Hydrochlorthiazidum

Hydrochlorthiazidum – drug with diuretic action.

Form of release and structure

Hydrochlorthiazidum is released in the form of tablets (on 10 pieces in blister strip packagings, on 2 packagings in a cardboard pack).

Active agent is a part of 1 tablet: a hydrochlorothiazide – 25 or 100 mg.

Indications to use

• Arterial hypertension (as monotherapy or along with other hypotensive medicines);
• Control of a polyuria (most often at a nephrogenic not diabetes mellitus);
• Edematous syndrome of various genesis (nephrotic syndrome, chronic heart failure, acute glomerulonephritis, premenstrual syndrome, portal hypertensia, chronic renal failure, treatment by corticosteroids).

Also Hydrochlorthiazidum is shown for prevention of formation of stones in an urinogenital path at predisposed patients (for reduction of a hypercalcuria).

Contraindications

• Anury;
• Unmanageable diabetes mellitus;
• Hepatic or heavy renal (the clearance of creatinine is less than 30 ml in a minute) insufficiency;
• Gout;
• Addison's disease;
• Hypercalcemia, hypopotassemia, hyponatremia;
• First trimester of pregnancy and period of a lactation;
• Age up to 3 years;
• Hypersensitivity to drug components, and also to other sulfonamides.

It is necessary to be careful at use of Hydrochlorthiazidum by women in the II-III trimesters of pregnancy.

Route of administration and dosage

Hydrochlorthiazidum is accepted inside.

For a lowering of arterial pressure drug appoint 25-50 mg in a daily dose. As a rule, the insignificant natriuresis and a diuresis are noted in the first day of therapy. Drug is used for a long time along with other hypotensive medicines: inhibitors of an angiotensin-converting enzyme (APF), vazodilatator, beta adrenoblockers, sympatholytics. At increase in a dose from 25 to 100 mg proportional increase in a natriuresis, a diuresis and a lowering of arterial pressure is usually observed. At reception of Hydrochlorthiazidum in a single dose more than 100 mg further lowering of arterial pressure and increase of a diuresis are insignificant, at the same time disproportionate increase in loss of electrolytes, especially Mg2 + and K+ is observed. Increase in a dose up to 200 mg is also more inexpedient as strengthening of a diuresis does not happen.

At an edematous syndrome Hydrochlorthiazidum is appointed in the doses which are defined by a state and reaction of the patient to therapy. The daily dose can vary from 25 to 100 mg. Drug is accepted once in the morning or in the first half of day in 2 receptions. Patients of advanced age usually accept 1-2 times a day 12,5 mg.

To children from 2 months to 14 years Hydrochlorthiazidum is appointed at the rate of 1 mg/kg a day.

The maximum daily doses are defined by age:

• Children up to 6 months – 3,5 mg/kg;
• Children up to 2 years – 12,5-37,5 mg;
• Children of 3-12 years – 100 mg.

The daily dose is accepted in 2-3 receptions.

After 3-5 days of therapy it is recommended to take a break for 3-5 days. As the maintenance therapy in the specified dose Hydrochlorthiazidum is appointed by 2 times a week. At use of a discontinuous course of treatment with administration of drug in 1-3 days or within 2-3 days with the subsequent break side effects develop less often and reduction of efficiency is expressed to a lesser extent.

For decrease in intraocular pressure Hydrochlorthiazidum is usually appointed 1 time in 1-6 days on 25 mg. As a rule, the effect develops in 1-2 days.

At not diabetes mellitus of a tablet it is necessary to accept 1-2 times a day 25 mg with gradual increase in a dose up to 100 mg (before achievement of medical effect – reduction of a polyuria and thirst). Further decrease in a dose is possible.

Side effects

• Bodies of digestive tract: pancreatitis or cholecystitis, lock, cholestatic jaundice, sialadenitis, diarrhea, anorexia;
• Nervous system and sense bodys: indistinct sight (temporary), dizziness, paresthesias, headache;
• Cardiovascular system and blood (hemostasis, hemopoiesis): vasculitis, orthostatic hypotension, arrhythmias; very seldom – an agranulocytosis, a leukopenia, hemolitic anemia, thrombocytopenia, aplastic anemia;
• Disturbance of electrolytic balance: hyponatremia (convulsions, confusion of consciousness, delay of process of thinking, lethargy, excitability, fatigue, muscular spasms); the hypomagnesiemia, a hypopotassemia, a hypercalcemia (thirst, dryness in a mouth, changes in mentality or mood, an irregular heart rhythm, spasms and muscle pain, vomiting, nausea, unusual weakness or fatigue), besides a gipokhloremichesky alkalosis can cause a hepatic coma or hepatic encephalopathy;
• Metabolic phenomena: a glucosuria, a hyperglycemia, a hyperuricemia with development of an attack of gout. Therapy of a tiazidama can lower tolerance to glucose, and the diabetes mellitus latentno proceeding can demonstrate. At use of high doses of Hydrochlorthiazidum increase in level of lipids in blood serum is possible;
• Hypersensitivity reactions: a purpura, a small tortoiseshell, Stephens-Johnson's syndrome, a necrotic vasculitis, photosensitivity, a respiratory distress syndrome (including not cardiogenic hypostasis of a lung and a pneumonitis), anaphylactic reactions up to shock;
• Others: disturbance of renal function, decrease in a potentiality, intersticial nephrite.

Special instructions

At prolonged course treatment it is necessary to control carefully clinical signs of disturbance of water and electrolytic balance, first of all, at patients of group of the increased risk. Patients with abnormal liver functions and diseases of cardiovascular system treat them, and also patients at whom severe vomiting developed or appeared such signs of disturbance of water and electrolytic balance as thirst, dryness in a mouth, weakness, drowsiness, a lethargy, concern, spasms or muscular pains, tachycardia, muscular weakness, an oliguria, hypotension, complaints from digestive tract.

Development of a hypopotassemia, especially at the strengthened potassium loss (long treatment, a profound diuresis) or at simultaneous treatment by glycosides of a foxglove or corticosteroid medicines, it is possible to avoid, accepting kaliysoderzhashchy drugs or food rich with potassium (fruit, vegetables). Tiazida increase removal with magnesium urine, it can lead to development of a hypomagnesiemia.

At the lowered function of kidneys it is necessary to control clearance of creatinine. With an impaired renal function Hydrochlorthiazidum can cause an azotemia in patients. Development of cumulative effects is also possible. At an obvious renal failure in case of an oliguria it is recommended to consider the possibility of cancellation of therapy.

At a heavy cerebral and coronary sclerosis purpose of Hydrochlorthiazidum demands extra care.

Patients with dysfunctions or the progressing liver diseases should apply Hydrochlorthiazidum with care as little changes of level of ammonium in serum, and also water and electrolytic balance can lead to development of a hepatic coma.

Use of Hydrochlorthiazidum can break portability of glucose. During a long course of therapy at the latent or demonstrating diabetes mellitus it is necessary to control metabolism of carbohydrates systematically.

Barbiturates, alcohol and narcotic analgetics can strengthen orthostatic hypotensive effect of Hydrochlorthiazidum.

At long treatment the pathological change of epithelial bodies which is followed by a hypophosphatemia and a hypercalcemia was in rare instances observed.

The patients having a lactose intolerance can have gastrointestinal complaints that it is connected with existence in structure of tablets of lactose.

At the beginning of therapy (duration of this period is defined individually) to drive the car and to perform the works requiring special attention it is forbidden.

Medicinal interaction

The medicines (Clofibratum, indirect anticoagulants, non-steroidal anti-inflammatory drugs) which are intensively contacting proteins strengthen diuretic effect of Hydrochlorthiazidum.

The hypotensive effect of drug is strengthened by vazodilatator, tricyclic antidepressants, beta adrenoblockers, fenotiazina, barbiturates, ethanol.

Hydrochlorthiazidum strengthens a neurotoxicity of salicylates; reduces removal of quinidine and effect of oral contraceptives; weakens effect of peroral hypoglycemic drugs, Epinephrinum, Norepinephrinum and antigouty medicines; strengthens side effects of cardiac glycosides, neurotoxic and cardiotoxic effect of the drugs Li+, action of peripheral muscle relaxants.

At a concomitant use of Hydrochlorthiazidum with metildopy hemolysis development is possible.

Terms and storage conditions

To store in protected from light, the place, dry, unavailable to children, at a temperature up to 25 °C.

Period of validity – 2 years.