Thiazifar Pharmedic treatment for heart failure, hypertension (10 blisters x 10 tablets)

hydrociorothiazid increases the excretion of sodium chloride and waters water due to the mechanism of inhibiting the reabsorption of sodium and chloride ions in the distance. The excretion of other electrolytes also increases, especially potassium and magnesi, and calcium decreases. Hydroclorothiazid also reduces the activity of the carbon dioxide, so it increases the secretion of bicarbonate but this effect is usually less than the secretion of chloride ion and does not significantly change the urine pH.

Thiazid diuretics may also reduce glomerular filtration rate. Thiazids have a moderate diuretic effect because about 90% of sodium ions have been reabsorbed before arriving in the distance is the main position of the drug.

hydrochlorothiazid has the effect of lowering blood pressure, firstly due to a decrease in plasma volume and extracellular fluids related to sodium urine. Then, during the use of the drug, the effect of lowering blood pressure depends on the decrease in peripheral resistance, through the gradual adaptation of blood vessels from the reduction of sodium concentration. Therefore, the hypotension effect of hydrochlorothiazid is shown slowly after 1 to 2 weeks, while diuretic effects occur quickly, it can be seen right after a few hours.

pharmacokinetic

absorption

After drinking, hydrochlorothiazid is quickly absorbed (TMAX about 2 hours). The average increase in AUC is linear and proportional to the dose in the treatment range.

Effects of food less affects the absorption of hydrochlorothiazid. After drinking, absolute bioavailability of hydrochlorothiazid is 70%.

In patients with congestive heart failure, the absorption of hydrochlorothiazid.

Prolonged dose does not affect the metabolism of hydrochlorothiazid. After 3 months of treatment with 50 mg/day, absorption and elimination similar to the short -term treatment.

Distribution

hydrochlorothiazid accumulated in red blood cells, reaching a maximum concentration of 4 hours after drinking. After 10 hours, the concentration of red blood cells is about 3 times higher than in the blood. Blood protein is about 40 - 70% and an estimated distribution of 4 to 8 l/kg.

Different selling time from one object to another: The difference is about 6 to 25 hours.

Elimination

hydrochlorothiazid is excreted from blood mainly in a constant form, the sale time is about 6-15 hours in the last phase of excretion. In 72 hours, 60-80% of the single dose is eliminated through the kidneys, 95% in the form of constant and 4% is 2-amino-4-chloro-Benzenedisulfonamid hydrolyzate (ABCS). About 24% of oral doses are found in stool and an insignificant amount is excreted through the bile.

In patients with renal failure and heart failure, the renal clearance of hydrochlorothiazide decreases and the selling time increases. This is also true in the elderly, increasing the maximum concentration in plasma.

Prisable when using

Note

Thiazifar 25 mg is not recommended in the case of narrowing of the kidneys or renal function decreased and lowering blood potassium.

hydrochlorothiazid is a sulfonamide. There may be cross -reactions with other sulfonamids, especially with antibacterial drugs, this reaction is still theoretical and no clinical value.

liver failure

thiazid diuretics, such as other diuretics, can cause electrolyte imbalance, liver, or liver -kidney syndrome when used to treat ascites. Caution should be used with special hydrochlorothiazid in patients with severe liver failure.

Light sensitive reaction has been reported when taking thiazid diuretics.

If light sensitive reaction occurs during treatment, it is advisable to stop treatment. If treatment is necessary, it is necessary to protect the exposure to the sun or artificial UVA.

Thiazifar can be used in the case of fat diarrhea. Gluten may contain gluten, but only according to the amount of traces and therefore are considered safe for patients with fat diarrhea.

This drug contains lactose. Patients with rare genetic problems of galactose tolerance, lactase enamel deficiency or glucose-galactose are not used by this drug.

Precautions

Balance of water electrolytes

Sodium blood

Check blood sodium before starting treatment, then regularly check. Thiazid diuretics can cause hypoglycemia or severe hypoglycemia in advance. In subjects significantly reducing blood sodium and/ or reducing water volume, as seen in patients with high doses of diuretics, blood pressure symptoms may rarely occur after starting treatment with hydromorothiazide.

Due to the initial decrease in blood sodium, the regular monitoring is necessary and should be more frequent in high -risk subjects such as the elderly, malnourished people and cirrhosis.

In patients with ascites cirrhosis and in edema patients related to nephrotic syndrome, special monitoring should be monitored.

Cases of hypoglycemia with neurological symptoms (nausea, loss of orientation, apathy) have been observed. Thiazid diuretics should only be taken after normalizing the reduction of sodium and/or reducing the existing water volume. If not, the treatment will be conducted under the supervision of a specialist.

blood potassium

Thiazid and diuretics can cause hypokalemia or worsen the existing condition of blood potassium in patients with kidney disease or kidney dysfunction of renal (cardiovascular).

The risk of hypokalemia (

Patients with prolonged ECG QT are also at risk, whether the origin is congenital or medication. Hypotension (as well as slow heartbeat) then occurs as a factor that promotes severe arrhythmia, especially torsion, can be fatal, especially the presence of slow heart rate.

Normal chemistry hypotension and hypoglycemia is recommended before starting treatment with thiazid diuretics.

It is advisable to perform the first blood potassium control within a week after treatment. After that, regular monitoring of blood potassium should be monitored. Electrolyte balance, especially potassium should be controlled in all patients taking thiazid diuretics.

In the case of chronic treatment, blood potassium control should be controlled at the beginning of treatment. Control at 3 to 4 weeks may be considered depending on the risk factors. After that, the regular check in patients at risk.

Uric acid

Thiazifar is like other diuretic, which can increase the concentration of uric acid in the blood, due to reducing the excretion through the kidneys and thus promoting hyperuricemia or seriously increasing blood uric acid in advance, which can cause seizures in patients susceptible to this disease.

Dosage will be adjusted according to the concentration of uric acid in the blood.

Metabolic effect

blood calcium

thiazid diuretics reduce calcium excretion through the kidneys and can cause mild and fleeting calcium hypercalcemia in the absence of abnormalities of calcium metabolism. Caution should be used for thiazifar 25 mg in patients with hypercalcemia and should only be used after adjusting any blood calcium hypercalcium. Thiazifar should be discontinued 25 mg if blood calcium increases occurs during treatment.

Monitor calcium regularly while treating thiazid diuretics. Hypercalcemia may be a sign of hiding the hyperpointed gland function. Thiazid diuretics should be discontinued before exploring the parathyroid function.

Blood glucose and blood lipid

thiazid diuretics, including hydrochlorothiazid, can reduce glucose and increase cholesterol and blood triglycerides. It may be necessary to adjust insulin dose or blood glucose oral medication in diabetes patients.

Kidney function and diuretic

Thiazid diuretics only work well when normal or less renal function (e.g. test by calculating creatinine clearance from blood creatinine). In the elderly, it is advisable to adjust the value of creatinine to the age, weight and gender of the patient, according to the Cockroft formula, for example:

CLCR = (140 - Age) x Weight/0.814 x Creatinin.

with:

Age is expressed in the year;

weight in kg;

blood creatinine in µm/l.

This formula is valid for elderly male subjects, and must be adjusted for women by causing results with 0.85.

Reducing blood volume, sodium loss and secondary water due to diuretic at the beginning of treatment leading to reduced glomerular filtration. This can lead to increased blood urea and blood creatinine.

Temporary renal function measurement can worsen the kidney failure before.

Negative and glaucoma of secondary angle closed angle

hydrochlorothiazid, a sulfonamid, is given a specific reaction that leads to temporary myopia and increasing the closed angle of the angle. Symptoms include sudden onset of acute vision or eye pain and usually occurs within hours to a few weeks after the beginning of treatment. If not treated, narrow -angle glaucoma can lead to permanent vision loss. The initial treatment is to stop hydrochlorothiazid as soon as possible. History of allergy to sulfonamid or penicillin is a risk factor in the development of glaucoma.

Other

Combined with hypotension

Dosage in case of combination with other antihypertensive drugs, at least at the beginning of treatment.

Hypotension effects of ACE inhibitors, Angiotensin II antagonists or reinforced Renin inhibitors increases blood renin activity (diuretics).

Be careful when ACE inhibitors, Angiotensin II antagonists, or lenin inhibitors directly inhibit with Thiazifar 25 mg, especially in patients significantly reduced sodium and/ or reduced water volume.

Sports

hydrochlorothiazid may cause a positive reaction to tests during doping control.

Other

lupus erythematosa

Sacomotic cases of the whole body erythematosus have been reported when using thiazid diuretics, including hydrochlorothiazid.

Hypersensitivity reactions to hydrochlorothiazid more common in patients with allergies and asthma.

The ability to drive and operate machinery

There is no evidence of the effect of the drug on the ability to drive and operate machinery.

Pregnancy

There are many notices that prove that thiazid diuretics (as well as straps diuretics) are all through the placenta into the fetus, causing electrolytes, thrombocytopenia and jaundice in newborns. Therefore, this drug should not be used in the last 3 months of pregnancy.

Breastfeeding period

The drug goes into breast milk with the amount that can be harmful to the child and inhibit milk secretion. Therefore, it is necessary to consider not using medication or stop breastfeeding depending on the degree of need for the drug for the mother.

Medicinal interaction

Use hydrochlorothiazid with alcohol, barbiturates or addictive sleeping pills that can occur vertical hypotension.

Use at the same time hydrochlorothiazid with diabetes treatment (oral and insulin medication) need to adjust the dose.

Using other antihypertensive drugs at the same time as hydrochlorothiazid: The effect of synergies or increased hypotension.

The absorption of hydrochlorothiazid is reduced by the presence of anion exchange resin. Single dose of cholestyramin or colestipol mounted hydrochlorothiazid and reduces the absorption through the gastrointestinal tract.

Using hydrochlorothiazid with corticosteroids, ACTH increases electricity loss, especially hypotension.

hydrochlorothiazid may reduce response to hypertension (e.g. norepinephrin), but not enough to prevent use.

hydrochlorothiazid may increase the response to muscle relaxants (for example: tubocurarin).

Do not share lithiums with diuretics, because of reducing lithium clearance in the kidneys and increasing the toxicity of this substance.

Steroid anti -inflammatory drugs can reduce the effect in some patients. Therefore, if used with hydrochlorothiazid, you must monitor to see if it is the desired effect on diuretic.

Use hydrochlorothiazid and quinidine easily causing torsion, vibration that causes death.

Thiazid reduces the effects of anticoagulants, gout drugs.

Thiazid increases the effects of anesthesia, glycosid, vitamin D.

cholestyramin or colestipol: potential to attach thiazid diuretics, reducing the absorption of these drugs through the gastrointestinal tract.

hydrochlorothiazid increases the toxicity of digitalis and increases the risk of arrhythmia with drugs that extend QT about Astemizol, Terfenadin, Halofantrin, Pimozid and Sotalol.

Allopurinol, tetracyclin: Increased toxicity when used with thiazid.

Licorice causes water, sodium, increased potassium. If you use hydrochlorothiazid to treat hypertension, you should avoid the same dong because the dong quai is active. Avoid using hydrochlorothiazid with Ma Hoang, Ginseng, Yohimbe because it can make the condition of hypertension worse.