Hydrochlorothiazide
Hydrochlorothiazide
HydrochlorothiazidePharmacological action
Diuretic. The diuretic effect comes through 2 h, reaches a maximum through 4 h and proceeds 6-12 h. Possesses antihypertensive properties, preparation application is possible at an arterial hypertensia both as monotherapy, and for intensifying of antihypertensive action of other preparations. The hypotensive effect develops at the expense of expansion of arterioles.
Antihypertensive action comes in 3-4 days, but for achievement of optimum therapeutic effect 3-4 weeks can be demanded. Hypotensive action remains within a week after preparation cancellation.
Diuretics reduce deducing of calcium with urine and by that reduce formation of renal stones.
Indications
- An arterial hypertensia (in the form of monotherapy and as an auxiliary agent as a part of complex antihypertensive therapy);
- A hydropic syndrome of a various genesis (including at a chronic heart failure, a nephrotic syndrome, at renal insufficiency, a liquid delay at adiposity);
- Lithogenesis preventive maintenance in urinary ways at predisposed patients.
Dosage regimen
Establish individually.
The adult at a hydropic syndrome the preparation is prescribed in a dose by of 25-75 mg/days the Maximum daily dose makes 100 mg. Probably daily application of a preparation, however is more often it prescribe in 1-2 days.
For preventive maintenance of formation of stones prescribe on 50 mg 2 times/days
At an arterial hypertensia the recommended dose varies from 25 to 100 mg/sut, frequency rate of reception 1-2 times/24h in the form of monotherapy or as a part of the combined antihypertensive therapy. Preparation application in an initial dose of 12.5 mg is on occasion effective, dose rising is if necessary possible. The preparation should be used in the minimum effective dose. The maximum daily dose - 100 mg.
At a nephrogenic diabetes the recommended initial dose of a preparation makes 50-100 mg/sut parted on 2-4 receptions, in further it can be lowered.
At appointment of a preparation persons of advanced age should consider, that patients of this age category can be more sensitive to the diuretic applied in an average recommended dose.
The average daily dose for children is defined from calculation of mass of a body of 1-2 mg/kg or 30-60 mg/m2 of a surface of a body; frequency rate of reception 1-2 times/days to Children is elderly till 2 years a preparation prescribe in a dose of 12 mg/sut, to children at the age from 2 till 12 years - 25-100 mg/days
Side effect
From vodno-electrolytic and acid-alkaline balance: development of a hypopotassemia and dryness in a mouth, intensifying of thirst, disturbance of a rhythm of heart, change of mood and mentality, a cramp or a pain in muscles, a nausea, the vomiting, unusual weariness and delicacy is possible, hyponatremias (confusion of consciousness, a cramp, apathy, retardation of process of thinking, weariness, irritability), arrhythmias.
From hemopoiesis system: an agranulocytosis, a thrombocytopenia, a hemolitic and aplastic anaemia.
From cardiovascular system: an arrhythmia, an orthostatic hypotension, a tachycardia.
From the alimentary system: a cholecystitis, a pancreatitis, an icterus, a diarrhoeia, a sialadenitis, a constipation, an anorexia, pains in epigastriums.
From a metabolism: a hyperglycaemia, a glucosuria, a hyperuricemia, a gout exacerbation.
Allergic reactions: a dermal eruption, purpura, a necrotic vasculitis, Stevens-Johnson's syndrome, a respiratory distress ( not cardiogenic edema of a lung) a photosensitization, anaphylactic reactions (up to an anaphylactic shock menacing to a life).
The other: potency depression.
Contraindications
- Serious forms of a gout;
- A diabetes of a serious current;
- Pregnancy;
- A lactemia (thoracal feeding);
Pregnancy and lactemia
The preparation is contraindicative to application at pregnancy since the risk of development of an icterus of newborns and thrombocytopenias raises. Hydrochlorothiazide worsens blood supply of a placenta and gets through a placental barrier. In need of appointment of a preparation in a lactemia it is necessary to stop thoracal feeding.
Special indicatings
With care prescribe a preparation at the expressed disturbances of function of kidneys. At this category of patients probably development of cumulative effect of a preparation and azotemia occurrence. If advance of diseases of kidneys does not cause doubts, it is necessary to suspend or interrupt therapy by diuretics.
It is necessary to apply with care at patients with disturbances of function of a liver or with progressing diseases of a liver since little changes of vodno-electrolytic balance can cause a hepatic coma.
Allergic reactions are more probable at patients with allergic reactions or a bronchial asthma in the anamnesis.
Against preparation application probably exacerbation of a current of diseases of a connecting tissue (including a system lupus erythematosus).
In application of a preparation patients should recommend observance of the diet enriched by a potassium.
The general complications of a hyperthyroidism (such as a nephrolithiasis and a round ulcer) were not observed till now.
Preparation application should be stopped before carrying out of the analysis of function of a parathyroid gland.
At application of Hypothiazidum concentration of bilirubin in Serum can raise (because of replacement from places of linkage with an albumin), and also rising of level of cholesterol, triglycerides is possible.
The control of laboratory indicators
At long application of a preparation it is necessary to supervise regularly level of electrolytes of blood and a creatinine clearance.
Influence on ability to driving of motor transport and to management of mechanisms
Against application of a preparation ability to employment by kinds of the activity demanding special attention, can be broken.
Overdosage
Symptoms: dryness in a mouth, delicacy, drowsiness, an arterial hypotension, an oliguria, a tachycardia.
Treatment: a gastric lavage, reception of the activated coal; if necessary spend symptomatic therapy. The specific antidote is not present.
Medicinal interaction
At simultaneous application of glycosides of Digitalis with diuretics the probability of implication of toxic effects of glycosides (including hypererethism of ventricles) because of probable development of a hypopotassemia and a hypomagnesiemia is enlarged.
At simultaneous reception Colestyraminum reduces absorption diuretics on 85 %.
At joint application Hydrochlorothiazide can raise concentration of salts of lithium in plasma to toxic level (such combination is not recommended).
Conditions and periods of storage
The preparation should be stored in protected from light and a place inaccessible to children at temperature from 15 to 25 C. The Period of validity - 5 years.
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