Index of drugs

Hypertension or moderate blood pressure (as monotherapy or with other medicines that lower blood pressure). Congestive circulatory insufficiency. Cirrhosis of the liver with ascites and edema.

Tialorid: 1 tabl. contains 5 mg of amiloride hydrochloride and 50 mg of hydrochlorothiazide. Tialorid mite: 1 tabl. contains 2.5 mg amiloride hydrochloride and 25 mg hydrochlorothiazide. The tablets contain lactose.

The preparation is a medicine composed of two diuretics: hydrochlorothiazide and amiloride. Hydrochlorothiazide directly influences the inhibition of the reversal transport of sodium ions in the distal tubules, which in turn results in increased natriuresis and diuresis. Increased sodium excretion involves the excretion of potassium ions due to the inhibition of the exchange of sodium and potassium ions in the distal tubules, which is prevented by the amiloride found in the preparation. Hydrochlorothiazide, like other thiazides, increases the reabsorption of Calcium and reduces its excretion in the urine; increases the excretion of Magnesium ions; inhibits the excretion of uric acid, which may be the cause of hyperuricemia. Non-renal effects of hydrochlorothiazide result in fasting hyperglycemia and abnormal glycaemia after Glucose loading. Hydrochlorothiazide causes a slight decrease in glomerular filtration, which limits its use in patients with renal insufficiency. The digestive tract is absorbed incompletely. The effect usually occurs after 2 h and lasts for 6-12 h, the maximum effect occurs after 3-6 h. It is excreted in the urine, mainly unchanged. Amiloride is a potassium-sparing diuretic that increases the natriuretic, diuretic and hypotensive effects of hydrochlorothiazide. It impedes the penetration of hydrogen ions into the tubular epithelia in the distal part of the nephron, and thus inhibits the flow of these ions to the point of their exchange into potassium ions. As a result of this action, the sodium reabsorption and secretion of potassium and hydrogen ions is reduced. It is absorbed from the gastrointestinal tract in about 50%, the food reduces its absorption to 30%. After a dose of 20 mg C_max occurs after 3-4 h. It is excreted in the urine, mainly unchanged.

Hypersensitivity to amiloride, hydrochlorothiazide or other sulfonamides. Hyperkalaemia (serum potassium> 5.5 mmol / l). Increased serum calcium. Concentration of urea in the blood> 10 mmol / l, creatinine> 130 μmol / l. Treatment with lithium preparations. Treatment with other potassium-sparing drugs (eg triamterene, amiloride). Use of potassium supplements or a high potassium diet (in severe and refractory cases of hypokalemia you can use the drug under control). Severe hepatic failure. Pre-ascites state in liver cirrhosis. Severe renal failure. Anuria. Diabetic nephropathy. Diabetes. Addison's disease. Breastfeeding period. It is not recommended for use in children, as safety and efficacy have not been established.

The drug may cause hyperkalemia, which may be the cause of life-threatening arrhythmias. Hyperkalaemia is more common in patients with renal insufficiency, in patients with diabetes and in elderly patients. In all treated patients, monitoring of potassium levels in blood is recommended, especially at the beginning of treatment and after the appropriate dose has been established. If hyperkalemia occurs, the preparation should be discontinued and measures to reduce potassium should be taken if necessary. Although there is a lower risk of electrolyte disturbances after application of the product (hyponatraemia, hypochloremic alkalosis, hypokalemia, hypomagnesaemia), it is recommended to control water and electrolyte balance. Such control is recommended especially when the patient is vomiting and / or if he receives parenterally fluids. Hypokalemia may occur as a result of rapid diuresis, long-term therapy and severe liver cirrhosis. Hypokalemia may increase the sensitivity of the heart to the toxic effects of digitalis.Hyponatraemia caused by the drug is most often mild and asymptomatic and elderly people are particularly at risk. The drug should be used with caution in patients with: renal impairment (urea nitrogen> 30 mg / dl or creatinine> 1.5 mg / dl) - the risk of hyperkalemia and uremic symptoms due to drug accumulation; with cirrhosis, with coexisting ascites, metabolic alkalosis and edema (higher risk of increased serum urea nitrogen during forced diuresis, severe hepatic insufficiency may result in encephalopathy or hepatic coma); with bronchial asthma or current allergies - the risk of hypersensitivity to the drug; with heart and lung disease or uncontrolled diabetes - risk of developing respiratory and metabolic acidosis, frequent control of acid-base balance (the drug should not be administered to patients with diabetes due to the risk of developing hyperkalemia; renal function, it may be necessary to change the dose of antidiabetic medicines appropriately); in patients with gout - the drug may increase the concentration of uric acid in the blood and trigger a gout attack; in people with systemic lupus erythematosus, hydrochlorothiazide may exacerbate the symptoms of the disease. The drug contains lactose; should not be used in patients with rare galactose intolerance, Lapp lactase deficiency or malabsorption of glucose-galactose.

The drug can be used during pregnancy only in case of extreme necessity. Thiazides pass through the placenta; they are not indicated during pregnancy, even for the treatment of moderate edema, because they do not prevent the development of pregnancy poisoning, but they can cause hypovolaemia, increase the viscosity of the blood and reduce the blood supply to the placenta. We observed jaundice in fetuses and newborns as well as thrombocytopenia in neonates born by mothers who used thiazides during pregnancy. In women who used thiazides before delivery, uric acid and creatinine increased in the amniotic fluid. Hydrochlorothiazide is excreted in human milk, should not be used during breastfeeding.

Lack of appetite, taste disturbances, nausea, vomiting, cramps, diarrhea, constipation, stomach pain, bleeding, feeling of fullness in the abdomen, thirst, dry mouth, hiccups, pancreatitis; dizziness and headache, paresthesia, stupor, restlessness; insomnia, nervousness, memory disorders, depression, drowsiness; leukopenia, agranulocytosis, thrombocytopenia, aplastic anemia, hemolytic anemia; arrhythmias, tachycardia, increased toxicity of digitalis, hypotension, also orthostatic, ischemic heart disease; impotence, impaired urination, urinary incontinence, impaired renal function, including renal failure; pruritus, rash, redness of the face, profuse sweating, hypersensitivity reactions to light; pain in the limbs, muscle cramps, joint pain, chest pain, back pain; shortness of breath, cough, nasal congestion; transient visual disorder; hyperkalemia, electrolyte imbalance, dehydration, gout, hyperglycemia; tiredness, weakness, fatigue, feeling unwell, fever, fainting. Hydrochlorothiazide reduces glucose tolerance - may reveal the disease in patients with latent diabetes; it can increase serum cholesterol and triglyceride levels.

Orally. Adults.Hypertension: initially 2.5 mg + 25 mg once a day (1/2 Tialorid or 1 Tialorid mite); if necessary, the dose can be increased to 5 mg + 50 mg daily (1 Tialorid or 2 Tialorid mite) - once or in two divided doses.Congestive circulatory insufficiency: initially 2.5 mg + 25 mg per day (1/2 Tialorid or 1 Tialorid mite), the dose can be gradually increased; Do not exceed the daily dose of 10 mg + 100 mg.Cirrhosis: treatment starts with low doses, which is gradually increased until a suitable diuretic effect is obtained; Do not exceed the daily dose of 10 mg + 100 mg. After the edema has resolved, the dose should be reduced; The maintenance dose may be less than the initial dose. In the elderly, the dose should be selected depending on the state of renal function and clinical response to treatment.