Pharmacological action Hctz 25 mg
Hctz 25 mg Thiazide diuretic. Violates the reabsorption of sodium, chlorine and water in the distal tubules of the nephron. Increases the excretion of potassium, magnesium, bicarbonate, delays in the body, calcium ions. Diuretic effect occurs within 2 h, reaching a peak after 4 hours and lasts up to 12 hours Helps reduce high blood pressure. In addition, reduces polyuria in patients with diabetes insipidus (mechanism of action is not fully clarified). In some cases, lowers intraocular pressure in glaucoma.
Pharmacokinetics Hctz 25 mg
After oral administration 60-80% of the dose absorbed from the gastrointestinal tract. Time to achieve Cmax in plasma – 1.5-3 hours Hctz accumulates in red blood cells. In the phase of elimination, its concentration in red blood cells 3-9 times higher than in plasma. Plasma protein binding - 40-70%. Vd in the terminal phase elimination is 3-6 L / kg (equivalent to 210-420 hp with a body weight 70 kg).
Hctz is metabolized to a small degree. His only found in trace amounts metabolite is 2-amino-4-chloro-N-benzendisulfonamid.
Excretion of Hctz from plasma is biphasic: T1 / 2 in the initial phase is 2 h, in the terminal phase – about 10 hours in patients with normal renal function, excretion is carried out almost exclusively by the kidneys. In general, 50-75% of an oral dose excreted in the urine in unchanged form.
Elderly patients and renal impairment the clearance of Hctz is significantly reduced, which leads to a significant increase in its concentration in blood plasma. Reduced clearance, were observed in elderly patients appears to be associated with worsening renal function. In patients with cirrhosis of the liver changes in the pharmacokinetics of Hctz is not marked.
Statement Hctz 25 mg
Hypertension, edema syndrome of different genesis (chronic heart failure, nephrotic syndrome, renal failure, water retention in obesity), diabetes insipidus, glaucoma ( subcompensated form).
Dosing regimen Hctz 25 mg
Set individually. Single dose – 25-50 mg daily dose – 25-100 mg. Frequency of admission depends on the indications and patient response to treatment.
Side effect Hctz 25 mg
From the digestive system: nausea, vomiting, diarrhea, rarely – pancreatitis.
Cardio-vascular system: orthostatic hypotension, tachycardia.
From a metabolism: hypokalemia, hypomagnesemia, hyponatremia, gipohloremichesky alkalosis, hyperuricemia, hypercalcemia.
From the endocrine system: hyperglycemia.
From the hematopoietic system: rarely – neutropenia, thrombocytopenia.
On the part of the vision: rarely – visual impairment.
CNS and peripheral nervous system: weakness, fatigue, dizziness, paresthesias.
Allergic reactions: Rarely – allergic dermatitis.
Contraindications Hctz 25 mg
Expressed by renal dysfunction , hepatic failure, severe forms of gout and diabetes, hypersensitivity to sulfonamides.
Application of pregnancy and breastfeeding
Adequate and well controlled clinical studies on the safety of Hctz in pregnancy was conducted.
In experimental studies, no signs of adverse effects on the fetus. Given this, use during pregnancy is possible only for health reasons and only when the intended benefits to the mother outweighs the potential risk to the fetus.
Hctz passes into breast milk. It is recommended to avoid the use of Hctz in the first month of breastfeeding, as there are reports about the suppression of lactation.
Cautions Hctz 25 mg
With careful use in patients with gout and diabetes.
In patients with renal failure requires systematic monitoring of plasma concentrations of electrolytes and spacecraft.
When you see signs of potassium deficiency, and while the application of cardiac glycosides, corticosteroids and ACTH demonstrated appointment of preparations of potassium or potassium-sparing diuretics.
With prolonged use should follow a diet rich in potassium.
Not recommended for concurrent use of diuretics with NSAIDs.
Drug Interactions Hctz 25 mg
With the simultaneous application of antihypertensive agents, nondepolarizing muscle relaxants their effect is enhanced.
With the simultaneous use of barbiturates, diazepam, ethanol increases the risk of orthostatic hypotension.
In an application with corticosteroids is a risk of hypokalemia, and orthostatic hypotension.
In an application with ACE inhibitors (including captopril, enalapril) increased antihypertensive effect.
Possible severe hypotension, especially after the first dose of hydrochlorothiazide, apparently due to hypovolemia, which leads to a transient increase hypotensive effect of ACE inhibitor.
Increased risk of renal dysfunction. Does not exclude the development of hypokalemia.
With the simultaneous use of oral hypoglycemic agents reduced their effectiveness.
With the simultaneous application of calcium supplements and / or vitamin D in high doses can hypercalcemia and the risk of developing metabolic acidosis due to slow excretion of calcium in the urine under the influence of thiazide diuretics.
In an application with allopurinol increases the risk of allergic reactions, especially in patients with impaired renal function.
In an application with digoxin may increase the risk of glycoside intoxication.
In an application with indomethacin, piroxicam, naproxen, phenylbutazone may be some reduction of hypotensive effect.
In an application with irbesartan may develop an additive hypotensive effect.
In an application with carbamazepine has been reported to develop hyponatremia.
In an application with colestipol, kolestiraminom decreases absorption and diuretic effect of hydrochlorothiazide.
In an application with lithium carbonate may increase blood concentrations of lithium salts to toxic levels.
In an application with Orlistat decreases the effectiveness of hydrochlorothiazide, which may lead to a significant increase in BP and the development of hypertensive crisis.
In an application with sotalol possible hypokalemia and the development of ventricular arrhythmias such as “pirouette”.
