Orthostatic hypotensive effect of thiazide diuretics. Hypothiazide is a diuretic

HYPOTHIAZID®

Representation:
SANOFI-AVENTIS ATX code: C03AA03 Marketing authorization holder:
CHINOIN Pharmaceutical and Chemical Works Private, Co. Ltd.
hydrochlorothiazide

Release form, composition and packaging

The tablets are white or almost white, round, flat, with an “H” engraving on one side and a scored line on the other. 1 tab.
hydrochlorothiazide 25 mg
-"- 100 mg

Excipients: magnesium stearate, talc, gelatin, corn starch, lactose monohydrate.

20 - blisters (1) - cardboard packs.

Clinical and pharmacological group: Diuretic

Registration No.:
tablets 25 mg: 20 - P No. 013510/01, 11/21/07
tablets 100 mg: 20 - P No. 013510/01, 11/21/07
The description of the drug HYPOTHIAZIDE® is based on the officially approved instructions for use of the drug HYPOTHIAZIDE® for specialists and approved by the manufacturer for the 2010 edition.
Pharmacological action | Pharmacokinetics | Indications | Dosage regimen | Side effect | Contraindications | Pregnancy and lactation | Special instructions | Overdose | Drug interactions | Terms of release from pharmacies | Storage conditions and expiration dates
pharmachologic effect

At maximum therapeutic doses, the diuretic/natriuretic effect of all thiazides is approximately the same. Natriuresis and diuresis occur within 2 hours and reach their maximum after about 4 hours. They also reduce carbonic anhydrase activity by increasing the excretion of bicarbonate ion, but this effect is usually mild and does not affect urine pH.

Hydrochlorothiazide also has antihypertensive properties. Thiazide diuretics have no effect on normal blood pressure.

Pharmacokinetics

Suction and distribution

Hydrochlorothiazide is incompletely, but rather quickly absorbed from the gastrointestinal tract. This effect lasts for 6-12 hours. After oral administration of a dose of 100 mg, Cmax in the blood plasma is achieved after 1.5-2.5 hours. At the maximum diuretic activity (approximately 4 hours after administration), the concentration of hydrochlorothiazide in the blood plasma is 2 mcg/ml .

Plasma protein binding is 40%.

Removal

The primary route of elimination is by the kidneys (filtration and secretion) in unchanged form. T1/2 for patients with normal renal function is 6.4 hours. T1/2 for patients with moderate renal failure is 11.5 hours. T1/2 for patients with CC<30 мл/мин составляет 20.7 ч. Гидрохлоротиазид проникает через плацентарный барьер и выделяется с грудным молоком.

Indications for use of the drug HYPOTHIAZIDE®

- arterial hypertension (in the form of monotherapy, as part of complex antihypertensive therapy);

- edematous syndrome of various origins (including chronic heart failure, nephrotic syndrome, premenstrual tension syndrome, acute glomerulonephritis, chronic renal failure, portal hypertension, treatment with corticosteroids);

— control of polyuria, mainly in nephrogenic diabetes insipidus;

- prevention of stone formation in the urinary tract in predisposed patients (reduction of hypercalciuria).

Dosage regimen

The dose should be selected individually. With constant medical supervision, the minimum effective dose is established. The drug should be taken orally after meals.

For adults

For arterial hypertension, the initial dose is 25-50 mg/single dose, as monotherapy or in combination with other antihypertensive drugs. For some patients, an initial dose of 12.5 mg is sufficient (either as monotherapy or in combination). It is necessary to use the minimum effective dose not exceeding 100 mg. When combining Hypothiazide with other antihypertensive drugs, it may be necessary to reduce the dose of the other drug to prevent an excessive decrease in blood pressure.

The hypotensive effect appears within 3-4 days, but it may take 3-4 weeks to achieve optimal effect. After completion of therapy, the hypotensive effect persists for 1 week.

For edematous syndrome of various origins, the initial dose is 25-100 mg once or once every 2 days. Depending on the clinical response, the dose may be reduced to 25-50 mg once or once every 2 days. In some severe cases, at the beginning of treatment, it may be necessary to increase the dose of the drug to 200 mg/day.

For premenstrual tension syndrome, the drug is prescribed at a dose of 25 mg/day and is used from the onset of symptoms until the onset of menstruation.

Due to increased loss of potassium and magnesium ions during treatment (serum potassium levels may be<3.0 ммоль/л) возникает необходимость в замещении калия и магния.

Doses should be set based on the child’s body weight. Usual pediatric daily doses: 1-2 mg/kg body weight or 30-60 mg/m2 body surface 1 time/ The daily dose for children aged 3 to 12 years is 37.5-100 mg.

Side effect

From the central nervous system and peripheral nervous system: dizziness, temporarily blurred vision, headache, paresthesia.

From the digestive system: cholecystitis, pancreatitis, cholestatic jaundice, diarrhea, sialadenitis, constipation, anorexia.

From the cardiovascular system: arrhythmia, orthostatic hypotension, vasculitis.

From the urinary system: impaired renal function, interstitial nephritis.

From the hematopoietic system: very rarely - leukopenia, agranulocytosis, thrombocytopenia, hemolytic anemia, aplastic anemia.

From the metabolic side: hyperglycemia (a decrease in glucose tolerance can provoke the manifestation of previously latent diabetes mellitus), glucosuria, hyperuricemia (with the development of an attack of gout), hypokalemia, hypomagnesemia, hypercalcemia, hyponatremia (including confusion, convulsions, lethargy, slow thinking, fatigue, excitability, muscle cramps), hypochloremic alkalosis (including dry mouth, thirst, irregular heart rhythm, changes in mood or psyche, muscle cramps and pain, nausea, vomiting, unusual fatigue or weakness ). Hypochloremic alkalosis can cause hepatic encephalopathy or hepatic coma. When using the drug in high doses, an increase in serum lipid levels is possible.

Allergic reactions: urticaria, purpura, necrotizing vasculitis, Stevens-Johnson syndrome, respiratory distress syndrome (including pneumonitis, non-cardiogenic pulmonary edema), photosensitivity, anaphylactic reactions up to shock.

Other: decreased potency.

Contraindications to the use of the drug HYPOTHIAZIDE®

- anuria;

- severe renal failure (CK<30 мл/мин);

- severe liver failure;

- difficult to control diabetes mellitus;

- Addison's disease;

- refractory hypokalemia, hyponatremia, hypercalcemia;

- children under 3 years of age (for solid dosage form);

- hypersensitivity to the components of the drug;

- hypersensitivity to sulfonamide derivatives.

The drug should be used with caution in case of hypokalemia, hyponatremia, hypercalcemia, coronary artery disease, liver cirrhosis, gout, lactose intolerance, use of cardiac glycosides, as well as in elderly patients.

Use of the drug HYPOTHIAZIDE® during pregnancy and breastfeeding

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 it is necessary to use the drug during lactation, the issue of stopping breastfeeding should be decided.

Use for liver dysfunction

The use of the drug is contraindicated in severe liver failure.

The drug should be used with caution in patients with liver cirrhosis.

Thiazides should be used with caution in patients with impaired liver function or progressive liver disease, because small changes in water and electrolyte balance can cause hepatic coma.

Use for renal impairment

The use of the drug is contraindicated in severe renal failure (CR<30 мл/мин).

special instructions

The use of potassium-containing drugs or foods rich in potassium (including fruits, vegetables), especially when potassium is lost due to increased diuresis, prolonged diuretic therapy, or concomitant treatment with digitalis glycosides or corticosteroid drugs, helps avoid hypokalemia.

Increased magnesium excretion in urine when using thiazides can lead to hypomagnesemia.

With reduced renal function, monitoring of creatinine clearance is necessary. In patients with impaired renal function, the drug may cause azotemia and the development of cumulative effects. If renal dysfunction is obvious, discontinuation of the drug should be considered when oliguria occurs.

In patients with impaired liver function or progressive liver disease, thiazides should be used with caution, since slight changes in fluid and electrolyte balance, as well as serum ammonium levels, can cause hepatic coma.

In severe cerebral and coronary sclerosis, the use of the drug requires special caution.

Treatment with thiazide drugs may impair glucose tolerance. During a long course of treatment for manifest and latent diabetes mellitus, systematic monitoring of carbohydrate metabolism is necessary due to the potential need to change the dose of hypoglycemic drugs.

Enhanced monitoring of the condition of patients with impaired uric acid metabolism is required.

Alcohol, barbiturates, and opioid analgesics enhance the orthostatic hypotensive effect of thiazide diuretics.

In rare cases, during long-term therapy, pathological changes in the parathyroid glands were observed, accompanied by hypercalcemia and hypophosphatemia.

Thiazides can reduce the amount of iodine bound to serum proteins without causing signs of thyroid dysfunction.

The possibility of gastrointestinal complaints in patients with lactose intolerance should be taken into account, since Hypothiazide® 25 mg tablets contain 63 mg of lactose, Hypothiazide® 100 mg tablets contain 39 mg of lactose.

Impact on the ability to drive vehicles and operate machinery

In the initial stage of using the drug (the duration of this period is determined individually), it is forbidden to drive a car or perform work that requires increased attention.

Overdose

Treatment: artificial vomiting, gastric lavage, use of activated carbon. If blood pressure decreases or a state of shock occurs, blood volume and electrolytes (including potassium, sodium) should be replaced. Water and electrolyte balance (especially serum potassium levels) and renal function should be monitored until normal values are established. There is no specific antidote.

Drug interactions

The simultaneous use of Hypothiazide® with lithium salts should be avoided, since the renal clearance of lithium decreases and its toxicity increases.

With the simultaneous use of Hypothiazide® with antihypertensive drugs, their effect is potentiated and there may be a need for dose adjustment.

With simultaneous use of Hypothiazide with cardiac glycosides, hypokalemia and hypomagnesemia associated with the action of thiazide diuretics may increase the toxicity of digitalis.

With simultaneous use of Hypothiazide® with amiodarone, the risk of arrhythmias associated with hypokalemia increases.

With the simultaneous use of Hypothiazide® with oral hypoglycemic agents, the effectiveness of the latter decreases and hyperglycemia may develop.

With the simultaneous use of Hypothiazide® with corticosteroid drugs and calcitonin, the degree of potassium excretion increases.

With the simultaneous use of Hypothiazide® with NSAIDs, the diuretic and hypotensive effect of thiazides is weakened.

With the simultaneous use of Hypothiazide® with non-depolarizing muscle relaxants, the effect of the latter is enhanced.

With the simultaneous use of Hypothiazide® with amantadine, the concentration and toxicity of the latter increases, resulting in a decrease in its clearance.

With simultaneous use of Hypothiazide® with cholestyramine, the absorption of hydrochlorothiazide is reduced.

With simultaneous use of Hypothiazide® with ethanol, barbiturates and opioid analgesics, the risk of developing orthostatic hypotension increases.

Thiazides can reduce plasma protein-bound iodine levels; increase the concentration of bilirubin in the blood serum.

Before testing for parathyroid function, thiazides should be discontinued.

Conditions for dispensing from pharmacies

The drug is available with a prescription.

Storage conditions and periods

The drug should be stored out of the reach of children, protected from light at a temperature of 15° to 25°C. Shelf life - 5 years.

Quite often, specialists prescribe diuretic tablets “Hypothiazide”. This is explained by the fact that they not only help remove excess fluid from the body, but also help prevent the development of stone disease. In addition, the drug eliminates swelling caused by various problems in the body.

Dosage form and packaging

"Hypothiazide" is available in tablet form. In color they are either pure white or beige. On one side of the tablet there is always an engraving “H”, and on the other there is a line in the form of a recess that passes through the center. Two release options are possible - 0.025 and 0.1 grams of active substance. Sold in packs of 20 tablets in a cardboard package.

Composition of a diuretic « »

The main effect is exerted by the substance hydrochlorothiazide. Its content in 1 tablet is 25 or 1 milligram. The drug also contains additional substances. First of all, it is magnesium stearate, which acts as a dietary supplement based on fatty acids. Talc and starch provide slip. Gelatin has a binding effect. Lactose monohydrate is used as a sweetener.

Pharmacology

This drug has a diuretic effect. This effect is achieved due to the removal of sodium and chlorine from the kidneys. The effect of the tablets begins 1-2 hours after administration. In addition, it is prescribed to reduce blood pressure. Gynecologists sometimes prescribe the diuretic “Hypothiazide” to pregnant women with severe toxicosis. The diuretic effect on the body does not decrease from long-term use.

Indications

The main indications include high blood pressure. Moreover, it can be used in combination with other drugs. Hypothiazide is also used for edema, which is a consequence of various diseases. It is effective for increased urine formation and as a prevention of urolithiasis. Less commonly, it is prescribed for liver cirrhosis and chronic kidney disease.

Contraindications

The drug is contraindicated in Addison's disease.

"Hypothiazide" diuretic has a number of contraindications. First of all, this is individual sensitivity to the constituent components of the drug. Also, the drug is not prescribed for problems with urine flow. Severe forms of renal and liver failure are a reason to discontinue the diuretic. In addition, if the level of potassium, sodium and magnesium in the body is high, the drug is contraindicated. The same applies to patients with Addison's disease.

Side effects

Improper use of Hypothiazide or use with existing contraindications can cause a number of side effects. So, from the gastrointestinal tract it can be diarrhea, constipation or the development of pancreatitis. Cardiac arrhythmia is possible. Other side effects include dizziness, nausea that progresses to vomiting, dry mouth, hives and muscle cramps.

Overdose

An incorrectly selected dosage or regimen of use leads to excessive removal of fluid from the body. This is fraught with a sharp drop in blood pressure and tachycardia; lack of urine formation or disturbances in this process; vomiting, which leads to thirst. There is no means to remove hydrochlorothiazide from the body. Therefore, gastric lavage in combination with taking activated carbon or another sorbent can help.

Directions for use and doses

The tablets should be taken after meals with a moderate amount of liquid. The following are the average dosages of the drug for adults:

In case of high blood pressure, 25-50 mg of the active substance is prescribed per dose. The daily norm is no more than 100 mg. The duration of the course is 3 weeks.
When used for edema, the dose is 25-100 mg of the substance. Use once a day or every 2 days.
For diabetes insipidus, take 50-150 mg per day.

When prescribing the drug to children, the pediatrician calculates the dose based on 1-2 mg per kilogram of the child’s weight.

Diuretic
Drug: HYPOTHIAZIDE®

Active substance of the drug: hydrochlorothiazide
ATX code: C03AA03
CFG: Diuretic
Registration number: P No. 013510/01
Registration date: 11/21/07
Owner reg. credential: CHINOIN Pharmaceutical and Chemical Works Private Co. Ltd. (Hungary)

Hypothiazide release form, drug packaging and composition.

The tablets are white or almost white, round, flat, with an “H” engraving on one side and a scored line on the other. 1 tab. hydrochlorothiazide 25 mg - «- 100 mg
Excipients: magnesium stearate, talc, gelatin, corn starch, lactose monohydrate.
20 pcs. - blisters (1) - cardboard packs.

The description of the drug is based on the officially approved instructions for use.

Pharmacological action Hypothiazide

Diuretic.
The primary mechanism of action of thiazide diuretics is to increase diuresis by blocking the reabsorption of sodium and chloride ions at the beginning of the renal tubules. As a result, the excretion of sodium and chlorine and, consequently, water increases. The excretion of potassium and magnesium also increases.
At maximum therapeutic doses, the diuretic/natriuretic effect of all thiazides is approximately the same. Natriuresis and diuresis occur within 2 hours and reach their maximum after about 4 hours. They also reduce carbonic anhydrase activity by increasing the excretion of bicarbonate ion, but this effect is usually mild and does not affect urine pH.
Hydrochlorothiazide also has antihypertensive properties. Thiazide diuretics have no effect on normal blood pressure.

Pharmacokinetics of the drug.

Suction and distribution
Hydrochlorothiazide is incompletely, but rather quickly absorbed from the gastrointestinal tract. This effect lasts for 6-12 hours. After oral administration of a dose of 100 mg, Cmax in the blood plasma is achieved after 1.5-2.5 hours. At the maximum diuretic activity (approximately 4 hours after administration), the concentration of hydrochlorothiazide in the blood plasma is 2 mcg/ml .
Plasma protein binding is 40%.
Removal
The primary route of elimination is by the kidneys (filtration and secretion) in unchanged form. T1/2 for patients with normal renal function is 6.4 hours. T1/2 for patients with moderate renal failure is 11.5 hours. T1/2 for patients with CC<30 мл/мин составляет 20.7 ч. Гидрохлоротиазид проникает через плацентарный барьер и выделяется с грудным молоком.

Indications for use:

Arterial hypertension (as monotherapy, as part of complex antihypertensive therapy);
- edematous syndrome of various origins (including chronic heart failure, nephrotic syndrome, premenstrual tension syndrome, acute glomerulonephritis, chronic renal failure, portal hypertension, treatment with corticosteroids);
- control of polyuria, mainly in nephrogenic diabetes insipidus;
- prevention of stone formation in the urinary tract in predisposed patients (reduction of hypercalciuria).

Dosage and method of administration of the drug.

The dose should be selected individually. With constant medical supervision, the minimum effective dose is established. The drug should be taken orally after meals.
For adults
For arterial hypertension, the initial dose is 25-50 mg/day once, as monotherapy or in combination with other antihypertensive drugs. For some patients, an initial dose of 12.5 mg is sufficient (either as monotherapy or in combination). It is necessary to use the minimum effective dose, not exceeding 100 mg/day. When combining hypothiazide with other antihypertensive drugs, it may be necessary to reduce the dose of the other drug to prevent an excessive decrease in blood pressure.
The hypotensive effect appears within 3-4 days, but it may take 3-4 weeks to achieve optimal effect. After completion of therapy, the hypotensive effect persists for 1 week.
For edematous syndrome of various origins, the initial dose is 25-100 mg/day once or once every 2 days. Depending on the clinical response, the dose can be reduced to 25-50 mg/day once or once every 2 days. In some severe cases, at the beginning of treatment, it may be necessary to increase the dose of the drug to 200 mg/day.
For premenstrual tension syndrome, the drug is prescribed at a dose of 25 mg/day and is used from the onset of symptoms until the onset of menstruation.
For nephrogenic diabetes insipidus, the usual daily dose of the drug is 50-150 mg (in several doses).
Due to increased loss of potassium and magnesium ions during treatment (serum potassium levels may be<3.0 ммоль/л) возникает необходимость в замещении калия и магния.
For children
Doses should be set based on the child’s body weight. Usual pediatric daily doses: 1-2 mg/kg body weight or 30-60 mg/m2 body surface area 1 time/day. The daily dose for children aged 3 to 12 years is 37.5-100 mg.

Side effects of Hypothiazide:

From the central nervous system and peripheral nervous system: dizziness, temporarily blurred vision, headache, paresthesia.
From the digestive system: cholecystitis, pancreatitis, cholestatic jaundice, diarrhea, sialadenitis, constipation, anorexia.
From the cardiovascular system: arrhythmia, orthostatic hypotension, vasculitis.
From the urinary system: impaired renal function, interstitial nephritis.
From the hematopoietic system: very rarely - leukopenia, agranulocytosis, thrombocytopenia, hemolytic anemia, aplastic anemia.
From the metabolic side: hyperglycemia (a decrease in glucose tolerance can provoke the manifestation of previously latent diabetes mellitus), glucosuria, hyperuricemia (with the development of an attack of gout), hypokalemia, hypomagnesemia, hypercalcemia, hyponatremia (including confusion, convulsions, lethargy, slow thinking, fatigue, excitability, muscle cramps), hypochloremic alkalosis (including dry mouth, thirst, irregular heart rhythm, changes in mood or psyche, muscle cramps and pain, nausea, vomiting, unusual fatigue or weakness) . Hypochloremic alkalosis can cause hepatic encephalopathy or hepatic coma. When using the drug in high doses, an increase in serum lipid levels is possible.
Allergic reactions: urticaria, purpura, necrotizing vasculitis, Stevens-Johnson syndrome, respiratory distress syndrome (including pneumonitis, non-cardiogenic pulmonary edema), photosensitivity, anaphylactic reactions up to shock.
Other: decreased potency.

Contraindications to the drug:

Anuria;
- severe renal failure (CK<30 мл/мин);
- severe liver failure;
- difficult to control diabetes mellitus;
- Addison's disease;
- refractory hypokalemia, hyponatremia, hypercalcemia;
- children under 3 years of age (for solid dosage form);
- hypersensitivity to the components of the drug;
- hypersensitivity to sulfonamide derivatives.
The drug should be used with caution in case of hypokalemia, hyponatremia, hypercalcemia, coronary artery 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 if the expected benefit to the mother outweighs 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 it is necessary to use the drug during lactation, the issue of stopping breastfeeding should be decided.

Special instructions for the use of Hypothiazide.

During long-term course of treatment, clinical symptoms of water-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-electrolyte imbalance (in including dry mouth, thirst, weakness, lethargy, drowsiness, anxiety, muscle pain or cramps, muscle weakness, hypotension, oliguria, tachycardia, gastrointestinal complaints).
The use of potassium-containing drugs or foods rich in potassium (including fruits, vegetables), especially when potassium is lost due to increased diuresis, prolonged diuretic therapy, or concomitant treatment with digitalis glycosides or corticosteroid drugs, helps avoid hypokalemia.
Increased magnesium excretion in urine when using thiazides can lead to hypomagnesemia.
With reduced renal function, monitoring of creatinine clearance is necessary. In patients with impaired renal function, the drug may cause azotemia and the development of cumulative effects. If renal dysfunction is obvious, discontinuation of the drug should be considered when oliguria occurs.
In patients with impaired liver function or progressive liver disease, thiazides should be used with caution, since slight changes in fluid and electrolyte balance, as well as serum ammonium levels, can cause hepatic coma.
In severe cerebral and coronary sclerosis, the use of the drug requires special caution.
Treatment with thiazide drugs may impair glucose tolerance. During a long course of treatment for manifest and latent diabetes mellitus, systematic monitoring of carbohydrate metabolism is necessary due to the potential need to change the dose of hypoglycemic drugs.
Enhanced monitoring of the condition of patients with impaired uric acid metabolism is required.
Alcohol, barbiturates, and opioid analgesics enhance the orthostatic hypotensive effect of thiazide diuretics.
In rare cases, during long-term therapy, pathological changes in the parathyroid glands were observed, accompanied by hypercalcemia and hypophosphatemia.
Thiazides can reduce the amount of iodine bound to serum proteins without causing signs of thyroid dysfunction.
The possibility of gastrointestinal complaints in patients with lactose intolerance should be taken into account, since Hypothiazide 25 mg tablets contain 63 mg of lactose, Hypothiazide 100 mg - 39 mg of lactose.
Impact on the ability to drive vehicles and operate machinery
In the initial stage of using the drug (the duration of this period is determined individually), it is forbidden to drive a car or perform work that requires increased attention.

Drug overdose:

Symptoms: due to the loss of fluid and electrolytes with an overdose of the drug, tachycardia, decreased blood pressure, shock, weakness, confusion, dizziness, spasms of the calf muscles, paresthesia, impaired consciousness, fatigue, nausea, vomiting, thirst, polyuria, oliguria or anuria may be observed. (due to hemoconcentration), hypokalemia, hyponatremia, hypochloremia, alkalosis, increased levels of urea nitrogen in the blood (especially in patients with renal failure).
Treatment: artificial vomiting, gastric lavage, use of activated carbon. If blood pressure decreases or a state of shock occurs, blood volume and electrolytes (including potassium, sodium) should be replaced. Water and electrolyte balance (especially serum potassium levels) and renal function should be monitored until normal values are established. There is no specific antidote.

Interaction of Hypothiazide with other drugs.

The simultaneous use of hypothiazide with lithium salts should be avoided, since the renal clearance of lithium decreases and its toxicity increases.
With the simultaneous use of Hypothiazide with antihypertensive drugs, their effect is potentiated and there may be a need for dose adjustment.
With simultaneous use of Hypothiazide with cardiac glycosides, hypokalemia and hypomagnesemia associated with the action of thiazide diuretics may increase the toxicity of digitalis.
With simultaneous use of hypothiazide with amiodarone, the risk of arrhythmias associated with hypokalemia increases.
With the simultaneous use of Hypothiazide with oral hypoglycemic agents, the effectiveness of the latter decreases and hyperglycemia may develop.
With simultaneous use of Hypothiazide with corticosteroid drugs and calcitonin, the degree of potassium excretion increases.
With simultaneous use of Hypothiazide with NSAIDs, the diuretic and hypotensive effects of thiazides are weakened.
With simultaneous use of Hypothiazide with non-depolarizing muscle relaxants, the effect of the latter is enhanced.
With the simultaneous use of hypothiazide with amantadine, the concentration and toxicity of the latter increases, resulting in a decrease in its clearance.
With the simultaneous use of hypothiazide with cholestyramine, the absorption of hydrochlorothiazide decreases.
With simultaneous use of Hypothiazide with ethanol, barbiturates and narcotic analgesics, the risk of developing orthostatic hypotension increases.
Thiazides can reduce plasma protein-bound iodine levels; increase the concentration of bilirubin in the blood serum.
Before testing for parathyroid function, thiazides should be discontinued.

Terms of sale in pharmacies.

The drug is available with a prescription.

Terms of storage conditions for the drug Hypothiazide.

The drug should be stored out of the reach of children, protected from light at a temperature of 15° to 25°C. Shelf life – 5 years.

Hypothiazide is a modern drug from the group of diuretics that performs diuretic and antihypertensive functions.

Its therapeutic effect is achieved by reducing the total amount of fluid in the vessels. This remedy also prevents the appearance of stones in the urinary organs, prevents the appearance of edema and reduces intraocular pressure.

On this page you will find all the information about Hypothiazide: complete instructions for use for this drug, average prices in pharmacies, complete and incomplete analogues of the drug, as well as reviews from people who have already used Hypothiazide. Would you like to leave your opinion? Please write in the comments.

Clinical and pharmacological group

Diuretic.

Conditions for dispensing from pharmacies

Dispensed with a doctor's prescription.

Prices

How much does Hypothiazide cost? The average price in pharmacies is 110 rubles.

Release form and composition

White or almost white round flat tablets. They have an “H” engraving on one side and a line on the other to make it easier to divide.

The active ingredient is hydrochlorothiazide 25 or 100 mg.
Excipients - magnesium stearate, talc, gelatin, corn starch, lactose monohydrate.

Pharmacological effect

“Hypothiazide” performs 2 functions: it removes excess fluid and promotes the release of harmful sodium and chlorine from the body. Hydrochlorothiazide reduces the process of reabsorption of sodium and chlorine ions in the renal tubules. The disadvantage of use is the removal of beneficial potassium ions, which leads to a deficiency of the microelement.

The advantage of “Hypothiazide” is the lack of addiction to the active substance. As a result, the effect of using the medication does not decrease.

Indications for use

What does it help with? High blood pressure () - as a rule, not alone, but together with other medications that are not diuretics. Edema caused by various reasons: acute glomerulonephritis, chronic renal failure, premenstrual syndrome in women, treatment with corticosteroids.

Hypothiazide reduces the excretion of calcium in the urine. Thanks to this, it helps prevent the formation of certain types of stones in the genitourinary tract.

Contraindications

The instructions prohibit the use of the drug "Hypothiazide":

children under 3 years of age;
during the lactation period;
in the first trimester of pregnancy;
with severe liver or liver failure;
with hypokalemia;
for diabetes mellitus;
with Addison's disease;
with refractory hyponatremia;
with hypersensitivity to sulfonamides and components of the drug "Hypothiazide", which can cause an allergy;
with anuria;
with hypercalcemia.

Caution during therapy must be observed in patients with lactose intolerance, cardiac ischemia, gout, hypercalcemia, liver cirrhosis, hypokalemia, hyponatremia. Under medical supervision, the medication is taken by elderly patients in the 2nd-3rd trimester of pregnancy.

Use during pregnancy and lactation

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 it is necessary to use the drug during lactation, the issue of stopping breastfeeding should be decided.

Instructions for use

The instructions for use indicate that the dose of Hypothiazide should be selected individually. With constant medical supervision, the minimum effective dose is established. The drug should be taken orally after meals.

For premenstrual tension syndrome, the drug is prescribed at a dose of 25 mg/day and is used from the onset of symptoms until the onset of menstruation.
For edematous syndrome of various origins, the initial dose is 25-100 mg/day once or once every 2 days. Depending on the clinical response, the dose can be reduced to 25-50 mg/day once or once every 2 days. In some severe cases, at the beginning of treatment, it may be necessary to increase the dose of the drug to 200 mg/day.
For arterial hypertension, the initial dose is 25-50 mg/day once, as monotherapy or in combination with other antihypertensive drugs. For some patients, an initial dose of 12.5 mg is sufficient (either as monotherapy or in combination). It is necessary to use the minimum effective dose, not exceeding 100 mg/day. When combining hypothiazide with other antihypertensive drugs, it may be necessary to reduce the dose of the other drug to prevent an excessive decrease in blood pressure. The hypotensive effect appears within 3-4 days, but it may take 3-4 weeks to achieve optimal effect. After completion of therapy, the hypotensive effect persists for 1 week.
For nephrogenic diabetes insipidus, the usual daily dose of the drug is 50-150 mg (in several doses).

Side effects

The diuretic “Hypothiazide” has a number of side effects for the body. They appear when the medication is taken uncontrolled or when there are prohibitions on use.

Patients often complain of:

stool disorders;
dysbacteriosis;
impaired functioning of the kidneys and liver;
a sharp drop in blood pressure on the vessels;
deficiency of potassium in the blood;
fatigue, clouding of consciousness;
heart failure;
dizziness;
feeling of nausea;
hives and skin itching.

Overdose

The clinical picture of overdose is manifested due to a sharp loss of electrolytes and fluid, which is manifested by the following symptoms:;

alkalosis;
hypochloremia;
confusion;
paresthesia;
dizziness;
drop in blood pressure;
spasms in the calf muscles;
hypokalemia
severe weakness, apathy;
tachycardia;
oliguria;
polyuria;
nausea;
vomit;
increased concentration of urea nitrogen (more pronounced in patients with pathology of the renal system);
hyponatremia;
anuria (as a result of hemoconcentration).

If symptoms of a drug overdose develop, the patient should immediately consult a doctor. There is no specific antidote. Treatment consists of gastric lavage, oral administration of enterosorbents and symptomatic therapy.

special instructions

Get regular blood tests for sodium, glucose, creatinine and other indicators that your doctor deems important. If your test results get worse, talk to your doctor about replacing Hypothiazide tablets, for example, with Indapamide. Eat green vegetables and drink herbal tea to supplement your body with potassium.

Once you start taking the medicine Hypothiazide, refrain from driving or driving dangerous machinery for 2-7 days. You can drive again when you are sure that you tolerate the treatment well and there is no fatigue or weakness.

Drug interactions

With simultaneous use of this diuretic with corticosteroid drugs, the degree of potassium excretion increases.
The simultaneous use of hypothiazide with lithium salts may increase its toxicity and reduce renal clearance.
Combining the above drug with cardiac glycosides can provoke hypomagnesemia and hypokalemia.
Hypothiazide in combination with Amiodarone increases the likelihood of arrhythmias that are associated with hypokalemia.
The combination of a diuretic with oral hypoglycemic drugs leads to the development of hyperkalemia and a decrease in the effectiveness of the latter.
It is not recommended to take the drug simultaneously with Cholestyramine, since the combination of these drugs leads to a decrease in the absorption of hydrochlorothiazide.

Hypothiazid is a diuretic or diuretic.

Hypothiazide is the trade name of the drug. The active ingredient in it is Hydrochlorothiazide or Hydrochlorothiazide.

This substance has the chemical formula C 7 H 8 ClN 3 O 4 S 2 and is designated as 6-Chloro-3,4-dihydro-2H-1,2,4-benzothiadiazine-7-sulfonamide-1,1-dioxide.

Hydrochlorothiazide refers to thiazide derivatives or benzothiadiazine derivatives.

In physical terms, Hydrochlorothiazide is a white or white-yellow crystalline powder, poorly soluble in water, methanol, ether, and highly soluble in alkaline solvents.

Mechanism of action

The scope of use of Hypothiazide is largely due to its diuretic effect. Hypothiazide, like other thiazide drugs, has a diuretic effect by affecting the proximal and, to a lesser extent, the distal convoluted tubules of the nephron.

Both the proximal tubules located close to the nephron glomerulus and the distal tubules located far from it are located in the cortical layer of the kidney.

As for the loop of Henle, the U-shaped junction between the proximal and distal tubules, Hypothiazide acts only on small portions of the loop located in the cortex. Hypothiazide has no effect on the part of the loop located in the medulla.

Under the influence of this drug, the reabsorption (reabsorption) of sodium in the convoluted tubules of the nephrons is inhibited. Sodium enters the convoluted tubules as part of the primary urine formed during the filtration of blood plasma in the renal glomeruli. Then, in certain areas of the tubules and loop of Henle, some of the sodium ions are reabsorbed.

Sodium is the most important electrolyte in the extracellular space, which forms the osmotic or concentration pressure of various body fluids.

Sodium “pulls” water onto itself. Therefore, according to all the rules of osmosis, water is passively reabsorbed in the renal tubules along with sodium. If you reduce sodium reabsorption, the opposite effect will be observed.

Sodium will be excreted in the urine. Water will be released along with sodium, and the volume of urine will increase. The action of thiazides is similar to that of loop diuretics (Furosemide, Lasix, Uregit, Ethacrynic acid).

Both loop diuretics and thiazide derivatives are classified as saluretics. The latter term, literally translated from Latin, means salt in the urine, i.e., stimulation of urination is achieved due to the excretion of salts.

True, in terms of potency and diuretic activity, thiazides are significantly inferior to loop diuretics. Apparently, this is due to the fact that, unlike the latter, they act only on a limited area of the loop of Henle.

In general, among all diuretic drugs, Hypothiazide and its analogues occupy an intermediate place in their strength. If loop diuretics are stronger than hypothiazide, then many drugs of other groups are inferior in activity to it.

Such weak diuretics include carbonic anhydrase inhibitors (Diacarb, Fonurit), potassium-sparing agents (Spironolactone, Veroshpiron), sodium channel blockers (Amiloride, Triamterene). Stimulation of diuresis under the influence of Goipothiazide leads to a decrease or complete disappearance of tissue edema, and also causes a hypotensive effect - a decrease in blood pressure (BP).

Hypotension is largely associated with a decrease in BCC (circulating blood volume) due to an increase in the amount of urine excreted. However, a decrease in blood volume in this case is not the only mechanism of hypotension. Due to the increased administration of water and sodium, the thickness of the arterial vascular wall decreases.

As a result, the lumen of arterioles (small arteries) increases and blood pressure decreases. The decrease in blood pressure under the influence of Hypothiazide compensatoryly, according to the feedback principle, activates the RAAS (renin-angiotensin-aldosterone system), the action of which is aimed at increasing blood pressure.

One of the components of the RAAS, aldosterone, stimulates the excretion of potassium in the urine, and this is one of the negative effects of this drug. Along with potassium, other vital electrolytes are also lost in the urine: chlorides, bicarbonates, magnesium, chlorine. A deficiency of these electrolytes develops in the blood plasma: hyponatremia, hypokalemia, hypochloremia, hypomagnesemia. At the same time, the reabsorption of another electrolyte, calcium, increases.

Reducing calcium excretion prevents the formation of stones in the urinary tract. In addition, a decrease in calcium reabsorption under the influence of Hypothiazide plays a positive role in all conditions accompanied by a deficiency of this electrolyte in the body. Therefore, hypothiazide is often the drug of choice in patients with concomitant osteoporosis.

But the excretion of uric acid salts, urates, on the contrary, slows down while taking Hypotizide. This negatively affects the condition of patients with gout. Along with urates, the excretion of other nitrogenous compounds in the urine may slow down. In addition, there is evidence that with long-term use of Hypothiazide, tissue tolerance to glucose decreases.

The level of glucose in the blood rises (hyperglycemia), and it begins to be excreted in the urine (glucosuria). Increased excretion of chlorides in the urine over time leads to metabolic alkalosis - a shift in the acid-base state (acid-base state) to the alkaline side.

Changes in CBS, electrolyte balance, retention of nitrogenous waste in the body - all this negatively affects the bile-forming and detoxifying functions of the liver, the state of the central nervous system, and the excretory function of the kidneys.

In addition, metabolic disorders caused by the action of Hypothiazide can lead to inhibition of the synthesis of high-density cholesterol and an increase in the content of lipids (fats and fat-like substances) in the blood plasma with the further development of atherosclerosis.

It is noteworthy that in diabetes insipidus, hypothiazide causes a paradoxical effect - a decrease in diuresis. Diabetes insipidus is a syndrome in which the functioning of pituitary and hypothalamic hormones (vasopressin, antidiuretic hormone) is disrupted.

As a result, diabetes develops - the release of large amounts of low-density urine, leading to thirst and dehydration. In the central form of this pathology, there is an absolute deficiency of these hormones.

The peripheral or nephrogenic form is characterized by the fact that hormones can be released in sufficient quantities, but the kidney tissue is not sensitive to them. In peripheral diabetes insipidus, hypothiazide inhibits diuresis and increases the concentration of urine excreted. The mechanism of action of the drug in this case is complex and not fully understood.

Some weight loss programs strongly recommend the use of diuretics, particularly hypothiazide. They say that with constant use, body weight decreases over time.

Indeed, the excretion of urine and a decrease in blood volume automatically leads to the loss of extra pounds, but only at first and to a small extent. And then the negative effect on carbohydrate and fat metabolism makes itself felt with new weight gain. As a result, existing obesity is aggravated by the side effects of the drug.

A little history

Diuretics as a separate medicinal group made their presence known in the 50s of the last century. Then, in 1957, the first thiazide diuretic, Chlorothiazide, was synthesized.

A little later, in 1958, based on this drug, a more powerful and effective dihydro-73 chlorothiazide (Dichlorothiazide, Hydrochlorothiazide, Hypothiazide) was obtained.

Initially, thiazide diuretics were planned to be used in combination with raufolfia drugs (Octadine, Reserpine) if their hypotensive activity was insufficient. Subsequently, it was found that Hypothiazide can be used as monotherapy, i.e., without combination with other antihypertensive drugs.

True, monotherapy with Hypothiazide is practically not carried out at present - it is still combined with other drugs. Hypothiazide as a diuretic is included in the treatment regimens for hypertension in many patients. The drug is prescribed in Russia, CIS countries, and abroad.

Synthesis technology

Hydrochlorothiazide is obtained through complex multi-step organic synthesis reactions. Along with the active substance, magnesium stearate, talc, lactose monohydrate, corn starch, and gelatin are used. These substances are auxiliary and act as fillers in solid tablet form.

Release forms

Tablets 25 and 100 mg.

Hypothiazide is produced by the Hungarian pharmaceutical company Hinoin. Many Russian pharmaceutical companies market the drug under the names Hydrochlorothiazide, Dichlorothiaide, Polythiazide. Abroad, it may be called Hydrodiuril, Hydrochlorot, Microzide.

Hypothiazide, along with other antihypertensive drugs, is included in such drugs as Adelphan ezidrex, Atagexal compositum, Triampur Compositum, Novospirozin, Moduretic, Kapozin, Sinipress.

Previously, the thiazide diuretic Chlorthalidone was actively used. It was part of such products as Neocristepin, Tenorik, Trirezide. Now Chlorthalidone and combination drugs based on it are practically not used.

Indications

Arterial hypertension;
Various conditions accompanied by edematous syndrome (chronic cardiac and chronic renal failure, gestosis, portal hypertension, nephrotic syndrome, acute glomerulonephritis);
Prevention of urolithiasis;
Nephrogenic diabetes insipidus.

Dosages

Previously, the drug was prescribed in daily doses of up to 100 mg or more. Currently, the use of such doses is considered inappropriate, because the frequency of side effects increases. As a rule, they are limited to a daily dose of 50 mg, which is taken once.

The tablets are taken before meals, washed down with water. In many cases, especially if Hypothiazide is combined with other antihypertensive drugs, the daily dose is reduced to 25 mg, and even to 12.5 mg. And only in case of massive edema or diabetes insipidus, the daily dose can be increased to 150 or 200 mg.

In these cases, the drug is taken after 1-2 days or divided into several doses. The duration of treatment is determined individually for each patient. It should be borne in mind that the diuretic effect develops 2 hours after administration, reaches its maximum effect after 4 hours, and lasts 6-12 hours. The hypotensive effect develops more slowly, but lasts longer.

It occurs within 3-4 days, reaches a therapeutically significant level after 3-4 weeks, and persists for 1 week after discontinuation of the drug. For children, the daily dose is determined at the rate of 1-2 mg/kg body weight. The maximum daily dose for children 3-12 years old is 37.5-100 mg.

Pharmacodynamics

The drug is absorbed into the gastrointestinal tract in an amount of 60-80% of that taken orally. About 40% of hypothiazide entering the body binds to plasma proteins. A certain part can accumulate in erythrocytes. Hypothiazide does not undergo metabolic transformations and is mainly excreted through the kidneys (about 70%), and to a lesser extent through feces (11.5-24%).

Excretion by the kidneys is carried out by filtration in the renal glomeruli and secretion into the lumen of the renal tubules. The half-life is initially 3-4 hours, then can increase to 12 hours. It also increases in patients suffering from impaired renal function.

Side effects

Cardiovascular system: hypotension, vasculitis, arrhythmias, anaphylactic shock;
Gastrointestinal tract: dry mouth, thirst, nausea, vomiting, anorexia, constipation, diarrhea, cholecystitis, pancreatitis, cholestasis, jaundice, liver failure;
CNS: hepatic coma, hepatic encephalopathy, general weakness, mental changes, headache, dizziness, visual disturbances, paresthesia;
Urinary system: impaired urine output, interstitial nephritis;
Respiratory organs: respiratory distress syndrome, pneumonitis, non-cardiogenic pulmonary edema;
Musculoskeletal system: myalgia;
Skin: necrotizing vasculitis, dermatitis, urticaria, itching, photosensitivity;
Reproductive system: erectile dysfunction;
Blood: anemia, leukopenia, thrombocytopenia, agranulocytosis;
Metabolism (metabolism): hyponatremia, hypokalemia, hypochloremia, hypercalcemia, metabolic alkalosis, hyperglycemia, glycosuria, hyperuricemia, hyperbilirubinemia.

Contraindications

Individual intolerance to the components of Hypothiazide;
Complete absence of urination (anuria);
Severe renal failure;
Severe liver failure;
Severe metabolic disorders, incl. decompensated diabetes mellitus;
Addison's disease;
Children under 3 years old.

Hypothiazide should be used with caution in elderly patients. It is not advisable to take it while driving vehicles or working with potentially dangerous machines and mechanisms.

Interaction with other drugs

Antihypertensive drugs of other groups - increased hypotensive effect, requiring a reduction in the dose of Hypothiazide;
ACE inhibitors – reducing the degree of hypokalemia;
Tablets of hypoglycemic drugs – decreased effectiveness of these drugs, hyperglycemia;
Amiodarone – increased hypokalemia, risk of arrhythmias;
Lithium salts – increased toxicity of these drugs;
Cardiac glycosides of the digitalis group – worsening hypokalemia and hypomagnesemia;
Corticosteroids, calcitonin – worsening hypokalemia
NSAIDs - weaken the hypotensive and diuretic effect of Hypothiazide;
Amantadine – increased toxicity of this drug;
Ethyl alcohol, opioids, barbiturates - a sharp increase in the hypotensive effect;
Non-depolarizing muscle relaxants - Hypothiazide enhances the effect of these drugs.

Pregnancy and lactation

Hypothiazide penetrates the placental barrier and into breast milk. Once in the body of the fetus and newborn, it can cause jaundice, thrombocytopenia, and a number of other serious disorders. Therefore, taking Hypothiazide during pregnancy and breastfeeding is contraindicated.

Storage

Hypothiazide is stored at a temperature not exceeding 25 0 C. Shelf life is 5 years. The drug is available with a doctor's prescription.

Dear visitors of the Farmamir website. This article does not constitute medical advice and should not serve as a substitute for consultation with a physician.