Akzuid pills coated 20mg + 12.5mg N30
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Active ingredients
Hydrochlorothiazide + Hinapril
Release form
Pills
Composition
Active ingredient: hydrochlorothiazide 12.5 mghinapril hydrochloride 21.664 mg (equivalent to 20 mg quinapril) excipients: lactose monohydrate - 77.196 mg; magnesium carbonate - 70.64 mg; Povidone K25 - 8 mg; Crospovidone - 8 mg; magnesium stearate - 2 mg film coating: Opadry pink OY-S-6937 (hypromellose, hyprolosis, titanium dioxide, macrogol 400, iron dye yellow oxide, iron dye red oxide) - 6 mg; herbal wax - 0.1 mg
Pharmacological effect
Diuretic, hypotensive.
Pharmacokinetics
Quinapril and hydrochlorothiazide do not affect the pharmacokinetics of each other. Quinapril Tmax quinapril in the blood plasma when administered orally - 1 h. Quinapril is rapidly metabolized to quinaprilat by cleavage of the ester group (the main metabolite is dibasic acid of hinapril), which is a potent inhibitor of ACE. Quinapril and its metabolites by the kidneys, the degree of absorption is approximately 60%. About 38% of the ingested dose of quinapril circulates in the blood plasma as quinaprilat. T1 / 2 quinapril from blood plasma is about 1 hour. Tmax hinaprilat in blood plasma is approximately 2 hours after ingesting quinapril. Hinaprilat is excreted mainly by the kidneys, T1 / 2 - about 3 hours. Approximately 97% of quinapril and quinaprilat circulate in the blood plasma in protein-bound form. Quinapril and its metabolites do not penetrate through the BBB. In patients with renal insufficiency, T1 / 2 hinaprilat increases with decreasing creatinine clearance. Elimination of hinaprilat is also reduced in elderly patients (over 65) and closely correlates with the degree of renal dysfunction, however, in general, differences in efficacy and safety of treatment for patients of older and younger patients have not been detected. Hydrochlorothiazide Absorption is somewhat slower (1–2.5 h) and fuller (50–80%). Hydrochlorothiazide is not metabolized in the liver and excreted unchanged by the kidneys. T1 / 2 ranges from 4 to 15 hours. About 61% of the ingested dose is excreted unchanged for 24 hours. Hydrochlorothiazide passes through the placenta and into breast milk, but does not pass through the BBB.
Indications
Treatment of infectious and inflammatory diseases caused by susceptible microorganisms: - nonspecific vaginitis; - fungal vaginitis; - mixed vaginitis; - vulvovaginitis; - cervicovaginitis. Prevention of infectious complications: - before operating gynecological interventions; - before and after diatercoagulation of the cervix; procedures; - before childbirth.
Contraindications
- Angioedema edema in history as a result of previous therapy with ACE inhibitors, idiopathic and hereditary angioedema; - Severe renal failure (CC less than 30 ml / min); - Anuria; - Severe hepatic insufficiency; - Addison's disease; - Refractory hypokalemia, Hypermia, and hemorrhiamia, in case of hypertension; - obstruction of the outflow tract of the left ventricle of the heart; - diabetes mellitus with the presence of chronic kidney disease with moderately severe renal failure (GFR less than 60 ml / min); - children and adolescents up to 18 years (efficacy and safety of the drug have not been established); - lactose intolerance, lactase deficiency, glucose-galactose malabsorption; - hypersensitivity to active substances, auxiliary components of the drug; - hypersensitivity to sulfonamide derivatives.- simultaneous use with aliskiren in patients with diabetes mellitus, in patients with impaired renal function (GFR less than 60 ml / min / 1.73 m2), in patients with hyperkalemia (more than 5 mmol / l), in patients with chronic heart failure with decreased - simultaneous use with angiotensin II receptor antagonists or other ACE inhibitors in patients with diabetes mellitus and target organ damage in the terminal stage, in patients with impaired renal function from moderate to severe (GFR less than 60 ml / min / 1.73 m2), in patients with hyperkalemia (more than 5 mmol / l), in patients with chronic heart failure with low blood pressure.
Use during pregnancy and lactation
Angioedema. When treating with ACE inhibitors, cases of angioedema of the face and neck are described, including 0.1% of patients receiving Quinapril. When a guttural whistle or angioedema of the face, tongue, or glottis appears, Accuzide should be canceled immediately. The patient should be given adequate treatment and should be observed until the symptoms of edema disappear. Antihistamines may be used to reduce symptoms. Angioedema involving the larynx can be fatal. If the swelling of the tongue, glottis or larynx threatens the development of airway obstruction, adequate emergency treatment is necessary, including the injection of adrenaline 1: 1000 (0.3–0.5 ml) by subcutaneous injection. In cases of treatment with ACE inhibitors, swelling of the intestine.Patients had abdominal pain (with / without nausea and vomiting); in some cases without prior angioedema of the face and with normal C1-esterase activity. The diagnosis was established using ultrasound, computed tomography of the abdominal area or at the time of surgical intervention. Symptoms disappeared after discontinuation of ACE inhibitors. For patients who have had angioedema that is not associated with ACE inhibitors, there is a risk of its development when treated with drugs of this group. Patients simultaneously receiving therapy with inhibitors of the enzyme mTOR (eg temsirolimus) and DPP-4 ( for example, vildagliptin) may be at greater risk of developing angioedema. Ethnic differences. ACE inhibitors often cause angioedema in patients of the Negroid race than in Caucasians. Just as with the use of other ACE inhibitors, quinapril may be less effective for reducing blood pressure in patients of the Negroid race. Conducting desensitization therapy. In patients receiving ACE inhibitors during desensitization therapy with hymenoptera venom (wasps, bees), persistent anaphylactoid reactions that threaten life can develop. Temporary discontinuation of the use of an ACE inhibitor contributes to the regression of symptoms, but they can occur again when the therapy is restarted with ACE inhibitors. Hemodialysis. Anaphylactoid reactions can also develop with the use of ACE inhibitors in patients who have undergone LDL apheresis using dextran sulfate, or patients on hemodialysis using high-flow membranes, such as polyacrylonitrile. Alternative antihypertensive therapy should be used or other membranes for hemodialysis should be used. Arterial hypotension . The drug Accuzide can cause transient arterial hypotension, but not more often than with monotherapy by the components that make up the drug. Symptomatic arterial hypotension is rarely seen in the treatment of quinapril in patients with uncomplicated arterial hypertension, but it can develop as a result of therapy with ACE inhibitors in patients with reduced BCC, for example after previous diuretic therapy, while observing a diet with limitation of salt or hemodialysis. In the event of the appearance of symptomatic arterial hypotension, the patient should be given a prone position with the legs elevated and a 0.9% sodium chloride solution should be given in / in infusion.Transient arterial hypotension is not a contraindication to the further use of the drug Accuzide, however in such cases it is advisable to reduce its dose. CHF. In patients with CHF with and / or without renal insufficiency, treatment with an ACE inhibitor for hypertension can lead to an excessive decrease in blood pressure, which can be accompanied by oliguria, azotemia, and in rare cases, acute renal failure and even death. The treatment of such patients with Accuzide should be started under close medical supervision and supervision during the first 2 weeks of therapy and with an increase in the dose of the drug. Agranulocytosis. In rare cases, therapy with ACE inhibitors may be accompanied by the development of agranulocytosis and suppression of bone marrow function in patients with uncomplicated arterial hypertension, but more often in patients with impaired renal function, especially with connective tissue diseases. In these cases, the number of leukocytes in the blood should be monitored. If any symptoms of infection appear (for example, sore throat, fever), patients should immediately consult a doctor, since they may be manifestations of neutropenia. Systemic lupus erythematosus. Thiazide diuretics can sometimes cause an exacerbation of the course of systemic lupus erythematosus. Kidney function. Accuzide is not recommended for use in patients with severely impaired renal function (Cl creatinine less than 30 ml / min), since Thiazide diuretics contribute to the progression of azotemia and have a cumulative effect with long-term use in these patients. Loop-diuretics are the drugs of choice in this group of patients receiving quinapril therapy. For this reason, a fixed combination of hydrochlorothiazide + quinapril should not be used in patients with severe renal insufficiency (see “Contraindications”). T1 / 2 hinaprilat increases with decreasing creatinine clearance. Patients with Cl creatinine less than 60 ml / min, but more than 30 ml / min quinapril should be prescribed in a lower initial dose. In such patients, the dose of Accuzide should be increased taking into account the clinical condition of the patient, with regular monitoring of renal function, although clinical studies did not show further deterioration of renal function when treated with Accuzide. , especially in combination with a diuretic, an increase in the concentration of urea nitrogen in the blood and creatinine in the serum was observed,which was usually mild and transient. Such changes are most likely in patients with baseline renal dysfunction. In such cases, it may be necessary to lower the dose of the Accuzide preparation. In all patients with arterial hypertension, renal function should be monitored. Accuse should not be used as initial therapy in patients with Cl creatinine less than 60 ml / min. Effect of RAAS. In some patients, suppression of the activity of the RAAS can lead to impaired renal function. In patients with severe CHF, the kidney function depends on the activity of the RAAS, therefore treatment with ACE inhibitors, including quinapril, can lead to oliguria and / or progressive azotemia, and in rare cases - to acute renal failure and / or death. The RAAS double blockade. The use of angiotensin II receptor antagonists, ACE inhibitors or aliskiren can lead to a double blockade of RAAS activity. This effect may be manifested by a decrease in blood pressure, hyperkalemia, and changes in renal function (including acute renal failure) compared with monotherapy. Blood pressure, kidney function and electrolyte levels in blood plasma should be carefully monitored in patients taking Accused and other drugs that affect the RAAS. The simultaneous use of RAAS-active agents and quinapril should be avoided. The use of this combination should be limited to individual cases with careful monitoring of renal function and the content of potassium in the blood plasma. Stenosis of the renal artery. In clinical studies in patients with arterial hypertension with bilateral renal artery stenosis or arterial stenosis of a single kidney in treatment with ACE inhibitors, in some cases an increase in the concentration of urea nitrogen and serum creatinine was observed. These changes are almost always reversible and took place after the abolition of the ACE inhibitor and / or diuretic. In such cases, for the first few weeks of treatment with Accuzide, monitoring of renal function is necessary. Violation of the liver. The drug Accuzide should be used with caution in patients with impaired liver function or progressive liver disease, since even small violations of the water-electrolyte balance of the blood can cause the development of hepatic coma. The electrolytic electrolyte balance of the blood. In order to identify possible violations of the water-electrolyte balance of the blood, it is necessary to regularly monitor the content of electrolytes in the blood serum.In patients receiving Quinapril monotherapy, as well as other ACE inhibitors, potassium levels may increase. Blood serum potassium. Hyperkalemia (≥5.8 mmol / l) was observed in approximately 2% of patients taking quinapril, but in most cases this deviation was single and occurred during further therapy. Risk factors for the development of hyperkalemia are kidney dysfunction, diabetes mellitus and the simultaneous use of potassium-sparing diuretics, potassium preparations and / or salt substitutes containing potassium. The simultaneous intake of potassium-sparing diuretics with the drug Accuzide, which includes thiazide diuretic, is not recommended. Treatment with thiazide diuretics, on the contrary, is accompanied by hypokalemia, hyponatremia and hypochloremic alkalosis. These disorders are sometimes manifested by the following symptoms: dry oral mucosa, thirst, weakness, lethargy, drowsiness, anxiety, muscle weakness, muscle pain or spasm, decreased blood pressure, oliguria, tachycardia, nausea, confusion, convulsions and vomiting. Hypokalemia may also enhance the toxic effect of cardiac glycosides. The risk of hypokalemia is increased in case of liver cirrhosis, forced diuresis, inadequate use of drugs that improve myocardial metabolism, concomitant GCS or ACTH therapy, and concurrent use with drugs that increase the risk of developing hypokalemia while taking thiazide diuretics. In most patients, the opposite effects of quinapril and hydrochlorothiazide should be expected in relation to the content of potassium in the blood serum. In some cases, the effect of one component of the drug Accuzide may prevail over the other. Prior to and during treatment with Accuzide, the electrolyte content should be periodically monitored to detect possible disturbances in water and electrolyte balance. The chloride deficit associated with thiazide diuretic therapy is usually mild and only in exceptional cases requires appropriate treatment (for example, for diseases of the liver and or kidney). Hyponatremia. In hot weather, patients with peripheral edema may develop hyponatremia. When hyponatremia requires adequate replacement therapy. Hypocalcemia.Thiazide diuretics reduce calcium excretion by the kidneys. Parathyroid glands. In rare cases, patients receiving long-term therapy with thiazide diuretics developed changes in the parathyroid glands, accompanied by hypercalcemia and hypophosphatemia. More serious complications of hyperparathyroidism (nephrolithiasis, bone resorption and peptic ulcer) are not described. Before conducting a study of the function of the parathyroid glands, thiazide diuretics must be canceled. Magnesium. Thiazide diuretics increase the excretion of magnesium by the kidneys and can cause hypomagnesemia. Glucose. Thiazide diuretics increase serum levels of cholesterol, triglycerides and uric acid. These effects are usually minor, but the development of overt gout or diabetes mellitus can be triggered in patients with a predisposition to these diseases. Diabetes mellitus. Hyperglycemia, induced by high doses of thiazide diuretics (including hydrochlorothiazide at a dose of ≥100 mg / day), can interfere with the control of plasma glucose concentration. A decrease in potassium in the blood plasma leads to an increase in glucose tolerance. Plasma glucose concentration should be monitored, potassium preparations should be prescribed to maintain potassium levels in the blood plasma and correct hypoglycemic therapy. ACE inhibitor therapy may be accompanied by the development of hypoglycemia in diabetic patients receiving insulin or hypoglycemic agents for oral administration. When treating patients with diabetes, it may be necessary to more closely monitor and adjust the dose of hypoglycemic agents. Cough. In the treatment of ACE inhibitors, including Quinapril, noted the development of cough. In the typical case, it is unproductive, persistent and passes after cessation of therapy. In the differential diagnosis of cough, you should consider its possible relationship with the use of ACE inhibitors. Surgical intervention. In patients undergoing surgery or general anesthesia, ACE inhibitors should be used with caution, because they block the formation of angiotensin II, caused by compensatory renin secretion. This can lead to arterial hypotension, which is eliminated by increasing the BCC.In the case of surgery, the patient should warn the anesthesiologist that he is taking an ACE inhibitor. OTC. Patients should be warned that inadequate fluid intake, increased sweating can lead to an excessive decrease in blood pressure by lowering the BCC. Other causes of reduced BCC, such as vomiting or diarrhea, can also lead to a sharp drop in blood pressure. Acute myopia and angle-closure glaucoma. Hydrochlorothiazide (a sulfonamide derivative) can lead to the development of acute transient myopia and acute angle-closure glaucoma. Symptoms include an acute attack of reduced visual function or eye pain and usually occur within the first hours / weeks after starting therapy. Without appropriate treatment, angle-closure glaucoma can lead to irreversible loss of vision. The main method of treatment of this condition is to cancel the treatment of hydrochlorothiazide as soon as possible. Early medical or surgical intervention may be necessary if IOP remains uncontrolled. Risk factors for the development of acute angle-closure glaucoma may include allergic reactions to sulfonamides and penicillin in history. Effect on the ability to drive and work with mechanisms. Care should be taken when driving or doing other work that requires increased attention, especially at the beginning of treatment with Accuzide.
Dosage and administration
The drug is taken orally 1 time / day, regardless of the meal. For patients who do not receive a diuretic (regardless of whether Quinapril was administered alone or not), the recommended initial dose of Accuzide is 10 mg + 12.5 mg 1 time / day. In the future, if necessary, the dose can be increased to a maximum dose of 20 mg + 25 mg 1 time / day. Effective control of blood pressure is usually achieved with the use of the drug Accuzide in the dose range from 10 mg + 12.5 mg / day to 20 mg + 12.5 mg / day. In patients with impaired renal function of mild severity (CC greater than 60 ml / min), the initial dose of the drug Accuzide is 10 mg + 12.5 mg. The drug Accuzide should not be prescribed as initial therapy in patients with impaired renal function with a CC of less than 60 ml / min.In patients with impaired renal function of moderate severity (CK 60-30 ml / min), quinapril should be used in an initial dose of 5 mg with further titration. Elderly patients do not need to adjust the dose of the drug Accuzide. The initial dose of the drug is 10 mg + 12.5 mg.
Side effects
Tetracycline and other drugs that interact with magnesium. With the simultaneous use of the drug Accuzide and tetracycline, the absorption of the latter decreases by approximately 28–37% due to the presence of magnesium carbonate as a filler in the composition of the drug Accuzide. This interaction should be taken into account with the simultaneous use of the drug Accuzide and tetracycline or other drugs that can interact with magnesium. Lithium. Generally, lithium should not be used in combination with diuretics, since the latter reduce the renal clearance of lithium and increase the risk of undesirable effects. In patients taking lithium preparations and ACE inhibitors, there is an increase in serum concentrations of lithium and symptoms of lithium intoxication. These changes are associated with sodium loss under the influence of ACE inhibitors. When using the drug Accuzide, the risk of lithium intoxication may be increased. At the same time, these drugs should be used with caution. Diuretics. With simultaneous use of quinapril with diuretics, there is a marked increase in the antihypertensive effect (see “Special Instructions”). Ethanol, barbiturates and narcotic analgesics. With simultaneous use with the drug Accuzide may increase the risk of orthostatic hypotension (the drug includes a thiazide diuretic - hydrochlorothiazide). Hypoglycemic agents (hypoglycemic agents for oral administration and insulin). May require dose adjustment of hypoglycemic agents. Thiazide diuretic-induced hyperglycemia can interfere with plasma glucose control. A decrease in potassium in the blood plasma leads to an increase in glucose tolerance. Plasma glucose concentration should be monitored, potassium preparations should be prescribed as necessary in order to maintain potassium levels in the blood plasma, and hypoglycemic therapy should be adjusted. Other antihypertensive drugs.Thiazide diuretic, which is part of the drug Accuzide, can enhance the action of other antihypertensive drugs, especially ganglioblokatorov or beta-blockers. Due to the content of hydrochlorothiazide, the hypotensive effect of the drug Accuzide may increase after sympathectomy. GCS, corticotropin (ACTH). Increased loss of electrolytes, especially potassium. Pressure amines (for example, norepinephrine). Perhaps a decrease in the therapeutic effect of pressor amines (clinical significance is negligible). Non-polarizing muscle relaxants (for example, tubocurarine chloride). Perhaps the strengthening of the action of muscle relaxants. NPVS. In some patients, NSAIDs can cause a weakening of the diuretic, natriuretic and hypotensive effect of the loop, potassium-sparing and thiazide diuretics. In this regard, while using these drugs with the drug Accuzide, patients should be monitored to assess the effectiveness of therapy. In addition, in elderly patients, patients with reduced BCC (including patients receiving diuretic therapy) or impaired renal function, simultaneous use NSAIDs (including selective COX-2 inhibitors) with ACE inhibitors, including quinapril, can lead to deterioration of renal function, including possible acute renal failure. It should regularly monitor the state of renal function in patients receiving both NSAIDs and Quinapril. There may also be a weakening of the antihypertensive effect of ACE inhibitors, including quinapril, with simultaneous use with NPVS. Preparations that can cause hyperkalemia. Quinapril is an ACE inhibitor that lowers the concentration of aldosterone, which in turn can lead to hyperkalemia. In this regard, when treating Accuzide with potassium preparations and salt substitutes containing potassium, it should be used with caution, controlling the content of potassium in blood serum. Considering that a diuretic is included in the Accuzide preparation, the addition of a potassium-saving diuretic is not recommended. Digoxin. Water-electrolyte abnormalities caused by thiazide diuretics (i.e. hypokalemia, hypomagnesemia) increase the risk of developing digoxin toxicity symptoms, which can lead to fatal rhythm disturbances (see "Special Instructions"). Ion-exchange resins.Hydrochlorothiazide absorption is reduced in the presence of colestiramine and colestipol. When used once, these drugs bind hydrochlorothiazide and reduce its absorption in the gastrointestinal tract by 85% and 43%, respectively. Medications for treating gout (allopurinol, uricosuric drugs, xanthine oxidase inhibitors). Thiazide diuretic-induced hyperuricemia may interfere with the control of patients with gout by allopurinol and probenecid. The simultaneous use of hydrochlorothiazide and allopurinol may increase the frequency of hypersensitivity reactions to allopurinol. Other drugs. Signs of clinically significant pharmacokinetic interaction of quinapril with propranolol, hydrochlorothiazide or cimetidine were not detected. The use of quinapril 2 times a day did not significantly affect the anticoagulant effect of warfarin when it was administered once (assessed on the basis of PV). A single multiple application of warfarin at one time (assessed based on PT). a dose of 80 mg did not lead to significant changes in the equilibrium pharmacokinetic parameters of atorvastatin. Antihypertensive drugs, narcotic analgeti ki, drugs for general anesthesia increase the antihypertensive effect of quinapril. Quinapril increases the risk of developing leukopenia with simultaneous use with allopurinol, cytostatic agents, immunosuppressants, procainamide. When using ACE inhibitors and gold preparations (sodium aurothiomalate, i / c), symptomatom complex is simultaneously used. facial flushing, nausea, vomiting, lowering blood pressure and flu-like syndrome. With the simultaneous use of cardiac glycosides and other drugs that can lead to whith the development of ventricular tachycardia type "pirouette" Caution should be exercised due to the possibility of hypokalemia and thereby - amplification preparatov.Primenenie toxic effect of angiotensin II receptor antagonists, ACE inhibitors or aliskiren can lead to dual blockade of the RAAS activity. This effect may manifest as a decrease in blood pressure, hyperkalemia, and changes in kidney function (including acute renal failure) compared with monotherapy. It is not necessary to use Quinapril and hydrochlorothiazide simultaneously with aliskiren in patients with diabetes mellitus, impaired renal function from moderate to severe severity (GFR is less than 60 ml / min / 1.73 m2), hyperkalemia (≥5 mmol / l), CHF with low blood pressure (see"Contraindications"). You should not use Quinapril and hydrochlorothiazide simultaneously with angiotensin II receptor antagonists or other ACE inhibitors in patients with diabetes and target organ damage in the terminal stage, impaired renal function from moderate to severe severity (GF less than 60 ml / min / 1.73 m2), hyperkalemia (≥5 mmol / l), CHF with low blood pressure (see "Contraindications"). Patients simultaneously receiving therapy with inhibitors of the enzymes mTOR (for example, temsirolimus) and DPP-4 (for example, vildagliptin) can be subject to There is a greater risk of developing angioedema. Caution should be exercised while the simultaneous use of these drugs with the drug Accuzide.
Overdose
Adverse reactions occurring in patients who received Quinapril in combination with hydrochlorothiazide. More than 1% of patients: headache, dizziness, cough, non-productive persistent cough (disappeared after cessation of therapy), increased fatigue, myalgia, viral infections, rhinitis, nausea, vomiting, upper infections respiratory tract, insomnia, bronchitis, dyspepsia, asthenia, pharyngitis, vasodilation symptoms, vertigo, chest pain, abdominal pain, back pain. In general, adverse reactions were mild and transient, not dependent on age, sex, race, and duration of therapy. Laboratory indicators: an increase (by more than 1.25 times compared to VGN) in the concentration of creatinine and urea nitrogen in the blood, respectively, in 3% and 4% of patients receiving quinapril and hydrochlorothiazide. reactions occurring in 0.5-1% of patients who received Quinapril in combination with hydrochlorothiazide. From the side of the hematopoietic system: hemolytic anemia, thrombocytopenia, leukopenia, agranulocytosis. From the nervous system: increased excitability, paresthesia, depression , Sonlivost.So Cardiovascular system: palpitations, tachycardia, marked reduction in blood pressure, orthostatic hypotension, syncope, cardiac arrhythmias, myocardial infarction, ischemic stroke, peripheral edema (including generalized), hypertensive crisis, angina, heart failure. On the part of the respiratory system: shortness of breath, sinusitis. On the part of the digestive system: dryness of the mucous membrane of the mouth and throat,constipation or diarrhea, flatulence, pancreatitis, hepatitis, gastrointestinal hemorrhage, disturbance of a crude cerebral counteractive test. Allergic reactions: skin rash, pruritus, urticaria, angioedema, angioedema of the intestines, photosensitization, multiforme exudation, photosensitization, multiform edema, photosensitization, multiform edema, photosensitization, multiforme edema, photosensitization, multiforme edema, photosensitization, multiforme edema - Johnson, anaphylactic reactions. From the musculoskeletal and connective tissue: pain in the joints. From the urinary system: urinary tract infections, dysfunction of the kidney k, acute renal failure. From the reproductive system: reduced potency. From the organ of vision: visual impairment. Other: alopecia, hyperkalemia, increased sweating. Symptom complex is described with simultaneous use of ACE inhibitors and gold preparations (sodium aurothiomalate for IV). , including facial flushing, nausea, vomiting, lowering blood pressure and flu-like syndrome. Adverse reactions observed with hydrochlorothiazide On the metabolic side: hypokalemia, hypomagnesaemia, hypercalcemia and hypochlorum ical alkalosis, hyponatremia (confusion, convulsions, lethargy, slow thinking, fatigue, excitability, muscle cramps), hyperglycemia, glycosuria, hyperuricemia with the development of an attack of gout. Hypochloraemic alkalosis (dry oral mucosa, craving, craving, craving, craving, craving, gout). changes in mood or psyche, cramps and muscle pain, nausea, vomiting, fatigue or weakness) can cause hepatic encephalopathy or hepatic coma. Treatment with thiazides may reduce lerantnost glucose and flowing latent diabetes mellitus may manifest. With the use of high doses, the concentration of lipids in the blood plasma may increase. On the part of the digestive system: cholecystitis, sialadenitis, anorexia. On the part of the cardiovascular system: arrhythmias, orthostatic hypotension, vasculitis. On the side of the blood-forming organs: aplastic anemia. Allergic reactions: purpura, necrotizing vasculitis, respiratory distress syndrome (including pneumonitis and non-cardiogenic pulmonary edema), photosensitivity, anaphylactic reactions up to shock. On the part of the organ of vision: transient fuzzy s view,Transient acute myopia and acute open-angle glaucoma. On the urinary system: impaired renal function, interstitial nephritis. On the part of the reproductive system: reduced potency. Postmarketing research systems: gastrointestinal tumors, cholestatic jaundice, hepatitis, esophagitis, vomiting, diarrhea. On the side of the hemopoietic system: anemia. On the side of metabolism: weight loss. On the side - motor apparatus: myopathy, myositis, arthritis. From the nervous system: paralysis, hemiplegia, speech disorders, gait disturbance, meningism, amnesia. From the respiratory system: pneumonia, bronchial asthma. rash, petechiae. From the urinary system: albuminuria, pyuria, hematuria, nephrosis. Others: shock