Synonyms: Hypothiazide (V), Nefriks (P), Dichlotride Dihydran, Dihydrochlorthiazid, Disalunil (D), Esidrex, Esidrix, Hidrosaluretil, Hydrex, Hydril, Hydrochlorothothiazidum, Hydrochlorthiazide, Hydro-Diuril, Shishar, Hidrosaluretil, Hydrochlorothiazidum, Hydrochlorothiazidum, Hydrochlorthiazide, Hydrochlorthiazid , Nefrix (P), Novodiurex, Oretic, Panurin, Unazid (U), Urodiazin (G), Vetidrex, etc.
White or white with a yellowish sheen crystalline powder. Very little soluble in water, a little - in alcohol, it is easy in solutions of caustic alkalis.
Dichlothiazide is a highly active diuretic agent acting by oral administration. By chemical structure, it belongs to the group of benzothiadiazine derivatives containing a sulfonamide group in position C (7). The presence of this group is related to dichlothiazide with diacarb. However, dichlothiazide inhibits carbonic anhydrase significantly less than diacarb, and dichlothiazide is much more effective in terms of the diuretic effect.
The first representative of the diuretics (saluretics) of the benzothiadiazine group was chlorothiazide. Dichlothiazide differs from chlorothiazide in the absence of a double bond in the 3.4 position of the thiadiazine nucleus. Compared with chlorothiazide, dichlothiazide is more effective and acts in much lower doses. Studies have shown that relatively small changes in the chlorothiazide molecule can lead to a significant change in activity. So, in even smaller doses than dichlothiazide, cyclomethiazide acts. The relative activity, based on the inverse relationship of doses that have the same diuretic effect, is approximately 1: 10: 1000 for chlorothiazide, dichlothiazide and cyclomethiazide.
The diuretic effect of dichlothiazide, as well as other diuretics of the benzothiadiazine group, is due to a decrease in the reabsorption of sodium ions in the proximal (and partially in the distal) part of the convoluted tubules of the kidneys; reabsorption of potassium and bicarbonate is also inhibited, but to a lesser extent. Due to the strong increase in natriuresis while enhancing the excretion of chlorides, dichlothiazide is considered as an active saluretic agent; excretion of sodium and chlorine occurs in equivalent amounts. The drug has a diuretic effect in both acidosis and alkalosis. Diuretic effect with long-term use of dichlothiazide is not reduced.
It should be pointed out that with diabetes insipidus, dichlothiazide, as well as other diuretics of the benzothiadiazine series, has a “paradoxical” effect, causing a decrease in polyuria. There is also a decrease in thirst. The increased osmotic pressure of blood plasma, which accompanies this disease, is greatly reduced. The mechanism of this effect is not clear enough. According to modern concepts, it is partially associated with an improvement in the concentration ability of the kidneys (peripheral action) and the suppression of the activity of the thirst center (central action).
Dichlothiazide also has a hypotensive effect, which is usually observed with elevated blood pressure. This action may partly be associated with increased excretion of salts and water from the body, which leads to some decrease in the volume of circulating plasma and extracellular fluid. There are, however, data showing that the hypotensive effect is not directly associated with increased diuresis: benzothiadiazine derivatives have been obtained that lack diuretic action and have a hypotensive effect. In addition, in the absence of congestive events in hypertensive patients, the administration of dichlothiazide causes a decrease in blood pressure, not accompanied by an increase in diuresis. Experimental studies suggest that under the influence of benzothiadiazine derivatives, there is a change in metabolic processes in the arteriole cell membranes and, in particular, the extraction of Na ions from them, which leads to a decrease in swelling and a decrease in peripheral vascular resistance. It is possible that in this case the role is not played by an absolute decrease in the content of Na + in the walls of blood vessels, but by a change in the ratio between its intra- and extracellular contents.
Under the influence of dichlothiazide, the vascular system reactivity changes, the pressor response to vasoconstrictor substances (adrenaline, etc.) decreases, and the depressor response to ganglioblokiruyuschie means increases.
Hypothiazide is used as a diuretic (saluretic) agent for stagnation in the small and large circulation, associated with cardiovascular insufficiency; cirrhosis of the liver with symptoms of portal hypertension; nephrosis and nephritis (with the exception of severe progressive forms with a decrease in glomerular filtration rate); pregnancy toxicosis (nephropathy, edema, eclampsia); premenstrual states, accompanied by stagnation.
Dichlothiazide prevents the retention of sodium ions and water in the body, accompanying the use of mineralocorticoids; therefore, it is also prescribed for edema caused by adrenal hormones and adrenocorticotropic hormone of the pituitary gland. The use of dichlothiazide prevents or reduces the increase in blood pressure caused by these drugs.
The diuretic effect after taking dichlothiazide develops quickly (within the first 1-2 hours) and lasts up to 10-12 hours or more after a single dose.
Dichlothiazide is also a valuable tool in the treatment of hypertension. Especially recommended is the use of the drug for hypertension, accompanied by circulatory failure. Since dichlothiazide potentiates the action of reserpine, apressin, octadine and other antihypertensive drugs, it is advisable to prescribe it in combination with these drugs, especially in patients with high blood pressure. blood pressure. Combined treatment can also be effective in the malignant course of hypertension (N. A. Ratner et al.).
Doses of antihypertensive drugs with combined use with dichlothiazide can be reduced (2-3 times).
The hypotensive effect of dichlothiazide is somewhat enhanced when a salt-free diet is observed, but it is not recommended to strongly restrict salt intake with the diet.
Dichlothiazide in some cases lowers intraocular pressure and normalizes Ophthalmotonus in glaucoma (mainly in subcompensated forms). The effect occurs within 24-48 hours after taking the drug. Against the background of the use of miotics, the normal level of intraocular pressure lasts from 1 to 6 days, then the pressure rises again and decreases after the next intake of dichlothiazide.
Assign dichlothiazide inside tablets. Doses are selected individually depending on the severity of the disease and the effect.
A single dose for different patients when prescribed as a diuretic can range from 0.025 g (25 mg) to 0.2 g (200 mg).
In mild cases, prescribed to 0.025-0.05 g (1-2 tablets) per day, in more severe cases, 0.1 g per day. Take once (in the morning) or in 2 doses (in the first half of the day). Sometimes prescribed to 0.2 g per day. Increasing the dose of more than 0.2 g is impractical, since a further increase in diuresis usually does not occur. Elderly patients with cerebral forms of hypertension are prescribed the drug in smaller doses (0.0125 g 1-2 times a day) (N. B. Mankovsky and others).
The drug can be prescribed for 3-5-7 days in a row, then take a break for 3-4 days and again continue taking the drug; in milder cases, take breaks after every 1-2 days of admission. The duration of the course and the total duration of treatment depend on the nature and severity of the disease, the resulting effect, tolerance. Treatment, especially in the early days, should be made under the supervision of a physician.
When hypertension is prescribed by 0.025-0.05 g (1-2 tablets) per day, usually together with antihypertensive drugs.
Patients with glaucoma appoint 0,025 g per day.
Dichlothiazide is usually well tolerated, but with long-term use hypokalemia (usually moderate) and hypochloraemic alkalosis can develop. Hypokalemia often develops in patients with cirrhosis of the liver and nephrosis. Hypochloremic alkalosis is more often observed with a salt-free diet or with loss of chlorides due to vomiting or diarrhea. Dichlothiazide treatment is recommended against the backdrop of a diet rich in potassium salts. When symptoms of hypokalemia occur, potassium salts should be prescribed (a solution of potassium chloride at the rate of 2 g of the drug per day). Potassium salts are also recommended to be prescribed to patients receiving concurrently digitalis and corticosteroids along with dichlothiazide. In hypochloremic alkalosis, sodium chloride is prescribed.
With the use of dichlothiazide, exacerbation of latent gout and diabetes mellitus can be observed.
When using large doses of dichlothiazide, weakness, nausea, vomiting, diarrhea are sometimes possible; these phenomena take place with a decrease in dose or a short break in taking the drug. In rare cases, dermatitis is possible.
When combined with ganglioblokiruyuschimi drugs should take into account the possibility of increasing postural hypotension.
Dichlothiazide should not be administered to patients with severe renal insufficiency. In less severe cases, it is necessary to monitor the balance of electrolytes and non-protein nitrogen content.
Product form: tablets of 0.025 g (25 mg).
Storage: List B. In a dry place.
In 1 tablet hydrochlorothiazide 25 mg or 100 mg.
Release form
Tablets 100 mg and 25 mg.
pharmachologic effect
Diuretic.
Pharmacodynamics and pharmacokinetics
Pharmacodynamics
Dichlothiazide is a means of affecting water-salt metabolism. It is a thiazide diuretic, having an average potency. Reduces the reabsorption of sodium in the cortical loops of henle and does not affect the area of \u200b\u200bthe loop of the medulla. This is what determines the less pronounced effect compared to furosemide . Enhances the excretion of potassium, magnesium, phosphates and bicarbonates. Detains calcium in the body and uric acid .
The diuretic effect is observed after 1-2 hours, the action maximum after 4 hours, in general, the effect lasts up to 12 hours. Lowers arterial pressure , reducing bcc, expanding arterioles and reducing pressor effect epinephrine . Hypotensive effect is observed after 4 days, and the optimal effect after 3-4 weeks.
Pharmacokinetics
Not metabolized in the body and quickly excreted by the kidneys. The elimination half-life fluctuates in an interval of 6-14 hours.
Indications for use
Dichlothiazide is used for:
Contraindications
- hypersensitivity;
- gout ;
- decompensated diabetes ;
- anuria ;
- renal failure;
- addison disease ;
- heavy hypokalemia ;
- lactation;
- age up to 3 years;
- lactose intolerance;
- I term of pregnancy .
Be wary appointed with progressive liver disease, hypercalcemia , hypokalemia , while taking cardiac glycosides, liver cirrhosis in old age.
Side effects
Dichlothiazide may cause:
- nausea;
- allergic reactions ;
- vomiting;
- weakness;
- dry mouth;
- diarrhea ;
- dizziness ;
- cramps gastrocnemius muscles;
- heartbeat ;
- hypokalemia and Magnesium;
- aggravation gout ;
- thrombosis ;
- interstitial nephritis ;
- orthostatic hypotension .
Dichlothiazide, instructions for use (method and dosage)
Dichlothiazide tablets are taken in order to reduce pressure 25-50 mg per day, along with aCE inhibitors , beta-blockers or vasodilators. Increasing the dose to 100 mg increases diuresis . An increase of more than 200 mg per day is not advisable - there is no increase in diuresis.
When edematous syndrome prescribed from 25 mg to 100 mg (depending on the effect and severity of edema) once in the morning. Elderly patients prescribe 12.5 mg per day. After 3-4 days of treatment, take a break for a week. As maintenance therapy prescribed 2 times a week. With such intermittent treatment, side effects are less developed. To reduce intraocular pressure - 25 mg once a week.
With diabetes mellitus The treatment begins with 25 mg per day, then the dose is increased to 100 mg, and having reached the effect, it is reduced again.
For the prevention of stone formation take 50 mg twice a day.
Overdose
Overdose manifests itself hypokalemia (constipation, weakness, arrhythmias ), decrease in blood pressure, sleepiness .
Treatment consists in the restoration of electrolyte disorders - the appointment of potassium-saving diuretics and potassium preparations.
Interaction
Indirect anticoagulants and nonsteroidal anti-inflammatory drugs enhance the diuretic effect.
Kolesteramin reduces the absorption of the drug.
Hypotensive effect is enhanced when taking vasodilators, barbiturates, beta-blockers, antidepressants .
Weakens the effect of peripheral muscle relaxants, hypoglycemic and anti-arthritic drugs. Enhances the neurotoxicity of salicylates, side effects of cardiac glycosides, lithium preparations.
Development hemolysis celebrated at reception methyldopes .
Reduces the effect of oral contraceptives.
Terms of sale
Over the counter.
Storage conditions
Temperature up to 25 ° C.
Shelf life
Analogs
Matches for ATC code 4th level:
Verte Hydrochlorothiazide , Hypothiazide , Hydrochlorothiazide .
Dichlothiazide is a diuretic agent containing active ingredient hydrochlorothiazide. It is used for the treatment of edema and essential hypertension.
Dichlothiazide
Attention! In the ATH pharmacology reference book, the drug is indicated in Latin letters and numbers C03AB03. The international non-proprietary name Dichlothiazide is hydrochlorothiazide.
Dichlothiazide acts in the same way as other dehydrating substances of the thiazide type. The active chemical compound blocks the sodium and chloride transport system in the kidney cells. As a result, sodium chloride (NaCl) and its associated water are eliminated faster from the body. Dichlothiaisd is similar in some situations to loop diuretics. It promotes the excretion of potassium in the urine and is effective even with impaired renal function.
Pharmacodynamics of the drug Indications for use
Hydrochlorothiazide increases the excretion of fluid and electrolytes (sodium, chloride, potassium, and calcium through the kidneys). It is used to remove water from the tissues (edema). Edema can have various causes: heart disease, liver or kidney disease.
Increased excretion of fluid lowers blood pressure, making dichotiazide an effective antihypertensive drug in the treatment of essential hypertension.
Dichlothiazide: instructions for use
Dichlothiazide tablets are available with 12.5 mg and 25 mg of the active substance. To achieve the desired dosage, you can take several tablets with a lower dose. Conversely, tablets in high dosage are divided in half.
In the treatment of high blood pressure, 12.5 to 25 mg of the active ingredient is initially administered once a day.
In the treatment of edema, 25 to 50 mg of Dichlothiazide is used once a day. For long-term therapy, it is recommended to use from 25 to 50 and a maximum of 100 mg per day. In chronic myocardial insufficiency, together with ACE inhibitors, 25 to 37.5 mg of dichotiazide is prescribed per day. In case of liver dysfunction or renal dysfunction, the dose should be adjusted accordingly.
It is worth noting that the analogues (hypothiazide) and the original drug are available on prescription.
Important! Prescription form can only be prescribed by a doctor. The price of drugs containing HCT varies greatly.
Contraindications
Dichlothiazide cannot be used with:
- Hypersensitivity to sipamid, thiazides, or sulfonamides;
- Severe liver dysfunction;
- Low potassium concentration in the bloodstream;
- High blood calcium levels;
- Concomitant therapy with spironolactone;
- Gout;
- Excessively reduced sodium levels;
- Dehydration and anemia.
With an increase in the level of uric acid in the blood, low blood pressure, circulatory disorders of the coronary and cerebral vessels, diabetes, the use of the drug by a doctor is considered only with caution and with the inefficiency of safer analogues.
Pregnancy, lactation and use in children
During pregnancy and lactation Dichlothiazide should not be taken. This can cause side effects that will harm the baby.
Children should not be treated with Dichlothiazide.
Side effects
Very common adverse reactions:
- Potassium deficiency in the blood;
- Gastric disorders;
- ECG changes;
- Increased sensitivity to cardiac glycosides;
- Cardiac arrhythmia;
- Atony.
Common side effects:
- Apathy;
- Lethargy;
- Anxiety;
- Excitation;
- Headache;
- Dizziness;
- Hyposalivation;
- Fatigue;
- Hyperhidrosis;
- Orthostatic hypotension;
- Palpitations;
- Occlusion of blood vessels (with venous disease and high doses);
- Stomach ache;
- Diarrhea;
- Constipation;
- Muscle spasms;
- Fluid imbalance;
- Disorders of the metabolism of minerals in the body.
Rare side effects:
- Allergic reactions;
- Increased concentration of fat in the blood;
- The occurrence of diabetes;
- Increased blood sugar (hyperglycemia);
- Blurred vision;
- Bleeding in the pancreas (due to inflammation);
- Stones in the gallbladder;
- Allergic skin reactions (itching, redness, urticaria, chronic sensitivity to light);
- Magnesium deficiency in the blood (with convulsions or cardiac arrhythmias).
Increased excretion of minerals and water due to treatment can generally cause or worsen the body's acid deficiency (metabolic alkalosis). The concentration of uric acid in the blood may increase and lead to gout. Severe dehydration can cause the body to dry out.
At the same time, absorption may decrease or potassium loss may increase, for example, with vomiting, chronic diarrhea, or severe extremity hyperhidrosis. This can manifest itself as muscle weakness, nerve abnormalities, and paralysis. Severe potassium loss can cause intestinal paralysis or coma.
Hydrochlorothiazide Increased excretion of sodium in the urine can lead to hyponatremia, especially if sodium chloride is not consumed with food in the required amount. Common symptoms include apathy, angina pectoris, loss of appetite, weakness, drowsiness, vomiting, and confusion of consciousness.
Increased calcium excretion can lead to hypocalcemia. It rarely causes severe cramps.
Dichotyazide treatment should be discontinued by a doctor immediately if the following side effects occur: increased myopia, pancreatitis, low blood pressure when changing body position, gall bladder infection, anemia, uncontrolled mineral imbalances, severe upset stomach, dysfunction of the brain, vascular inflammation and anaphylaxis.
Interactions
Dichlothiazide increases the major and side effects of digoxin and other cardiac glycosides, which can increase cardiac output due to increased excretion of potassium.
The toxic effect of lithium is increased when combined with Dichlothiazide.
The effect of antidiabetic substances, that is, drugs for lowering blood sugar levels, decreases with simultaneous administration with Dichlothiazide.
Combination with diazoxide, a drug for lowering blood pressure, can lead to an excessive decrease in blood pressure and an increase in blood sugar and uric acid levels. The risk of serious hypotension exists with the simultaneous use of ACE inhibitors, which are also prescribed for the treatment of high blood pressure.
In combination with nonsteroidal anti-inflammatory drugs (NSAIDs), such as acetylsalicylic acid, the therapeutic effect of Dichlothiazide is reduced.
Combined use with licorice root, which is often found in mucolytic mixtures, can lead to life-threatening hypokalemia. This also applies to the simultaneous use of Dichlothiazide with laxatives or glucocorticoids.
If calcium supplements or vitamin D derivatives are taken at the same time, there may be a sharp increase in blood calcium levels.
Precautionary measures
If Dichlothiazide is taken for a long period of time, blood sugar, lipid, uric acid, creatinine and electrolytes (especially potassium) concentrations must be monitored.
Care must be taken during treatment with Dichlothiazide and constantly drink the right amount of fluid. In the opposite case, life-threatening dehydration may occur.
Potassium The drug can influence the psychomotor reaction to the extent that driving can be dangerous.
Tip! Dichlothiazide can cause allergic reactions of varying severity. Therefore, if any warning signs of allergy appear, you should immediately contact your doctor or call an ambulance.
Still:
The mechanism of action of the Co-Renitek, composition, precautions for use, instructions for use, analogues, prices and reviews
Hydrochlorothiazide (hydrochlorothiazide)
The composition and release form of the drug
Pills white or almost white with a yellowish shade of color, round, flat-cylindrical, without risks, with a chamfer; light marbling is allowed.
Excipients: lactose monohydrate - 70 mg, microcrystalline cellulose - 20 mg, potato starch - 13.7 mg, magnesium stearate - 1.3 mg.
7 pieces - Contour cell packages (2) - cardboard packs.
7 pieces - Contour cell packages (3) - cardboard packs.
7 pieces - Contour cell packages (4) - cardboard packs.
10 pieces. - Contour cell packages (1) - cardboard packs.
10 pieces. - Contour cell packages (2) - cardboard packs.
10 pieces. - Contour cell packages (3) - cardboard packs.
10 pieces. - Contour cell packages (4) - cardboard packs.
10 pieces. - Contoured cell packs (5) - cardboard packs.
pharmachologic effect
Thiazide diuretic. Violates the reabsorption of sodium, chlorine and water ions in the distal nephron tubules. Increases the excretion of potassium, magnesium, bicarbonate ions; retains calcium ions in the body. The diuretic effect occurs after 2 hours, reaches a maximum after 4 hours and lasts up to 12 hours. Helps reduce high blood pressure. In addition, it reduces polyuria in patients with diabetes insipidus (the mechanism of action is not fully understood). In some cases, lowers intraocular pressure in glaucoma.
Pharmacokinetics
After ingestion, 60-80% of the dose is absorbed from the gastrointestinal tract. The time to reach C max in 1.5-3 hours. Hydrochlorothiazide accumulates in the erythrocytes. In the elimination phase, its concentration in erythrocytes is 3–9 times greater than in plasma. Binding to plasma proteins - 40-70%. V d in the terminal phase of elimination is 3-6 l / kg (which is equivalent to 210-420 l with a body weight of 70 kg).
Hydrochlorothiazide is metabolized to a very small extent. Its only metabolite found in trace amounts is 2-amino-4-chloro-M-benzene disulfonamide.
Removal of hydrochlorothiazide from plasma has a two-phase character: T 1/2 in the initial phase is 2 hours, in the terminal phase - about 10 hours. In patients with normal renal function, the excretion is almost exclusively by the kidneys. In general, 50-75% of the ingested dose is excreted in the urine unchanged.
In elderly patients and in renal dysfunction, the clearance of hydrochlorothiazide is significantly reduced, which leads to a significant increase in its concentration in the blood plasma. Decrease in clearance, noted in elderly patients, apparently, is associated with deterioration of renal function. In patients with liver cirrhosis, no change in the pharmacokinetics of hydrochlorothiazide is observed.
Indications
Arterial hypertension, edematous syndrome of various genesis (chronic insufficiency, nephrotic syndrome, renal failure, fluid retention for obesity), diabetes insipidus, glaucoma (subcompensated forms).
Contraindications
Severe renal dysfunction, liver failure, severe forms of gout and diabetes, hypersensitivity to sulfonamides.
Dosage
Install individually. Single dose - 25-50 mg daily dose - 25-100 mg. The frequency of treatment depends on the indications and the patient's response to treatment.
Side effects
From the digestive system: nausea, vomiting, diarrhea; rarely - pancreatitis.
Since the cardiovascular system: orthostatic hypotension, tachycardia.
Metabolism: hypokalemia, hypomagnesemia, hyponatremia, hypochloraemic alkalosis, hyperuricemia, hypercalcemia.
On the part of the endocrine system: hyperglycemia.
From the hemopoietic system: rarely - neutropenia, thrombocytopenia.
On the part of the organ of vision: rarely - visual impairment.
From the side of the central nervous system and peripheral nervous system: weakness, fatigue, dizziness, paresthesias.
Allergic reactions: rarely - allergic dermatitis.
Drug interactions
With the simultaneous use of antihypertensive agents, non-depolarizing their action is enhanced.
With the simultaneous use of barbiturates, diazepam, ethanol increases the risk of orthostatic hypotension.
With simultaneous use with GCS, there is a risk of hypokalemia and also orthostatic hypotension.
With simultaneous use with ACE inhibitors (including captopril, enalapril), the antihypertensive effect is enhanced.
Possible pronounced arterial hypotension, especially after taking the first dose of hydrochlorothiazide, apparently due to hypovolemia, which leads to a transient increase in the hypotensive effect of the ACE inhibitor.
Increased risk of renal dysfunction. The development of hypokalemia is not excluded.
With simultaneous use of oral hypoglycemic drugs reduces their effectiveness.
With the simultaneous use of calcium and / or D in high doses, hypercalcemia and the risk of metabolic acidosis are possible due to the slowing down of calcium in the urine under the influence of thiazide diuretics.
With simultaneous use with an increased risk of allergic reactions, especially in patients with impaired renal function.
With simultaneous use with digoxin may increase the risk of glycosidic intoxication.
With simultaneous use with indomethacin, piroxicam, phenylbutazone, some decrease in the hypotensive effect is possible.
With simultaneous use with irbesartan, an additive hypotensive effect may develop.
With simultaneous use with carbamazepine, there are reports of the development of hyponatremia.
With simultaneous use with colestipol, colestiramine decreases the absorption and diuretic effect of hydrochlorothiazide.
With simultaneous use of lithium carbonate, it is possible to increase the concentration of lithium salts in the blood to a toxic level.
With simultaneous use with orlistat decreases the effectiveness of hydrochlorothiazide, which can lead to a significant increase in blood pressure and the development of hypertensive crisis.
With simultaneous use with sotalol possible hypokalemia and the development of ventricular arrhythmias of the "pirouette" type.
special instructions
It is used with caution in patients with gout and diabetes.
In patients with renal failure, systematic monitoring of plasma electrolyte concentration and CC is necessary.
With the appearance of signs of potassium deficiency, as well as with the simultaneous use of cardiac glycosides, GCS and ACTH, administration of potassium or potassium-saving diuretics is indicated.
With prolonged use should follow a diet rich in potassium.
Pregnancy and lactation
Adequate and well-controlled clinical studies of the safety of hydrochlorothiazide during pregnancy have not been conducted.
AT experimental studies there were no signs of adverse effects on the fetus. Given this, use during pregnancy is possible only for health reasons and only in the case when the intended benefits to the mother outweigh the potential risk to the fetus.
Hydrochlorothiazide passes into breast milk. It is recommended to avoid the use of hydrochlorothiazide in the first month of breastfeeding, since there are reports of suppression of lactation.
For violations of the kidneys
Contraindicated in severe renal impairment. In patients with renal failure, systematic monitoring of plasma electrolyte concentration and CC is necessary.
With abnormal liver function
Contraindicated in liver failure.
Hypertension is dangerous because it does not always make itself felt with pronounced symptoms. A person may not be serious about changes in his condition, although an increased pressure on the vascular walls is fraught with heart attacks and strokes. Therefore, at the first signs of illness, it is important to visit a doctor.
At the initial stage of hypertension, hydrochlorothiazide is often prescribed. This is a thiazide diuretic of medium duration, which, in addition to the diuretic, also has a hypotensive effect. It is used as a first-line drug with a small level of pressure increase, when the possibilities to normalize it without using medications are exhausted. The average price of hydrochlorothiazide is 70-80 rubles.
Release form and composition
Available in tablets - 20 pieces per pack. The active substance is hydrochlorothiazide (25 or 100 mg per tablet).
Medicinal properties
The diuretic effect manifests itself after 2 hours, reaches its peak after 4 hours and lasts 12 hours. The drug contributes to lowering the increased pressure. It also reduces polyuria (excessive urine formation) for diabetes insipidus. May reduce intraocular pressure in patients with glaucoma. 
Indications
Doses and methods of use
The instructions for use of Hydrochlorothiazide, said that the pill drink before meals. Dosages are selected by the doctor, based on the specific case.
Adults
Hypertension: 25-50 mg per day, one-time (as part of monotherapy or with other drugs that lower blood pressure). Sometimes 12.5 mg is enough. It is necessary to use the minimum effective dose selected by the doctor, but it should not be more than 100 mg per day.
It may be necessary to reduce the doses of other antihypertensive drugs to prevent excessive pressure drop. Hypotensive action occurs in 3-4 days, and the optimal effect is to wait 3-4 weeks. After the cancellation of the funds, the achieved effect lasts for 1 week.
Edema: 25-100 mg 1 time per day or every other day, then a reduction to 25-50 mg is acceptable. In severe cases, 200 mg per day is sometimes required.
PMS: 25 mg per day. Tablets drink before the onset of menstruation.
Diabetes insipidus: 50-150 mg per day, divided into several doses.
The dosage is determined based on the weight of the child. This is usually a single dose of 1-2 mg per 1 kg or 30-60 mg per 1 square meter. m. body surface per day. The dose for children younger than 2 years per day is 12.5-37.5 mg, for children 2-12 years old - up to 100 mg. 
Side effects
Gastrointestinal tract: pancreatitis, cholestatic jaundice, cholecystitis, weight loss, constipation or diarrhea.
Cardiovascular system and blood: arrhythmias, vasculitis, hypotension, extremely rare - anemia, leukopenia.
Electrolyte imbalance: changes in sodium, magnesium, calcium and potassium levels, accompanied by convulsions, lethargy, cramps and muscle pain, slow thinking, lethargy, anxiety, thirst, arrhythmia, mood swings, confusion, nausea, vomiting; possible hypochloremic alkalosis followed by hepatic coma / encephalopathy. 
Hypersensitivity reactions: purpura, photosensitivity, urticaria, anaphylactic shock.
Central nervous system and sensory organs: blurred vision (normal after drug withdrawal), paresthesia, headaches and dizziness.
It is also possible malfunction of the kidneys and a decrease in potency.
.Contraindications
During lactation and in the first trimester of pregnancy, the drug is not prescribed, in 2 and 3 it is used with caution.
Interaction with other drugs
The diuretic effect of hydrochlorothiazide is enhanced when it is taken with drugs that bind proteins intensively. These are nonsteroidal anti-inflammatory, Clofibrate, indirect anticoagulants.
Hypotensive effect is enhanced when combined with beta-blockers, barbiturates, tricyclic antidepressants, phenothiazines, ethyl alcohol. 
Under the action of the drug, neurotoxicity of salicylates is enhanced, quinidine excretion and the effectiveness of birth control pills are reduced. It also weakens the effect of oral hypoglycemia agents, Epinephrine and gout medications.
In combination with hydrochlorothiazide, it is possible to enhance the side effects of cardiac glycosides, the neuro and cardiotoxic effects of Li + drugs and peripheral muscle relaxants.
Combination with methyldopa is fraught with hemolysis.
special instructions
The first time you can not drive a car and do work that requires high concentration of attention.
With prolonged use of hydrochlorothiazide, it is necessary to monitor violations of water and electrolyte balance, especially with a predisposition.
Risk factors are malfunctions of the liver, heart disease and blood vessels, the appearance of thirst, dry mouth, severe vomiting, drowsiness, anxiety, fatigue, lethargy, hypotension, muscle cramps, pain and weakness, tachycardia, oliguria, problems with the gastrointestinal tract. 
To avoid hypokalemia, along with Hydrochlorothiazide, you need to take potassium preparations or eat vegetables with fruits that are rich in this element. This is especially important with long treatment and simultaneous use of digitalis or corticosteroids.
Taking Hydrochlorothiazide may cause impaired glucose tolerance. With long-term treatment of latent or manifest diabetes, it is important to regularly check the carbohydrate metabolism.
When taking thiazides, the excretion of magnesium in the urine increases, which is fraught with hypomagnesemia. With a decrease in kidney function, creatinine clearance should be observed. The drug can provoke azotemia. If oliguria occurs, it is recommended to stop treatment.
Analogs
If hydrochlorothiazide is not suitable, you can pick up similar drugs with the same active ingredient:
There are also a number of combination drugs. The combination + hydrochlorothiazide is included in the composition of Bloktran GT, Gizortana, Losapa plus, Losartana-N Richter.
Valsartan and hydrochlorothiazide are active ingredients of Valsakor, Vanatex Combi, Co-Diovan, Duopress.
In combination with dihydralazine hydrochlorothiaz is included in Adelfan-Ezidreksa.
The combination of hydrochlorothiazide + is present in Burlipril plus, Prilenapa, Ename N, Co-renitke, Reniprile GT, Enalaprile N, Enafarm-N.
Active substances and hydrochlorothiazide are included in the composition of Coaprovel and Ibertan Plus. 
Storage
Dark, dry, inaccessible to children place with a temperature of not more than +25 degrees.
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Develop memory in adult games
The project of landscaping the site group
Modern comfortable housing: the principles of formation
File mdf than open on windows 7