Orthostatic hypotensive effect of thiazide diuretics. Hypothiazide is a diuretic

HYPOTHIAZID® (HYPOTHIAZID®)

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

Release form, composition and packaging

Tablets are white or almost white, round, flat, engraved with "H" on one side and a notch on the other. 1 tab.
hydrochlorothiazide 25 mg
- "- 100 mg

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

20 - blisters (1) - packs of cardboard.

Clinico-pharmacological group: Diuretic

Registration Nos.:
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 HYPOTHIAZID® medicinal product is based on the officially approved instructions for use of the HYPOTHIAZID® preparation for specialists and approved by the manufacturer for the 2010 edition.
Pharmacological action | Pharmacokinetics | Indications | Dosing regimen | Side effect | Contraindications | Pregnancy and lactation | Special Instructions | Overdose | Drug interaction | Terms of dispensing 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 the activity of carbonic anhydrase by increasing the excretion of bicarbonate ion, but this effect is usually weak and does not affect urine pH.

Hydrochlorothiazide also has antihypertensive properties. Thiazide diuretics do not affect normal blood pressure.

Pharmacokinetics

Suction and distribution

Hydrochlorothiazide is incompletely but fairly rapidly absorbed from the gastrointestinal tract. This effect persists for 6-12 hours. After an oral dose of 100 mg, Cmax in plasma is reached after 1.5-2.5 hours. At the maximum diuretic activity (approximately 4 hours after ingestion), the concentration of hydrochlorothiazide in blood plasma is 2 μg / ml .

Plasma protein binding is 40%.

breeding

The primary route of excretion 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 insufficiency 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 the use of the drug HYPOTHIAZID®

- 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).

Dosing 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.

Adults

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

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

With edematous syndrome of various origins, the initial dose is 25-100 mg / day or 1 time in 2 days. Depending on the clinical response, the dose may be reduced to 25-50 mg/day 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.

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

Due to the 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 body weight of the child. Usual pediatric daily doses: 1-2 mg / kg of body weight or 30-60 mg / m2 of body surface 1 time / Daily dose in children aged 3 to 12 years is 37.5-100 mg.

Side effect

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

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

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

On the part of metabolism: hyperglycemia (a decrease in glucose tolerance can provoke a manifestation of previously latent diabetes mellitus), glucosuria, hyperuricemia (with the development of a gout attack), hypokalemia, hypomagnesemia, hypercalcemia, hyponatremia (including confusion, convulsions, lethargy, slow thinking, fatigue, irritability, muscle cramps), hypochloremic alkalosis (including dry mouth, thirst, irregular heart rate, mood or mental changes, muscle cramps and pain, nausea, vomiting, unusual tiredness or weakness ). Hypochloremic alkalosis can cause hepatic encephalopathy or hepatic coma. When using the drug in high doses, it is possible to increase the levels of lipids in the blood serum.

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

Others: reduced potency.

Contraindications to the use of the drug HYPOTHIAZID®

- anuria;

- severe renal insufficiency<30 мл/мин);

- severe liver failure;

- difficult-to-control diabetes mellitus;

- Addison's disease;

- refractory hypokalemia, hyponatremia, hypercalcemia;

- children's age up to 3 years (for solid dosage form);

- hypersensitivity to the components of the drug;

- Hypersensitivity to sulfonamide derivatives.

With caution, the drug should be used for hypokalemia, hyponatremia, hypercalcemia, coronary artery disease, cirrhosis, gout, lactose intolerance, the use of cardiac glycosides, as well as in elderly patients.

The use of the drug HYPOTHIAZID® during pregnancy and lactation

Hydrochlorothiazide crosses the placental barrier. There is a danger 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.

Application for violations of liver function

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

The drug should be used with caution in cirrhosis of the liver.

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

Application for violations of kidney function

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

special instructions

The use of potassium-containing drugs or foods rich in potassium (including fruits, vegetables), especially with loss of potassium due to increased diuresis, prolonged diuretic therapy, or simultaneous treatment with digitalis glycosides or corticosteroid drugs, avoids hypokalemia.

An increase in the excretion of magnesium in the urine with the use of thiazides can lead to hypomagnesemia.

With reduced renal function, control of creatinine clearance is necessary. In patients with impaired renal function, the drug can cause azotemia and the development of cumulative effects. If impaired renal function is evident, discontinuation of the drug should be considered upon the onset of oliguria.

In patients with impaired liver function or progressive liver disease, thiazides should be used with caution, since a slight change 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 care.

Treatment with thiazide drugs may impair glucose tolerance. During a long course of treatment for overt 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, opioid analgesics enhance the orthostatic hypotensive effect of thiazide diuretics.

In rare cases, with prolonged therapy, a pathological change in the parathyroid glands was observed, accompanied by hypercalcemia and hypophosphatemia.

Thiazides can reduce the amount of iodine that binds to serum proteins without showing signs of thyroid dysfunction.

The possibility of gastrointestinal complaints in patients with lactose intolerance should be considered, since Hypothiazid® 25 mg tablets contain 63 mg of lactose, Hypothiazid® 100 mg - 39 mg of lactose.

Influence on the ability to drive vehicles and control mechanisms

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

Overdose

Treatment: artificial vomiting, gastric lavage, the use of activated charcoal. With a decrease in blood pressure or a state of shock, the BCC and electrolytes (including potassium, sodium) should be replaced. The state of water and electrolyte balance (especially the level of potassium in the serum) and kidney function should be monitored until normal values are established. There is no specific antidote.

drug interaction

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

With the simultaneous use of Hypothiazid® with antihypertensive drugs, their action is potentiated and it may be necessary to adjust the dose.

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

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

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

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

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

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

With the simultaneous use of Hypothiazid® with amantadine, the concentration and toxicity of the latter increases, as a result, its clearance decreases.

With the simultaneous use of Hypothiazide with cholestyramine, the absorption of hydrochlorothiazide decreases.

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

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

Thiazides should be discontinued before testing for parathyroid function.

Terms of dispensing from pharmacies

The drug is dispensed by prescription.

Terms and conditions of storage

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, diuretic tablets "Hypothiazid" are prescribed by specialists. This is due to the fact that they not only contribute to the removal of 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

"Hypothiazid" is available in the form of tablets. 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 a line is drawn in the form of a recess that passes through the center. There are two release options - 0.025 and 0.1 grams of the active substance. Sold by 20 tablets in a carton.

The composition of the diuretic « »

The main action is provided by the substance hydrochlorothiazide. Its content in 1 tablet is 25 or 1 milligram. Also in the preparation there are additional substances. First of all, it is magnesium stearate, which acts as a dietary supplement based on fatty acids. Talc and starch provide glide. 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 excretion of sodium and chlorine from the kidneys. The action of the tablets begins 1-2 hours after ingestion. In addition, it is prescribed to reduce blood pressure. Gynecologists sometimes attribute the diuretic "Hypothiazid" to pregnant women with severe toxicosis. The diuretic effect on the body is not reduced by prolonged use.

Indications

The main indications include high blood pressure. Moreover, it can be used in combination with other drugs. Also, "Hypothiazid" is used for edema, which are the result of various diseases. It is effective for increased urination and as a prevention of urolithiasis. Less commonly, it is prescribed for cirrhosis of the liver and chronic kidney disease.

Contraindications

The drug is contraindicated in Addison's disease.

"Hypothiazid" diuretic has a number of contraindications. First of all, it is individual sensitivity to the constituent components of the drug. Also, do not prescribe a remedy for violations of the flow of urine. Severe forms of renal and hepatic insufficiency are the reason for the abolition of the diuretic. In addition, with a high level of potassium, sodium and magnesium in the body, the drug is contraindicated. The same applies to patients with Addison's disease.

Side effects

The wrong way to use "Hypothiazid" or use with existing contraindications can provoke a number of side effects. So, from the gastrointestinal tract, it can be diarrhea, constipation or the development of pancreatitis. From the side of the heart, arrhythmia is possible. Other side effects include dizziness, nausea that turns into vomiting, dry mouth, hives, and muscle cramps.

Overdose

Incorrectly chosen dosage or regimen of application leads to abundant excretion of fluid from the body. This is fraught with a sharp drop in blood pressure and tachycardia; lack of urination or disturbances in this process; vomiting, which brings with it thirst. There is no means for removing hydrochlorothiazide from the body. Therefore, gastric lavage in conjunction with the intake of activated charcoal or another sorbent can help.

Dosage and administration

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 not more than 100 mg. The duration of the course is 3 weeks.
In the case of application from edema, the dose is 25-100 mg of the substance. Use 1 time per day or 2 days.
In diabetes insipidus origin, 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: HYPOTHIAZID®

The active substance of the drug: hydrochlorothiazide
ATX code: C03AA03
CFG: Diuretic
Registration number: P No. 013510/01
Date of registration: 21.11.07
The owner of the reg. Credit: CHINOIN Pharmaceutical and Chemical Works Private Co. Ltd. (Hungary)

Hypothiazid release form, drug packaging and composition.

Tablets are white or almost white, round, flat, engraved with "H" on one side and a notch on the other. 1 tab. hydrochlorothiazide 25 mg - "- 100 mg
Excipients: magnesium stearate, talc, gelatin, corn starch, lactose monohydrate.
20 pcs. - blisters (1) - packs of cardboard.

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

Pharmacological action Hypothiazid

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 the activity of carbonic anhydrase by increasing the excretion of bicarbonate ion, but this effect is usually weak and does not affect urine pH.
Hydrochlorothiazide also has antihypertensive properties. Thiazide diuretics do not affect normal blood pressure.

Pharmacokinetics of the drug.

Suction and distribution
Hydrochlorothiazide is incompletely but fairly rapidly absorbed from the gastrointestinal tract. This effect persists for 6-12 hours. After an oral dose of 100 mg, Cmax in plasma is reached after 1.5-2.5 hours. At the maximum diuretic activity (approximately 4 hours after ingestion), the concentration of hydrochlorothiazide in blood plasma is 2 μg / ml .
Plasma protein binding is 40%.
breeding
The primary route of excretion 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 insufficiency 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 (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 and method of application 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.
Adults
In arterial hypertension, the initial dose is 25-50 mg / day once, as monotherapy or in combination with other antihypertensive agents. For some patients, an initial dose of 12.5 mg is sufficient (both in the form of monotherapy and 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 another drug to prevent an excessive decrease in blood pressure.
The hypotensive effect is manifested within 3-4 days, but it may take 3-4 weeks to achieve the optimal effect. After the end of therapy, the hypotensive effect persists for 1 week.
With edematous syndrome of various origins, the initial dose is 25-100 mg / day once or 1 time in 2 days. Depending on the clinical response, the dose may be reduced to 25-50 mg / day once or 1 time in 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.
With premenstrual tension syndrome, the drug is prescribed at a dose of 25 mg / day and is used from the onset of symptoms to the onset of menstruation.
In nephrogenic diabetes insipidus, the usual daily dose of the drug is 50-150 mg (in divided doses).
Due to the 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.
children
Doses should be set based on the body weight of the child. Usual pediatric daily doses: 1-2 mg / kg of body weight or 30-60 mg / m2 of body surface 1 time / day. The daily dose in children aged 3 to 12 years is 37.5-100 mg.

Side effects Hypothiazid:

From the side of 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 side of 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.
On the part of metabolism: hyperglycemia (a decrease in glucose tolerance can provoke a manifestation of previously latent diabetes mellitus), glucosuria, hyperuricemia (with the development of a gout attack), hypokalemia, hypomagnesemia, hypercalcemia, hyponatremia (including confusion, convulsions, lethargy, slow thinking, fatigue, irritability, muscle cramps), hypochloremic alkalosis (including dry mouth, thirst, irregular heart rate, mood or mental changes, muscle cramps and pain, nausea, vomiting, unusual tiredness or weakness) . Hypochloremic alkalosis can cause hepatic encephalopathy or hepatic coma. When using the drug in high doses, it is possible to increase the levels of lipids in the blood serum.
Allergic reactions: urticaria, purpura, necrotizing vasculitis, Stevens-Johnson syndrome, respiratory distress syndrome (including pneumonitis, non-cardiogenic pulmonary edema), photosensitivity, anaphylactic reactions up to shock.
Others: reduced potency.

Contraindications to the drug:

Anuria;
- severe renal insufficiency<30 мл/мин);
- severe liver failure;
- hard-to-control diabetes mellitus;
- Addison's disease;
- refractory hypokalemia, hyponatremia, hypercalcemia;
- children's age up to 3 years (for solid dosage form);
- Hypersensitivity to the components of the drug;
- Hypersensitivity to sulfonamide derivatives.
With caution, the drug should be used for hypokalemia, hyponatremia, hypercalcemia, coronary artery disease, cirrhosis, gout, lactose intolerance, the use of cardiac glycosides, as well as in elderly patients.

Use during pregnancy and lactation.

The use of the drug in the first trimester of pregnancy is contraindicated. In the II and III third trimesters of pregnancy, the use of the drug is possible only if the intended benefit to the mother outweighs the potential risk to the fetus.
Hydrochlorothiazide crosses the placental barrier. There is a danger 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.

Special instructions for use Hypothiazid.

With prolonged course treatment, clinical symptoms of water and electrolyte imbalance should be carefully monitored, first of all, in patients at high risk: patients with diseases of the cardiovascular system, impaired liver function, with severe vomiting or signs of water and 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 with loss of potassium due to increased diuresis, prolonged diuretic therapy, or simultaneous treatment with digitalis glycosides or corticosteroid drugs, avoids hypokalemia.
An increase in the excretion of magnesium in the urine with the use of thiazides can lead to hypomagnesemia.
With reduced renal function, control of creatinine clearance is necessary. In patients with impaired renal function, the drug can cause azotemia and the development of cumulative effects. If impaired renal function is evident, discontinuation of the drug should be considered upon the onset of oliguria.
In patients with impaired liver function or progressive liver disease, thiazides should be used with caution, since a slight change 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 care.
Treatment with thiazide drugs may impair glucose tolerance. During a long course of treatment for overt 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, opioid analgesics enhance the orthostatic hypotensive effect of thiazide diuretics.
In rare cases, with prolonged therapy, a pathological change in the parathyroid glands was observed, accompanied by hypercalcemia and hypophosphatemia.
Thiazides can reduce the amount of iodine that binds to serum proteins without showing signs of thyroid dysfunction.
The possibility of gastrointestinal complaints in patients with lactose intolerance should be considered, since Hypothiazid 25 mg tablets contain 63 mg of lactose, Hypothiazid 100 mg - 39 mg of lactose.
Influence on the ability to drive vehicles and control mechanisms
At the initial stage of the drug use (the duration of this period is determined individually), it is forbidden to drive a car and perform work that requires increased attention.

Drug overdose:

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

Interaction Hypothiazid 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 action is potentiated and it may be necessary to adjust the dose.
With the simultaneous use of Hypothiazide with cardiac glycosides, hypokalemia and hypomagnesemia, associated with the action of thiazide diuretics, can increase the toxicity of digitalis.
With the 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, 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 Hypothiazid 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, as a result, its clearance decreases.
With the simultaneous use of hypothiazide with cholestyramine, the absorption of hydrochlorothiazide decreases.
With the simultaneous use of Hypothiazide with ethanol, barbiturates and narcotic analgesics, the risk of developing orthostatic hypotension increases.
Thiazides can reduce plasma levels of protein-bound iodine; increase the concentration of bilirubin in the blood serum.
Thiazides should be discontinued before testing for parathyroid function.

Conditions of sale in pharmacies.

The drug is dispensed by prescription.

The timing of the storage conditions of the drug Hypothiazid.

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 lowering the total amount of fluid in the vessels. Also, this remedy provides prevention of 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 Hypothiazid: complete instructions for use for this drug, average prices in pharmacies, complete and incomplete analogues of the drug, as well as reviews of people who have already used Hypothiazid. Want to leave your opinion? Please write in the comments.

Clinical and pharmacological group

Diuretic.

Terms of dispensing from pharmacies

Released by prescription.

Prices

How much does Hypothiazid cost? The average price in pharmacies is at the level of 110 rubles.

Release form and composition

White or almost white round flat tablets. On one side they have an engraving "H", and on the other - a risk, so that it is more convenient to divide.

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

Pharmacological effect

"Hypothiazid" performs 2 functions: removes excess fluid and promotes the release of harmful sodium and chlorine from the body. Hydrochlorothiazide reduces the reabsorption of sodium and chloride ions in the renal tubules. The disadvantage of using is the excretion of useful potassium ions, which leads to a trace element deficiency.

The advantage of "Hypothiazid" is the lack of addiction to the active substance. As a result, the effect of the use of the drug does not decrease.

Indications for use

What helps? High blood pressure () - as a rule, not alone, but together with other non-diuretic drugs. Edema caused by various causes: acute glomerulonephritis, chronic renal failure, premenstrual syndrome in women, treatment with corticosteroids.

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

Contraindications

The use of the drug "Hypothiazid" instruction prohibits:

babies under the age of 3;
during the lactation period;
in the first trimester of pregnancy;
with severe hepatic or hepatic insufficiency;
with hypokalemia;
with diabetes;
with Addison's disease;
with refractory hyponatremia;
with hypersensitivity to sulfonamides and components of the drug "Hypothiazide", from which an allergy can develop;
with anuria;
with hypercalcemia.

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

Use during pregnancy and lactation

Hydrochlorothiazide crosses the placental barrier. There is a danger 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.

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.

With premenstrual tension syndrome, the drug is prescribed at a dose of 25 mg / day and is used from the onset of symptoms to the onset of menstruation.
With edematous syndrome of various origins, the initial dose is 25-100 mg / day once or 1 time in 2 days. Depending on the clinical response, the dose may be reduced to 25-50 mg / day once or 1 time in 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.
In arterial hypertension, the initial dose is 25-50 mg / day once, as monotherapy or in combination with other antihypertensive agents. For some patients, an initial dose of 12.5 mg is sufficient (both in the form of monotherapy and 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 another drug to prevent an excessive decrease in blood pressure. The hypotensive effect is manifested within 3-4 days, but it may take 3-4 weeks to achieve the optimal effect. After the end of therapy, the hypotensive effect persists for 1 week.
In nephrogenic diabetes insipidus, the usual daily dose of the drug is 50-150 mg (in divided doses).

Side effects

Diuretic "Hypothiazid" has a number of adverse reactions for the body. They appear with uncontrolled medication or with existing prohibitions for use.

Patients often complain about:

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;
disruptions in the work of the heart;
dizziness;
feeling of nausea;
hives and pruritus.

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;
an increase in the concentration of urea nitrogen (more pronounced in patients with pathology of the renal system);
hyponatremia;
anuria (as a result of hemoconcentration).

With the development of symptoms of an overdose of the drug, the patient should urgently 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 things your doctor thinks are important. If your test results get worse, talk to your doctor about changing Hypothiazid tablets, such as Indapamide. Eat green vegetables and drink herbal tea to keep your body full of potassium.

Starting to take the medicine Hypothiazid, refrain from driving transport and dangerous mechanisms for 2-7 days. You can drive again when you are sure that you tolerate the treatment well, there is no fatigue, no weakness.

drug interaction

With the simultaneous use of this diuretic with corticosteroid drugs, the degree of potassium excretion increases.
Simultaneous use of hypothiazide with lithium salts can increase its toxicity and reduce renal clearance.
The combination of the above drug with cardiac glycosides can provoke hypomagnesemia and hypokalemia.
Hypothiazide in combination with amiodarone increases the likelihood of arrhythmias 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 Colestyramine, since the combination of these drugs leads to a decrease in the absorption of hydrochlorothiazide.

Hypothiazid is a diuretic or diuretic.

Hypothiazide is the brand name for the drug. The active substance in it is Hydrochlorothiazide or Hydrochlorothiazide (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.

Physically, Hydrochlorothiazide is a white or white-yellow crystalline powder, poorly soluble in water, methanol, ether, and readily soluble in alkaline solvents.

Mechanism of action

The scope 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 glomerulus of the nephron and the distal tubules remote from it are located in the cortical layer of the kidney substance.

As for the loop of Henle, a U-shaped joint between the proximal and distal tubules, Hypothiazide acts only on small sections of the loop located in the cortical layer. Hypothiazide does not act on the part of the loop located in the medulla.

Under the influence of this drug, sodium reabsorption (reabsorption) in the convoluted tubules of 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 the loop of Henle, some of the sodium ions are reabsorbed.

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

Sodium "pulls" water. Therefore, according to all the rules of osmosis, water is passively reabsorbed along with sodium in the renal tubules. If sodium reabsorption is reduced, the opposite effect will be observed.

The sodium will be excreted in the urine. Along with sodium, water will come out, 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 saluretics. The latter term, literally translated from Latin, means salt in the urine, i.e., stimulation of urinary excretion is achieved due to the excretion of salts.

True, in terms of strength of action, in terms of 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 section 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 from other groups are inferior to him in their activity.

Such weak diuretics include carbonic anhydrase inhibitors (Diacarb, Fonurit), potassium-sparing agents (Spironolactone, Veroshpiron), sodium channel blockers (Amiloride, Triamteren). Stimulation of diuresis under the action 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 (volume of circulating blood) due to an increase in the amount of urine excreted. However, the decrease in BCC in this case is not the only mechanism of hypotension. Due to the increased introduction 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 action of Hypothiazide compensatory, 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 lost in the urine: chlorides, bicarbonates, magnesium, chlorine. In the blood plasma, a deficiency of these electrolytes is formed: hyponatremia, hypokalemia, hypochloremia, hypomagnesemia. At the same time, the reabsorption of another electrolyte, calcium, is enhanced.

Reduced excretion of calcium prevents the formation of stones in the urinary tract. In addition, a decrease in calcium reabsorption under the action 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, while taking Hypotizide, on the contrary, slows down. This negatively affects the condition of patients with gout. Along with urates, the excretion of other nitrogenous compounds in the urine may be slowed down. In addition, there is evidence that long-term use of Hypothiazide reduces tissue tolerance to glucose.

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 acid-base balance (acid-base state) to the alkaline side.

Changes in CBS, electrolyte balance, retention of nitrogenous wastes 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 to 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 work of pituitary and hypothalamic hormones (vasopressin, antidiuretic hormone) is disrupted.

As a result, diabetes develops - the release of a large amount 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 secreted in sufficient quantities, but the kidney tissue is not sensitive to them. Hypothiazide in peripheral diabetes insipidus inhibits diuresis and increases the concentration of urine. The mechanism of action of the drug in this case is complex and not fully understood.

Some weight management programs strongly recommend the use of diuretics, in particular Hypothiazide. Say, with its constant intake, body weight decreases over time.

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

A bit of history

Diuretic drugs as a separate drug group declared themselves in the 50s of the last century. Then, in 1957, the first thiazide diuretic Chlorthiazide was synthesized.

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

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

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

Synthesis technology

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

Release form

Tablets 25 and 100 mg.

Hypothiazide is produced by the Hungarian pharmaceutical company Quinoin. Many Russian pharmaceutical companies release the drug under the names Hydrochlorothiazide, Dichlotiaide, Polithiazide. Abroad, it can be called Hydrodiuril, Hydrochlorot, Microzid.

Hypothiazide, along with other antihypertensive drugs, is part of such drugs as Adelfan ezidrex, Atahexal compositum, Triampur Compositum, Novospirozin, Moduretik, Kapozin, Sinipress.

Previously, the thiazide diuretic Chlortalidone was actively used. He was part of such funds as Neokristepin, Tenorik, Trirezid. Now Chlortalidone and combined drugs based on it are practically not used.

Indications

Arterial hypertension;
Various conditions accompanied by edematous syndrome (chronic heart and chronic renal failure, preeclampsia, 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.

Tablets are drunk 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 with 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 the course is determined individually for each patient. It should be borne in mind that the diuretic effect develops 2 hours after ingestion, reaches its maximum effect after 4 hours, and lasts 6-12 hours. The hypotensive effect develops more slowly, but lasts longer.

It occurs in 3-4 days, reaches a therapeutically significant level in 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 of body weight. The maximum daily dose for children 3-12 years old is 37.5-100 mg.

Pharmacodynamics

The drug is absorbed in the gastrointestinal tract in the amount of 60-80% of the intake. About 40% of the Hypothiazid that enters the body binds to plasma proteins. A certain part can accumulate in erythrocytes. Hypothiazide does not undergo metabolic transformations, and is mainly excreted with the kidneys (about 70%), and to a lesser extent with 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 elimination half-life is 3-4 hours at first, then it can increase up 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: violation of urine output, interstitial nephritis;
Respiratory organs: respiratory distress syndrome, pneumonitis, non-cardiogenic pulmonary edema;
Musculoskeletal system: myalgia;
Skin: necrotizing vasculitis, dermatitis, urticaria, pruritus, photosensitivity;
Reproductive system: erectile dysfunction;
Blood: anemia, leukopenia, thrombocytopenia, agranulocytosis;
Metabolism (metabolism): hyponatremia, hypokalemia, hypochloremia, hypercalcemia, metabolic alkalosis, hyperglycemia, glucosuria, hyperuricemia, hyperbilirubinemia.

Contraindications

Individual intolerance to the components of Hypothiazid;
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 is prescribed with caution to elderly patients. It is not advisable to take it while driving vehicles and working with potentially dangerous machines and mechanisms.

Interaction with other drugs

Antihypertensive drugs of other groups - increased hypotensive effect, requiring a dose reduction of Hypothiazide;
ACE inhibitors - reducing the degree of hypokalemia;
Tableted hypoglycemic drugs - a decrease in the effectiveness of these drugs, hyperglycemia;
Amiodarone - increased hypokalemia, risk of developing arrhythmias;
Lithium salts - increased toxicity of these drugs;
Cardiac glycosides of the digitalis group - aggravation of hypokalemia and hypomagnesemia;
Corticosteroids, calcitonin - aggravation of 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 crosses 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 - 5 years. The drug is dispensed by prescription.

Dear visitors of the site Farmamir. This article is not medical advice and should not be used as a substitute for consultation with a physician.