What are the interactions between hydrochlorothiazide and alcohol? How can they affect your health? Get the answers to these questions and more in this detailed article.

Hydrochlorothiazide and Alcohol Interactions

Hydrochlorothiazide, a diuretic medication commonly used to treat high blood pressure, can interact with alcohol in several ways. When taken together, hydrochlorothiazide and alcohol may have additive effects in lowering your blood pressure, leading to potentially dangerous side effects such as headache, dizziness, lightheadedness, fainting, and changes in pulse or heart rate.

These side effects are most likely to occur at the beginning of treatment with hydrochlorothiazide, following a dose increase, or when treatment is restarted after an interruption. It is important to notify your doctor if you experience these symptoms and they do not go away after a few days or become troublesome. To avoid potential risks, it is recommended to avoid driving or operating hazardous machinery until you know how the medications affect you, and to use caution when getting up from a sitting or lying position.

Hydrochlorothiazide and Food Interactions

In addition to interactions with alcohol, hydrochlorothiazide can also interact with certain foods. Thiazide diuretics, including hydrochlorothiazide, have been shown to increase serum triglyceride and cholesterol levels, primarily LDL and VLDL. However, whether these effects are dose-related and sustained during chronic therapy is not well-established.

Patients with pre-existing hyperlipidemia (high blood lipid levels) may require closer monitoring during thiazide therapy, and adjustments may need to be made in their lipid-lowering regimen accordingly. It is important for healthcare providers to be aware of these potential interactions and to monitor patients closely for any changes in their lipid profile during treatment with hydrochlorothiazide.

Hydrochlorothiazide and Triglyceride Levels

Several studies have investigated the effects of hydrochlorothiazide and other thiazide diuretics on lipid metabolism. A comparison of the effects of hydrochlorothiazide and captopril (an ACE inhibitor) on glucose and lipid metabolism in patients with hypertension found that hydrochlorothiazide treatment was associated with a significant increase in serum triglyceride levels.

Similarly, a study on the effects of antihypertensive therapy with metoprolol, propranolol, and hydrochlorothiazide on serum lipoproteins showed that hydrochlorothiazide treatment led to an increase in serum triglyceride levels. These findings suggest that the use of hydrochlorothiazide may have a negative impact on lipid metabolism, particularly in terms of increasing triglyceride levels.

Hydrochlorothiazide and Cholesterol Levels

In addition to the effects on triglycerides, hydrochlorothiazide and other thiazide diuretics have also been found to increase serum cholesterol levels, primarily LDL and VLDL cholesterol. A study comparing the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in hypertensive patients found a significant increase in LDL and VLDL cholesterol levels with hydrochlorothiazide treatment.

Another study on the metabolic side effects of antihypertensive therapy, including hydrochlorothiazide, reported similar findings, with an increase in serum cholesterol levels observed during thiazide diuretic treatment. These results indicate that the use of hydrochlorothiazide may contribute to an unfavorable lipid profile, potentially increasing the risk of cardiovascular disease in some patients.

Monitoring Lipid Levels During Hydrochlorothiazide Therapy

Due to the potential impact of hydrochlorothiazide on lipid metabolism, it is important for healthcare providers to monitor patients’ lipid levels during treatment. Patients with pre-existing hyperlipidemia may require closer monitoring and potential adjustments to their lipid-lowering regimen to ensure optimal management of their cardiovascular risk factors.

Regular monitoring of serum triglyceride and cholesterol levels, including LDL and VLDL, can help healthcare providers identify any significant changes and make appropriate treatment decisions. This may include adjusting the dose of hydrochlorothiazide, adding or modifying lipid-lowering medications, or considering alternative antihypertensive therapies that have a more favorable impact on lipid profiles.

Potential Mechanisms of Hydrochlorothiazide’s Effects on Lipids

The exact mechanisms by which hydrochlorothiazide and other thiazide diuretics can impact lipid metabolism are not fully understood. However, several potential mechanisms have been proposed based on the available evidence:

1. Increased hepatic very-low-density lipoprotein (VLDL) production: Thiazide diuretics may stimulate the liver to produce more VLDL, leading to increased serum triglyceride and VLDL cholesterol levels.
2. Decreased lipoprotein lipase activity: Thiazide diuretics may reduce the activity of lipoprotein lipase, an enzyme responsible for the clearance of triglyceride-rich lipoproteins, contributing to hypertriglyceridemia.
3. Alterations in insulin sensitivity: Thiazide diuretics have been associated with a reduction in insulin sensitivity, which can lead to increased hepatic VLDL production and decreased peripheral triglyceride clearance.
4. Diuretic-induced potassium depletion: Thiazide diuretics can cause potassium depletion, which may impair the regulation of lipid metabolism and contribute to the observed changes in lipid profiles.

These potential mechanisms highlight the complex interplay between hydrochlorothiazide, diuretic-induced metabolic changes, and lipid metabolism. Further research is needed to fully elucidate the underlying processes and develop strategies to mitigate the undesirable effects of hydrochlorothiazide on lipid profiles.

Conclusion

In summary, hydrochlorothiazide, a commonly prescribed diuretic medication, can interact with alcohol and have an impact on lipid metabolism. The concomitant use of hydrochlorothiazide and alcohol may lead to additive effects in lowering blood pressure, potentially causing various side effects. Additionally, hydrochlorothiazide and other thiazide diuretics have been associated with increases in serum triglyceride and cholesterol levels, particularly LDL and VLDL cholesterol.

Healthcare providers should be aware of these interactions and monitor patients closely during hydrochlorothiazide therapy, especially those with pre-existing hyperlipidemia. Regular monitoring of lipid profiles and appropriate adjustments to treatment plans, including potential modifications to lipid-lowering regimens, may be necessary to ensure optimal management of cardiovascular risk factors in patients receiving hydrochlorothiazide.

Hydrochlorothiazide and Alcohol/Food Interactions – Drugs.com

Print

Save

There are 2 alcohol/food/lifestyle interactions with hydrochlorothiazide.

HydroCHLOROthiazide and ethanol may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

thiazides – hyperlipidemia

Thiazide diuretics may increase serum triglyceride and cholesterol levels, primarily LDL and VLDL. Whether these effects are dose-related and sustained during chronic therapy are unknown. Patients with preexisting hyperlipidemia may require closer monitoring during thiazide therapy, and adjustments made accordingly in their lipid-lowering regimen

References

1. Pollare T, Lithell H, Berne C “A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension.” N Engl J Med 321
   (1989): 868-73
2. Ames RP, Hill P “Increase in serum-lipids during treatment of hypertension with chlorthalidone.” Lancet 1
   (1976): 721-3
3. Pollare T, Lithell H, Berne C “A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension.” N Engl J Med 321
   (1989): 868-73
4. Fager G, Berglund G, Bondjers G, Elmfeldt D, Lager I, Olofsson SO, Smith U, Wiklund O “Effects of anti-hypertensive therapy on serum lipoproteins. Treatment with metoprolol, propranolol and hydrochlorothiazide.” Artery 11
   (1983): 283-96
5. Beling S, Vukovich RA, Neiss ES, Zisblatt M, Webb E, Losi M “Long-term experience with indapamide.” Am Heart J 106
   (1983): 258-62
6. Slotkoff L “Clinical efficacy and safety of indapamide in the treatment of edema.” Am Heart J 106
   (1983): 233-7
7. “Product Information. HydroDIURIL (hydrochlorothiazide).” Merck & Co., Inc
   (2002):
8. “Product Information. Lozol (indapamide).” Rhone Poulenc Rorer
   (2002):
9. Luther RR, Glassman HN, Estep CB, Maurath CJ, Jordan DC “The effects of terazosin and methyclothiazide on blood pressure and serum lipids.” Am Heart J 117
   (1989): 842-7
10. “Product Information. Zaroxolyn (metolazone).” Rhone Poulenc Rorer
    (2001):
11. “Product Information. Thalitone (chlorthalidone).” Monarch Pharmaceuticals Inc
    (2001):
12. “Product Information. Diuril (chlorothiazide).” Merck & Co., Inc
    (2001):
13. Smith WM “Diuretics and cholesterol elevation.” JAMA 242
    (1979): 1612
14. “Product Information. Enduron (methyclothiazide).” Abbott Pharmaceutical
    (2001):
15. “Product Information. Metahydrin (trichlormethiazide).” Hoechst Marion Roussel
    (2001):
16. “Product Information. Diucardin (hydroflumethiazide).” Wyeth-Ayerst Laboratories
    (2001):
17. Elmfeldt D, Berglund G, Wedel H, Wilhelmsen L “Incidence and importance of metabolic side-effects during antihypertensive therapy.” Acta Med Scand Suppl 672
    (1983): 79-83
18. Winchester JF, Kellett RJ, Boddy K, Boyle P, Dargie HJ, Mahaffey ME, Ward DM, Kennedy AC “Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations. ” Clin Pharmacol Ther 28
    (1980): 611-8
19. Petri M, Cumber P, Grimes L, Treby D, Bryant R, Rawlins D, Ising H “The metabolic effects of thiazide therapy in the elderly: a population study.” Age Ageing 15
    (1986): 151-5
20. “Product Information. Renese-R (reserpine-polythiazide).” Pfizer US Pharmaceuticals, New York, NY.
21. Kasiske BL, Ma JZ, Kalil RS, Louis TA “Effects of antihypertensive therapy on serum lipids.” Ann Intern Med 122
    (1995): 133-41
22. Freis ED “The efficacy and safety of diuretics in treating hypertension.” Ann Intern Med 122
    (1995): 223-6
23. Ames RP “A comparison of blood lipid and blood pressure responses during the treatment of systemic hypertension with indapamide and with thiazides.” Am J Cardiol 77
    (1996): b12-6

View all 23 references

Hydrochlorothiazide drug interactions

There are 452 drug interactions with hydrochlorothiazide.

Hydrochlorothiazide disease interactions

There are 11 disease interactions with hydrochlorothiazide which include:

• anuria
• electrolyte losses
• liver disease
• lupus erythematosus
• renal function disorders
• asthma
• diabetes
• hyperlipidemia
• hyperparathyroidism
• hyperuricemia
• thyroid function tests

Report options

Loading…

QR code containing a link to this page

More about hydrochlorothiazide

• hydrochlorothiazide consumer information
• Check interactions
• Compare alternatives
• Pricing & coupons
• Reviews (183)
• Drug images
• Latest FDA alerts (2)
• Side effects
• Dosage information
• Patient tips
• During pregnancy
• Support group
• Drug class: thiazide diuretics
• Breastfeeding
• En español

Related treatment guides

• Edema
• Diabetes Insipidus
• Osteoporosis
• High Blood Pressure
• Nephrocalcinosis

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major	Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate	Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor	Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown	No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Hydrochlorothiazide/lisinopril and Alcohol/Food Interactions – Drugs.com

Print

Save

There are 5 alcohol/food/lifestyle interactions with hydrochlorothiazide / lisinopril.

Although hydroCHLOROthiazide and lisinopril are frequently combined together, their effects may be additive on lowering your blood pressure. You may need a dose adjustment or special tests to safely take both medications. Contact your doctor if you have a reduced heart rate, dizziness, fainting, or headaches. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

HydroCHLOROthiazide and ethanol may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

Consumer information for this interaction is not currently available.

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

1. Sternbach H “Fluoxetine-associated potentiation of calcium-channel blockers.” J Clin Psychopharmacol 11
   (1991): 390-1
2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA “Ethanol intoxication complicating intravenous nitroglycerin therapy.” Ann Intern Med 101
   (1984): 498-9
3. Feder R “Bradycardia and syncope induced by fluoxetine.” J Clin Psychiatry 52
   (1991): 139
4. Ellison JM, Milofsky JE, Ely E “Fluoxetine-induced bradycardia and syncope in two patients. ” J Clin Psychiatry 51
   (1990): 385-6
5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. “Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients.” Ther Drug Monit 23
   (2001): 435-40
6. Cerner Multum, Inc. “Australian Product Information.” O 0
7. Pacher P, Kecskemeti V “Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?” Curr Pharm Des 10
   (2004): 2463-75
8. Andrews C, Pinner G “Postural hypotension induced by paroxetine.” BMJ 316
   (1998): 595

View all 8 references

Consumer information for this interaction is not currently available.

GENERALLY AVOID: Moderate-to-high dietary intake of potassium can cause hyperkalemia in some patients who are using angiotensin converting enzyme (ACE) inhibitors. In some cases, affected patients were using a potassium-rich salt substitute. ACE inhibitors can promote hyperkalemia through inhibition of the renin-aldosterone-angiotensin (RAA) system.

MANAGEMENT: It is recommended that patients who are taking ACE inhibitors be advised to avoid moderately high or high potassium dietary intake. Particular attention should be paid to the potassium content of salt substitutes.

References

1. “Product Information. Vasotec (enalapril).” Merck & Co., Inc
   (2002):
2. Good CB, McDermott L “Diet and serum potassium in patients on ACE inhibitors.” JAMA 274
   (1995): 538
3. Ray K, Dorman S, Watson R “Severe hyperkalaemia due to the concomitant use of salt substitutes and ACE inhibitors in hypertension: a potentially life threatening interaction.” J Hum Hypertens 13
   (1999): 717-20

thiazides – hyperlipidemia

Thiazide diuretics may increase serum triglyceride and cholesterol levels, primarily LDL and VLDL. Whether these effects are dose-related and sustained during chronic therapy are unknown. Patients with preexisting hyperlipidemia may require closer monitoring during thiazide therapy, and adjustments made accordingly in their lipid-lowering regimen

References

1. Pollare T, Lithell H, Berne C “A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension.” N Engl J Med 321
   (1989): 868-73
2. Ames RP, Hill P “Increase in serum-lipids during treatment of hypertension with chlorthalidone.” Lancet 1
   (1976): 721-3
3. Pollare T, Lithell H, Berne C “A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension.” N Engl J Med 321
   (1989): 868-73
4. Fager G, Berglund G, Bondjers G, Elmfeldt D, Lager I, Olofsson SO, Smith U, Wiklund O “Effects of anti-hypertensive therapy on serum lipoproteins. Treatment with metoprolol, propranolol and hydrochlorothiazide.” Artery 11
   (1983): 283-96
5. Beling S, Vukovich RA, Neiss ES, Zisblatt M, Webb E, Losi M “Long-term experience with indapamide.” Am Heart J 106
   (1983): 258-62
6. Slotkoff L “Clinical efficacy and safety of indapamide in the treatment of edema.” Am Heart J 106
   (1983): 233-7
7. “Product Information. HydroDIURIL (hydrochlorothiazide).” Merck & Co., Inc
   (2002):
8. “Product Information. Lozol (indapamide).” Rhone Poulenc Rorer
   (2002):
9. Luther RR, Glassman HN, Estep CB, Maurath CJ, Jordan DC “The effects of terazosin and methyclothiazide on blood pressure and serum lipids.” Am Heart J 117
   (1989): 842-7
10. “Product Information. Zaroxolyn (metolazone).” Rhone Poulenc Rorer
    (2001):
11. “Product Information. Thalitone (chlorthalidone).” Monarch Pharmaceuticals Inc
    (2001):
12. “Product Information. Diuril (chlorothiazide).” Merck & Co., Inc
    (2001):
13. Smith WM “Diuretics and cholesterol elevation.” JAMA 242
    (1979): 1612
14. “Product Information. Enduron (methyclothiazide).” Abbott Pharmaceutical
    (2001):
15. “Product Information. Metahydrin (trichlormethiazide).” Hoechst Marion Roussel
    (2001):
16. “Product Information. Diucardin (hydroflumethiazide).” Wyeth-Ayerst Laboratories
    (2001):
17. Elmfeldt D, Berglund G, Wedel H, Wilhelmsen L “Incidence and importance of metabolic side-effects during antihypertensive therapy.” Acta Med Scand Suppl 672
    (1983): 79-83
18. Winchester JF, Kellett RJ, Boddy K, Boyle P, Dargie HJ, Mahaffey ME, Ward DM, Kennedy AC “Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations. ” Clin Pharmacol Ther 28
    (1980): 611-8
19. Petri M, Cumber P, Grimes L, Treby D, Bryant R, Rawlins D, Ising H “The metabolic effects of thiazide therapy in the elderly: a population study.” Age Ageing 15
    (1986): 151-5
20. “Product Information. Renese-R (reserpine-polythiazide).” Pfizer US Pharmaceuticals, New York, NY.
21. Kasiske BL, Ma JZ, Kalil RS, Louis TA “Effects of antihypertensive therapy on serum lipids.” Ann Intern Med 122
    (1995): 133-41
22. Freis ED “The efficacy and safety of diuretics in treating hypertension.” Ann Intern Med 122
    (1995): 223-6
23. Ames RP “A comparison of blood lipid and blood pressure responses during the treatment of systemic hypertension with indapamide and with thiazides.” Am J Cardiol 77
    (1996): b12-6

View all 23 references

Hydrochlorothiazide/lisinopril drug interactions

There are 595 drug interactions with hydrochlorothiazide / lisinopril.

Hydrochlorothiazide/lisinopril disease interactions

There are 19 disease interactions with hydrochlorothiazide / lisinopril which include:

• angioedema
• bone marrow suppression
• CHF
• hemodialysis
• hyperkalemia
• hypotension
• anuria
• electrolyte losses
• liver disease
• lupus erythematosus
• renal function disorders
• liver disease
• renal dysfunction
• asthma
• diabetes
• hyperlipidemia
• hyperparathyroidism
• hyperuricemia
• thyroid function tests

Report options

Loading…

QR code containing a link to this page

More about hydrochlorothiazide / lisinopril

• hydrochlorothiazide/lisinopril consumer information
• Check interactions
• Compare alternatives
• Pricing & coupons
• Reviews (78)
• Drug images
• Side effects
• Dosage information
• During pregnancy
• Drug class: ACE inhibitors with thiazides
• En español

Related treatment guides

• Heart Failure
• High Blood Pressure

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major	Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate	Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor	Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown	No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Hydrochlorothiazide – description of the substance, pharmacology, use, contraindications, formula

Contents

• Structural formula

• Russian name

• English title

• Latin name

• chemical name

• Gross formula

• Pharmacological group of the substance Hydrochlorothiazide

• Nosological classification

• CAS code

• pharmachologic effect

• Characteristic

• Pharmacology

• Application of the substance Hydrochlorothiazide

• Contraindications

• Application restrictions

• Use during pregnancy and lactation

• Side effects of hydrochlorothiazide

• Interaction

• Overdose

• Dosage and administration

• Precautionary measures

• Trade names with the active substance Hydrochlorothiazide

Structural formula

Russian name

Hydrochlorothiazide

English name

Hydrochlorothiazide

Latin name

Hydrochlorothiazidum ( genus Hydrochlorothiazidi)

Chemical name

3

C ₇ H ₈ ClN ₃ O ₄ S ₂

Pharmacological group of the substance Hydrochlorothiazide

Diuretics

Nosological classification

ICD-10 code list

CAS code

58-93-5

Pharmacological action

Pharmacological action –

hypotensive , diuretic .

Characteristics

White or yellowish crystalline powder. Slightly soluble in water, sparingly soluble in methanol, insoluble in ether, freely soluble in alkaline solutions. Molecular weight 297.72.

Pharmacology

Reduces the reabsorption of sodium and chloride ions (to a lesser extent – potassium and bicarbonates) in the proximal tubules of the kidneys, increases the excretion of magnesium ions, reduces – calcium ions, uric acid. It inhibits the reactivity of the vascular wall in relation to the vasoconstrictive effects of mediators due to a decrease in the concentration of sodium ions in the cytoplasm of vascular myocytes, reduces BCC, lowers blood pressure.

Incompletely, but fairly rapidly absorbed from the gastrointestinal tract. In the blood, 40–60% binds to proteins. Penetrates through the hematoplacental barrier and into breast milk. Excreted by the kidneys. The diuretic effect develops after 30-60 minutes, reaches a maximum after 4-6 hours, persists for 6-12 hours.

The use of the substance Hydrochlorothiazide

chronic heart failure, nephrotic syndrome, premenstrual syndrome, acute glomerulonephritis, chronic renal failure, portal hypertension, corticosteroid treatment), control of polyuria (mainly in nephrogenic diabetes insipidus), prevention of urinary tract stones in predisposed patients (reduction of hypercalciuria).

Contraindications

Hypersensitivity (including to other sulfonamides), anuria, severe renal (Cl creatinine – less than 30 ml / min) or liver failure, difficult-to-control diabetes mellitus, Addison’s disease, gout, children’s age (up to 3 years ).

Restrictions for use

Hypokalemia, hyponatremia and hypercalcemia, ischemic heart disease, concomitant use of cardiac glycosides, impaired liver and kidney function, pregnancy, old age.

Use during pregnancy and lactation

FDA fetal category B.

Breastfeeding should be discontinued during treatment.

Substance side effects Hydrochlorothiazide

Electrolyte imbalance

Hypokalemia, hypomagnesemia, hypercalcemia and hypochloremic alkalosis: dry mouth, thirst, irregular heart rhythm, changes in mood or psyche, cramps and muscle 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 effects: hyperglycemia, glucosuria, hyperuricemia with the development of an attack of gout. Treatment with thiazides may reduce glucose tolerance, and latent diabetes mellitus may manifest. At high doses, serum lipid levels may increase.

From the digestive tract: cholecystitis or pancreatitis, cholestatic jaundice, diarrhea, sialadenitis, constipation, anorexia.

From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): arrhythmias, orthostatic hypotension, vasculitis; very rarely – leukopenia, agranulocytosis, thrombocytopenia, hemolytic anemia, aplastic anemia.

From the nervous system and sensory organs: dizziness, blurred vision (temporarily), headache, paresthesia.

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: decreased potency, impaired renal function, interstitial nephritis.

Interactions

Simultaneous use of hydrochlorothiazide with lithium salts should be avoided (renal clearance of lithium decreases, its toxicity increases).

It should be used with caution with antihypertensive drugs (their action is potentiated, it may be necessary to adjust the dose), cardiac glycosides (hypokalemia and hypomagnesemia associated with the action of thiazide diuretics may increase digitalis toxicity), amiodarone (its use simultaneously with thiazide diuretics may lead to an increased risk of arrhythmias associated with hypokalemia), oral hypoglycemic agents (their effectiveness decreases, hyperglycemia may develop), corticosteroids, calcitonin (increase potassium excretion), NSAIDs (may weaken the diuretic and hypotensive effect of thiazides), non-depolarizing muscle relaxants (their the effect may be enhanced), amantadine (clearance of amantadine may be reduced by hydrochlorothiazide, which leads to an increase in plasma concentrations of amantadine and possible toxicity), colestyramine (reduces the absorption of hydrochlorothiazide), ethanol, barbiturates and narcotic analgesics, which increase the effect of orthostatic hypotension.

Thiazides may reduce plasma levels of protein-bound iodine.

Thiazides should be discontinued before performing parathyroid function tests. Serum bilirubin concentration may be elevated.

Overdose

Symptoms: dehydration, severe electrolyte disturbances, confusion, dry mouth, lethargy, muscle weakness, drowsiness, tachycardia, hypotension, oliguria, decreased blood pressure, shock.

Treatment: induction of vomiting, gastric lavage, intravenous fluid, electrolytes, symptomatic therapy. The specific antidote is unknown.

Dosage and administration

Inside. The dosing regimen is set 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), it becomes necessary to replace potassium and magnesium. With arterial hypertension – 25-50 mg 1 time per day (for some patients, an initial dose of 12. 5 mg is enough), with edematous syndrome – 25-100 (up to 200) mg / day. For children from 3 years old, the daily dose is 1-2 mg / kg, 3-12 years old – 37.5-100 mg / day.

Precautions

With prolonged course treatment, it is necessary to carefully monitor the clinical symptoms of fluid and electrolyte imbalance, primarily in high-risk patients: patients with diseases of the cardiovascular system and impaired liver function; in case of severe vomiting or if there are signs of a violation of the water and electrolyte balance, such as dry mouth, thirst, weakness, lethargy, drowsiness, anxiety, muscle pain or cramps, muscle weakness, hypotension, oliguria, tachycardia, complaints from the gastrointestinal tract.

Hypokalemia, especially in case of increased potassium loss (increased diuresis, prolonged treatment) or concomitant treatment with digitalis glycosides or corticosteroid drugs, can be avoided by the use of potassium-containing drugs or potassium-rich foods (fruits, vegetables). Thiazides have been shown to increase urinary excretion of magnesium, which may lead to hypomagnesemia.

If renal function is impaired, creatinine clearance needs to be monitored. In patients with impaired renal function, the drug may cause azotemia, and cumulative effects may also develop. If impaired renal function is evident, discontinuation of the drug should be considered upon the onset of oliguria.

In patients with impaired liver function or progressive liver disease, thiazides should be used with caution because slight changes in fluid and electrolyte balance, as well as serum ammonium levels, can cause hepatic coma.

In the case of severe cerebral and coronary sclerosis, the administration of the drug requires special care.

Treatment with thiazide drugs may impair glucose tolerance. During a long course of treatment with manifesting or latent diabetes mellitus, systematic monitoring of carbohydrate metabolism is necessary; it may be necessary to change the dose of hypoglycemic drugs. Enhanced monitoring of patients with impaired uric acid metabolism is required.

Alcohol, barbiturates, narcotic analgesics increase the orthostatic hypotensive effect of thiazide diuretics.

With long-term therapy, in rare cases, a pathological change in the parathyroid glands was observed, accompanied by hypercalcemia and hypophosphatemia. Thiazides can reduce the amount of iodine that binds to serum proteins without showing signs of thyroid dysfunction.

Patients suffering from lactose intolerance may experience gastrointestinal complaints due to the presence of lactose in the composition of the tablets.

At the initial stage of drug use (the duration of this period is determined individually), it is forbidden to drive a car and perform work that requires increased attention.

Trade names with active substance Hydrochlorothiazide

Reset filters

Lek. form
All lek. forms substance substance-powder tablets

Dosage
All dosages 100 mg 25 mg No dosage

Manufacturer
All manufacturers Biochemist JSC Biochemist JSC Borisov Plant of Medical Preparations JSC (JSC “BZMP”) Valenta Pharmaceutics JSC (JSC “Valenta Pharm”) Valenta Pharmaceutics PJSC (PJSC “Valenta Pharm”) Ipka Laboratories Ltd. Cambrex Propharmaco Milan S.r.L. Ozone LLC Opella Healthcare Hungary Ltd. Polpharma S.A., Poland Pharmaceutical plant Pranapharm CTIX Life Science Pvt. Ltd. Pharmasyntez-Tyumen Pharmstandard-Leksredstva LLC Quinoin Plant of Pharmaceutical and Chemical Products ZAO Chanzhou Pharmaceutical Factory Unikem Laboratories Ltd.

Co-Vamloset tablet film 10 mg + 160 mg + 25 mg x30

Amlodipine + valsartan + hydrochlorothiazide

When using the drug, adverse events were mostly mild or moderately pronounced. Termination of treatment with the drug due to the development of adverse events was required in rare cases. Most often, the drug was discontinued due to the development of dizziness and a pronounced decrease in blood pressure.

No new adverse events were identified with the use of the drug compared with dual combination therapy and monotherapy with individual components.

As with short-term use, the drug was well tolerated with long-term use (within a year).

The incidence of adverse events was not related to gender, age or race.

When using the drug, changes in laboratory parameters were minimal and did not differ from those during monotherapy with individual components. With the simultaneous use of hydrochlorothiazide together with valsartan (triple combination therapy), there is a decrease in the hypokalemic effect of hydrochlorothiazide.

The most common adverse events reported in clinical studies (whether or not associated with the use of the drug) were dizziness, peripheral edema, headache, dyspepsia, fatigue, muscle spasm, back pain, nasopharyngitis, nausea.

The following criteria were used to estimate the frequency (according to WHO classification): very often (≥1/10), often (≥1/100, &lt.1/10), infrequently (≥1/1000, &lt.1/100) , rare (≥1 / 10,000, &lt,1/1000), very rare (&lt,1/10,000), frequency unknown (not enough data to estimate the frequency of development).

From the side of metabolism: often – hypokalemia, infrequently – hypercalcemia, hyperlipidemia, hyponatremia.

From the side of the nervous system: often – dizziness, headache, infrequently – insomnia / sleep disturbances, coordination disorders, postural dizziness and dizziness due to exercise, taste disorders, lethargy, paresthesia, neuropathy, incl. peripheral, drowsiness, fainting.

Sense organs: infrequently – visual disturbances, vertigo.

From the side of the cardiovascular system: often – a pronounced decrease in blood pressure, infrequently – tachycardia, orthostatic hypotension, phlebitis, thrombophlebitis.

From the respiratory system: infrequently – cough, shortness of breath, irritation in the throat.

From the digestive system: often – dyspepsia, infrequently – anorexia, abdominal discomfort, pain in the upper abdomen, bad breath, diarrhea, dry mouth, nausea, vomiting.

Dermatological reactions: infrequently – increased sweating, itching.

From the musculoskeletal system and connective tissue: infrequently – back pain, swelling in the joints, muscle spasms, muscle weakness, myalgia, pain in the extremities.

From the urinary system: often – pollakiuria, infrequently – increased plasma creatinine concentration, acute renal failure.

From the reproductive system: infrequently – erectile dysfunction.

On the part of the body as a whole: often – peripheral edema, increased fatigue, infrequently – abasia, gait disturbances, asthenia, general weakness, pain in the chest area.

From the side of laboratory parameters: infrequently – an increase in the content of urea nitrogen in the blood plasma, hyperuricemia, weight gain.

Amlodipine

, &lt,1/100), rarely (≥1/10,000, &lt,1/1000), very rare (&lt,1/10,000), the frequency is unknown (there is not enough data to estimate the frequency of development).

From the side of the hematopoietic system: very rarely – leukopenia, thrombocytopenia.

From the immune system: very rarely – hypersensitivity reactions.

From the side of metabolism: very rarely – hyperglycemia.

From the nervous system: often – dizziness, headache, drowsiness, infrequently – insomnia / sleep disturbances, mood lability, paresthesia, fainting, tremor, very rarely – muscular hypertension, peripheral neuropathy, neuropathy, frequency unknown – extrapyramidal disorders .

From the senses: infrequently – visual disturbances, tinnitus, taste disturbances.

From the side of the cardiovascular system: often – a feeling of palpitations, flushing of the face, infrequently – a pronounced decrease in blood pressure, very rarely – vasculitis, arrhythmias (including bradycardia, ventricular tachycardia, atrial fibrillation).

From the respiratory system: infrequently – shortness of breath, rhinitis, very rarely – cough.

From the digestive system: often – abdominal discomfort, pain in the upper abdomen, nausea, infrequently – change in the frequency of defecation, diarrhea, dry mouth, dyspepsia, vomiting, very rarely – gastritis, gingival hyperplasia, pancreatitis.

From the side of the liver and biliary tract: very rarely – increased activity of liver enzymes, increased plasma bilirubin concentration, hepatitis, intrahepatic cholestasis, jaundice.

Dermatological reactions: infrequently – alopecia, increased sweating, itching, rash, incl. exanthema, purpura, discoloration of the skin, very rarely – angioedema, erythema multiforme, urticaria.

From the musculoskeletal system and connective tissue: infrequently – arthralgia, back pain, muscle spasms, myalgia.

From the urinary system: infrequently – urination disorders, nocturia, pollakiuria.

From the reproductive system: infrequently – erectile dysfunction, gynecomastia.

On the part of the body as a whole: often – increased fatigue, edema, infrequently – asthenia, discomfort, general weakness, pain in the chest, pain of various localization.

From the side of laboratory parameters: infrequently – increase or decrease in body weight.

Valsartan

The following criteria were used to estimate the frequency (according to WHO classification): very often (≥1/10), often (≥1/100, &lt,1/10), infrequently (≥ 1/1000, &lt ,1/100), rarely (≥ 1/10,000, &lt,1/1000), very rare (&lt,1/10,000), the frequency is unknown (there is not enough data to estimate the frequency of development).

From the side of the hematopoietic system: the frequency is unknown – a decrease in hemoglobin and hematocrit, leukopenia, thrombocytopenia.

From the immune system: frequency unknown – hypersensitivity reactions.

On the part of the organ of hearing: infrequently – vertigo.

From the side of the cardiovascular system: the frequency is unknown – vasculitis.

From the respiratory system: infrequently – cough.

From the digestive system: infrequently – abdominal discomfort, pain in the upper abdomen.

From the side of the liver and biliary tract: frequency unknown – increased activity of liver enzymes, increased plasma bilirubin concentration.

Allergic reactions: frequency unknown – angioedema, itching, rash.

From the musculoskeletal system: the frequency is unknown – myalgia.

From the urinary system: the frequency is unknown – an increase in the concentration of creatinine in the blood plasma, impaired renal function, including acute renal failure.

On the part of the body as a whole: infrequently – increased fatigue.

From the side of laboratory parameters: the frequency is unknown – an increase in the content of potassium in the blood plasma.

In clinical studies with the use of valsartan in monotherapy, the following adverse events were noted (regardless of their causal relationship with the study drug): viral infections, upper respiratory tract infections, sinusitis, rhinitis, neutropenia, insomnia.

In rare cases, the use of valsartan may be accompanied by a decrease in hemoglobin and hematocrit. In controlled studies, in 0.8% and 0.4% of patients treated with valsartan, there was a significant decrease (more than 20%) in hematocrit and hemoglobin, respectively. For comparison, in patients receiving placebo, a decrease in both hematocrit and hemoglobin was noted in 0.1% of cases.

Neutropenia was detected in 1.9% of patients treated with valsartan and in 1.6% of patients treated with an ACE inhibitor.

In controlled studies, 3.9% and 16.6% of patients with chronic heart failure treated with valsartan showed an increase in the concentration of creatinine and blood urea nitrogen by more than 50%, respectively. For comparison, in patients receiving placebo, an increase in the concentration of creatinine and urea nitrogen was observed in 0.9% and 6.3% of cases.

A doubling of serum creatinine concentration was detected in 4.2% of patients after myocardial infarction who received valsartan and in 3.4% who received captopril.

In controlled studies, 10% of patients with chronic heart failure showed an increase in serum potassium by more than 20%. For comparison, in patients receiving placebo, an increase in potassium was observed in 5.1% of cases.

Hydrochlorothiazide

The following criteria were used to estimate the frequency (according to WHO classification): very often (≥1/10), often (≥1/100, &lt,1/10), infrequently (≥1/1000, &lt ,1/100), rarely (≥1/10,000, &lt,1/1000), very rare (&lt,1/10,000), the frequency is unknown (there is not enough data to estimate the frequency of development).

From the side of the hematopoietic system: rarely – thrombocytopenia, very rarely – agranulocytosis, depression of bone marrow hematopoiesis, hemolytic anemia, leukopenia.

From the immune system: very rarely – hypersensitivity reactions.

From the side of metabolism: often – hypokalemia, infrequently – hyperuricemia, hypomagnesemia, hyponatremia, rarely – hypercalcemia, hyperglycemia, very rarely – hypochloremic alkalosis.

From the nervous system: rarely – insomnia / sleep disturbances, depression, dizziness, headache, lethargy.

On the part of the organ of vision: infrequently – visual disturbances.

From the side of the cardiovascular system: infrequently – orthostatic hypotension, rarely – arrhythmias (including bradycardia, ventricular tachycardia, atrial fibrillation).

From the respiratory system: very rarely – respiratory distress syndrome, pulmonary edema and pneumonitis.

From the digestive system: infrequently – loss of appetite, nausea, vomiting, rarely – abdominal discomfort, pain in the upper abdomen, constipation, diarrhea, very rarely – pancreatitis.

From the side of the liver and biliary tract: rarely – hepatitis, intrahepatic cholestasis, jaundice.

Dermatological reactions: infrequently – rash, urticaria, rarely – increased photosensitivity, purpura, very rarely – necrotizing vasculitis, toxic epidermal necrolysis, lupus-like reactions, exacerbation of skin manifestations of systemic lupus erythematosus ki.