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Hydrochlorothiazide absorbed primarily in the duodenum and proximal small intestine. Absorption is 70% and increased by 10% when taken with food. The level of the maximum serum concentration is reached in 1.5-5 hours. The volume of distribution of about 3 l / kg. Communication buy proviron online with plasma proteins – 40%. The drug is accumulated in the erythrocytes, accumulation mechanism is not known. Do not metabolized by the liver and excreted mainly by the kidneys: 95% unchanged and about 4% as the hydrolyzate, 2-amino-4-chloro-m-benzenedisulfonamida. Hydrochlorothiazide renal clearance in healthy volunteers and patients with hypertension of approximately 5.58 ml / s (335 ml / min). Hydrochlorothiazide has a biphasic elimination profile. The half-life (T ½ ) in an initial phase of 2 hours, in the final phase (10-12 h after administration) -. About 10 hours, crosses the placental barrier and accumulate in the amniotic fluid. Serum concentrations of hydrochlorothiazide in the blood of the umbilical vein is almost the same as in the maternal blood. In the amniotic fluid concentration exceeds that in serum from umbilical vein (19 times). The level of hydrochlorothiazide in breast milk is very low.
In elderly patients hydrochlorothiazide has no negative effect on the pharmacokinetics of enalapril, but the serum concentration of enalaprilat is better. When assigning hydrochlorothiazide in patients with heart failure found that its absorption decreases proportionally to the degree of the disease – 20 -70%. T ½ of hydrochlorothiazide is increased to 28.9 hours; renal clearance of 0.17 – 3.12 ml / s (10 – 187 ml / min) (mean values of 1.28 ml / s (77 ml / min)) in patients who had undergone intestinal bypass surgery for obesity, suction. hydrochlorothiazide can be reduced by 30%, and the serum concentration by 50% than in healthy volunteers. Co-administration of enalapril and hydrochlorothiazide has no effect on the pharmacokinetics of each.

Indications
Hypertension (in patients who have shown combination therapy).

Contraindications

  • Hypersensitivity (including to the individual components of the drug, or sulfonamides)
  • anuria
  • pronounced renal dysfunction (creatinine clearance less than 30 ml / min)
  • angioedema in history associated with previous ACE inhibitors, as well as hereditary or idiopathic angioedema
    • primary aldosteronism
    • Addison’s disease
    • porphyria
  • age of 18 years (effectiveness and safety have been established).

 

Carefully

  • bilateral renal artery stenosis buy proviron online or stenosis of the artery to a solitary kidney, renal dysfunction (creatinine clearance 30-75 ml / min)
    • pronounced aortic stenosis or idiopathic hypertrophic subaortic stenosis
  • Ischemic heart disease and cerebrovascular diseases (including cerebrovascular insufficiency)
  • Chronic heart failure
    • severe systemic autoimmune connective tissue disease (including systemic lupus erythematosus, scleroderma)
  • inhibition of bone marrow hematopoiesis
  • diabetes
  • hyperkalemia
  • condition after kidney transplantation,
  • of the liver and / or kidney disease
    • state, accompanied by a decrease in circulating blood volume (as a result of diuretic therapy, while limiting salt intake, diarrhea and vomiting)
    • old age gout.

 

Pregnancy and lactation
The drug is contraindicated in pregnancy. When pregnancy occurs the drug should be discontinued immediately. If necessary, the appointment during lactation nursing mothers should abandon breastfeeding.

Dosing and Administration
Inside, regardless of meals. The dosage is adjusted individually.
The usual dose is 1 tablet per day (10 mg + 12.5 mg or failure of the therapeutic effect of 10 mg + 25 mg). Patients should take the tablets whole during or after delivery, squeezed small amounts of liquid. If not achieved a satisfactory therapeutic effect, we recommend adding another drug or change therapy.
In patients on diuretic therapy, the recommended treatment is to cancel or reduce the dose of diuretics for at least 3 days prior to initiation of treatment buy proviron online for the prevention of symptomatic hypotension. Before treatment should be investigated renal function.

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