Диуретик. Первичным механизмом действия тиазидных диуретиков... Инструкция
Показания к применению
Лечение гипертензии — монотерапия или комбинация с прочими гипеотензивными препаратами;
различного генеза (при , острой и хронической, ХСН, предменструальном синдроме, при лечении кортикостероидами и при токсикозах беременных);отекинефротическом синдромепочечной недостаточности
Выраженные нарушения функции почек, печеночная недостаточность, тяжелые формы подагры и сахарного диабета, повышенная чувствительность к сульфонамидам.
Диуретик. Первичным механизмом действия тиазидных диуретиков является повышение диуреза путем угнетения реабсорбции ионов натрия и хлора в начальной части почечных канальцев. Это приводит к повышению экскреции натрия и хлора и, следовательно, воды. Также увеличивается экскреция других электролитов, а именно - калия и магния. В максимальных терапевтических дозах диуретический/натрийуретический эффект всех тиазидов приблизительно одинаков.
Натрийурез и диурез наступают в течение 2 ч и достигают максимального уровня примерно через 4 ч.
Тиазиды также уменьшают активность карбоангидразы путем увеличения выведения ионов бикарбоната, но это действие обычно проявляется слабо и не влияет на pH мочи.
Гидрохлоротиазид обладает также гипотензивными свойствами. Тиазидные диуретики не влияют на нормальное АД.
Показания к применению
Лечение гипертензии — монотерапия или комбинация с прочими гипеотензивными препаратами;
различного генеза (при , острой и хронической, ХСН, предменструальном синдроме, при лечении кортикостероидами и при токсикозах беременных);отекинефротическом синдромепочечной недостаточности
Выраженные нарушения функции почек, печеночная недостаточность, тяжелые формы подагры и сахарного диабета, повышенная чувствительность к сульфонамидам.
С осторожностью
С осторожностью применяют у пациентов с подагрой и сахарным диабетом.
Способ применения и дозы
Устанавливают индивидуально. Разовая доза - 25-50 мг, суточная доза - 25-100 мг. Частота приема зависит от показаний и реакции пациента на лечение.
Побочное действие
Нарушение электролитного баланса
Гипокалиемия, гипомагниемия, гиперкальциемия и гипохлоремический алкалоз: сухость во рту, жажда, нерегулярный ритм сердца, изменения в настроении или психике, судороги и боль в мышцах, тошнота, рвота, необычная усталость или слабость. Гипохлоремический алкалоз может вызывать печеночную энцефалопатию или печеночную кому.
Метаболические явления: гипергликемия, глюкозурия, гиперурикемия с развитием приступа подагры. Лечение тиазидами может снижать толерантность к глюкозе, и латентно протекающий сахарный диабет может манифестировать. При применении высоких доз могут повышаться уровни липидов в сыворотке крови.
Со стороны органов ЖКТ: холецистит или панкреатит, холестатическая желтуха, диарея, сиаладенит, запор, анорексия.
Со стороны сердечно-сосудистой системы и крови (кроветворение, гемостаз): аритмии, ортостатическая гипотензия, васкулит; очень редко — лейкопения, агранулоцитоз, тромбоцитопения, гемолитическая анемия, апластическая анемия.
Со стороны нервной системы и органов чувств: головокружение, расплывчатое зрение (временно), головная боль, парестезии.
Реакции повышенной чувствительности: крапивница, пурпура, некротический васкулит, синдром Стивенса-Джонсона, респираторный дистресс-синдром (включая пневмонит и некардиогенный отек легкого), фоточувствительность, анафилактические реакции вплоть до шока.
Прочие: снижение потенции, нарушение почечной функции, интерстициальный нефрит.
Взаимодействие с другими лекарственными средствами
При одновременном применении антигипертензивных средств, недеполяризующих миорелаксантов их действие усиливается.
При одновременном применении барбитуратов, диазепама, этанола повышается риск развития ортостатической гипотензии.
При одновременном применении с ГКС возникает риск развития гипокалиемии, а также ортостатической гипотензии.
При одновременном применении с ингибиторами АПФ (в т.ч. каптоприлом, эналаприлом) усиливается антигипертензивное действие.
Возможна выраженная артериальная гипотензия, особенно после приема первой дозы гидрохлоротиазида, по-видимому, за счет гиповолемии, которая приводит к транзиторному усилению гипотензивного эффекта ингибитора АПФ.
Повышается риск нарушения функции почек. Не исключается развитие гипокалиемии.
При одновременном применении пероральных гипогликемических препаратов снижается их эффективность.
При одновременном применении препаратов кальция и/или витамина D в высоких дозах возможна гиперкальциемия и риск развития метаболического ацидоза вследствие замедления выведения кальция с мочой под влиянием тиазидных диуретиков.
При одновременном применении с аллопуринолом повышается риск развития аллергических реакций, особенно у пациентов с нарушениями функции почек.
При одновременном применении с дигоксином возможно повышение риска развития гликозидной интоксикации.
При одновременном применении с индометацином, пироксикамом, напроксеном, фенилбутазоном возможно некоторое уменьшение гипотензивного эффекта.
При одновременном применении с ирбесартаном возможно развитие аддитивного гипотензивного эффекта.
При одновременном применении с карбамазепином имеются сообщения о развитии гипонатриемии.
При одновременном применении с колестиполом, колестирамином уменьшается абсорбция и диуретический эффект гидрохлоротиазида.
При одновременном применении с лития карбонатом возможно повышение концентрации в крови солей лития до токсического уровня.
При одновременном применении с орлистатом уменьшается эффективность гидрохлоротиазида, что может привести к значительному повышению АД и развитию гипертонического криза.
При одновременном применении с соталолом возможна гипокалиемия и развитие желудочковой аритмии типа "пируэт".
Особые указания
У больных с почечной недостаточностью необходим систематический контроль концентрации в плазме электролитов и КК.
При появлении признаков дефицита калия, а также при одновременном применении сердечных гликозидов, ГКС и АКТГ показано назначение препаратов калия или калийсберегающих диуретиков.
При длительном применении следует придерживаться диеты, богатой калием.
Не рекомендуется одновременное применение диуретиков с НПВС.
Форма выпуска
Таблетки.
Условия хранения
В защищенном от света месте, при температуре не выше 25 °C. В герметичной упаковке.
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Первичным механизмом действия тиазидных диуретиков является повышение диуреза путем угнетения реабсорбции ионов натрия и хлора в начальной части почечных канальцев. Это приводит к повышению экскреции натрия и хлора и, следовательно, воды. Также увеличивается экскреция других электролитов, а именно - калия и магния. В максимальных терапевтических дозах диуретический/натрийуретический эффект всех тиазидов приблизительно одинаков."}},{"type":"paragraph","data":{"text":"Натрийурез и диурез наступают в течение 2 ч и достигают максимального уровня примерно через 4 ч."}},{"type":"paragraph","data":{"text":"Тиазиды также уменьшают активность карбоангидразы путем увеличения выведения ионов бикарбоната, но это действие обычно проявляется слабо и не влияет на pH мочи."}},{"type":"paragraph","data":{"text":"Гидрохлоротиазид обладает также гипотензивными свойствами. Тиазидные диуретики не влияют на нормальное АД."}}]},{"id":10,"name":"Показания к применению","slug":"indications","body":[{"type":"list","data":{"style":"ordered","items":["Лечение гипертензии — монотерапия или комбинация с прочими гипеотензивными препаратами;","различного генеза (при , острой и хронической, ХСН, предменструальном синдроме, при лечении кортикостероидами и при токсикозах беременных);отекинефротическом синдромепочечной недостаточности","нефрогенный несахарный диабет (контроль полиурии)."]}}]},{"id":11,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":" Выраженные нарушения функции почек, печеночная недостаточность, тяжелые формы подагры и сахарного диабета, повышенная чувствительность к сульфонамидам."}}]},{"id":12,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"С осторожностью применяют у пациентов с подагрой и сахарным диабетом."}}]},{"id":14,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Устанавливают индивидуально. Разовая доза - 25-50 мг, суточная доза - 25-100 мг. Частота приема зависит от показаний и реакции пациента на лечение."}}]},{"id":15,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Нарушение электролитного баланса"}},{"type":"paragraph","data":{"text":"Гипокалиемия, гипомагниемия, гиперкальциемия и гипохлоремический алкалоз: сухость во рту, жажда, нерегулярный ритм сердца, изменения в настроении или психике, судороги и боль в мышцах, тошнота, рвота, необычная усталость или слабость. Гипохлоремический алкалоз может вызывать печеночную энцефалопатию или печеночную кому."}},{"type":"paragraph","data":{"text":"Гипонатриемия: спутанность сознания, конвульсии, летаргия, замедление процесса мышления, усталость, возбудимость, мышечные судороги."}},{"type":"paragraph","data":{"text":"Метаболические явления: гипергликемия, глюкозурия, гиперурикемия с развитием приступа подагры. Лечение тиазидами может снижать толерантность к глюкозе, и латентно протекающий сахарный диабет может манифестировать. При применении высоких доз могут повышаться уровни липидов в сыворотке крови."}},{"type":"paragraph","data":{"text":"Со стороны органов ЖКТ: холецистит или панкреатит, холестатическая желтуха, диарея, сиаладенит, запор, анорексия."}},{"type":"paragraph","data":{"text":"Со стороны сердечно-сосудистой системы и крови (кроветворение, гемостаз): аритмии, ортостатическая гипотензия, васкулит; очень редко — лейкопения, агранулоцитоз, тромбоцитопения, гемолитическая анемия, апластическая анемия."}},{"type":"paragraph","data":{"text":"Со стороны нервной системы и органов чувств: головокружение, расплывчатое зрение (временно), головная боль, парестезии."}},{"type":"paragraph","data":{"text":"Реакции повышенной чувствительности: крапивница, пурпура, некротический васкулит, синдром Стивенса-Джонсона, респираторный дистресс-синдром (включая пневмонит и некардиогенный отек легкого), фоточувствительность, анафилактические реакции вплоть до шока."}},{"type":"paragraph","data":{"text":"Прочие: снижение потенции, нарушение почечной функции, интерстициальный нефрит."}}]},{"id":17,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"При одновременном применении антигипертензивных средств, недеполяризующих миорелаксантов их действие усиливается."}},{"type":"paragraph","data":{"text":"При одновременном применении барбитуратов, диазепама, этанола повышается риск развития ортостатической гипотензии."}},{"type":"paragraph","data":{"text":"При одновременном применении с ГКС возникает риск развития гипокалиемии, а также ортостатической гипотензии."}},{"type":"paragraph","data":{"text":"При одновременном применении с ингибиторами АПФ (в т.ч. каптоприлом, эналаприлом) усиливается антигипертензивное действие."}},{"type":"paragraph","data":{"text":"Возможна выраженная артериальная гипотензия, особенно после приема первой дозы гидрохлоротиазида, по-видимому, за счет гиповолемии, которая приводит к транзиторному усилению гипотензивного эффекта ингибитора АПФ."}},{"type":"paragraph","data":{"text":"Повышается риск нарушения функции почек. Не исключается развитие гипокалиемии."}},{"type":"paragraph","data":{"text":"При одновременном применении пероральных гипогликемических препаратов снижается их эффективность."}},{"type":"paragraph","data":{"text":"При одновременном применении препаратов кальция и/или витамина D в высоких дозах возможна гиперкальциемия и риск развития метаболического ацидоза вследствие замедления выведения кальция с мочой под влиянием тиазидных диуретиков."}},{"type":"paragraph","data":{"text":"При одновременном применении с аллопуринолом повышается риск развития аллергических реакций, особенно у пациентов с нарушениями функции почек."}},{"type":"paragraph","data":{"text":"При одновременном применении с дигоксином возможно повышение риска развития гликозидной интоксикации."}},{"type":"paragraph","data":{"text":"При одновременном применении с индометацином, пироксикамом, напроксеном, фенилбутазоном возможно некоторое уменьшение гипотензивного эффекта."}},{"type":"paragraph","data":{"text":"При одновременном применении с ирбесартаном возможно развитие аддитивного гипотензивного эффекта."}},{"type":"paragraph","data":{"text":"При одновременном применении с карбамазепином имеются сообщения о развитии гипонатриемии."}},{"type":"paragraph","data":{"text":"При одновременном применении с колестиполом, колестирамином уменьшается абсорбция и диуретический эффект гидрохлоротиазида."}},{"type":"paragraph","data":{"text":"При одновременном применении с лития карбонатом возможно повышение концентрации в крови солей лития до токсического уровня."}},{"type":"paragraph","data":{"text":"При одновременном применении с орлистатом уменьшается эффективность гидрохлоротиазида, что может привести к значительному повышению АД и развитию гипертонического криза."}},{"type":"paragraph","data":{"text":"При одновременном применении с соталолом возможна гипокалиемия и развитие желудочковой аритмии типа \"пируэт\"."}}]},{"id":18,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"У больных с почечной недостаточностью необходим систематический контроль концентрации в плазме электролитов и КК."}},{"type":"paragraph","data":{"text":"При появлении признаков дефицита калия, а также при одновременном применении сердечных гликозидов, ГКС и АКТГ показано назначение препаратов калия или калийсберегающих диуретиков."}},{"type":"paragraph","data":{"text":"При длительном применении следует придерживаться диеты, богатой калием."}},{"type":"paragraph","data":{"text":"Не рекомендуется одновременное применение диуретиков с НПВС."}}]},{"id":20,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Таблетки."}}]},{"id":21,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"В защищенном от света месте, при температуре не выше 25 °C. 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