Почечная недостаточность тяжелой степени, анурия, тяжелая печеночная недостаточность или печеночная энцефалопатия (риск развития печеночной комы), тяжелые формы подагры и сахарного диабета, рефрактерная гипокалиемия, гиперкальциемия, гипонатриемия, недостаточность функции коры надпочечников (болезнь Аддисона); I триместр беременности, период грудного ...
гидрохлоротиазида (в пересчете на 100% вещество) - 25 мг или 100 мг;
Вспомогательные вещества:
целлюлоза микрокристаллическая,
сахар молочный (лактоза),
крахмал картофельный,
магния стеарат.
Фармакологические свойства
Тиазидный диуретик. Нарушает реабсорбцию ионов натрия, хлора и воды в дистальных канальцах нефрона. Увеличивает выведение ионов калия, магния, бикарбоната; задерживает в организме ионы кальция. Диуретический эффект наступает через 2 ч, достигает максимума через 4 ч и продолжается до 12 ч. Способствует снижению повышенного АД. Кроме того, уменьшает полиурию у больных с несахарным диабетом (механизм действия окончательно не выяснен). В ряде случаев понижает внутриглазное давление при глаукоме.
Фармакокинетика
После приема внутрь 60-80% дозы абсорбируется из ЖКТ. Время достижения Cmax в плазме - 1.5-3 ч. Гидрохлоротиазид накапливается в эритроцитах. В фазе выведения его концентрация в эритроцитах в 3-9 раз больше, чем в плазме. Связывание с белками плазмы - 40-70%. Vd в терминальной фазе выведения составляет 3-6 л/кг (что эквивалентно 210-420 л при массе тела 70 кг).
Гидрохлоротиазид метаболизируется в очень малой степени. Его единственным обнаруженным в следовых количествах метаболитом является 2-амино-4-хлоро-М-бензендисульфонамид.
Выведение гидрохлоротиазида из плазмы имеет двухфазный характер: T1/2 в начальной фазе составляет 2 ч, в терминальной фазе - около 10 ч. У пациентов с нормальной функцией почек выведение осуществляется почти исключительно почками. В целом 50-75% принятой внутрь дозы выводится с мочой в неизмененном виде.
У пациентов пожилого возраста и при нарушениях функции почек клиренс гидрохлоротиазида существенно снижается, что приводит к значительному увеличению его концентрации в плазме крови. Снижение клиренса, отмечаемое у пожилых больных, по-видимому, связано с ухудшением функции почек. У больных с циррозом печени изменений фармакокинетики гидрохлоротиазида не отмечается.
Показания к применению
Артериальная гипертензия (в качестве монотерапии или в составе комбинированной терапии), отечный синдром различного генеза (хроническая сердечная недостаточность, нефротический синдром, предменструальный синдром, острый гломерулонефрит, хроническая почечная недостаточность, портальная гипертензия, задержка жидкости при ожирении, лечение кортикостероидами), уменьшение симптоматической полиурии при несахарном диабете, глаукома (субкомпенсированные формы), профилактика образования кальций-фосфатных конкрементов в мочевыводящих путях при гиперкальциурии.
Противопоказания
Почечная недостаточность тяжелой степени, анурия, тяжелая печеночная недостаточность или печеночная энцефалопатия (риск развития печеночной комы), тяжелые формы подагры и сахарного диабета, рефрактерная гипокалиемия, гиперкальциемия, гипонатриемия, недостаточность функции коры надпочечников (болезнь Аддисона); I триместр беременности, период грудного вскармливания; детский возраст до 3 лет (для твердой лекарственной формы); повышенная чувствительность к сульфонамидам.
Применение при беременности и в период грудного вскармливания
Противопоказано применение в I триместре беременности и в период грудного вскармливания.
С осторожностью применять во II и III триместрах беременности.
Гидрохлоротиазид выделяется с грудным молоком.
Способ применения и дозы
Принимают внутрь. Схема применения зависит от показаний, клинической ситуации, сопутствующих заболеваний.
Для взрослых разовая доза составляет 12.5-100 мг 1 раз/сут.
Для детей старше 3 лет доза составляет 1-2 мг/кг/сут или 30-60 мг/м2 поверхности тела 1 раз/сут.
Побочное действие
Со стороны пищеварительной системы: тошнота, рвота, диарея; редко - панкреатит.
Со стороны сердечно-сосудистой системы: ортостатическая гипотензия, тахикардия.
Со стороны обмена веществ: гипокалиемия, гипомагниемия, гипонатриемия, гипохлоремический алкалоз, гиперурикемия, гиперкальциемия.
Со стороны эндокринной системы: гипергликемия.
Со стороны системы кроветворения: редко - нейтропения, тромбоцитопения.
Со стороны органа зрения: редко - нарушения зрения.
Со стороны нервной системы: слабость, утомляемость, головокружение, парестезии.
Аллергические реакции: редко - аллергические дерматиты.
Со стороны кожи и подкожных тканей: немеланомный рак кожи (на основании имеющихся данных эпидемиологических исследований между гидрохлоротиазидом и НМРК была выявлена кумулятивная дозозависимая взаимосвязь).
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
С осторожностью применяют у пациентов с подагрой и сахарным диабетом, при увеличении длительности интервала QT на ЭКГ, при одновременном применении с препаратами, которые способны вызывать полиморфную желудочковую тахикардию типа "пируэт" или увеличивать длительность интервала QT на ЭКГ; одновременно с препаратами лития, способными вызывать гипокалиемию, с сердечными гликозидами; при аллергических реакциях на пенициллин в анамнезе; при системной красной волчанке; при ИБС, выраженном атеросклерозе коронарных или церебральных артерий, хронической сердечной недостаточности; при немеланомном раке кожи в анамнезе; у пациентов пожилого возраста; во II и III триместрах беременности; у детей от 3 до 18 лет.
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
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вещество:\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"гидрохлоротиазида (в пересчете на 100% вещество) - 25 мг или 100 мг; "}},{"type":"paragraph","data":{"text":"\u003ci\u003eВспомогательные вещества:\u003c/i\u003e"}},{"type":"paragraph","data":{"text":" целлюлоза микрокристаллическая,"}},{"type":"paragraph","data":{"text":"сахар молочный (лактоза),"}},{"type":"paragraph","data":{"text":"крахмал картофельный,"}},{"type":"paragraph","data":{"text":"магния стеарат."}}]},{"id":9,"name":"Фармакологические свойства","slug":"pharmacologic_effects","body":[{"type":"paragraph","data":{"text":"Тиазидный диуретик. Нарушает реабсорбцию ионов натрия, хлора и воды в дистальных канальцах нефрона. Увеличивает выведение ионов калия, магния, бикарбоната; задерживает в организме ионы кальция. Диуретический эффект наступает через 2 ч, достигает максимума через 4 ч и продолжается до 12 ч. Способствует снижению повышенного АД. Кроме того, уменьшает полиурию у больных с несахарным диабетом (механизм действия окончательно не выяснен). В ряде случаев понижает внутриглазное давление при глаукоме."}},{"type":"header","data":{"text":"Фармакокинетика","level":4}},{"type":"paragraph","data":{"text":"После приема внутрь 60-80% дозы абсорбируется из ЖКТ. Время достижения C\u003csub\u003emax\u003c/sub\u003e в плазме - 1.5-3 ч. Гидрохлоротиазид накапливается в эритроцитах. В фазе выведения его концентрация в эритроцитах в 3-9 раз больше, чем в плазме. Связывание с белками плазмы - 40-70%. V\u003csub\u003ed\u003c/sub\u003e в терминальной фазе выведения составляет 3-6 л/кг (что эквивалентно 210-420 л при массе тела 70 кг)."}},{"type":"paragraph","data":{"text":"Гидрохлоротиазид метаболизируется в очень малой степени. Его единственным обнаруженным в следовых количествах метаболитом является 2-амино-4-хлоро-М-бензендисульфонамид."}},{"type":"paragraph","data":{"text":"Выведение гидрохлоротиазида из плазмы имеет двухфазный характер: T\u003csub\u003e1/2\u003c/sub\u003e в начальной фазе составляет 2 ч, в терминальной фазе - около 10 ч. У пациентов с нормальной функцией почек выведение осуществляется почти исключительно почками. В целом 50-75% принятой внутрь дозы выводится с мочой в неизмененном виде."}},{"type":"paragraph","data":{"text":"У пациентов пожилого возраста и при нарушениях функции почек клиренс гидрохлоротиазида существенно снижается, что приводит к значительному увеличению его концентрации в плазме крови. Снижение клиренса, отмечаемое у пожилых больных, по-видимому, связано с ухудшением функции почек. У больных с циррозом печени изменений фармакокинетики гидрохлоротиазида не отмечается."}}]},{"id":10,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"Артериальная гипертензия (в качестве монотерапии или в составе комбинированной терапии), отечный синдром различного генеза (хроническая сердечная недостаточность, нефротический синдром, предменструальный синдром, острый гломерулонефрит, хроническая почечная недостаточность, портальная гипертензия, задержка жидкости при ожирении, лечение кортикостероидами), уменьшение симптоматической полиурии при несахарном диабете, глаукома (субкомпенсированные формы), профилактика образования кальций-фосфатных конкрементов в мочевыводящих путях при гиперкальциурии."}}]},{"id":11,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"Почечная недостаточность тяжелой степени, анурия, тяжелая печеночная недостаточность или печеночная энцефалопатия (риск развития печеночной комы), тяжелые формы подагры и сахарного диабета, рефрактерная гипокалиемия, гиперкальциемия, гипонатриемия, недостаточность функции коры надпочечников (болезнь Аддисона); I триместр беременности, период грудного вскармливания; детский возраст до 3 лет (для твердой лекарственной формы); повышенная чувствительность к сульфонамидам."}}]},{"id":13,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"Противопоказано применение в I триместре беременности и в период грудного вскармливания."}},{"type":"paragraph","data":{"text":"С осторожностью применять во II и III триместрах беременности."}},{"type":"paragraph","data":{"text":"Гидрохлоротиазид выделяется с грудным молоком."}}]},{"id":14,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Принимают внутрь. Схема применения зависит от показаний, клинической ситуации, сопутствующих заболеваний."}},{"type":"paragraph","data":{"text":"Для взрослых разовая доза составляет 12.5-100 мг 1 раз/сут."}},{"type":"paragraph","data":{"text":"Для детей старше 3 лет доза составляет 1-2 мг/кг/сут или 30-60 мг/м\u003csup\u003e2\u003c/sup\u003e поверхности тела 1 раз/сут."}}]},{"id":15,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"\u003ci\u003eСо стороны пищеварительной системы:\u003c/i\u003e тошнота, рвота, диарея; редко - панкреатит."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо стороны сердечно-сосудистой системы:\u003c/i\u003e ортостатическая гипотензия, тахикардия."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо стороны обмена веществ:\u003c/i\u003e гипокалиемия, гипомагниемия, гипонатриемия, гипохлоремический алкалоз, гиперурикемия, гиперкальциемия."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо стороны эндокринной системы:\u003c/i\u003e гипергликемия."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо стороны системы кроветворения:\u003c/i\u003e редко - нейтропения, тромбоцитопения."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо стороны органа зрения:\u003c/i\u003e редко - нарушения зрения."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо стороны нервной системы:\u003c/i\u003e слабость, утомляемость, головокружение, парестезии."}},{"type":"paragraph","data":{"text":"\u003ci\u003eАллергические реакции:\u003c/i\u003e редко - аллергические дерматиты."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСо стороны кожи и подкожных тканей:\u003c/i\u003e немеланомный рак кожи (на основании имеющихся данных эпидемиологических исследований между гидрохлоротиазидом и НМРК была выявлена кумулятивная дозозависимая взаимосвязь)."}}]},{"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":"С осторожностью применяют у пациентов с подагрой и сахарным диабетом, при увеличении длительности интервала QT на ЭКГ, при одновременном применении с препаратами, которые способны вызывать полиморфную желудочковую тахикардию типа \"пируэт\" или увеличивать длительность интервала QT на ЭКГ; одновременно с препаратами лития, способными вызывать гипокалиемию, с сердечными гликозидами; при аллергических реакциях на пенициллин в анамнезе; при системной красной волчанке; при ИБС, выраженном атеросклерозе коронарных или церебральных артерий, хронической сердечной недостаточности; при немеланомном раке кожи в анамнезе; у пациентов пожилого возраста; во II и III триместрах беременности; у детей от 3 до 18 лет."}},{"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 сухом, защищенном от света месте, при температуре не выше 25 °C"}}]},{"id":22,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"2 года."}}]},{"id":23,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"По рецепту."}}]}],"source":{"title":"('Эркафарм/Столетов',)","url":"https://stoletov.ru/"}},"description_toggle":false,"short_description":"Тиазидный диуретик. Нарушает реабсорбцию ионов натрия, хлора и воды в дистальных канальцах нефрона. Увеличивает выведение ионов калия, магния, бикарбоната; задерживает в организме ионы кальция. Диуретический эффект наступает через 2 ч, достигает максимума через 4 ч и продолжается до 12 ч. Способствует снижению повышенного АД. Кроме того, уменьшает полиурию у больных с несахарным диабетом (механизм действия окончательно не выяснен). В ряде случаев понижает внутриглазное давление при глаукоме. После приема внутрь 60-80% дозы абсорбируется из ЖКТ. Время достижения Cmaxв плазме - 1.5-3 ч. Гидрохлоротиазид накапливается в эритроцитах. В фазе выведения его концентрация в эритроцитах в 3-9 раз больше, чем в плазме. Связывание с белками плазмы - 40-70%. Vdв терминальной фазе выведения составляет 3-6 л/кг (что эквивалентно 210-420 л при массе тела 70 кг). Гидрохлоротиазид метаболизируется в очень малой степени. Его единственным обнаруженным в следовых количествах метаболитом является 2-амино-4-хлоро-М-бензендисульфонамид. Выведение гидрохлоротиазида из плазмы имеет двухфазный характер: T1/2в начальной фазе составляет 2 ч, в терминальной фазе - около 10 ч. У пациентов с нормальной функцией почек выведение осуществляется почти исключительно почками. В целом 50-75% принятой внутрь дозы выводится с мочой в неизмененном виде. У пациентов пожилого возраста и при нарушениях функции почек клиренс гидрохлоротиазида существенно снижается, что приводит к значительному увеличению его концентрации в плазме крови. Снижение клиренса, отмечаемое у пожилых больных, по-видимому, связано с ухудшением функции почек. 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