Hypothiazide: instructions for use

In this article, you can read the instructions for using the drug Hypothiazide. Provides feedback from visitors to the site - the consumers of this medicine, as well as the opinions of medical specialists on the use of Hypothiazide in their practice. A big request is to actively add your reviews about the diuretic: the medicine helped or did not help get rid of the disease, what complications and side effects were observed, possibly not announced by the manufacturer in the annotation. Hypothiazide analogues in the presence of available structural analogues. Use for the treatment of arterial hypertension and edematous syndrome in adults, children, as well as during pregnancy and lactation.

Hypothiazide - diuretic (diuretic). The primary mechanism of action of thiazide diuretics is to increase diuresis by inhibiting the reabsorption of sodium and chlorine ions in the initial part of the renal tubules. This leads to increased excretion of sodium and chlorine and, therefore, water. The excretion of other electrolytes, namely potassium and magnesium, also increases. At maximum therapeutic doses, the diuretic / natriuretic effect of all thiazides is approximately the same.

Natriuresis and diuresis occur within 2 hours and reach a maximum level after about 4 hours.

Thiazides also reduce the activity of carbonic anhydrase by increasing the excretion of bicarbonate ions, but this effect is usually weak and does not affect the pH of the urine.

Hydrochlorothiazide (the active substance of the drug Hypothiazide) also has antihypertensive properties. Thiazide diuretics do not affect normal blood pressure.

Composition

Hydrochlorothiazide + excipients.

Pharmacokinetics

Hypothiazide is incomplete, but is absorbed quite quickly from the digestive tract. This effect persists for 6-12 hours. Hydrochlorothiazide crosses the placental barrier and is excreted in breast milk. The primary route of excretion is by the kidneys (filtration and secretion) in an unchanged form.

Indications

  • arterial hypertension (both for monotherapy and in combination with other antihypertensive drugs),
  • edema syndrome of various origins (chronic heart failure, nephrotic syndrome, premenstrual tension syndrome, acute glomerulonephritis, chronic renal failure, portal hypertension, treatment with corticosteroids),
  • control of polyuria, mainly with nephrogenic diabetes insipidus,
  • prevention of stone formation in the urinary tract in susceptible patients (decreased hypercalciuria).

Release Forms

Tablets 25 mg and 100 mg.

Instructions for use and dosage

The dose should be selected individually. With constant medical supervision, the minimum effective dose is established. The drug should be taken orally after a meal.

With arterial hypertension, the initial dose is 25-50 mg per day once, in the form of monotherapy or in combination with other antihypertensive agents. For some patients, an initial dose of 12.5 mg is sufficient (both as monotherapy and in combination). It is necessary to apply the minimum effective dose, not exceeding 100 mg per day. When combining hypothiazide with other antihypertensive drugs, it may be necessary to reduce the dose of another drug to prevent an excessive decrease in blood pressure.

The antihypertensive effect is manifested within 3-4 days, but it may take 3-4 weeks to achieve the optimal effect. After the end of therapy, the hypotensive effect persists for 1 week.

With edematous syndrome of various origins, the initial dose is 25-100 mg per day once or 1 time in 2 days. Depending on the clinical response, the dose may be reduced to 25-50 mg per day once or once every 2 days. In some severe cases, at the beginning of treatment, an increase in the dose of the drug to 200 mg per day may be required.

With premenstrual tension syndrome, the drug is prescribed at a dose of 25 mg per day and is used from the onset of symptoms to the onset of menstruation.

With nephrogenic diabetes insipidus, the usual daily dose of 50-150 mg is recommended (in several doses).

Due to the increased loss of potassium and magnesium ions during treatment (serum potassium levels may be

Pharmachologic effect

The diuretic effect of hydrochlorothiazide is primarily responsible for the direct blockade of the reabsorption of Na + and SG in the distal tubules. Under its influence, the excretion of Na + and SG is enhanced and, due to this, the excretion of water, as well as potassium and magnesium. The diuretic effect of hydrochlorothiazide reduces the volume of circulating plasma, increases the activity of plasma renin, enhances the excretion of aldosterone, as a result of which the excretion of potassium and bicarbonate in the urine increases and the concentration of potassium in the serum decreases. Angiotensin-P regulates the renin-aldosterone bond, therefore, the combined use of the angiotensin-P receptor antagonist can reverse the potassium excretion process associated with a thiazide diuretic.

The drug also has a weak blocking effect on carbonic anhydrase, to a moderate degree, thereby enhancing the secretion of bicarbonate, while there is no significant change in urine pH.

Pharmacokinetics

Hydrochlorothiazide is well absorbed after oral administration, its diuretic and natriuretic effects occur within 2 hours after administration and reach their maximum after about 4 hours. This action lasts for 6-12

Excreted through the kidneys in unchanged form. The half-life for patients with normal renal function is 6.4 hours, for patients with moderate renal failure - 11.5 hours, and for severe renal failure with creatinine clearance less than 30 ml / min. - 20.7 hours. Hydrochlorothiazide crosses the placental barrier and is excreted in breast milk in small quantities.

Indications for use

• Hypertension (in mild forms - both in the form of monotherapy, and in combination with other antihypertensive drugs).

• Edema of cardiac, hepatic or renal etiology, premenstrual edema, edema accompanying pharmacotherapy, such as corticosteroid.

• With nephrogenic diabetes insipidus to reduce polyuria (paradoxical effect)

• To reduce hypercalciuria.

Contraindications

• Hypersensitivity to the drug or to other sulfonamides

• Severe renal (creatinine clearance below 30 ml / min) or liver failure

• Resistant to therapy hypokalemia or hypercalcemia

• Symptomatic hyperuricemia (gout)

The drug is not indicated for use in children under 6 years of age.

Pregnancy and lactation

The experience with hydrochlorothiazide during pregnancy, especially in the first trimester, is limited. The data obtained in animal tests are insufficient. Hydrochlorothiazide crosses the placental barrier. If hydrochlorothiazide is used in the second and third trimester, it (due to its pharmacological action) can disrupt fetoplacental perfusion and cause fetal or newborn jaundice, electrolyte imbalance and thrombocytopenia.

Hydrochlorothiazide should not be used during pregnancy to treat edema, hypertension or preeclampsia, because instead of having a beneficial effect on the disease, it increases the threat of a decrease in plasma volume and the threat of impaired blood supply to the uterus and placenta.

Hydrochlorothiazide cannot be used to treat essential hypertension in pregnant women, except in rare cases when other therapy cannot be used.

Hydrochlorothiazide tablets should not be used during pregnancy - they can be used only in well-founded cases.

Hydrochlorothiazide passes into breast milk; its use is contraindicated during breastfeeding. If its use is inevitable, breastfeeding should be stopped.

Dosage and administration

The dosage should be selected individually and requires constant medical supervision. Due to the increased loss of potassium and magnesium during treatment (serum potassium level may drop below 3.0 mmol / l), there is a need for potassium and magnesium replacement. Particular care should be taken in patients with heart failure, patients with impaired liver function, or in patients undergoing digitalis glycoside treatment. Tablets should be taken after meals.

As an antihypertensive agent, the usual initial daily dose is 25-100 mg in one dose, in the form of monotherapy or in combination with other antihypertensive drugs. For some patients, an initial dose of 12.5 mg is sufficient, both in the form of monotherapy and in combination. It is necessary to apply a minimum effective dose not exceeding 100 mg per day. If hypothiazide is combined with other antihypertensive drugs, it may be necessary to reduce the doses of individual drugs in order to prevent an excessive drop in blood pressure.

The antihypertensive effect is manifested within 3-4 days, however, to achieve the optimal effect, it may take up to 3-4 weeks. After treatment, the hypotensive effect persists for up to a week.

In the treatment of edema the usual starting dose is 25-100 mg of the drug once a day or once every two days. Depending on the clinical response, the dose should be reduced to 25-50 mg once a day or once every two days. In some severe cases, initial doses of up to 200 mg per day may be required.

In premenstrual edema, the usual dose is 25 mg per day and is used from the onset of symptoms to the onset of menstruation.

With nephrogenic diabetes insipidus The usual daily dose of 50-150 mg (in several doses) is recommended.

Doses should be established based on the weight of the child. The usual pediatric daily doses, 1-2 mg / kg of body weight or 30-60 mg per square meter of body surface, are prescribed once a day. The total daily dose for children aged 6 to 12 years is 37.5-100 mg per day.

Overdose

Call your doctor or emergency room immediately if you overdose!

The most noticeable manifestation of hydrochlorothiazide poisoning is acute loss of fluid and electrolytes, expressed in the following signs and symptoms:

Cardiovascular: Tachycardia, hypotension, shock

Neuromuscular: weakness, confusion, dizziness and muscle cramps, paresthesia, impaired consciousness, fatigue.

Gastrointestinal: nausea, vomiting, thirst,

Renal: polyuria, oliguria or anuria.

Laboratory indicators - hypokalemia, hyponatremia, hypochloremia, alkalosis, elevated levels of nitrogen in the blood (especially in patients with renal failure).

Overdose treatment: Specific antidote for intoxication

Induction of vomiting, gastric lavage can be ways to excrete the drug. The absorption of the drug can be reduced by using activated carbon. In case of hypotension or shock, the volume of circulating plasma and electrolytes (potassium, sodium, magnesium) should be compensated.

Water-electrolyte balance (especially serum potassium levels) and kidney function should be monitored until normal values ​​are established.

Interaction with other drugs

Be sure to inform your healthcare provider about all medicines you take, even if it happens on a case-by-case basis.

Perhaps the interaction between thiazide diuretics and the following drugs with their simultaneous use.

Alcohol, barbiturates, anesthetics and antidepressants:

May enhance orthostatic hypotension.

Antidiabetic agents (oral and insulin):

Thiazide treatment may decrease glucose tolerance. You may need to change the dose of hypoglycemic drugs. Metformin should be used with caution because of the risk of lactic acidosis due to possible functional renal failure associated with hydrochlorothiazide.

Other antihypertensive agents:

Colestyramine and colestipol resins:

In the presence of anion exchange resins, absorption of hydrochlorothiazide from the digestive tract is impaired. A single dose of colestyramine or colestipole resins binds hydrochlorothiazide and reduces its absorption in the gastric tract, respectively, by 85% and 43%.

Pressor amines (e.g. adrenaline):

It is possible that the action of pressor amines is weakened, but not to such an extent as to prevent their use.

Non-depolarizing muscle relaxants (e.g. tubocurarine):

The muscle relaxant effect may increase.

Diuretics reduce the renal clearance of lithium and significantly increase the risk of toxic effects of lithium. Their simultaneous use is not recommended. Medicines for the treatment of gout (probenicid, sulfinpyrazone and allopurinol):

A dose adjustment of uricosuric agents may be required, since hydrochlorothiazide may increase serum uric acid levels. An increase in the dose of probenicide or sulfinpyrazone may be required. The simultaneous use of thiazides can increase the frequency of hypersensitivity reactions to allopurinol.

Anticholinergics (e.g., atropine, biperiden):

Due to the decrease in the motility of the gastrointestinal tract and the degree of gastric emptying, the bioavailability of the diuretic of the thiazide type increases.

Cytotoxic agents (e.g. cyclophosphamide, methotrexate):

Thiazides can reduce the renal excretion of cytotoxic drugs and enhance their myelosuppressive effect.

In the case of high doses of salicylates, hydrochlorothiazide can enhance the toxic effect of salicylates on the central nervous system.

In some cases, hemolytic anemia was reported with the simultaneous use of hydrochlorothiazide and methyldopa.

Concomitant use with cyclosporine may increase hyperuricemia and the risk of developing complications such as gout.

Hypokalemia or hypomagnesemia caused by thiazide can contribute to the development of arrhythmias provoked by digitalis.

Medicines that are affected by changes in serum potassium:

Periodic determination of serum potassium levels and recording of an electrocardiogram are recommended if hydrochlorothiazide is used simultaneously with drugs that are affected by changes in serum potassium concentrations (for example, digital glycosides and antiarrhythmic drugs), as well as with the following pirouette-type tachycardia drugs (ventricular tachycardia) (including also some antiarrhythmic drugs), because hypokalemia is a factor contributing to the development of tachycardia such as pirouette:

• antiarrhythmic drugs of class 1a (for example, quinidine, hydroquinidine, disopyramide),

• class III antiarrhythmic drugs (eg, amiodarone, sotalol, dofetilide, ibutilide),

• some antipsychotics (for example, thioridazine, chlorpromazine, levomepromazine, trifluoperazin, cyamemazine, sulpiride, sultopride, amisulpride, tiapride, pimozide, haloperidol, droperidol),

• other medicines (for example, bepridil, cisapride, diphemanil, intravenous erythromycin, halofantrine, misolastine, pentamidine, terfenadine, intravenous vincamine).

Thiazide diuretics increase serum calcium levels due to reduced excretion. If there is a need for the appointment of agents that replenish the calcium content, it is necessary to control the level of calcium in the serum and, in accordance with it, select a dose of calcium.

The interaction between drugs and laboratory tests: Due to the effect on calcium metabolism, thiazides can distort the results of parathyroid function tests

Application features

Clinical and biological monitoring is necessary because of the danger of symptomatic hyponatremia.

Iodine-containing contrast agents:

In case of dehydration caused by diuretics, the risk of acute renal failure increases, mainly when high doses of iodine-containing drug are used. Before using iodine, it is necessary to replenish the fluid in the body of patients.

Amphotericin B (parenteral), corticosteroids, ACTH and stimulant laxatives:

Hydrochlorothiazide can contribute to electrolyte imbalance, mainly the development of hypokalemia.

Release form and composition

Dosage form: tablets are round, flat, with a dividing line on one side and the engraving "H" on the other, white or almost white (20 pcs. In blisters, in a cardboard box 1 blister and instructions for use of Hypothiazide).

The active ingredient is hydrochlorothiazide, its content in 1 tablet is 25 or 100 mg.

Auxiliary components: gelatin, magnesium stearate, corn starch, talc, lactose monohydrate.

Pharmacodynamics

The active component of Hypothiazide is the thiazide diuretic hydrochlorothiazide, the primary mechanism of action of which is to increase diuresis by inhibiting the reabsorption of sodium and chlorine ions in the initial part of the renal tubules. As a result, the excretion of sodium, chlorine, and, accordingly, water is increased. In addition, the excretion of other electrolytes - potassium and magnesium - is growing. The diuretic / natriuretic effect of all thiazides when taken at maximum therapeutic doses is approximately the same.

Natriuretic action and diuretic effect occur in 2 hours, reach a maximum level after about 4 hours.

Thiazide diuretics, in addition, by increasing the excretion of bicarbonate ions reduce the activity of carbonic anhydrase, but usually this effect is weakly expressed and does not affect urine pH.

Hydrochlorothiazide has antihypertensive properties. Thiazide diuretics do not affect normal blood pressure (BP).

Hypothiazide, instructions for use: method and dosage

Hypothiazide tablets are taken orally after a meal.

The dose is selected individually during treatment. Assessing the clinical condition of the patient, the doctor prescribes the minimum effective dose of hypothiazide.

Initial dosing for adults:

  • Edematous syndrome of various etiologies: 25-100 mg 1 time per day or 1 time in 2 days, in severe cases - 200 mg per day. Given the clinical reactions, it is possible to reduce the dose to 25-50 mg per day once or once every 2 days,
  • Syndrome of premenstrual tension: 25 mg once a day, administration starts from the moment the first symptoms appear before the onset of menstruation,
  • Arterial hypertension (combined and monotherapy): 25-50 mg once a day, for some patients 12.5 mg is enough. The minimum effective dose should not exceed 100 mg per day. The therapeutic effect is manifested within 3-4 days, for optimal stabilization of blood pressure (BP) it may take 3-4 weeks. After withdrawal of hypothiazide, the hypotensive effect lasts for 1 week. To prevent a strong decrease in blood pressure during combination therapy, a dose reduction of other antihypertensive agents may be required,
  • Nephrogenic diabetes insipidus: 50-150 mg per day in several doses.

Hypothiazide dosage for children is calculated taking into account the weight of the child. The pediatric daily dose is usually 1-2 mg per 1 kg of the child’s weight or 30-60 mg per 1 square meter. body surface 1 time per day, for children from 3 to 12 years old - 37.5-100 mg per day.

Side effects

The use of hypothiazide can cause the following side effects:

  • Digestive system: anorexia, diarrhea or constipation, cholecystitis, cholestatic jaundice, pancreatitis, sialadenitis,
  • Metabolism: lethargy, confusion, slowing of the thinking process, convulsions, irritability, fatigue, muscle cramps on the background of hypercalcemia, hypomagnesemia, hypokalemia, hyponatremia. Irregular heart rhythm, dry mouth, thirst, unusual tiredness or weakness, changes in the psyche or mood, cramps and muscle pain, nausea, vomiting due to hypochloremic alkalosis (in addition, hypochloremic alkalosis can cause hepatic encephalopathy or coma). Glycosuria, hyperuricemia with the development of an attack of gout. Hyperglycemia, which can provoke the development of previously latent diabetes mellitus. High-dose treatment can increase serum lipids,
  • Cardiovascular system: arrhythmia, vasculitis, orthostatic hypotension,
  • Hematopoietic system: very rarely - thrombocytopenia, leukopenia, hemolytic anemia, agranulocytosis, aplastic anemia,
  • Nervous system: temporary blurred vision, headache, dizziness, paresthesia,
  • Urinary system: interstitial nephritis, functional impairment of the kidneys,
  • Allergic reactions: urticaria, photosensitivity, necrotic vasculitis, purpura, Stevens-Johnson syndrome, anaphylactic reactions up to shock. Respiratory distress syndrome, including pneumonitis and non-cardiogenic pulmonary edema,
  • Other: decreased potency.

Special instructions

During prolonged course treatment, it is necessary to control the clinical signs of impaired water-electrolyte balance, especially in patients with impaired liver function, diseases of the cardiovascular system.

The use of hypothiazide promotes enhanced excretion of magnesium and potassium ions, therefore, in parallel with the treatment process, measures must be taken to eliminate their deficiency.

In patients with impaired renal function, creatinine clearance should be systematically monitored; in the event of oliguria, the question of withdrawal of hypothiazide should be addressed.

In patients with impaired liver function, thiazides should be used with caution, since minor changes in the water-electrolyte balance and serum ammonia levels can cause hepatic coma.

The use of hypothiazide in patients with severe coronary and cerebral sclerosis requires special care.

Long-term treatment for latent and manifest diabetes mellitus must be accompanied by systematic monitoring of carbohydrate metabolism and dose adjustment of hypoglycemic drugs.

Constant assessment of the condition requires patients with impaired uric acid metabolism.

Long-term therapy, in rare cases, can lead to a pathological change in the parathyroid glands.

Pregnancy and lactation

Hydrochlorothiazide passes through the placental barrier, and therefore there is a risk of fetal / newborn jaundice, thrombocytopenia, and other negative reactions.

The use of hypothiazide in the first trimester of pregnancy is strictly contraindicated. In the II – III trimesters, the drug is prescribed only if necessary, when the expected benefit to the mother is higher than the potential risk to the fetus.

Hydrochlorothiazide is excreted in lactation with breast milk. If you need to use it during this period, you must stop breastfeeding.

Composition and form of release

Pills1 tab.
hydrochlorothiazide25 mg
100 mg
Excipients: magnesium stearate, talc, gelatin, corn starch, lactose monohydrate

in a blister 20 pcs., in a cardboard box 1 blister.

Indications Hypothiazide ®

arterial hypertension (used both in monotherapy and in combination with other antihypertensive drugs),

edema syndrome of various origins (chronic heart failure, nephrotic syndrome, premenstrual syndrome, acute glomerulonephritis, chronic renal failure, portal hypertension, treatment with corticosteroids),

control of polyuria, mainly with nephrogenic diabetes insipidus,

prevention of the formation of stones in the genitourinary tract in susceptible patients (reduction of hypercalciuria).

Pregnancy and lactation

Hydrochlorothiazide crosses the placental barrier. The use of the drug in the first trimester of pregnancy is contraindicated. In the II and III trimesters of pregnancy, the drug can be prescribed only in case of urgent need, when the benefit to the mother outweighs the potential risk to the fetus and / or child. There is a risk of developing jaundice of the fetus or newborn, thrombocytopenia and other consequences.

The drug passes into breast milk, therefore, if the use of the drug is absolutely necessary, breast-feeding should be discontinued.

Hypothiazide

Hypothiazide is a synthetic diuretic drug from the benzothiadiazine group. The diuretic effect of hypothiazide is due to a decrease in the absorption of chlorine, sodium ions in the renal tubules. Increased sodium excretion from the body entails the loss of water. As a result of water removal, the volume of circulating blood decreases, which leads to a decrease in blood pressure (if it was elevated, normal blood pressure does not decrease). The drug also promotes the excretion of potassium, bicarbonates and magnesium ions from the body, but to a lesser extent.

The diuretic (diuretic) effect begins 1-2 hours after taking the drug, reaches a maximum after 4 hours and lasts 6-12 hours. Long-term use of hypothiazide does not reduce its diuretic effect. Limiting the use of salt with food enhances the hypotensive effect of the drug.

Intraocular pressure also decreases with Hypothiazide. The drug can cross the placental barrier. Excreted in the urine and breast milk. With renal failure, the release of the drug is significantly slowed down.

The active substance of the drug is hydrochlorothiazide.

Hypothiazide Treatment

With obesity, there is a tendency to water retention in the body due to increased hydrophilicity of tissues. In addition, often against the background of obesity, cardiovascular failure develops, increasing fluid retention. Then there is a need to apply in the treatment of not only cardiac drugs, but also diuretics. Of the diuretics, hypothiazide is most often used, given its good diuretic effect and rarely occurring adverse reactions.

However, use of hypothiazide for weight loss should be extremely careful and only as directed by a doctor. The use of this diuretic without good reason can lead to serious consequences - the non-edematous form of obesity will become edematous for the reason that prolonged frequent use of diuretics causes a paradoxical effect: the fluid in the tissues accumulates even faster.

It is easier and better to remove excess fluid from the body using decoctions and infusions of medicinal plants (bearberry, horsetail, etc.).
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