Edema in congestive heart failure, liver cirrhosis, impaired renal function (eg in nephrotic syndrome, acute glomerulonephritis). Hypertension, usually in combination with other potassium-sparing diuretics or other antihypertensive drugs.
Composition:
1 tabl contains 12.5 mg or 25 mg hydrochlorothiazide. The preparation contains lactose.
Action:
A diuretic from the group of thiazide diuretics. It inhibits sodium reabsorption in the distal tubules, which results in increased natiuresis and diuresis. Increases the excretion of potassium and magnesium. Increases Calcium reabsorption, thereby reducing its excretion. It inhibits the excretion of uric acid. It causes a reduction in glomerular filtration. Non-renal effects of hydrochlorothiazide result in fasting hyperglycemia and the occurrence of an abnormal glycemic curve after Glucose loading. As a result of a decrease in the volume of circulating fluids, it increases the activity of renin in the plasma. It lowers arterial blood pressure in hypertensive patients by reducing the volume of extracellular fluids and peripheral resistance. By reducing the sodium concentration in the walls of blood vessels, they reduce their sensitivity to endogenous catechol amines. After oral administration, the onset of the diuretic occurs after about 2 h and the maximum effect after about 3-6 h after administration, the duration of action is 6-12 h. The onset of hypotensive effect occurs after 3-4 days. After discontinuation of long-term administration, the hypotensive effect disappears in the first week after discontinuation of the drug. The drug binds to plasma proteins in 40-68%. It is not metabolized. It is excreted in the urine in unchanged form. T0,5 It is 5.6-14.8 h. In patients with decompensated heart failure or kidney problems, the excretion is slower.
Contraindications:
Hypersensitivity to sulphonamides or other ingredients of the preparation. Anuria. Severe renal failure. Severe hepatic failure. Addison's disease. Hypercalcemia. The use of lithium compounds.
Precautions:
Hydrochlorothiazide is not effective if the creatinine clearance is <30 ml / min. Exercise caution in patients with congestive heart failure or liver disease, because the drug can cause hyponatraemia in those people (in hot weather), especially in the elderly, women with low body mass, people using a low-sodium diet, taking small amounts of fluids and electrolytes - above. people should limit the supply of liquids to about 500 ml / day and discontinue diuretic; the risk of hypokalemia (among others, long-term or cirrhotic patients, hypokalaemia increases the toxicity of digitalis glycosides); with bronchial asthma or allergy (increased risk of hypersensitivity to hydrochlorothiazide); with hepatic impairment (risk of hepatic coma caused by electrolyte imbalance). It may worsen symptoms or speed up the occurrence of uremia in patients with impaired renal function - discontinuation of hydrochlorothiazide is necessary; in patients with latent diabetes, it may accelerate its exposure; may cause or exacerbate the symptoms of systemic lupus erythematosus; it can cause hyperuricemia and trigger a gout attack. Blood electrolytes should be monitored during treatment, particularly in patients who are receiving parenterally fluid or who have persistent vomiting. The use of hydrochlorothiazide in infants and children is not recommended. Due to the lactose content, do not use the preparation in patients with rare hereditary galactose intolerance, Lapp lactase deficiency or malabsorption of glucose-galactose.
Pregnancy and lactation:
Hydrochlorothiazide crosses the placental barrier. Used in the second and third trimester of pregnancy, it may reduce the blood flow through the placenta and cause fetal and neonatal disturbances in electrolyte metabolism, jaundice and thrombocytopenia (due to the risk of decreased plasma volume and placental hypoperfusion, without beneficial effects on the course of the disease).It should not be used to treat essential hypertension in pregnant women, except in rare situations where no other treatment can be used. Hydrochlorothiazide is excreted in small amounts in breast milk. The use of thiazides in high doses increases diuresis and may inhibit milk production. The use of hydrochlorothiazide during breast-feeding is not recommended and the doses administered should be the lowest effective doses.
Side effects:
Lack of appetite, irritation of the gastric mucosa, nausea, vomiting, stomach cramps, diarrhea, constipation, pancreatitis, salivary glands, jaundice, headache and dizziness, paresthesia, restlessness, leukopenia, agranulocytosis, thrombocytopenia, aplastic and hemolytic anemia, hypotension ( including orthostatic), renal dysfunction, interstitial nephritis, purpura, photosensitivity, rash, urticaria, periarteritis, exfoliative dermatitis, fever, respiratory distress syndrome (including pneumonia and pulmonary edema), hypersensitivity reactions, reactions anaphylactic, toxic epidermal necrolysis, hyperglycemia, glycosuria, hyperuricaemia, gout, electrolyte imbalance (hyponatraemia, hypochloremic alkalosis, hypomagnesaemia, hypokalemia), muscle spasms, weakness, impotence, yellow vision, blurred vision. Hydrochlorothiazide may cause or worsen systemic lupus erythematosus or uremia, and may increase triglycerides and cholesterol in the blood. It reduces the excretion of calcium in the urine, causing some patients (without metabolic disturbances) to have a small increase in calcium levels in the blood. It reduces the binding of Iodine to plasma proteins without affecting thyroid function.
Dosage:
Orally. Adults.edema: initially 25-75 mg / day in 1 dose or in 2 divided doses; after improvement, gradually reduce the dose to the maintenance dose and administer every other day; the recommended maximum daily dose is 100 mg.Hypertension: initially 25 mg / day in a single dose or in divided doses, in some patients the therapeutic effect occurs after a dose of 12.5 mg (in monotherapy or in combination with another antihypertensive agent); the maximum daily dose is 50 mg; in the case of combination therapy with other antihypertensive drugs, the dosage of hydrochlorothiazide or antihypertensive drug should be reduced. In elderly patients, the dose is determined depending on renal function and clinical response.
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