Impaired renal function
In patients with impaired renal function, it is preferable to use "loop" diuretics. If the drug Kandecor® ND 32 is used in patients with impaired renal function, it is recommended to periodically monitor the potassium content and the concentration of creatinine and uric acid in the blood plasma.
Kidney Transplantation
The experience of using Candecor® ND 32 in patients who have recently undergone kidney transplantation is absent.
Stenosis of the renal artery
In patients with bilateral stenosis of the renal artery, as well as stenosis of the artery of the only functioning kidney, drugs affecting the RAAS, incl. and ARA II, can increase urea and creatinine concentrations in the blood plasma.
Reduction of BCC (hypovolemia) and / or hyponatraemia
In patients with hypovolemia and / or hyponatremia, with the administration of Candecor® ND 32, symptomatic arterial hypotension may develop, as with other drugs that affect RAAS. Therefore, the use of Candecor® ND 32 is not recommended until these conditions are eliminated.
General anesthesia / surgery
Before surgery (including dentistry), an anesthesiologist should be warned about the use of Candecor® ND 32. When performing surgery under general anesthesia, patients with ARA II may develop arterial hypotension due to RAAS blockade. Very rarely arterial hypotension can be pronounced and require intravenous fluid and / or vasopressors.
Impaired liver function
Thiazide diuretics should be used with caution in patients with impaired liver function or progressive liver disease, since even minimal disturbances of the water-electrolyte balance can contribute to the development of the hepatic coma. The experience of using Candecor® ND 32 in patients with severe liver dysfunction is absent.
Stenosis of aortic and / or mitral valves, GOKMP
The drug Kandecor® ND 32, like other vasodilators, must be used with caution in patients with hemodynamically significant stenosis of the aortic and / or mitral valves or with GOKMP.
Primary hyperaldosteronism
Patients with primary hyperaldosteronism are resistant to antihypertensive drugs that affect RAAS; therefore, such patients are not recommended for using Candecor® ND 32.
Violations of the water-electrolyte balance
In all patients taking diuretics, it is necessary to periodically monitor the content of electrolytes in the blood plasma.
Thiazide diuretics, including hydrochlorothiazide, can cause disturbance of the water-electrolyte balance (hypercalcemia, hypokalemia, hyponatremia, hypomagnesemia and hypokalemic alkalosis).
Thiazide diuretics can reduce the excretion of calcium by the kidneys and cause a temporary and insignificant increase in the calcium content in the blood plasma.
Expressed hypercalcemia may be a sign of latent hyperparathyroidism. Before the study of the function of parathyroid glands, thiazide diuretics should be discontinued.
Hydrochlorothiazide, depending on the dose, enhances the excretion of potassium and can cause hypokalemia. This effect of hydrochlorothiazide is less pronounced when applied simultaneously with candesartan. The risk of hypokalemia is increased in patients with cirrhosis of the liver, with hypovolemia or in patients who follow a salt-free diet, or who simultaneously take glucocorticosteroids or ACTH.
The use of Candecor® ND 32 can provoke hyperkalemia, especially in patients with heart failure and / or renal insufficiency. Simultaneous use with potassium-sparing diuretics, potassium preparations, potassium substitutes or other agents that can increase the potassium content in the blood plasma (eg, heparin) can lead to the development of hyperkalemia. If necessary, monitor potassium levels in serum.Thiazide diuretics increase the excretion of magnesium by the kidneys, which can lead to hypomagnesemia.
Metabolic and endocrine effects
Caution is needed in all patients receiving treatment with hypoglycemic agents for ingestion or insulin, since hydrochlorothiazide can weaken their action. Against the background of therapy with thiazide diuretics latent-flowing diabetes mellitus can manifest.
Against the background of treatment with thiazide diuretics, it is possible to increase the concentration of cholesterol and triglycerides in the blood serum. However, when using a combination of hydrochlorothiazide / candesartan containing hydrochlorothiazide 12.5 mg, there was minimal or no such effects.
Therapy with thiazide diuretics in some patients can aggravate
hyperuricemia and / or aggravation of gout.
Photosensitivity
The cases of development of photosensitivity against hydrochlorothiazide are described. In the case of development of photosensitivity manifestations, it is recommended to stop therapy. If it is necessary to continue therapy, it is recommended to protect open areas of the body from exposure to sunlight and ultraviolet rays.
Anti-doping test
Hydrochlorothiazide, which is part of Candecor® ND 32, may be the cause of a positive anti-doping test.
Acute myopia and secondary acute closed-angle glaucoma
Hydrochlorothiazide is a sulfonamide that can cause an idiosyncratic reaction leading to the development of transient acute myopia and acute closed-angle glaucoma. Symptoms include: sudden reduction in visual acuity or eye pain, which usually appears within a few hours or weeks of initiating hydrochlorothiazide therapy. In the absence of treatment, acute closed-angle glaucoma can lead to persistent loss of vision.
Treatment: stop hydrochlorothiazide as soon as possible. If intraocular pressure remains uncontrolled, immediate medical treatment or surgery may be required. Risk factors for the development of acute closed-angle glaucoma are: an allergic reaction to sulfonamide or benzylpenicillin in the anamnesis.
Are common
In patients whose renal function depends on the state of RAAS (eg, in chronic heart failure III-IY functional class by classification NYHA, kidney disease, including renal artery stenosis), therapy with drugs that affect RAAS may be accompanied by severe arterial hypotension, oliguria and / or progressive azotemia, and in rare cases acute renal failure. It is impossible to exclude the development of these disorders due to the suppression of RAAS activity against the background of taking ARA II. A sharp decrease in blood pressure in patients with ischemic cardiomyopathy or cerebrovascular diseases of ischemic genesis with the use of any antihypertensive drugs can lead to the development of myocardial infarction or stroke.
In patients taking thiazide diuretics, hypersensitivity reactions can develop both in the presence and in the absence of a history of an allergic reaction or bronchial asthma, but are more likely if there are any in the history. There are reports of an exacerbation of the systemic lupus erythematosus with the use of thiazide diuretics.
Simultaneous use with other antihypertensive drugs potentiates the hypotensive effect of Candecor® ND 32.
Special information on excipients
The drug Kandekor® ND 32 contains lactose, therefore the drug is contraindicated in patients with lactase deficiency, lactose intolerance, glucose-galactose malabsorption syndrome.