• Rating:
  • Manufacturer:
  • Model:
    789
  • Available:
    In stock
  • Availability date:
    2020-07-30
  • Dosage form:
    tablets
  • In stock:
    618 Items

$17.90
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Composition:


active ingredient: chlortalidone;


1 tablet contains 25 mg or 50 mg of Chlortalidone;


excipients: microcrystalline cellulose, pre-chelated starch, Quinoline yellow (E104), sodium starch glycolate, colloidal anhydrous silicon dioxide, stearic acid.


Dosage form. Pills.


Basic physical and chemical properties: flat, rounded tablets without a yellow shell with beveled edges on both sides.


Pharmacotherapeutic group.


Non-thiazide diuretics with moderate activity. Sulfonamides, simple. ATX code C03B A04.


Pharmacological properties.


Pharmacodynamics.


Chlortalidone is a long-acting oral diuretic with antihypertensive activity.


The drug Dichlor causes diuresis with an increase in the excretion of sodium and chlorine ions. It acts on the distal convoluted tubules of the nephron. The diuretic effect of Chlortalidone causes a decrease in extracellular fluid volume, plasma volume, cardiac output, Total Sodium metabolism, glomerular filtration rate and renal plasma flow.


In people suffering from arterial hypertension, Chlortalidone gently lowers blood pressure. Although the mechanism of action of Chlortalidone is not entirely clear, reduced sodium and water levels probably provide its antihypertensive effect. With further use, the hypotensive effect persists, probably due to a drop in peripheral resistance; cardiac output returns to its previous values, plasma volume decreases slightly, and plasma renin activity may be increased.


Chlortalidone increases the excretion of bicarbonate, phosphate and magnesium in the urine (mainly through the proximal tubules); the excretion of sodium, chloride and potassium in the urine (mainly through the distal tubules).


The diuretic effect of Chlortalidone begins on average 2.6 hours after administration and lasts up to 72 hours.


Like thiazide diuretics, Chlortalidone causes a dose-dependent decrease in serum potassium levels, an increase in serum uric acid and blood glucose levels, and this can lead to a decrease in sodium and chlorine levels.


Pharmacokinetics.


When administered orally, Chlortalidone is absorbed from the gastrointestinal tract (about 65%). However, there is very little free Chlortalidone in the blood, the largest amount is associated with red cell carbonic anhydrase (98%). The concentration in red blood cells is 50-80 times the concentration in plasma or serum.


Metabolites have not been identified. 50-65% of the oral dose is excreted unchanged in the urine. Up to 10% can be detected in the stool, which indicates biliary or intestinal dialysis. The average plasma half-life of Chlortalidone is 40 to 60 hours.


Clinical characteristics.


Indications.


Treatment of arterial hypertension, essential or nephrogenic, or isolated systolic hypertension.


Treatment of stable, mild to moderate chronic heart failure (NYHA functional class II or III).


Treatment of edema.


Contraindications.


- Hypersensitivity to Chlortalidone or other drugs derived from sulfonamides.


- Anuria.


- Severe hepatic or renal failure (creatinine clearance


- Refractory hypokalemia, hypercalcemia and hyponatremia.


- Symptomatic hyperuricemia (gout or uric acid stones in the Anamnesis).


- Hypertension during pregnancy.


- Untreated Addison's disease.


- Concomitant lithium therapy.


- Children's age.


- Pregnancy, breast-feeding period.


- Intoxication with cardiac glycoside preparations.


Interactions with other drugs and other types of interactions.


Chlortalidone may enhance the effects of other antihypertensive drugs (for example, guanethidine, methyldopa, beta-blockers, vasodilators, calcium antagonists, and angiotensin-converting enzyme (ACE) inhibitors). The antihypertensive effect of ACE inhibitors is potentiated by agents that increase the plasma activity of renin (diuretics). Patients should be monitored for several hours after the first dose.


The hypokalemic effect of diuretics can be potentiated by corticosteroids, corticotropin, beta-2 agonists, amphotericin and carbenoxolone. The need for insulin in diabetic patients may vary. Higher doses of oral hypoglycemic drugs may be required.


Chlortalidone and related medications may increase sensitivity to tubocurarin. Chlortalidone and related medications may reduce arterial sensitivity to norepinephrine.


Concomitant use of certain nonsteroidal anti-inflammatory drugs (for example, indomethacin) may reduce the diuretic and antihypertensive effects of Chlortalidone; there have been isolated reports of impaired renal function in predisposed patients.


The bioavailability of thiazide diuretics may be increased by anticholinergic agents (for example, atropine, biperiden), possibly due to reduced motility and gastric emptying.


Absorption of thiazide diuretics is impaired in the presence of anionic exchange resins, such as colestyramine. It is possible to reduce the pharmacological effect.


Concomitant use of thiazide diuretics may increase the frequency of hypersensitivity reactions to allopurinol, increase the risk of adverse effects caused by amantadine, increase the hyperglycemic effect of diazoxide, reduce renal excretion of cytotoxic agents (for example, cyclophosphamide, methotrexate) and increase their myelosuppressive effect.


The pharmacological effects of calcium and vitamin D salts may increase to clinically significant levels with the addition of thiazide diuretics. The consequences of hypercalcemia usually go away, but can be persistent and symptomatic (weakness, weakness, anorexia) in patients with hyperparathyroidism.


Concomitant treatment with cyclosporine increases the risk of hyperuricemia and gout-type complications.


Renal clearance of lithium is reduced by Chlortalidone, which increases the risk of lithium toxicity.


AIDS patients should be warned that drinking alcohol may cause dizziness.


Thiazide derivatives may increase bone marrow suppression caused by cancer chemotherapy (e.g., neutropenia).


Application features.


With caution, the drug is prescribed to patients with diabetes mellitus, gout, with severe atherosclerosis of the coronary and cerebral vessels, with impaired excretory function of the kidneys. With prolonged use of the drug Dichlor, as well as when it is used simultaneously with cardiac glycosides, glucocorticosteroids, ACTH in order to prevent hypokalemia, it is recommended to prescribe potassium preparations or potassium-sparing diuretics.


Chlortalidone should be used with caution in cases of kidney disease. In patients with kidney disease, Chlortalidone or similar medications may accelerate azotemia. The cumulative effect of the drug may develop in patients with impaired renal function. Chlortalidone should be used with caution in patients with impaired liver function or progressive liver disease, as minor changes in the water-electrolyte balance can lead to hepatic coma.


Use during pregnancy or lactation.


Use is contraindicated.


Ability to influence the reaction rate when driving vehicles or other mechanisms.


Given the possibility of dizziness when using the drug, you should refrain from driving vehicles and performing work that requires increased attention.


Dosage and administration.


Arterial hypertension.


Monotherapy. For the treatment of hypertension, the recommended starting dose of Chlortalidone for adults is 25 mg per day. This is enough to cause the maximum hypotensive effect in most patients. If a decrease in blood pressure does not occur at a dose of 25 mg/day, it can be increased to 50 mg/day. If additional antihypertensive therapy is used, increasing the dose of the drug over 50 mg increases metabolic complications and rarely has a therapeutic effect.


Combination therapy. If combination therapy is required for the treatment of arterial hypertension, the dosage can be adjusted, first of all, when using each drug separately.


Stable chronic heart failure (NYHA functional class II or III).


The recommended starting dose is 25 to 50 mg/day, in severe cases the dose can be increased to 100-200 mg/day. The usual maintenance dose is the lowest effective dose, such as 25 to 50 mg daily or every other day. If the reaction is insufficient, digitalis preparations and/or ACE inhibitors can be added. Edema.


The minimum effective dose should be determined by titration and taken only for a limited period. It is not recommended to exceed the dose of 50 mg per day. Elderly patients and patients with impaired renal function. For patients with mild renal insufficiency and for elderly patients, the minimum effective dose of Chlortalidone is recommended. Contraindicated in patients with creatinine clearance .


In elderly patients, Chlortalidone is excreted more slowly than in young healthy adult patients, despite the same absorption. Therefore, the usual dose should be reduced. When treating elderly patients with Chlortalidone, they should be closely monitored clinically.

Children.


The drug is not used in children.


Overdose.


Symptoms of acute overdose include nausea, weakness, drowsiness, hypovolemia, hypotension, dizziness, and electrolyte imbalance associated with cardiac arrhythmias and muscle spasms.


There is no specific antidote to Chlortalidone. To reduce absorption, gastric lavage is used, vomiting is caused, or activated charcoal is used. Blood pressure and water-electrolyte balance should be monitored and appropriate corrective measures should be taken.


Adverse reactions.


From the digestive tract: anorexia, nausea, vomiting, cramps, diarrhea, constipation, jaundice, pancreatitis.


Nervous system disorders: dizziness, vertigo, paresthesia, headache, xanthopsia.


From the blood system: leukopenia, agranulocytosis, thrombocytopenia, aplastic anemia, eosinophilia.


From the skin: Purpura, photosensitization, rash, urticaria, necrotizing angiitis vasculitis (cutaneous vasculitis), Lyell's syndrome (toxic epidermal necrolysis).


From the cardiovascular system: orthostatic hypotension, which may be aggravated by alcohol, barbiturates or drugs. Very rarely, cardiac arrhythmias may occur.


From the hepatobiliary system: hypokalemia, hypopatriemia, hypomagnesemia, hyperglycemia, hyperuricemia, increased blood lipids, glucosuria and hypochloremic alkalosis. Other: muscle spasms, weakness, anxiety, impotence. Very rarely, there may be a kind of pulmonary edema (respiratory disorders), allergic interstitial nephritis. If moderate or severe adverse reactions occur, the dose of Chlortalidone should be reduced or therapy should be discontinued.


Sensitivity reactions may occur in patients with a history of allergies or asthma. Exacerbation or activation of systemic lupus erythematosus has been reported with thiazide diuretics that are structurally related to Chlortalidone. However, systemic lupus erythematosus has not been reported with Chlortalidone.

Tags: Chlortalidone