Xlortalidon

When ATH:
C03BA04

Characteristic.

Tiazidopodobnый diuretic. White or white with a faint yellowish tinge crystalline powder. Practically insoluble in water, ether, xloroforme, Insoluble methanol, slightly soluble in ethanol. pKa — 9,4. Molecular weight 338,76.

Pharmacological action.
Diuretic, gipotenzivnoe.

Application.

Chronic heart failure II Art., arterial hypertension, c liver cirrhosis portal hypertension, nephrosis, jade, Late preeclampsia (nephropathy, swelling, eclampsia), fluid retention with premenstrual syndrome, nesaharnыy diabetes, disproteinemicheskie swelling, obesity.

Contraindications.

Hypersensitivity, kaliopenia, acute renal failure (anurija), pechenochnaya coma, acute hepatitis, diabetes (severe), gout.

Restrictions apply.

Renal and / or hepatic insufficiency, allergic reactions, bronchial asthma, systemic lupus erythematosus.

Pregnancy and breast-feeding.

In experiments on rats and rabbits, receiving at doses chlorthalidone, to 420 times the dose for humans, chlorthalidone adverse effects on the fetus are not found.

When pregnancy only on the grounds (possible adverse effects is fetal or neonatal jaundice, thrombocytopenia, hypokalemia in infants).

Category actions on the fetus by the FDA — B. (The study of reproduction in animals revealed no risk of adverse effects on the fetus, and adequate and well-controlled studies in pregnant women have not done.)

Chlorthalidone passes into breast milk, In this connection it is necessary to resolve the issue or termination of breastfeeding, either on the admission of chlorthalidone (Considering the importance of the drug to the mother).

Side effects.

From the nervous system and sensory organs: dizziness, vertigo, headache, paraesthesia, Xanthopsia.

Cardio-vascular system and blood (hematopoiesis, hemostasis): orthostatic hypotension (may increase under the influence of ethanol, barbiturates and anesthetics), arrhythmia (due to hypokalemia), thrombocytopenia, leukopenia, agranulocytosis, eozinofilija, aplasticheskaya anemia.

From the digestive tract: anorexia, nausea, vomiting, gastrospazm, constipation / diarrhea, intrahepatic cholestasis, jaundice, pancreatitis.

Allergic reactions: purpura, photosensitivity, rash, hives, kozhnыy vasculitis / syndrome Layella (toxic epidermal necrolysis).

Other: violation of the salt balance, such as hyponatremia (incl. accompanied by neurological symptoms — confusion, spasms and cramps, the weakening of the thought processes, fatiguability, irritability), hypochloraemic alkalosis, and hypokalemia (incl. dry mouth, increased thirst, irregular heartbeat, changes in mood or mental changes, spasms or muscle aches, nausea or vomiting, unusual tiredness or weakness, low pulse), gipomagniemiya, hypercalcemia, hyperuricemia (gout), giperglikemiâ, glycosuria, hyperlipidemia, reduced potency.

Cooperation.

Concomitant use with lithium is not recommended, because due to weakening renal clearance may show toxic effects of lithium; Besides, lithium has nephrotoxic effects. It enhances the action of muscle relaxants and curariform antihypertensive drugs (incl. guanethidine, methyldopa, beta-blockers, vasodilators, BCC, MAO inhibitors). In patients receiving cardiac glycosides may worsen arrhythmias, caused by digitalis intoxication. Gipokaliemicheskoe effect is enhanced by concomitant administration of glucocorticoids, amphotericin and carbenoxolone. NSAIDs weaken the diuretic and antihypertensive action. It may necessitate correction (increase or decrease) insulin dose and increase the dose of oral hypoglycemic drugs.

Overdose.

Symptoms: dizziness, nausea, drowsiness, gipovolemiя, excessive reduction of blood pressure, arrhythmia, convulsions.

Treatment: gastric lavage, the appointment of activated charcoal inside, simptomaticheskaya therapy (incl. in / in a saline solution to restore the electrolyte balance of blood).

Dosing and Administration.

Inside, the dose of 25-200 mg. Titration is carried out individually depending on the severity of the disease and its effect. When long-term therapy is recommended to prescribe the lowest effective dose, sufficient to maintain the optimum effect, especially in elderly patients.

Precautions.

In the period of treatment must periodically determine blood electrolytes, especially in patients, taking digitalis preparations. Not recommended for patients is very strict salt-free diet. If signs of hypokalemia (myasthenia, heart rhythm disturbances) or if there are more patients with the possibility of losing K⁺ (vomiting, diarrhea, malnutrition, cirrhosis, hyperaldosteronism, ACTH or corticosteroid therapy) shows the substitution therapy with potassium. To prevent dehydration during severe nausea, vomiting or diarrhea occurs and continuing need to consult a doctor.

Hyponatremia as a complication is rare, but if it develops rapidly, it is a medical emergency.

Patients with hyperlipidemia must constantly monitor the level of serum lipids (in case of increase of the concentration of therapy should be discontinued). In patients receiving thiazides noted exacerbation of systemic lupus erythematosus; Although such phenomena when receiving chlorthalidone is not revealed, when administered to patients with this disease should be cautious.

Cooperation