Nosological classification (ICD-10)
- E23.2 Diabetes insipidus
- I10 Essential (primary) hypertension
- I15 Secondary hypertension
- I15.0 Renovascular hypertension
- I50.0 Congestive heart failure
- K76.6 Portal hypertension
- N00 Acute nephritic syndrome
- N04 Nephrotic syndrome
- N18.9 Chronic renal failure, unspecified
- N25.1 Nephrogenic diabetes insipidus
- R35 Polyuria
- R60 Edema, not elsewhere classified
- R82.9 Other and unspecified abnormalities detected by urine examination
- Y42.0 Adverse reactions during therapeutic use of glucocorticoids and their synthetic analogues
Pharmacodynamics
The primary mechanism of action of thiazide diuretics is to increase diuresis by blocking the reabsorption of sodium and chloride ions at the beginning of the renal tubules. By doing this, they increase the excretion of sodium and chlorine and, therefore, water. Excretion of other electrolytes, namely potassium and magnesium, also increases.
At maximum therapeutic doses, the natriuretic/diuretic effect of all thiazides is approximately the same. Natriuresis and diuresis occur within 2 hours and reach their maximum after about 4 hours. They also reduce carbonic anhydrase activity by increasing the excretion of bicarbonate ion, but this effect is usually mild and does not affect urine pH. Hydrochlorothiazide also has antihypertensive properties. Thiazide diuretics have no effect on normal blood pressure.
pharmachologic effect
Diuretic. The principle of action of thiazide diuretics is based on increasing diuresis through suppressing the reabsorption of Na and Cl ions in the initial sections of the tubules of the renal system, which causes increased excretion of Na, Cl ions and water. of electrolytes (Mg, K, etc.) increases
Maximum therapeutic dosages of thiazide duretics provide approximately the same natriuretic/diuretic effect. Diuresis and natriuresis are recorded after 2 hours, and the maximum effect appears after 4 hours. Thiazide diuretics are able to suppress carbonic anhydrase activity due to increased excretion of bicarbonate ions. This effect is weakly expressed and has virtually no effect on urine pH. Hydrochlorothiazide is characterized by a hypotensive effect . The active substance has no effect on normal blood pressure
Pharmacokinetics
Hydrochlorothiazide is incompletely, but rather quickly absorbed from the gastrointestinal tract. This effect lasts for 6–12 hours. After oral administration of a dose of 100 mg, Cmax in blood plasma is achieved after 1.5–2.5 hours.
At the maximum diuretic activity (approximately 4 hours after administration), the concentration of hydrochlorothiazide in the blood plasma is 2 mcg/ml. Plasma protein binding is 40%. It is excreted mainly through the kidneys (filtration and secretion) in unchanged form. T1/2 for patients with normal renal function is 6.4 hours, for patients with moderate renal failure - 11.5 hours, and for patients with creatinine Cl less than 30 ml/min - 20.7 hours.
Hydrochlorothiazide crosses the placental barrier and is excreted into breast milk.
Indications for the drug 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 in nephrogenic diabetes insipidus;
prevention of stone formation in the genitourinary tract in predisposed patients (reduction of hypercalciuria).
Indications for use of Hypothiazide
What are Hypothiazide tablets for? The medication is prescribed for edema syndrome of various origins:
- portal hypertension;
- chronic renal failure;
- nephrotic syndrome;
- taking corticosteroids;
- acute glomerulonerfit ;
- premenstrual tension syndrome;
- chronic course of heart failure.
Indications for use of Hypothiazide:
- control for polyuria ( diabetes insipidus , nephrogenic diabetes );
- arterial hypertension (in combination with other antihypertensive drugs, in monotherapy);
- prevention of stone formation in the urinary system in predisposed patients (reducing the risk of hypercalciuria ).
Contraindications
hypersensitivity to the drug or to other sulfonamides;
anuria;
severe renal (creatinine Cl - less than 30 ml/min) or liver failure;
difficult-to-control diabetes mellitus;
Addison's disease:
refractory hypokalemia, hyponatremia, hypercalcemia;
children under 3 years of age (solid dosage form).
Use with caution in case of hypokalemia, hyponatremia, hypercalcemia, in patients with coronary artery disease, with cirrhosis of the liver, gout, in the elderly, in patients suffering from lactose intolerance, when taking cardiac glycosides.
Use during pregnancy and breastfeeding
Hydrochlorothiazide penetrates the placental barrier. The use of the drug in the first trimester of pregnancy is contraindicated. In the second and third trimesters of pregnancy, the drug can be prescribed only in cases 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 fetal or newborn jaundice, thrombocytopenia and other consequences.
The drug passes into breast milk; therefore, if the use of the drug is absolutely necessary, breastfeeding should be discontinued.
Hypothiazide during pregnancy (and lactation)
The active component Hydrochlorothiazide is contraindicated during pregnancy in the first trimester. It is permissible to prescribe the medication in the 2nd and 3rd trimesters in cases where the possible benefit to the mother significantly exceeds the expected risk to the health of the fetus. The active substance can pass the placental barrier. Newborns may develop thrombocytopenia , jaundice and other consequences. The active component is released during lactation , which may require interruption of breastfeeding if it is necessary to take a diuretic.
Side effects
Electrolyte imbalance
Hypokalemia, hypomagnesemia, hypercalcemia and hypochloremic alkalosis: dry mouth, thirst, irregular heart rhythm, mood or mental changes, muscle cramps and pain, nausea, vomiting, unusual tiredness or weakness. Hypochloremic alkalosis can cause hepatic encephalopathy or hepatic coma.
Hyponatremia: confusion, convulsions, lethargy, slow thinking, fatigue, excitability, muscle cramps.
Metabolic phenomena: hyperglycemia, glucosuria, hyperuricemia with the development of an attack of gout. Treatment with thiazides may reduce glucose tolerance, and latent diabetes mellitus may become manifest. When using high doses, serum lipid levels may increase.
From the gastrointestinal tract: cholecystitis or pancreatitis, cholestatic jaundice, diarrhea, sialadenitis, constipation, anorexia.
From the cardiovascular system: arrhythmias, orthostatic hypotension, vasculitis.
From the nervous system and sensory organs: dizziness, blurred vision (temporarily), headache, paresthesia.
From the hematopoietic organs: very rarely - leukopenia, agranulocytosis, thrombocytopenia, hemolytic anemia, aplastic anemia.
Hypersensitivity reactions: urticaria, purpura, necrotizing vasculitis, Stevens-Johnson syndrome, respiratory distress syndrome (including pneumonitis and non-cardiogenic pulmonary edema), photosensitivity, anaphylactic reactions up to shock.
Other phenomena: decreased potency, impaired renal function, interstitial nephritis.
Interaction
The simultaneous use of the drug with lithium salts should be avoided (renal clearance of lithium decreases and its toxicity increases).
Use with caution with the following drugs:
- antihypertensive drugs (their effect is potentiated, there may be a need for dose adjustment);
- cardiac glycosides (hypokalemia and hypomagnesemia associated with the action of thiazide diuretics can increase the toxicity of digitalis);
- amiodarone (its use simultaneously with thiazide diuretics may lead to an increased risk of arrhythmias associated with hypokalemia);
- hypoglycemic agents for oral administration (their effectiveness decreases, hyperglycemia may develop);
- corticosteroid drugs, calcitonin (increase the degree of potassium excretion);
- NSAIDs (can weaken the diuretic and hypotensive effects of thiazides);
- non-depolarizing muscle relaxants (their effect may be enhanced);
- amantadine (the clearance of amantadine may be reduced by hydrochlorothiazide, which leads to an increase in plasma concentrations of amantadine and possible toxicity);
- cholestyramine, which reduces the absorption of hydrochlorothiazide;
- ethanol, barbiturates and narcotic analgesics, which enhance the effect of orthostatic hypotension.
Effect of the drug on laboratory test data
Thiazides may reduce plasma levels of protein-bound iodine.
Before testing the function of the parathyroid glands, thiazides should be discontinued. Serum bilirubin concentrations may be increased.
Hypothiazide analogs
Level 4 ATC code matches:
Dichlorothiazide
Hydrochlorothiazide
Structural analogues:
- Hydrochlorothiazide-SAR;
- Hydrochlorothiazide.
Medicines with similar pharmacological effects (diuretics):
- Veroshpiron;
- Diuver;
- Indapamide;
- Torasemide;
- Arifon;
- Spironolactone;
- Inspra;
- Lasix;
- Furosemide.
Directions for use and doses
Inside, after eating.
The dosage must be selected individually. With constant medical supervision, the minimum effective dose is established.
Due to the increased loss of potassium and magnesium ions during treatment (serum potassium levels may decrease below 3.0 mmol/l), there is a need to replace potassium and magnesium.
For adults. As an antihypertensive agent, the usual initial daily dose is 25–50 mg once, as monotherapy or in combination with other antihypertensive agents. For some patients, an initial dose of 12.5 mg is sufficient, either as monotherapy or in combination. It is necessary to use the minimum effective dose, not exceeding 100 mg/day. If Hypothiazide is combined with other antihypertensive drugs, it may be necessary to reduce the dose of the other drug in order to prevent an excessive decrease in blood pressure.
The hypotensive effect appears within 3–4 days, but it may take up to 3–4 weeks to achieve optimal effect. After completion of treatment, the hypotensive effect persists for 1 week.
Edema syndrome of various origins. The usual starting dose for the treatment of edema is 25–100 mg of the drug once a day or once every 2 days. Depending on the clinical response, the dose may be reduced to 25–50 mg once a day or once every 2 days. In some severe cases, doses up to 200 mg/day may be required at the beginning of treatment.
For premenstrual syndrome, the usual dose is 25 mg/day and is used from the onset of symptoms to the onset of menstruation.
For nephrogenic diabetes insipidus, the usual daily dose of 50–150 mg (in divided doses) is recommended.
For children. Doses should be set based on the child’s body weight. Usual pediatric daily doses are 1–2 mg/kg or 30–60 mg/m2 body surface area, given once daily. The total daily dose for children aged 3 to 12 years is 37.5–100 mg.
Hypothiazide price, where to buy
The cost of the medication is relatively low and varies within small ranges depending on the amount of the active substance, pharmacy chain, and region. The average price of Hypothiazide in Russia is 100 rubles.
- Online pharmacies in RussiaRussia
- Online pharmacies in UkraineUkraine
- Online pharmacies in KazakhstanKazakhstan
ZdravCity
- Hypothiazide tablets 25 mg 20 pcs. Chinoin
88 RUR order
Pharmacy Dialogue
- Hypothiazide tablets 100 mg No. 20Chinoin
108 RUR order
- Hypothiazide tablets 25 mg No. 20Chinoin
83 RUR order
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Pharmacy24
- Hypothiazide 25 mg N20 tablets Quinoin Pharmaceutical and Chemical Products Plant Private Co. Ltd., Ugorshchina
48 UAH.order - Hypothiazide 100 mg No. 20 tablets Quinoin Pharmaceutical and Chemical Products Plant Private Co. Ltd., Ugorshchina
75 UAH order
PaniPharmacy
- Hypothiazide tablets Hypothiazide tablets. 100 mg No. 20 Hungary, Chinoin
93 UAH order
- Hypothiazide tablets Hypothiazide tablets. 25 mg No. 20 Hungary, Chinoin
53 UAH order
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Overdose
The most noticeable manifestation of hydrochlorothiazide overdose is acute loss of fluid and electrolytes, manifested by the following signs and symptoms:
Cardiovascular: tachycardia, decreased blood pressure, shock.
Neuromuscular: weakness, confusion, dizziness and calf muscle spasms, paresthesia, disturbances of consciousness, fatigue.
Gastrointestinal: nausea, vomiting, thirst.
Renal: polyuria, oliguria or anuria (due to hemoconcentration).
Laboratory indicators: hypokalemia, hyponatremia, hypochloremia, alkalosis, increased levels of urea nitrogen in the blood (especially in patients with renal failure).
Treatment: There is no specific antidote for an overdose of hydrochlorothiazide.
Induction of vomiting and gastric lavage may be ways to eliminate the drug.
Absorption of the drug can be reduced by administering activated carbon. In case of decreased blood pressure or shock, blood volume and electrolytes (potassium, sodium) should be replaced.
Monitor fluid and electrolyte balance (especially serum potassium levels) and renal function until normal values are established.
special instructions
During long-term treatment, it is necessary to carefully monitor the clinical symptoms of water-electrolyte imbalance, primarily in patients at high risk: patients with diseases of the cardiovascular system and impaired liver function; in case of severe vomiting or when signs of water and electrolyte imbalance appear, such as dry mouth, thirst, weakness, lethargy, drowsiness, anxiety, muscle pain or cramps, muscle weakness, hypotension, oliguria, tachycardia, gastrointestinal complaints.
Hypokalemia can be avoided by using potassium-containing drugs or foods rich in potassium (fruits, vegetables), especially in the case of increased potassium loss (increased diuresis, prolonged treatment) or concomitant treatment with digitalis glycosides or corticosteroid drugs.
Thiazides have been shown to increase urinary excretion of magnesium; this may lead to hypomagnesemia.
With reduced renal function, monitoring of creatinine clearance is necessary. In patients with impaired renal function, the drug may cause azotemia, and cumulative effects may develop. If renal dysfunction is obvious, discontinuation of the drug should be considered when oliguria occurs.
In patients with impaired liver function or with progressive liver diseases, thiazides are prescribed with caution, since a slight change in water and electrolyte balance, as well as serum ammonium levels, can cause hepatic coma.
In cases of severe cerebral and coronary sclerosis, the administration of the drug requires special caution.
Treatment with thiazide drugs may impair glucose tolerance. During a long course of treatment for manifest and latent diabetes mellitus, systematic monitoring of carbohydrate metabolism is necessary; It may be necessary to change the dose of hypoglycemic drugs. Increased monitoring of patients with impaired uric acid metabolism is required.
Alcohol, barbiturates, and narcotic analgesics enhance the orthostatic hypotensive effect of thiazide diuretics.
With long-term therapy, in rare cases, pathological changes in the parathyroid glands were observed, accompanied by hypercalcemia and hypophosphatemia. Thiazides can reduce the amount of iodine bound to serum proteins without causing signs of thyroid dysfunction.
In patients suffering from lactose intolerance, gastrointestinal complaints may occur due to the presence of lactose in the tablets: Hypothiazide® 25 mg tablets contain 63 mg of lactose, Hypothiazide® 100 mg - 39 mg of lactose.
Impact on the ability to drive a car and perform work that requires increased attention. In the initial stage of using the drug (the duration of this period is determined individually), it is forbidden to drive a car or perform work that requires increased attention.
Reviews about Hypothiazide
The medication is often prescribed for diseases of the heart and vascular system, accompanied by edema syndrome. Patients note a mild diuretic effect of the drug if the dosages specified by the doctor are observed. The edema syndrome is relieved gradually, without washing away the necessary microelements from the body.
Reviews about Hypothiazide for weight loss are mixed. Weight does indeed decrease, but only due to lost fluid. The kilograms return after water enters the body. The medication does not have any effect on fat and muscle tissue, so the use of Hypothiazide for weight loss is inappropriate, and in some cases can be harmful to health (loss of microelements, dehydration, etc.)
