Marked reduction in blood pressure with all the clinical effects may be observed after the first dose of pills in patients with severe heart failure and hyponatremia, severe renal insufficiency, hypertension or left ventricular dysfunction and, in particular, in patients in a state of hypovolemia in result of diuretic therapy, salt-free diet, diarrhea, vomiting or hemodialysis. Arterial hypotension after the first dose and its more serious consequences is a rare and passing phenomenon. It is possible to avoid the cancellation of diuretics, if possible, before treatment bayer proviron .
In the case of hypotension patients must be laid on its back with a low headboard and if necessary to adjust the volume of the plasma by infusion of saline. Transient hypotension is not a contraindication to further treatment. After the normalization of blood pressure and volume replacement patients usually tolerate subsequent doses.
Caution is needed when used in patients with impaired renal function (creatinine clearance of 0.5 to 1.3 ml / s) Patients taking hydrochlorothiazide, may develop azotemia . In patients with renal impaired function may show signs of accumulation of the drug.
If necessary, can be used a combination of enalapril with a lower amount of hydrochlorothiazide or a combination therapy with enalapril and hydrochlorothiazide should be abolished.
It should be avoided in patients with bilateral renal artery stenosis or stenosis of the renal artery to a solitary kidney, as this can lead to a deterioration of renal function or even acute renal failure (enalapril effect). Therefore, a control of renal function before and during drug treatment. Requires caution in patients with heart disease ischemicheskoy expressed cerebrovascular diseases, aortic stenosis or stenosis of the other, preventing outflow of blood from the left ventricle, severe atherosclerosis in elderly patients due to the risk of hypotension and deterioration of perfusion of the heart, brain and kidneys. Requires regular monitoring of serum electrolytes during treatment to detect possible imbalance. Determination of serum electrolytes is necessary for patients with prolonged diarrhea, vomiting and receiving intravenous infusion. Patients taking bayer proviron signs should be identified electrolyte imbalance, such as dry mouth, thirst, weakness, drowsiness, lethargy, agitation, muscle pain or cramps (mainly calf muscle), decreased blood pressure, tachycardia, oliguria and gastrointestinal -kishechnye disturbances (nausea, vomiting).
should be used with caution in patients with hepatic impairment or progressive liver disease, since hydrochlorothiazide may cause hepatic coma even with minimal electrolyte disturbances.
during treatment can be marked hypomagnesemia and occasionally hypercalcemia arising a result of increased excretion of magnesium and slow excretion of calcium in the urine under the influence of hydrochlorothiazide. A significant increase in serum calcium levels may be a sign of hidden hyperparathyroidism. In some patients, as a result of action of hydrochlorothiazide may experience worsening of hyperuricemia or gout. If the rise is noted the concentration of uric acid in the blood serum, treatment should be discontinued. It may be resumed after the normalization of laboratory values and in the future, be carried out under their control. Caution is required in all patients receiving treatment with oral hypoglycemic agents or insulin, as hydrochlorothiazide may weaken, and enalapril to strengthen their action. Patients with diabetes should be seen more often, but may require some changes in the dose of hypoglycemic agents, if necessary. In the event of angioedema face or neck it is usually sufficient to cancel the therapy and patient appointment of antihistamines. In more severe cases (swelling of the tongue, pharynx and larynx) angioedema is treated with adrenaline, it is necessary to maintain the airway (intubation or thyroidotomy), antihypertensive effect bayer proviron can be amplified after sympathectomy. Due to the increased risk of anaphylactic reactions should not appoint to patients on hemodialysis with polyacrylonitrile membranes undergoing apheresis with dextran sulfate and immediately before the procedure desensitization to wasp or bee venom.