How does hydrochlorothiazide interact with alcohol. What are the potential side effects of combining these substances. Why should patients be cautious when consuming alcohol while taking hydrochlorothiazide. How can patients manage their blood pressure effectively while on this medication.

Understanding Hydrochlorothiazide: A Powerful Diuretic for Blood Pressure Management

Hydrochlorothiazide is a widely prescribed diuretic medication used to treat high blood pressure and fluid retention. As a thiazide diuretic, it works by helping the kidneys remove excess water and salt from the body, effectively lowering blood pressure. However, like many medications, hydrochlorothiazide can interact with various substances, including alcohol, potentially leading to adverse effects.

The Interaction Between Hydrochlorothiazide and Alcohol: A Cause for Concern

When hydrochlorothiazide and alcohol are consumed together, they can have additive effects on lowering blood pressure. This combination may result in several symptoms that patients should be aware of:

• Headache
• Dizziness
• Lightheadedness
• Fainting
• Changes in pulse or heart rate

These side effects are most likely to occur at the beginning of treatment, after a dose increase, or when resuming treatment following an interruption. It’s crucial for patients to monitor their symptoms and communicate any persistent or troublesome effects to their healthcare provider.

When Are These Side Effects Most Likely to Occur?

The interaction between hydrochlorothiazide and alcohol is most pronounced during the following situations:

1. Initial stages of treatment
2. After an increase in medication dosage
3. When restarting treatment after a break

Patients should be particularly vigilant during these periods and consider abstaining from alcohol consumption to minimize the risk of adverse effects.

Safety Precautions: Navigating Daily Activities While on Hydrochlorothiazide

Given the potential for dizziness and lightheadedness, patients taking hydrochlorothiazide should exercise caution in their daily activities. Here are some important safety measures to consider:

• Avoid driving or operating hazardous machinery until you understand how the medication affects you
• Use caution when transitioning from a sitting or lying position to standing
• Inform your healthcare provider about all other medications, vitamins, and herbs you are taking
• Never stop taking hydrochlorothiazide without first consulting your doctor

By following these precautions, patients can help minimize the risk of accidents or injuries related to the medication’s side effects.

Hydrochlorothiazide and Lipid Levels: An Important Consideration

In addition to its interaction with alcohol, hydrochlorothiazide may have an impact on lipid levels in the body. Studies have shown that thiazide diuretics can potentially increase serum triglyceride and cholesterol levels, primarily affecting LDL (low-density lipoprotein) and VLDL (very low-density lipoprotein) cholesterol.

Are These Effects Dose-Dependent?

The relationship between hydrochlorothiazide dosage and its impact on lipid levels is not fully understood. It remains unclear whether these effects are dose-related and whether they persist during long-term therapy. This uncertainty highlights the importance of regular monitoring for patients taking hydrochlorothiazide, especially those with pre-existing hyperlipidemia.

Monitoring and Management of Lipid Levels

For patients with pre-existing hyperlipidemia, closer monitoring may be necessary during thiazide therapy. Healthcare providers may need to adjust lipid-lowering regimens accordingly to maintain optimal cholesterol levels. Regular lipid panel tests can help track changes and guide treatment decisions.

Balancing the Benefits and Risks of Hydrochlorothiazide Therapy

While hydrochlorothiazide is an effective medication for managing hypertension and fluid retention, patients and healthcare providers must weigh its benefits against potential risks and side effects. The decision to use hydrochlorothiazide should be based on individual patient factors, including:

• Overall health status
• Existing medical conditions
• Other medications being taken
• Lifestyle factors, including alcohol consumption

By carefully considering these factors, healthcare providers can determine the most appropriate treatment plan for each patient.

Alternative Treatments and Lifestyle Modifications

For patients concerned about the potential interactions between hydrochlorothiazide and alcohol, or those experiencing significant side effects, there may be alternative treatment options to consider. These could include:

• Other classes of antihypertensive medications
• Combination therapies with lower doses of multiple medications
• Lifestyle modifications to support blood pressure management

Lifestyle Changes to Support Blood Pressure Control

In addition to medication, several lifestyle modifications can help manage blood pressure effectively:

1. Maintaining a healthy diet low in sodium and rich in fruits, vegetables, and whole grains
2. Engaging in regular physical activity
3. Achieving and maintaining a healthy weight
4. Limiting alcohol consumption
5. Quitting smoking
6. Managing stress through relaxation techniques or therapy

These lifestyle changes can complement medication therapy and may even reduce the need for higher doses of hydrochlorothiazide or additional medications.

The Importance of Open Communication with Healthcare Providers

Effective management of hypertension with hydrochlorothiazide requires open and honest communication between patients and their healthcare providers. Patients should feel comfortable discussing:

• Any side effects experienced, no matter how minor they may seem
• Concerns about alcohol consumption and its interaction with the medication
• Changes in lifestyle or other medications
• Questions about alternative treatment options

By maintaining an open dialogue, patients and healthcare providers can work together to optimize treatment plans and ensure the best possible outcomes.

Regular Check-ups and Monitoring

Patients taking hydrochlorothiazide should adhere to a regular schedule of check-ups and monitoring. These appointments may include:

1. Blood pressure measurements
2. Blood tests to check electrolyte levels
3. Lipid panel tests to monitor cholesterol and triglyceride levels
4. Kidney function tests

Regular monitoring allows healthcare providers to track the medication’s effectiveness, identify any potential side effects early, and make necessary adjustments to the treatment plan.

Patient Education: Empowering Informed Decision-Making

Educating patients about hydrochlorothiazide, its effects, and potential interactions is crucial for promoting medication adherence and overall treatment success. Healthcare providers should ensure that patients understand:

• The purpose of the medication and how it works
• Potential side effects and how to manage them
• The importance of avoiding or limiting alcohol consumption
• Proper dosing and administration instructions
• What to do if a dose is missed
• Signs that indicate a need for immediate medical attention

By providing comprehensive education, healthcare providers can empower patients to take an active role in their treatment and make informed decisions about their health.

Resources for Patient Education

To support patient education efforts, healthcare providers can utilize various resources, including:

1. Written materials such as brochures or handouts
2. Online educational resources from reputable medical organizations
3. Video tutorials or interactive learning modules
4. Support groups for patients with hypertension
5. One-on-one counseling sessions with pharmacists or nurse educators

These resources can help reinforce key information and provide patients with additional support in managing their condition and medication regimen.

Future Research and Developments in Hypertension Treatment

As medical research continues to advance, new insights into the treatment of hypertension and the use of diuretics like hydrochlorothiazide are likely to emerge. Areas of ongoing research include:

• Development of new antihypertensive medications with fewer side effects
• Personalized medicine approaches to tailor treatments to individual patient profiles
• Improved understanding of the long-term effects of thiazide diuretics on lipid metabolism
• Exploration of combination therapies to enhance efficacy and minimize side effects
• Investigation of novel drug delivery systems for more consistent blood pressure control

Staying informed about these developments can help healthcare providers and patients make more informed decisions about hypertension management strategies.

Emerging Technologies in Blood Pressure Monitoring

Advancements in technology are also shaping the future of hypertension management. Some promising developments include:

1. Wearable devices for continuous blood pressure monitoring
2. Smartphone apps for tracking medication adherence and blood pressure readings
3. Telemedicine platforms for remote patient monitoring and consultation
4. Artificial intelligence-powered systems for predicting hypertension risks and optimizing treatment plans

These technologies have the potential to improve patient outcomes by providing more comprehensive data and enabling more timely interventions when needed.

Conclusion: Balancing Effective Treatment with Patient Safety

Hydrochlorothiazide remains an important tool in the management of hypertension and fluid retention. However, its interaction with alcohol and potential effects on lipid levels underscore the need for careful consideration and monitoring during treatment. By understanding these interactions, taking necessary precautions, and maintaining open communication with healthcare providers, patients can maximize the benefits of hydrochlorothiazide therapy while minimizing potential risks.

As research continues to evolve and new treatment options emerge, the landscape of hypertension management will likely see further improvements. In the meantime, a balanced approach that combines effective medication use, lifestyle modifications, and regular monitoring offers the best path forward for patients managing high blood pressure with hydrochlorothiazide.

Ultimately, the goal is to achieve optimal blood pressure control while ensuring patient safety and quality of life. Through collaborative efforts between patients, healthcare providers, and ongoing medical research, this goal can be realized, leading to better outcomes and improved cardiovascular health for millions of individuals worldwide.

Hydrochlorothiazide and Alcohol/Food Interactions – Drugs.com

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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

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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

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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

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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.