Hypothiazide 25mg N20 pills
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Active ingredients
Hydrochlorothiazide
Release form
Pills
Composition
Active ingredient: Hydrochlorothiazide (Hydrochlorothiazide) Active ingredient concentration (mg): 25
Pharmacological effect
Diuretic. The primary mechanism of action of thiazide diuretics is to increase diuresis by inhibiting the reabsorption of sodium and chlorine ions in the initial part of the renal tubules. This leads to an increase in the excretion of sodium and chlorine and, consequently, of water. Also excretion of other electrolytes, namely potassium and magnesium, increases. At the maximum therapeutic doses, the diuretic / natriuretic effect of all thiazides is approximately the same. Natriuresis and diuresis occur within 2 hours and reach a maximum level after about 4 hours. on urine pH. Hydrochlorothiazide also has hypotensive properties. Thiazide diuretics do not affect normal blood pressure.
Pharmacokinetics
Absorption and distributionHydrochlorothiazide is incomplete, but rather quickly absorbed from the gastrointestinal tract. This effect lasts for 6-12 hours. After oral administration in a dose of 100 mg Cmax in the blood plasma is reached in 1.5-2.5 hours. At the maximum of the diuretic activity (approximately 4 hours after administration), the concentration of hydrochlorothiazide in the blood plasma is 2 μg / ml Binding to plasma proteins is 40%. Hydrochlorothiazide penetrates the placental barrier and is excreted in breast milk. ExcretionThe primary route of excretion is by the kidneys (filtration and secretion) in an unchanged form. T1 / 2 for patients with normal renal function is 6.4 hours. Pharmacokinetics in special clinical situations T1 / 2 for patients with moderate renal insufficiency is 11.5 hours. T1 / 2 for patients with CK less than 30 ml / min is 20.7 hours.
Indications
arterial hypertension (used both in monotherapy and in combination with other antihypertensive drugs), edematous syndrome of various origins (chronic heart failure, nephrotic syndrome, premenstrual syndrome, acute glomerulonephritis, chronic renal failure, portal hypertension, corticosteroid treatment), polyuria control, mainly in nephrogenic diabetes insipidus; prevention of stone formation in the urogenital tract in susceptible patients (decrease in hypercalcium Uriah).
Contraindications
Hypersensitivity to the drug or to other sulfonamides; anuria; severe renal (Cl creatinine - less than 30 ml / min) or liver failure; difficult to control diabetes; Addison's disease: refractory hypokalemia, hyponatremia, hypercalcemia, children under 3 years of age (solid dosage form ). Use with caution in hypokalemia, hyponatremia, hypercalcemia, in patients with coronary artery disease, with liver cirrhosis, gout, in the elderly, in patients suffering from lactose intolerance, while taking cardiac gly ozidov.
Precautionary measures
The drug should be used with caution in hypokalemia, hyponatremia, hypercalcemia, ischemic heart disease, liver cirrhosis, gout, lactose intolerance, use of cardiac glycosides, as well as in elderly patients.
Use during pregnancy and lactation
The use of the drug is contraindicated in the first trimester of pregnancy. In the second and third trimesters of pregnancy, the use of the drug is possible only when the intended benefit to the mother exceeds the potential risk to the fetus. Hydrochlorothiazide penetrates the placental barrier. There is a risk of fetal or neonatal jaundice, thrombocytopenia and other consequences. The drug is excreted in breast milk. If necessary, the use of the drug during lactation should decide on the termination of breastfeeding.
Dosage and administration
Inside, after meals. The dosage must be selected individually. With constant medical monitoring, the minimum effective dose is established. Due to the increased loss of potassium and magnesium ions during treatment (the level of potassium in the serum may decrease below 3.0 mmol / l), it becomes necessary to replace potassium and magnesium. As an antihypertensive, the usual initial daily dose is 25–50 mg once, as a monotherapy or in combination with other antihypertensive drugs. For some patients, an initial dose of 12.5 mg is sufficient, both as monotherapy and in combination. It is necessary to apply the minimum effective dose not exceeding 100 mg / day. If Hypothiazide is combined with other antihypertensive drugs, it may be necessary to reduce the dose of another drug in order to prevent an excessive decrease in blood pressure. The hypotensive effect occurs within 3-4 days, but it may take up to 3-4 weeks to achieve the optimal effect.After the end of treatment, the hypotensive effect persists for 1 week. The rest syndrome is of various genesis. The usual initial dose in the treatment of edema is 25-100 mg of the drug 1 time per day or 1 time in 2 days. Depending on the clinical response, the dose may be reduced to 25–50 mg once a day or 1 time in 2 days. In some severe cases, at the beginning of treatment, doses up to 200 mg / day may be required. In premenstrual syndrome, the usual dose is 25 mg / day and is used during the period from the onset of symptoms to the onset of menstruation. In case of nephroic diabetes mellitus, the usual daily dose of 50-150 mg is recommended. (in several tricks). For children. Doses should be set based on the body weight of the child. Regular pediatric daily doses of 1–2 mg / kg or 30–60 mg / m2 of body surface are administered once a day. The total daily dose for children aged 3 to 12 years is 37.5-100 mg.
Side effects
Hypokalemia, hypomagnesemia, hypercalcemia and hypochloremic alkalosis: dry mouth, thirst, irregular heart rhythm, changes in mood or psyche, cramps and muscle pain, nausea, vomiting, unusual tiredness or weakness. Hypochloremic alkalosis can cause hepatic encephalopathy or hepatic coma. Hyponatremia: confusion, convulsions, lethargy, slow thinking, fatigue, excitability, muscle cramps. Metabolic phenomena: hyperglycemia, glycosuria, hyperuricemia with the development of an attack of gout. Treatment with thiazides may decrease glucose tolerance, and latent diabetes mellitus can manifest. When high doses are used, serum lipid levels may increase. For the digestive tract: cholecystitis or pancreatitis, cholestatic jaundice, diarrhea, sialadenitis, constipation, anorexia. For the cardiovascular system: arrhythmias, orthostatic hypotension, vasculitis. For the nervous system sensory organs: dizziness, blurred vision (temporarily), headache, paresthesia. From the side of hematopoietic organs: very rarely - leukopenia, agranulocytosis, thrombocytopenia, hemolytic anemia, aplastic anemia. Reactions increased sensitivity: urticaria, purpura, necrotizing vasculitis, Stevens-Johnson syndrome, respiratory distress syndrome (including pneumonitis and non-cardiogenic pulmonary edema), photosensitivity, anaphylactic reactions up to shock. Other effects: decreased potency, impaired renal function, interstitial nephritis.
Overdose
Symptoms: due to acute loss of fluid and electrolytes, overdose of the drug may experience tachycardia, decreased blood pressure, shock, weakness, confusion, dizziness, spasms of the calf muscles, paresthesia, impaired consciousness, fatigue, nausea, vomiting, thirst, polyuria, oliguria or anuria (due to hemoconcentration), hypokalemia, hyponatremia, hypochloremia, alkalosis, increased blood urea nitrogen (especially in patients with renal insufficiency). Treatment: artificial vomiting, gastric lavage, use activated coal If blood pressure is lowered or shock is present, BCC and electrolytes (including potassium, sodium) should be reimbursed. It is necessary to control the state of water and electrolyte balance (especially the level of potassium in serum) and the function of the kidneys until normal values are established. There is no specific antidote.
special instructions
With prolonged treatment, clinical symptoms of water and electrolyte imbalance should be carefully monitored, primarily in high-risk patients: patients with diseases of the cardiovascular system, liver dysfunction, severe vomiting or signs of water and electrolyte imbalance ( including dry mouth, thirst, weakness, lethargy, drowsiness, anxiety, muscle pain or cramps, muscle weakness, hypotension, oliguria, tachycardia, complaints from the gastrointestinal tract). potassium-containing drugs or foods rich in potassium (including fruits, vegetables), especially when potassium is lost due to increased diuresis, prolonged diuretic therapy, or simultaneous treatment with digitalis glycosides or corticosteroids, avoids hypokalemia. Increased excretion of magnesium in urine when used Thiazides can lead to hypomagnesemia. In case of reduced renal function, control of creatinine clearance is necessary. In patients with impaired renal function, the drug may cause azotemia and the development of cumulative effects. If impaired renal function is evident, with the onset of oliguria, the possibility of discontinuing the drug should be considered. In patients with impaired liver function or progressive liver disease, thiazides should be used with caution, since a slight change in water-electrolyte balance,as well as the level of ammonium in the blood serum can cause hepatic coma. Thiazides can increase the concentration of bilirubin in the blood serum. In severe cerebral and coronary sclerosis, the use of the drug requires special care. Treatment with thiazide drugs may impair glucose tolerance. During a long course of treatment with manifest and latent diabetes mellitus, systematic control of carbohydrate metabolism is necessary due to the potential need to change the dose of hypoglycemic drugs. Intensive monitoring of the condition of patients with impaired uric acid metabolism is required. hypercalcemia and hypophosphatemia. Thiazides are able to reduce the amount of iodine that binds to protein and serum, without manifestation of signs of disorder of the thyroid gland. The possibility of gastrointestinal complaints in patients with lactose intolerance should be considered, since Hypothiazide 25 mg pills contain 63 mg of lactose, Hypothiazide 100 mg - 39 mg of lactose. Effect on ability to drive and control mechanismsIn the initial stage of the drug (the duration of this period is determined individually) it is forbidden to drive a car and perform work requiring increased attention.