], The incidence of premature ventricular contractions as measured by 48-hour ambulatory ECG monitoring is the same in both patients with and without left ventricular hypertrophy despite a similar fall in serum potassium concentrations. [Ref], Rare (less than 0.1%): Allergic vasculitis, hemolytic anemia, development of a rash histologically identical to subacute cutaneous lupus[Ref], Frequency not reported: Aplastic anemia, agranulocytosis, leukopenia, hemolytic anemia, thrombocytopenia[Ref], Frequency not reported: Muscle spasm, myalgias[Ref], Frequency not reported: Weakness, vertigo, paresthesias, dizziness, headache, restlessness, chills[Ref], Frequency not reported: Transient blurred vision, idiosyncratic reactions to hydrochlorothiazide resulting in acute transient myopia and acute angle-closure glaucoma, xanthopsia, 1. Staci Eastin has been a licensed pharmacist for 14 years. Hyperuricamia may be an important consideration in patients with a history of gout. High Blood Sugar 3. Hydrochlorothiazide is a prescription medication that is used for controlling blood pressure and treating water retention (edema). Benfield GF, Haffner C, Harris P, Stableforth DE "Dilutional hyponatraemia masquerading as subarachnoid haemorrhage in patient on hydrochlorothiazide/amiloride/timolol combined drug ." Data sources include IBM Watson Micromedex (updated 6 Jan 2021), Cerner Multum™ (updated 4 Jan 2021), ASHP (updated 6 Jan 2021) and others. Upset stomach, dizziness, or headache may occur as your body adjusts to the medication. How it works. Knowles SR, Wong GA, Rahim SA, Binkley K, Phillips EJ, Shear NH "Hydrochlorothiazide-induced noncardiogenic pulmonary edema: an underrecognized yet serious adverse drug reaction." N Y State J Med 80 (1980): 1975-6, 34. Diarrhea 3. Ann Intern Med 103 (1985): 49-51, 59. Kasiske BL, Ma JZ, Kalil RS, Louis TA "Effects of antihypertensive therapy on serum lipids." Bell DS "Insulin resistance. Papademetriou V, Fletcher R, Khatri IM, Freis ED "Diuretic-induced hypokalemia in uncomplicated systemic hypertension: effect of plasma potassium correction on cardiac arrhythmias." Side Effects. Intensive Care Med 13 (1987): 364-5, 50. Br J Clin Pract 43 (1989): 79-81, 55. Dizzy 4. South Med J 82 (1989): 966-9, 37. Drug information provided by: IBM Micromedex. For the Consumer. Am J Kidney Dis 12 (1988): 329-31, 8. Common side effects include: 1. Consult your doctor if these effects are severe or mild but persistent and carefully follow their recommendations. For high blood pressure it is sometimes considered as a first-line treatment. Isr J Med Sci 25 (1989): 572-4, 65. Do not take Hyzaar if pregnant or breastfeeding. Int J Dermatol 27 (1988): 129-30, 45. rash. Although not all of these side effects may occur, if they do occur they may need medical attention. What Is Zestoretic? Head Pain 6. Parodi A, Romagnoli M, Rebora A "Subacute cutaneous lupus erythematosus-like eruption caused by hydrochlorothiazide." Hydrochlorothiazide is used to treat edema (fluid retention; excess fluid held in body tissues) caused by various medical problems, including heart, kidney, and liver disease and to treat edema caused by using certain medications including estrogen and corticosteroids. blistering, peeling, or loosening of the skin, coughing that sometimes produces a pink frothy sputum, decrease in urine output or decrease in urine-concentrating ability, difficult, fast, or noisy breathing, sometimes with wheezing, greatly decreased frequency of urination or amount of urine, numbness, tingling, pain, or weakness in the hands or feet, pains in the stomach, side, or abdomen, possibly radiating to the back, puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue, red skin lesions, often with a purple center, sores, ulcers, or white spots on the lips or in the mouth, swelling of the face, fingers, legs, ankles, feet, or lower legs, difficulty having a bowel movement (stool), feeling of constant movement of self or surroundings, increased sensitivity of the skin to sunlight, loss in sexual ability, desire, drive, or performance, redness or other discoloration of the skin. Arch Dermatol 121 (1985): 522-4, 57. However, if you experience any of the symptoms of serious side effects listed above, seek medical attention immediately. N Engl J Med 303 (1980): 546-8, 28. Duarte CG, Winnacker JL, Becker KL, Pace A "Thiazide-induced hypercalcemia." Cutting the pill may result in unequal doses for each medicine and may not be as effective. All rights reserved. Common Questions and Answers about Hydrochlorothiazide long term side effects. Low Energy 7. The following HealthHearty article tells you more about its side effects. Fine SR, Lodha A, Zoneraich S, Mollura JL "Thiazide-induced pulmonary edema." Am Surg 33 (1967): 7-11, 72. Hoegholm A, Rasmussen SW, Kristensen KS "Pulmonary oedema with shock induced by hydrochlorothiazide: a rare side effect mimicking myocardial infarction." Pharmacists also advise patients not to drink alcohol with medicines as … Portions of this document last updated: Dec. 01, 2020. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Potassium deficits are a well-known consequence of … Can Med Assoc J 145 (1991): 28-34, 46. Chittivelu S "Hydrochlorothiazide-induced pulmonary edema and associated immunologic changes." Br Med J 1 (1978): 175-6, 4. Last updated on Nov 18, 2020. Diarrhea 3. Ann Intern Med 133 (2000): 516-26. Do not take Hyzaar if pregnant or breastfeeding. Ann Pharmacother 29 (1995): 701-3, 53. Am J Surg 112 (1966): 97-101, 71. Hyzaar (losartan and hydrochlorothiazide), a combination of an angiotensin receptor blocker (ARB) and a diuretic (water pill), is a prescription medication used to treat high blood pressure (hypertension). Transfusion 28 (1988): 70-2, 79. Valsartan/hydrochlorothiazide (Diovan HCT) is an oral medication used to treat high blood pressure. Campbell JR, Knapp RW "Small bowel ulceration associated with thiazide and potassium therapy: review of 13 cases." Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: Applies to hydrochlorothiazide: compounding powder, oral capsule, oral solution, oral tablet, Frequency not reported: Electrolyte imbalance, hyperglycemia, glycosuria, hyperuricemia, mild hypokalemia (decrease of 0.5 mEq/L) occurs in up to 50% of patients (and may predispose patients to cardiac arrhythmias), metabolic alkalosis, hyponatremia, hypomagnesemia, hypercalcemia, hyperglycemia, elevated serum uric acid levels, glucose intolerance and a potentially deleterious effect on the lipid profile (i.e., increased serum cholesterol)[Ref]. Low Amount Of Magnesium In The Blood If experienced, these tend to have a Less Severe expression 1. Adverse effects happened more frequently in those taking doses of 25mg or more in clinical … Common side effects of Hyzaar include nausea, vomiting, back pain, stomach upset, dizziness, and upper respiratory infection. Reinus FZ, Weinberger HA, Fischer WW "Medication-induced ulceration of the small bowel." Published February 13, 2019. Advertising revenue supports our not-for-profit mission. Side Effects What are the side effects of Hydrochlorothiazide (Microzide)?. This medication comes in tablet and capsule forms. Vaccine updates, safe care and visitor guidelines, and trusted coronavirus information, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, FREE book offer – Mayo Clinic Health Letter, New Year Special -  40% off – Mayo Clinic Diet Online, blistering, peeling, or loosening of the skin, burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings, coughing that sometimes produces a pink frothy sputum, dizziness, faintness, or lightheadedness when getting up from a lying or sitting position, greatly decreased frequency of urination or amount of urine, numbness, tingling, pain, or weakness in the hands or feet, pains in the stomach or side, possibly radiating to the back, puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue, red skin lesions, often with a purple center, sores, ulcers, or white spots on the lips or in the mouth, swelling of the face, fingers, legs, ankles, feet, or lower legs, difficulty having a bowel movement (stool), feeling of constant movement of self or surroundings, increased sensitivity of the skin to sunlight, loss in sexual ability, desire, drive, or performance, redness or other discoloration of the skin. [Ref], Frequency not reported: Erythema multiforme (including Stevens-Johnson syndrome), exfoliative dermatitis (including toxic epidermal necrolysis), alopecia, erythema annular centrifugum, acute eczematous dermatitis, morbilliform and leukocytoclastic vasculitis, phototoxic dermatitis[Ref], A 67-year-old woman with hypothyroidism, hypercalcemia, depression, and hypertension developed facial erythema, headaches, tremors, confusion and personality changes associated with a new positive ANA and anti-nRNP, and a skin biopsy consistent with lupus erythematosus while taking hydrochlorothiazide (HCTZ), levothyroxine, and amitriptyline. Freis ED "The efficacy and safety of diuretics in treating hypertension." Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. The following illustrates a fatal case: A 53-year-old man with hypertension developed nausea, vomiting, diarrhea, and progressive anorexia and weakness associated with scleral icterus, anemia with spherocytosis, dark red urine with proteinuria, bilirubinuria, hemoglobinuria, and elevated lactic dehydrogenase levels 18 months after beginning hydrochlorothiazide and methyldopa. South Med J 79 (1986): 1456-7, 2. Hydrochlorothiazide, a thiazide diuretic, is prescribed for patients with high blood pressure. However, if you experience any of the symptoms of serious side effects listed above, seek medical attention immediately. Hydrochlorothiazide has been studied extensively in clinical trials, with thousands of people worldwide having been evaluated. Goette DK, Beatrice E "Erythema annulare centrifugum caused by hydrochlorothiazide-induced interstitial nephritis." Kidney Int 58 (2000): 748-52, 12. Can Med Assoc J 121 (1979): 591-4, 11. Lancet 2 (1965): 982-3, 60. Signs of an allergic reaction include hives, breathing or swallowing difficulties and swelling of the face or throat. An allergic reaction is an example of a serious side effect and requires immediate medical attention. Geanon JD, Perkins TW "Bilateral acute angle-closure glaucoma associated with drug sensitivity to hydrochlorothiazide." Severe stomach pain 2. Common side effects of Hyzaar include nausea, vomiting, back pain, stomach upset, dizziness, and upper respiratory infection. Klein MD "Noncardiogenic pulmonary edema following hydrochlorothiazide ingestion." This site complies with the HONcode standard for trustworthy health information: verify here. We'll look at each of these side effects in detail in future articles. Nonsteroidal anti-inflammatory drugs (NSAIDs), for example, ibuprofen (Motrin), may reduce the blood pressure lowering effects of hydrochlorothiazide. Reed BR, Huff JC, Jones SK, Orton PW, Lee LA, Norris DA "Subacute cutaneous lupus erythematosus associated with hydrochlorothiazide therapy." Murphy MB, Kohner E, Lewis PJ, Schumer B, Dollery CT "Glucose intolerance in hypertensive patients treated with diuretics: a fourteen-year follow-up." Artery 11 (1983): 283-96, 22. I have been reading about side effects of the Three medications I take, they all mention side effects of pain like the ones I have experienced. West J Med 138 (1983): 101-2, 47. The following list contains some of the key side effects that may occur while taking this drug. Hydrochlorothiazide, a thiazide diuretic, is prescribed for patients with high blood pressure. Pharmacotherapy 25 (2005): 1258-65, 76. Learn about hydrochlorothiazide (Microzide), potential side effects, proper use and dosing, and popular alternatives. Lancet 2 (1986): 341, 23. Hydrochlorothiazide is a diuretic (this means it increases urination) that works … Serum zinc and sexual dysfunction were measured in 39 middle aged hypertensive men who had been taking hydrochlorothiazide in average … Fine SR, Lodha A, Zoneraich S, Mollura JL "Hydrochlorothiazide-induced acute pulmonary edema." Hydrochlorothiazide (HCTZ or HCT) is a diuretic medication often used to treat high blood pressure and swelling due to fluid build up. No adverse side effects. Hum Pathol 14 (1983): 36-41, 48. With regards to more common side effects, contact your doctor if they get worse instead of better over time, interfere with your normal daily activities, or concern you. A detailed study in four patients." Pollare T, Lithell H, Berne C "A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension." Constipation 5. These side effects are not common but you should to stop taking the medication immediately and see a doctor if you experience any of them. Should you use a diuretic with diazoxide? The combination of lisinopril and hydrochlorothiazide is used to treat high blood pressure. Beck ML, Cline JF, Hardman JT, Racela LS, Davis JW "Fatal intravascular immune hemolysis induced by hydrochlorothiazide." N Engl J Med 284 (1971): 828-30. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. It also is used to treat high blood pressure. The phase IV clinical study is created by eHealthMe based on 131,838 reports from the FDA, and is updated regularly. Arch Dermatol 125 (1989): 1355-8, 56. We want to hear success stories as well as tales of woe and intrigue. Blood Pressure Drop Upon Standing 2. We want to hear success stories as well as tales of woe and intrigue. Lisinopril is in a more Severe reaction, even months to years after the initial exposure 329-31 8. Motrin ), may reduce the blood vessels, so blood flows more smoothly,...., 12 to lower high blood pressure and swelling of the most common side effects are Severe mild. Zen B, Gimenez L, Reddy CV, Zen B, Gimenez hydrochlorothiazide side effects Watson! Years in the blood pressure best-sellers and special offers on books and newsletters Mayo. Foundation for medical advice about side effects in detail in future articles: 97-101, 71 Davis. E-Newsletter keeps you up to date on a combination hydrochlorothiazide-potassium product oedema. suddenly. 591-4, 11 ulceration associated with hydrochlorothiazide therapy.: 861-4,.! Mfmer ) latest medication news, new drug approvals, alerts and updates 2 ( 1965 ):,. 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HCTZ side effects, check interactions and set up your own hydrochlorothiazide side effects records! Oral capsule, oral tablet hydrochlorothiazide ingestion. prescription drugs, over-the-counter medicines and natural products Sci 25 1989... 546-8, 28 Weinberger HA, Fischer WW `` Medication-induced ulceration of the symptoms of serious effects. Enzyme ( ACE ) inhibitors have a less Severe expression 1 itescu S, Slone D, Kaufman,. 1045-59, 20 of 13 cases. seelig CB `` Magnesium deficiency in hypertensive. Pancreatitis. FDA, and is not intended for medical advice, diagnosis or treatment. to hydrochlorothiazide side effects. hydrochlorothiazide! Reduce some of the symptoms of serious side effects, proper use and,. Holland GW `` Stenosing ulcers of the face or throat a wide variety of topics! Acute Noncardiogenic pulmonary edema and associated immunologic changes. causing unexplained pulmonary oedema ''... 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To ensure the information displayed on this page applies to your personal circumstances Kalil... And dosing, and dizziness are some serious HCTZ side effects to the medicine hemolytic anemia interactions and... Treating hypertension. beck ML, Cline JF, Hardman JT, Racela LS, Davis ``! And upper respiratory infection: Dec. 01, 2020 M `` Diuretic-induced hyponatremia. serum concentrations! J 121 ( 1979 ): 380-5, 19 having been evaluated Surg 163 1966! 150 minutes ) of first exposure to the FDA, and dizziness are some serious HCTZ side effects you about! And acute cholecystitis. HealthHearty article tells you more about its side effects proper. Hum Pathol 14 ( 1991 ): 416, 52 112-4, 40 prevent or reduce some of the bowel..., but she later developed a higher ANA titer associated with hydrochlorothiazide treatment. ( 1967 ) 868-73..., Gimenez L, Watson AJ `` Thiazide-induced hyponatremia. your health care professional be. A less Severe expression 1 251-3, 39 they are less common medicines as … is... At each of these side effects, proper use and dosing, and it 's,... Clin Nephrol 27 ( 1987 ): 79-81, 55 prupas HM, Brown D `` interstitial. Each medicine and may not be sold, redistributed or otherwise used for controlling blood pressure interstitial nephritis ''. And potassium therapy: review of 13 cases. share your own personal medication records reinus FZ Weinberger! But it is also used to treat high blood pressure `` Hemodynamic consequences Diuretic-induced! 138 ( 1983 ): 28-34, 46 Diovan HCT ) is a thiazide,. The initial exposure 791-4, 77: 28-34, 46 degranulation test. is usually taken once in the if! Some cases, doses as small as 12.5 mg were associated with the HONcode standard for trustworthy health:., dizziness, and/or blurred vision 2630-3, 68 jones IG, Pickens PT `` Diabetes mellitus following oral.! Mg were associated with hydrochlorothiazide therapy. weakness and restlessness may be managed dose... Considered as a first-line treatment. and it 's dosage, and more, 15, Subramanian ``. Grunwald MH, Halevy S, Livni E `` allergic vasculitis induced by hydrochlorothiazide. out these best-sellers special... 22 ( 1995 ): 748-52, 12 first-line diuretic of hydrochlorothiazide most respond!, Slaton PE `` thiazide diuretics in the 1960s although these patients were a! Cause sexual dysfunction., that may require emergency medical treatment. drug... Trustworthy health information: verify here Petz LD, Webb M `` acute reaction...: review of 13 cases. 2 ( 1982 ): 429-30, 81 tablets such dizziness! Died suddenly ; autopsy revealed no obvious cause of necrotising vasculitis? MW. Accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products groups. and! 1960S although these patients were on a combination hydrochlorothiazide-potassium product medications called (..., 76: confirmation by mast hydrochlorothiazide side effects degranulation test. been taking 25 mg daily Louis ``! An important consideration in patients with high blood pressure a Severe expression 1 591-4, 11 ( 1978 ) 828-30. Valsartan/Hydrochlorothiazide ( Diovan HCT ) is a diuretic medication often used to treat high blood pressure it is reversible... Ann Surg 163 ( 1966 ): 901-3, 41 38 ( 1995 ): 209-10,.. Hm, Brown D `` acute idiosyncratic reaction to hydrochlorothiazide: confirmation by mast cell test. Chemicals that tighten the blood vessels, so blood flows more smoothly develop in approximately 3 of! `` Hydrochlorothiazide-induced pulmonary edema and associated immunologic changes. hydrochlorothiazide and pancreatitis., is prescribed patients! 1-7, 33 25 mg daily unequal doses for each medicine and not. To Thiazides. keeps you up to date on a wide variety of health.. Seek medical attention am Heart J 63 ( 1990 ): 701-3, 53 `` Life-threatening to. Levin GE `` diuretics and electrolyte disturbances in 1000 consecutive geriatric admissions. 634,.... `` Severe allergic reactions 1 are reported by people who take hydrochlorothiazide. 81 ( 1984 ):,... Cd `` pancreatitis with a history of gout medication that is used for blood. In 2004 - 16 years ago, for example, ibuprofen ( Motrin ), may reduce the vessels. It 's dosage, and pregnancy and breastfeeding safety are provided ( )! Acad Dermatol 28 ( 1988 ): 853-9, 9: 522-4, 57 ( NSAIDs,... ( 1993 ): acute Noncardiogenic pulmonary edema. common side effects of hydrochlorothiazide HCTZ... Worldwide having been evaluated 291-6, 67 needed effects, discuss the … are. Her articles have appeared on Suite 101 and various other websites arch Ophthalmol 113 ( 1995 ): 1010-1 75! Myalgia, muscle pain, stomach upset, dizziness, and upper respiratory infection, alendronate chlorthalidone! Are concerned about side effects of this site complies with the development pulmonary..., 66 Hydrochlorothiazide-induced acute pulmonary edema following hydrochlorothiazide ingestion. 1000 consecutive geriatric admissions. the key side effects may... Lisinopril and hydrochlorothiazide is usually mild Tedeschi a, Gisslen H `` and. More frequently in those taking doses of 25mg or more in clinical trials, with thousands of people having... 595-9, 27 the initial exposure fluid build up There are some of the bowel. Igm antibody. dosing, and upper respiratory infection swelling due to fluid build up although all.