Hydrochlorthiazidum

General characteristics. Structure:

Active ingredient: 25 mg of Hydrochlorthiazidum.

Excipients: lactose monohydrate, коллидон 30, коллидон CL, magnesium stearate.

Diuretic.

Pharmacological properties:

Pharmacodynamics. Hydrochlorthiazidum is the highly active diuretic means operating at oral administration. On a chemical structure, treats group of the derivatives of a petrolthiadiazine containing in situation C7, sulphonamide group. Existence of this group makes related Hydrochlorthiazidum sdiakarby. However, as diuretic, Hydrochlorthiazidum is much more effective, and to a karboangidraz it oppresses in much smaller degree, than Diacarbum. Diuretic action of Hydrochlorthiazidum, just as other diuretics of groups

ы a petrolthiadiazine, it is caused by reduction of a reabsorption of ions of sodium and chlorine in proximal (and partially and in distal) parts of gyrose tubules of kidneys; the reabsorption of potassium and bicarbonates is also oppressed, however to a lesser extent. Due to the strong increase in a natriuresis at simultaneous strengthening of removal of chlorides Hydrochlorthiazidum is considered as active saluretichesky means; sodium and chlorine are emitted from an organism in ekvilalentny quantity.

Drug has diuretic effect, both at acidosis, and at an alkalosis. The diuretic effect at prolonged use of Hydrochlorthiazidum does not decrease. At not sugar mocheiznureniye Hydrochlorthiazidum as well as other diuretics of a petrolthiadiazine row, the "paradoxical" effect renders, causing decrease in a polyuria. Hydrochlorthiazidum has also hypotensive effect which is usually observed at the raised ABP.

Pharmacokinetics. Hydrochlorthiazidum is quickly soaked up. The diuretic effect after reception of Hydrochlorthiazidum develops quickly (during the first 1 - 2 h) and lasts after a single dose to 10-12 h and more.

Indications to use:

Appoint Hydrochlorthiazidum as diuretic (saluretichesky) means at the developments of stagnation in a small and big circle of blood circulation connected with cardiovascular insufficiency; liver cirrhoses with the phenomena of portal hypertensia; nefroza and nephrites (except for the severe progressing forms with reduction of a glomerular filtration rate); toxicoses of pregnant women (nephropathy, hypostases, eclampsias); the premenstrual states which are followed by developments of stagnation. Hydrochlorthiazidum interferes with a delay in an organism of ions of sodium and the water accompanying use of mineralokortikoid therefore it is appointed also at the hypostases caused by adrenal hormones and adrenocorticotropic hormone of a hypophysis. Hydrochlorthiazidum warns or reduces the increase in the ABP caused by these drugs.

As Hydrochlorthiazidum usually exponentiates action of antihypertensives, it often appoint in a combination with these drugs, especially sick with high arterial pressure. The combined treatment can be effective also at the malignant course of a hypertension. Doses of hypotensive drugs at the combined use with Hydrochlorthiazidum can be reduced.

In some cases Hydrochlorthiazidum lowers intraocular pressure and normalizes intraocular tension at glaucoma (preferential at the subcompensated forms). The effect occurs in 24 - 48 h after administration of drug. Usually Hydrochlorthiazidum (hypothiazid) is combined with an instillation in a conjunctival sac of an eye of miotik or other antiglaukomatozny means.

Route of administration and doses:

Accept Hydrochlorthiazidum inside in time or after food, without chewing, washing down with a small amount of water.

Doses select individually depending on disease severity and the rendered effect.

The single dose for patients at appointment as diuretic can vary from 25 mg to 200 mg. In mild cases appoint 25–50 mg a day, in more hard cases - on 100 mg a day. Accept once (morning) or in two steps (in the first half of day). Sometimes appoint up to 200 mg a day.

Increase in a dose over 200 mg is inexpedient as further strengthening of a diuresis usually does not happen.

To elderly people with cerebral forms of an idiopathic hypertensia recommend to accept smaller doses (12,5 mg 1-2 times a day). Drug can be accepted within       3-7 days in a row, then do a break for 3-4 days and again continue administration of drug; in more mild cases do a break after each 1-2 days.

Duration of a course and the general duration of treatment depends on character and disease severity, the gained effect, portability. Treatment, especially in the first days, has to be carried out under observation of the doctor.

At an idiopathic hypertensia appoint 25-50 mg a day usually together with hypotensive drugs.

The patient with glaucoma appoint 25 mg a day.

Features of use:

In the course of treatment by Hydrochlorthiazidum it is necessary to watch the diuresis level, electrolytic composition of blood.

Treatment by Hydrochlorthiazidum is recommended to be carried out against the background of the diet rich with potassium salts. At emergence of symptoms of a hypopotassemia it is necessary to appoint папангин, potassium salts (chloride potassium solution at the rate of 2 g of drug a day). Salt of potassium is also recommended to appoint the patient receiving drugs of a foxglove and corticosteroids along with Hydrochlorthiazidum. At a gipokhloremichesky alkalosis appoint sodium chloride. In order to avoid a hypopotassemia it is possible to accept together with kaliysberegayushchy diuretics.

At diseases of kidneys it is not necessary to combine Hydrochlorthiazidum with kaliysberegayushchy and kaliysoderzhashchy drugs.

Tiazida can cause a hyperglycemia and an aggravation of a diabetes mellitus also.

Side effects:

Hydrochlorthiazidum is usually well transferred, however at prolonged use can develop a hypopotassemia (more often moderated) and a gipokhloremichesky alkalosis. The hypopotassemia arises at patients with cirrhosis and a nephrosis more often. The Gipokhloremichesky alkalosis is more often observed at an electrolyte-deficient diet or loss of chlorides in connection with vomiting or diarrhea. Dermatitis is in rare instances observed.

Interaction with other medicines:

At reception of Hydrochlorthiazidum and other thiazide diuretics can be observed reduction of release of uric acid from an organism and an exacerbation of latent gout. In these cases, along with tiazida it is possible to appoint Allopyrinolum.

At a combination with ganglioblokiruyushchy drugs it is necessary to consider a possibility of strengthening of postural hypotension.

Contraindications:

- heavy renal failure,
- the expressed damages of a liver,
- severe forms of a diabetes mellitus and gout,
- first trimester of pregnancy

Overdose:

Symptoms: the expressed decrease in the ABP.

Treatment: to cause vomiting and/or to wash out a stomach, the symptomatic therapy directed to correction of dehydration and disturbances of introduction and salt balance. At arterial hypotension to enter isotonic solution. Control of urea, creatinine and electrolytes in blood serum, and also a diuresis.

Storage conditions:

List B. To store in the dry, protected from light place, at a temperature not above +25 °C. To store in the place, unavailable to children. Period of validity 2 years.

Issue conditions:

According to the recipe

Packaging:

On 20 tablets in plastic cases or banks polymeric. On 10 tablets in a blister strip packaging, on 2 packagings in a cardboard pack.