Which group of patients should never be prescribed HCTZ?

Hydrochlorothiazide (HCTZ) is a commonly used thiazide diuretic that helps manage hypertension and edema. However, when considering patients with diabetes and gout, there are significant concerns about prescribing HCTZ.

In patients with diabetes, HCTZ can potentially cause an increase in blood glucose levels, which could worsen glycemic control. Furthermore, thiazide diuretics can lead to an increase in serum uric acid levels. This increase can precipitate gout attacks in susceptible individuals, making the medication particularly unsuitable for patients who already have gout.

Therefore, while HCTZ might be appropriate for managing hypertension or heart failure in other patient populations, its adverse effects on glucose and uric acid metabolism make it a poor choice for patients with both diabetes and gout. This is why this specific group of patients should be carefully considered before being prescribed HCTZ.