Hydrochlorothiazide - instructions for use, doses, side effects, contraindications

Hydrochlorothiazide	25 mg	100 mg
Excipients:
lactose monohydrate	70 mg	196 mg
microcrystalline cellulose	20 mg	60 mg
potato starch	13.7 mg	40 mg
magnesium stearate	1.3 mg	4 mg.

Description:

Tablets of 25 mg are round, flat-cylindrical, without risks, with a bevel, white or almost white with a yellowish hue of color. It is allowed to have a light marble.

Tablets of 100 mg are round, planocylindrical, with a risk and facet, white or almost white with a yellowish tint of color. It is allowed to have a light marble.

Pharmacotherapeutic group:Diuretics

ATX: & nbsp

C.03.A.A.03 Hydrochlorothiazide

Pharmacodynamics:

The mechanism of action of thiazide diuretics (thiazides) has not been fully studied.Thiazides block the reabsorption of sodium and chlorine ions at the beginning of the renal tubules. Thus, they increase the excretion of sodium and chlorine and, consequently, the excretion of water from the body.

As a result of the diuretic action of hydrochlorothiazide, the volume of circulating fluid decreases, resulting in increased renin activity and aldosterone in the blood plasma. This leads to an increase in the excretion of potassium ions in the urine and a decrease in the potassium content in the blood (hypokalemia). Hydrochlorothiazide also increases the excretion of magnesium ions and reduces the excretion of calcium ions in the urine. Thiazide diuretics reduce the excretion of uric acid by the kidneys and increase its content in the blood.

Thiazide diuretics also reduce the activity of carbonic anhydrase by increasing the excretion of bicarbonate ions. But the ego action is usually weak and does not affect pH urine.

At the maximum therapeutic doses, the diuretic / natriuretic effect of all thiazide diuretics is approximately the same. The natriuresis and diuresis occur within 2 hours and reach their maximum in about 4 hours. The duration of diuretic action of hydrochlorothiazide is from 6 to 12 hours.

Hydrochlorothiazide has an antihypertensive effect.On normal blood pressure, thiazide diuretics have no effect.

Pharmacokinetics:

Suction and distribution

Hydrochlorothiazide is incomplete, but it is quickly absorbed from the gastrointestinal tract. After oral administration in a dose of 100 mg, the maximum concentration of hydrochlorothiazide in the blood plasma is achieved across 1,5-2,5 hours. At the maximum of diuretic activity (approximately 4 hours after administration), the concentration of hydrochlorothiazide in blood plasma is 2 μg / ml. The connection with plasma proteins is 40%. Hydrochlorothiazide penetrates the placental barrier and is excreted into breast milk, but does not penetrate the blood-brain barrier.

Metabolism

Hydrochlorothiazide in the human body is not metabolized.

Excretion

The primary way of excretion through the kidneys (filtration and secretion) is unchanged. Approximately 61% of the dose taken internally is excreted within 24 hours. In patients with normal renal function, the half-life is between 5.6 and 14.8 hours (an average of 6.4 hours).

Pharmacokinetics in specific patient groups

Impaired renal function

In patients with moderate renal failure, the period half-life of hydrochlorothiazide averages 11.5 hours, and in patients with creatinine clearance less than 30 ml / min - 20.7 hours.

Indications:

- Arterial hypertension (used in both monotherapy and in combination with other antihypertensive drugs).

- Ocular syndrome of various genesis (chronic cardiac insufficiency, nephrotic syndrome, premenstrual syndrome, acute glomerulonephritis, chronic renal failure, portal hypertension, treatment corticosteroids).

- Reduction of symptomatic polyuria with nephrogenic diabetes insipidus.

- Prevention of the formation of calcium-phosphate stones in the genito-urinary tract with hypercalciuria.

Contraindications:

- Hypersensitivity to hydrochlorothiazide, other derivatives of sulfonamide or any of the excipients.

- Anuria.

- Severe renal insufficiency (creatinine clearance less than 30 ml / min).

- Severe hepatic insufficiency or hepatic encephalopathy (risk of hepatic coma development).

- Difficultly controlled diabetes mellitus.

- Refractory hypokalemia, hyponatremia, hypercalcemia.

- Insufficiency of the adrenal cortex (incl.Addison's disease).

- Pregnancy (I trimester) and the period of breastfeeding.

- Children up to 3 years of age (solid dosage form).

- Rare hereditary intolerance of galactose, lactase deficiency, glucose-galactose malabsorption syndrome (the drug contains lactose monohydrate).

Carefully:

- Impaired renal function.

- Violation of liver function of mild to moderate severity, progressive liver disease.

- Hypokalemia.

- Hyponatremia.

- Hypercalcemia.

- Increase the duration of the interval QT on the ECG.

- Simultaneous use of drugs that can cause polymorphic ventricular tachycardia such as "pirouette" or increase the duration of the interval QT on the ECG.

- Simultaneous use of lithium drugs, drugs that can cause hypokalemia, cardiac glycosides.

- Allergic reactions to penicillin in the anamnesis.

- Hyperparathyroidism.

- Diabetes.

- Hyperuricemia, gout.

- Systemic lupus erythematosus.

- Ischemic heart disease, severe atherosclerosis of the coronary or cerebral arteries.

- Chronic heart failure.

- Elderly age.

- Pregnancy (second and third trimester).

- Children's age (from 3 to 18 years).

Pregnancy and lactation:

Pregnancy

There is limited experience with the use of hydrochlorothiazide during pregnancy (especially in the first trimester). Preclinical safety data are not sufficient.

Hydrochlorothiazide penetrates the placental barrier and is detected in the umbilical cord blood. Taking into account the mechanism of pharmacological action of hydrochlorothiazide, its use in the second and third trimesters of pregnancy can disrupt fetoplacental perfusion and lead to development of complications in the fetus and newborn such as jaundice, water-electrolyte balance disorders and thrombocytopenia. The cases of development of thrombocytopenia in newborns whose mothers received thiazide diuretics are described.

The use of hydrochlorothiazide in the first trimester of pregnancy is contraindicated. In the second and third trimesters of pregnancy hydrochlorothiazide can only be used in the case of unconditional need, when the benefit to the mother exceeds the potential risk to the fetus and / or the child.

Hydrochlorothiazide can not be used to treat gestosis in the second half of pregnancy (edema, arterial hypertension or preeclampsia).it increases the risk of reducing the volume of circulating blood and placental hypoperfusion, but does not have a beneficial effect on the course of these complications of pregnancy. Diuretics do not prevent the development of gestosis.

Breastfeeding period

Hydrochlorothiazide penetrates into the mother's milk, and therefore its use during breastfeeding is contraindicated. If the use of hydrochlorothiazide during lactation is absolutely necessary, breastfeeding should be stopped.

Dosing and Administration:

Inside. Tablets should be taken after meals.

The dosage of hydrochlorothiazide should be selected individually. It is recommended to take the drug at the lowest effective dose.

To ensure the indicated dosage regimens if you need the use of hydrochlorothiazide in a single dose of 12.5 mg should be prescribed drugs of other manufacturers in the dosage form of "25 mg tablets" with a risk.

Adults

Arterial hypertension

The usual initial dose of hydrochlorothiazide is 25-50 mg once a day, in the form of monotherapy or in combination with other antihypertensive agents.In some patients, the antihypertensive effect is achieved with hydrochlorothiazide at an initial dose of 12.5 mg once a day (both in monotherapy and in combination with other drugs).

It is necessary to apply the most effective dose of the drug. The maximum daily dose of hydrochlorothiazide for the treatment of hypertension is 100 mg per day.

If hydrochlorothiazide is used in combination with other antihypertensive drugs, it may be necessary to reduce the dose of another drug in order to prevent excessive reduction in blood pressure (BP).

The antihypertensive effect of hydrochlorothiazide appears within 3-4 days, however, to achieve the optimal effect, it may take up to 3-4 weeks. After the end of treatment, the antihypertensive effect persists for one week.

Ocular syndrome of various origins

The usual initial dose of hydrochlorothiazide in the treatment of edema of various genesis is 25-100 mg once a day daily. Some patients respond to taking hydrochlorothiazide every other day or once every 3-5 days.Depending on the clinical response, the dose of the drug can be reduced to 25-50 mg once a day daily or once in 2-5 days. In some cases, at the beginning of the treatment, hydrochlorothiazide may need to be taken at the maximum dose (for this indication) of 200 mg per day.

With premenstrual syndrome, the usual dose is 25 mg per day and is applied from the time of onset of symptoms to the onset of menstruation.

Reduction of symptomatic polyuria in nephrogenic diabetes insipidus

The recommended daily dose of hydrochlorothiazide is 50-150 mg per day (in several doses).

Prevention of calcium-phosphate stone formation in the genito-urinary tract with hypercalciuria

The use of hydrochlorothiazide is indicated for calciuria more than 8 mmol / day. The recommended initial dose of hydrochlorothiazide is 25 mg once a day. Further, an increase to a maximum dose of 50 mg per day for this indication is indicated.

Children

Doses are set based on the weight of the child's body. Children older than 3 years - 1-2 mg / kg / day or 30-60 mg / m body surface 1 time per day. The total daily dose for children aged 3-12 years is 37.5-100 mg (the maximum daily dose for children is 100 mg per day).After 3-5 days of treatment, it is recommended to take a break for 3-5 days. As maintenance therapy in this dose prescribed 2 times a week. With the use of intermittent course of treatment with taking 1-3 days or 2-3 days followed by a break, the decrease in efficiency is less pronounced, and the side effects develop less often.

Side effects:

To describe the frequency of undesired reactions, the following frequency grades were used: often - ≥ 1/100 to <1/10, infrequently - ≥ 1/1000 to <1/100, rarely - ≥ 1/10000 to <1/1000, very rarely - <1/10000, the frequency is unknown - the frequency can not be estimated from the available data. The incidence of adverse reactions is given in accordance with the classification of the World Health Organization.

Violations of the blood and lymphatic system

rarely: leukopenia, agranulocytosis, thrombocytopenia, hemolytic anemia, aplastic anemia.

Immune system disorders

frequency unknown: urticaria, purpura, fever, necrotizing angiitis (vasculitis and cutaneous vasculitis), Stevens-Johnson syndrome, anaphylactic reactions right up to shock; exacerbation of the systemic lupus erythematosus.

Disturbances from the nervous system

infrequently: fainting (usually when used in high doses);

rarely: headache, dizziness, vertigo, paresthesia;

frequency is unknown: drowsiness, confusion.

Disturbances on the part of the organ of sight

rarely: transient blurred vision;

frequency is unknown: acute myopia, acute attack of angle-closure glaucoma, xantopsy.

Heart Disease

infrequently: bradycardia.

Vascular disorders

infrequently: orthostatic hypotension.

Disturbances from the respiratory system, organs of the thorax and mediastinum:

infrequently: interstitial pneumonia;

rarely: respiratory distress syndrome (including pneumonitis and noncardiogenic pulmonary edema).

Disorders from the gastrointestinal tract:

often: loss of appetite, anorexia, discomfort in the stomach, pain in the upper abdominal parts, diarrhea, nausea, vomiting, constipation;

infrequently: pancreatitis;

frequency is unknown: sialadenitis.

Disorders from the liver and biliary tract

rarely: jaundice (intrahepatic cholestatic jaundice);

infrequently: cholecystitis.

Disturbances from the skin and subcutaneous tissues

infrequently: skin rash, skin itch, photosensitivity;

frequency is unknown: alopecia.

Disturbances from musculoskeletal and connective tissue

rarely: convulsions, muscle weakness (especially when used in high doses).

Disorders from the kidneys and urinary tract

frequency is unknown: impaired renal function, interstitial nephritis, renal failure.

Violations of the genitals and mammary gland

frequency is unknown: decreased potency.

Disorders from the metabolism and nutrition

Often: hyponatremia, hypokalemia, hypomagnesemia, hypochloraemic alkalosis, hypercalcemia:

often: hyperuricemia (including with the development of a gout attack), the manifestation of latent diabetes mellitus;

frequency is unknown: Hyperglycemia and glucosuria in patients with diabetes mellitus, decreased glucose tolerance; increasing the concentration of cholesterol or triglycerides in the blood serum (usually when used in high doses).

General disorders and disorders at the site of administration

Often: fatigue, thirst (usually when used in high doses).

Overdose:

Symptoms

The most frequent manifestations of hydrochlorothiazide overdose are an increase in diuresis, accompanied by acute fluid loss (dehydration) and electrolyte disturbances (hypokalemia, hyponatremia, hypochloremia). An overdose of hydrochlorothiazide may be manifested by the following symptoms:

- from the cardiovascular system: tachycardia, lowering blood pressure, shock;

- from the nervous system: weakness, confusion, dizziness and spasms of the calf muscles, paresthesia, impaired consciousness, fatigue;

- from the gastrointestinal tract: nausea, vomiting, thirst;

- from the kidneys and urinary tract: polyuria, oliguria or anuria (due to hemoconcentration).

- Laboratory indicators: hypokalemia, hyponatremia, hypochloremia, alkalosis, increased urea nitrogen in the blood (especially in patients with renal insufficiency).

Treatment

In case of an overdose, symptomatic and supportive therapy is performed. If the drug was taken recently, to withdraw Hydrochlorothiazide is indicated by the induction of vomiting or gastric lavage.The absorption of hydrochlorothiazide can be reduced by the intake of activated carbon. In the case of a decrease in blood pressure or shock, the volume of circulating blood should be replenished with the introduction of plasma-replacing fluids and a deficiency of electrolytes (potassium, sodium). In respiratory disorders, inhalation of oxygen or artificial ventilation of the lungs is indicated. It is necessary to control the water-electrolyte balance (especially the content of potassium in the blood serum) and the function of the kidneys before their normalization. There is no specific antidote. Hydrochlorothiazide is excreted when Hemodialysis, but the degree of its excretion is not established.

Interaction:

Unrecommended combinations of drugs

Lithium preparations

With the simultaneous use of hydrochlorothiazide and lithium preparations, the renal clearance of lithium decreases, which can lead to an increase in the concentration of lithium in the blood plasma and increase its toxicity. If simultaneous use of hydrochlorothiazide is necessary, the dose of lithium preparations should be carefully selected, the concentration of lithium in the blood plasma should be regularly monitored and the dose of the preparation should be appropriately selected.

Combinations of medicines, requiring special attention

Preparations, can cause a polymorphic ventricular tachycardia such as "pirouette"

It should be used with extreme caution hydrochlorothiazide simultaneously with such drugs as:

- antiarrhythmic drugs class IA (quinidine, hydroquinidine, disopyramide, procainamide);

- antiarrhythmic medicines of III class (dofetilide, ibutilide, brethil tosylate), sotalol, dronedaron, amiodarone;

- other (non-antiarrhythmic) medicines, such as:

- antipsychotics: phenothiazines (chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoperazine, fluphenazine), benzamides (amisulpride, sultopride, sulpride, tiapride), butyrophenones (droperidol, haloperidol); pimozide, sertindole;

- antidepressants: tricyclic antidepressants, selective serotonin reuptake inhibitors (citalopram, escitalopram);

- antibacterial agents: fluoroquinolones (levofloxacin, moxifloxacin, sprafloxacin, ciprofloxacin); macrolides (erythromycin with intravenous administration, azithromycin, clarithromycin, roxithromycin, spiramycin), co-trimoxazole; antifungal agents: azoles (voriconazole, itraconazole, ketococonazole, fluconazole);

- antimalarials (quinine, chloroquine, mefloquine, halofantrine, lumefantrine);

- antiprotozoal agents (pentamidine with parenteral administration);

- antianginal agents (ranolazine, beprideal);

- antineoplastic agents (vandetanib, arsenic trioxide, oxaliplatinum, tacrolimus);

- antiemetics (domperidone, ondansetron);

- drugs that affect the motility of the gastrointestinal tract (cisapride);

- antihistamines (astemizole, terfenadine, misolastine);

- other medicinal products (anagrelide, vasopressin, diphemanyl methyl sulfate, ketanserin, probucol, propofol, sevoflurane, terlipressin, terodiline, cilostazol);

- due to increased risk of ventricular arrhythmias, especially polymorphic ventricular tachycardia such as pirouette (risk factor - hypokalemia).

It is necessary to determine the content of potassium in the blood plasma and, if necessary, adjust it before the beginning of the combined therapy with hydrochlorothiazide with the above drugs. It is necessary to monitor the clinical condition of the patient, the content of plasma electrolytes and ECG parameters.Patients with hypokalemia should use drugs that cause polymorphic ventricular tachycardia such as "pirouette".

Drugs that can increase the duration of the QT interval

The simultaneous use of hydrochlorothiazide with drugs that can increase the duration of the QT interval should be based on a careful assessment of the ratio of expected benefit and potential risk for each patient (possibly an increased risk of developing polymorphic ventricular pirouette tachycardia). When using such combinations, it is necessary to regularly register the ECG (to detect the prolongation of the QT interval), and to monitor the potassium content in the blood.

Drugs that can cause hypokalemia: amphotericin B (for intravenous administration), gluco- and mineralocorticosteroids (for systemic use), tetracosactide (ACTH), glycyrrhizic acid (carbenoxolone, drugs containing licorice root), laxatives that stimulate bowel motility

Increased risk of hypokalemia with simultaneous use with hydrochlorothiazide (additive effect).It is necessary to regularly monitor the potassium content in the blood plasma, if necessary - its correction. On the background of hydrochlorothiazide therapy it is recommended to use laxatives that do not stimulate intestinal motility.

Cardiac glycosides

Hypokalemia and hypomagnesemia, caused by the action of thiazide diuretics, increase the toxicity of cardiac glycosides. With the simultaneous use of hydrochlorothiazide and cardiac glycosides, the concentration of potassium in the blood plasma, the ECG parameters, and, if necessary, adjust the therapy should be regularly monitored.

Combinations of medicines, requiring attention

Other antihypertensive drugs

Potentiation of antihypertensive action of hydrochlorothiazide (additive effect). There may be a need for correction of the dose of simultaneously prescribed antihypertensive drugs.

It is recommended to stop taking hydrochlorothiazide 2-3 days before the start of therapy with angiotensin-converting enzyme (ACE) inhibitors to prevent the development of symptomatic arterial hypotension. If this is not possible, then the initial dose of ACE inhibitors should be reduced.

Ethanol, barbiturates, antipsychotic drugs (antipsychotics), antidepressants, anxiolytics, narcotic analgesics and means for general anesthesia

Possible increased antihypertensive action of hydrochlorothiazide and potentiation of orthostatic hypotension (additive effect).

Theophylline

Theophylline intensifies the action of diuretics.

Non-depolarizing muscle relaxants (eg, tubocurarine)

It is possible to enhance the effect of nondepolarizing muscle relaxants.

Adrenomimetics (pressor amines)

Hydrochlorothiazide can reduce the effect of adrenomimetics, such as epinephrine (epinephrine) and norepinephrine (norepinephrine).

Non-steroidal anti-inflammatory drugs (NSAIDs), including selective inhibitors of cyclooxygenase-2 (COX-2) and high doses of acetylsalicylic acid (≥3 g / day)

NSAIDs can reduce the diuretic and antihypertensive effects of hydrochlorothiazide. With simultaneous application, there is a risk of developing acute renal failure due to a decrease in glomerular filtration rate. Hydrochlorothiazide can enhance the toxic effect of high doses of salicylates on the central nervous system.

Hypoglycemic agents for oral administration and insulin

Thiazide diuretics affect glucose tolerance (possibly the development of hyperglycemia) and reduce the effectiveness of hypoglycemic agents (a dose adjustment of hypoglycemic agents may be required). It should be used with caution hydrochlorothiazide and metformin in connection with the risk of developing lactic acidosis against a background of kidney damage caused by hydrochlorothiazide.

Beta-adrenoblockers, diazoxide

The simultaneous use of thiazide diuretics (including hydrochlorothiazide), with beta-adrenoblockers or diazoxide may increase the risk of developing hyperglycemia.

Medications, used to treat gout (probenecid, sulfinopupazone, allopurinol)

It may be necessary to adjust the dose of uricosuric medicines, since hydrochlorothiazide increases the concentration of uric acid in the blood serum. Thiazide diuretics can increase the incidence of hypersensitivity reactions to allopurinol.

Amantadine

Thiazide diuretics (including hydrochlorothiazide) can reduce the clearance of amantadine, lead to an increase in the concentration of amantadine in the blood plasma and increase the risk of its undesirable effects.

Fluconazole

With multiple simultaneous use with hydrochlorothiazide, the maximum concentration of fluconazole in the blood plasma increases by 40%. Correction of the dose of fluconazole is not required, but this interaction should be taken into account.

Anticholinergic drugs (holinoblokatory)

Anticholinergic drugs (eg, atropine, biperidene) increase the bioavailability of thiazide diuretics due to a decrease in the motility of the gastrointestinal tract and the rate of gastric emptying.

Cytotoxic (antitumor) drugs

Thiazide diuretics reduce renal excretion of cytotoxic drugs (eg, cyclophosphamide and methotrexate) and potentiate their myelosuppressive effects.

Methyldopa

Cases of hemolytic anemia with simultaneous application of hydrochlorothiazide and methyldopa are described.

Carbamazepine

Risk of symptomatic hyponatraemia. With the simultaneous use of hydrochlorothiazide and carbamazepine, it is necessary to monitor the patient's condition and control the sodium content in the blood plasma.

Cyclosporin

With the simultaneous use of thiazide diuretics and cyclosporine, the risk of developing hyperuricemia and exacerbation of gout increases.

Oral anticoagulants

Thiazide diuretics can reduce the effect of oral anticoagulants.

Iodine-containing contrast agents

Dehydration of the body against thiazide diuretics increases the risk of acute renal failure, especially when using high doses of iodine-containing contrast agents. Before using iodine-containing contrast agents, fluid loss must be compensated.

Calcium preparations

With simultaneous use, it is possible to increase the calcium content in the blood and the development of hypercalcemia due to a reduction in the excretion of calcium ions by the kidneys. If simultaneous administration of calcium-containing drugs is necessary, the calcium content in the blood plasma should be monitored and the dosage of calcium preparations should be adjusted.

Anion exchange resins (colestramine and colestipol)

Anionic exchange resins reduce the absorption of hydrochlorothiazide. Single doses of colestyramine and colestipol reduce the absorption of hydrochlorothiazide in the gastrointestinal tract by 85% and 43%, respectively.

Special instructions:

Renal impairment

In patients with impaired renal function hydrochlorothiazide can cause azotemia. With renal failure, cumulation of hydrochlorothiazide is possible.

Patients with reduced renal function need periodic monitoring of creatinine clearance. With the progression of renal dysfunction and / or the onset of oligonuria (anuria) hydrochlorothiazide should be canceled.

Impaired liver function

When thiazide diuretics are used in patients with impaired liver function, hepatic encephalopathy may develop. Patients with severe hepatic insufficiency or hepatic encephalopathy the use of thiazides is contraindicated. In patients with mild or moderate hepatic insufficiency and / or progressive liver disease hydrochlorothiazide should be used with caution, since even a small change in the water electrolyte balance and accumulation of ammonium in the blood serum can cause hepatic coma. In case of symptoms of encephalopathy, diuretics should be discontinued immediately.

Water-electrolyte balance and metabolic disturbances

Thiazide diuretics (including hydrochlorothiazide) can cause a decrease in the volume of the circulating fluid (hypovolemia) and disturbance of the water-electrolyte balance (including hypokalemia, hyponatremia, hypochloraemic alkalosis). Clinical symptoms of violations of electro-electrolyte balance are dry mouth, thirst, weakness, lethargy, fatigue, drowsiness, anxiety, muscle pain or cramps, muscle weakness, pronounced blood pressure lowering, oliguria, tachycardia, arrhythmia and gastrointestinal disorders like nausea and vomiting). In patients receiving hydrochlorothiazide therapy (especially with prolonged course treatment), clinical symptoms of water electrolyte balance disorders should be identified, and the electrolyte content in the blood should be regularly monitored.

Sodium

All diuretics can cause hyponatremia, sometimes leading to severe complications. Hyponatremia and hypovolemia can lead to dehydration and orthostatic hypotension. A concomitant decrease in chloride ions can lead to secondary compensatory metabolic alkalosis, but the frequency and severity of this effect are negligible.It is recommended to determine the content of sodium ions in blood plasma before the start of treatment and regularly monitor this figure against the background of taking hydrochlorothiazide.

Potassium

With the use of thiazide and thiazide-like diuretics, there is a risk of a sharp drop in potassium in the blood plasma and development of hypokalemia (potassium concentration less than 3.4 mmol / l). Hypokalemia increases the risk of heart rhythm disturbances (including severe arrhythmias) and increases the toxic effect of cardiac glycosides. In addition, hypokalemia (as well as bradycardia) is a condition conducive to the development of polymorphic ventricular tachycardia such as pirouette, which can lead to death.

Hypokalemia is the most dangerous for the following groups of patients: elderly patients, patients simultaneously receiving antiarrhythmic and non-antiarrhythmic drugs that can cause polymorphic ventricular tachycardia such as pirouettes or increase the duration of the interval QT on ECG, patients with impaired liver function, ischemic heart disease, chronic heart failure.In addition, the high-risk group includes patients with an increased interval QT. It does not matter, this increase is caused by innate causes or effects of drugs.

In all the cases described above, you should avoid the risk of hypokalemia and regularly monitor the potassium content in the blood plasma. The first measurement of the content of potassium ions in the blood should be carried out within the first week after the start of treatment. When hypokalemia occurs, appropriate treatment should be prescribed. Hypokalemia can be corrected by the use of potassium-containing drugs or by the intake of foods rich in potassium (dried fruits, fruits, vegetables).

Calcium

Thiazide diuretics can reduce the excretion of calcium ions by the kidneys, leading to a slight and temporary increase in the calcium content in the blood plasma. In some patients with prolonged use Thiazide diuretics observed pathological changes in parathyroid glands with hypercalcemia and hyperphosphatemia, but without the typical complications of hyperparathyroidism (nephrolithiasis, bone mineral density reduction, peptic ulcer disease).Expressed hypercalcemia may be a manifestation of previously unidentified hyperparathyroidism.

Because of its effect on calcium metabolism, thiazides can affect the laboratory parameters of parathyroid gland function. Thiazide diuretics should be discontinued (including hydrochlorothiazide) before the study of parathyroid function.

Magnesium

It was found that thiazides increase the excretion of magnesium by the kidneys, which can lead to hypomagnesemia. The clinical significance of hypomagnesemia remains unclear.

Glucose

Treatment with thiazide diuretics can impair glucose tolerance. When hydrochlorothiazide is used in patients with manifest or latent diabetes mellitus, the concentration of glucose in the blood should be monitored regularly. You may need to adjust the dose of hypoglycemic drugs.

Uric Acida

Patients with gout may increase the incidence of attacks or exacerbate the course of gout. Careful monitoring of patients with gout and impaired uric acid metabolism (hyperuricemia) is necessary.

Lipids

When using hydrochlorothiazide, the concentration of cholesterol and triglycerides of blood plasma can increase.

Acute myopia / secondary closed glaucoma

Hydrochlorothiazide can cause an idiosyncratic reaction leading to the development of acute myopia and an acute attack of secondary closed-angle glaucoma. Symptoms include a sudden decrease in visual acuity or pain in the eyes, which usually appear within a few hours or weeks of the onset of therapy hydrochlorothiazide. In the absence of treatment acute acute angle glaucoma can lead to irreversible loss of vision. When symptoms develop, as soon as possible stop taking hydrochlorothiazide. If intraocular pressure remains uncontrolled, immediate medical treatment or surgery may be required. Risk factors for the development of acute angle-closure glaucoma are: an allergic reaction to sulfonamides or penicillin in an anamnesis.

Immune system disorders

There are reports that thiazide diuretics (incl. hydrochlorothiazide) can cause exacerbation or progression of systemic lupus erythematosus, as well as lupus-like reactions.

In patients receiving thiazide diuretics, hypersensitivity reactions can occur even if there is no indication of a history of allergic reactions or bronchial asthma.

Photosensitivity

There is information about cases of development of photosensitivity reactions when taking thiazide diuretics. In the case of photosensitivity when taking hydrochlorothiazide should stop treatment. If continuation of the diuretic is necessary, then protect the skin from exposure to sunlight or artificial ultraviolet rays.

Alcohol

During the treatment with hydrochlorothiazide, it is not recommended to drink alcoholic beverages. ethanol enhances the antihypertensive effect of thiazide diuretics.

Athletes

Hydrochlorothiazide can give a positive result in the conduct of doping control in athletes.

Other

In patients with severe atherosclerosis of the cerebral and coronary arteries, caution should be exercised hydrochlorothiazide. Thiazide diuretics can reduce the amount of iodine associated with plasma proteins, without manifestations of thyroid dysfunction.

Effect on the ability to drive transp. cf. and fur:

Special clinical studies to assess the effect of hydrochlorothiazide on the ability to drive vehicles and work with machinery were not conducted. It should be borne in mind the possibility of drowsiness and dizziness when taking the drug. Therefore, care must be taken when carrying out work requiring increased attention and in the management of vehicles, especially at the beginning of treatment, with increasing doses of hydrochlorothiazide.

Form release / dosage:

Tablets, 25 mg, 100 mg.

Packaging:

7 tablets per contour cell pack of film polyvinylchloride and aluminum foil printed. 2, 3, 4 contour squares, together with instructions for use, are placed in a pack of cardboard.

10 tablets per contour cell package of film polyvinylchloride and aluminum foil printed. 1, 2, 3, 4, 5 contour mesh packaging along with the instructions for use are placed in a pack of cardboard.

Storage conditions:

Store in a dark place at a temperature of no higher than 25 ° C. Keep out of the reach of children.

Shelf life:2 years.Do not use after the expiry date printed on the package.

Terms of leave from pharmacies:On prescription

Registration number:LP-004823

Date of registration:24.04.2018

Expiration Date:24.04.2023

The owner of the registration certificate:PRANAFARM, LLC PRANAFARM, LLC Russia

Manufacturer: & nbsp

PRANAFARM, LLC Russia

Information update date: & nbsp31.05.2018

Illustrated instructions

Instructions

Hydrochlorothiazide (Hydrochlorothiazide)