Pharmacological action Hctz 25 mg
Thiazide medium strength. Reduces the reabsorption of Na + at the cortical segment of the loop of Henle, no effect on her site, which takes place in the kidney medulla, which defines a weak diuretic effect in comparison with furosemide. Karboangidrazu blocks in the proximal convoluted tubule, increases urinary excretion K + (in the distal tubule Na + is exchanged for K +), hydrocarbons and phosphates. Virtually no effect on CBS (Na + output or together with Cl-, either with bicarbonate, so alkalosis increased excretion of hydrocarbons, with acidosis – chlorides). Increases the excretion of Mg2 +; delays in the body Ca2 + ions and excretion of urate. Diuretic effect develops after 1-2 h, reaching a peak after 4 hours, going 10-12 h. The action decreases with decreasing glomerular filtration rate and terminates at a value of less than 30 ml / min. In patients with diabetes insipidus has antidiuretic action (reduces urine volume and increases its concentration). Lowers blood pressure by reducing the BCC, the reactivity of the vascular wall, reducing the pressor effect of vasoconstrictor drugs (epinephrine, norepinephrine) and increased the depressor effect on ganglia.
Statement Hctz 25 mg
Hypertension; edematous syndrome of different genesis (CHF, portal hypertension, nephrotic syndrome, chronic renal failure, fluid retention in obesity), preeclampsia (nephropathy, edema, eclampsia), diabetes insipidus; subcompensated forms of glaucoma, prevention of formation of stones in the urinary tract.
Contraindications Hctz 25 mg
Hypersensitivity, gout, diabetes mellitus (severe), chronic renal insufficiency (creatinine clearance less than 20-30 ml / min, anuria), hypokalemia, hypercalcemia, hyponatremia, pregnancy (I term), the period laktatsii.C caution. II-III trimesters of pregnancy.
Side Effects Hctz 25 mg
Dry mouth, nausea, vomiting, diarrhea, weakness, fatigue, dizziness, headache, palpitations, muscle cramps calf muscles, hypokalemia, hypomagnesemia, hyponatremia, hyperuricemia, hypercalcemia, hyperglycemia, exacerbation of gout, thrombosis, thromboembolism, hypercreatininemia, acute interstitial nephritis , vasculitis, the progression of myopia, neutropenia, thrombocytopenia, hemorrhagic pancreatitis, acute cholecystitis (against cholelithiasis), orthostatic hypotension, allergic dermatit.Peredozirovka. Symptoms: hypokalemia (weakness, paralysis, constipation, arrhythmia), drowsiness, decreased blood pressure. Treatment: infusion of electrolyte solutions, compensation for deficiency K + (K + appointment of agents and potassium-sparing diuretics).
Dosing and Administration Hctz 25 mg
To reduce blood pressure: orally, 25-50 mg / day, with a slight diuresis and natriuresis observed only on the first day of admission (prescribed for a long time in conjunction with other antihypertensive drugs: vasodilators, ACE inhibitors, sympatholytic, beta-blockers). As the dose increases from 25 to 100 mg observed a proportional increase in diuresis, natriuresis and blood pressure reduction. In a single dose over 100 mg – increased diuresis and further reduction in blood pressure are insignificant, there has been disproportionately increasing loss of electrolytes, especially K + and Mg2 +. Increasing the dose above 200 mg is impractical because enhance diuresis does not occur. When edema syndrome (depending on the state and the reaction of the patient) prescribe a daily dose of 25-100 mg, taken once (morning) or in 2 divided doses (morning). The elderly – 12.5 mg 1-2 times a day. Children aged 2 months to 14 years – 1 mg / kg / day. The maximum dose for children aged 6 months – 3.5 mg / kg / day, up to 2 years – 12.5-37.5 mg / day, 3-12 years – 100 mg / day, divided into 2-3 doses. After 3-5 days of treatment is recommended to make a break for 3-5 days. As a maintenance therapy in this dose prescribed 2 times a week. When using intermittent treatment with a reception 1-3 days or for 2-3 days, followed by an interval decrease in the efficiency is weaker and less likely to develop side effects. To reduce intraocular pressure prescribed 25 mg of 1 per 1-6 days; effect occurs within 24-48 h. At diabetes insipidus – 25 mg 1-2 times a day, gradually increasing doses (daily dose – 100 mg) to achieve therapeutic effect (decrease thirst and polyuria), in the future may reduce the dose.
Cautions Hctz 25 mg
To prevent deficiency of K + and Mg2 + prescribe a diet with high content of salts, potassium-sparing diuretics, salt, K + and Mg2 +. Requires regular monitoring of plasma K +, glucose, uric acid, lipids and creatinine. During the period of treatment must be careful when driving vehicles and occupation of other potentially hazardous activities that require high concentration of attention and quickness of psychomotor reactions.
Interaction Hctz 25 mg
LS, intensively bind to proteins (indirect anticoagulants, clofibrate, NSAIDs), increase the diuretic effect. Hypotensive effect reinforce vasodilators, beta-blockers, barbiturates, phenothiazines, tricyclic antidepressants, ethanol. Strengthens the neurotoxicity of salicylates, reduces the effect of oral hypoglycemic drugs, norepinephrine, epinephrine and protivopodagricheskih drugs increases the side effects of cardiac glycosides, cardiotoxic and neurotoxic effects of drugs Li +, the action of the peripheral muscle relaxant, reduces excretion of quinidine. With the simultaneous admission of methyldopa may develop hemolysis. Kolestiramin reduces absorption. Reduces the effect of oral contraceptives.
