2010/06/07

RESERPINE+ DIHYDRALAZINE+ HYDROCHLOROTHIAZIDE

International name:
Reserpine + Hydrochlorothiazide + Digidralazin (Reserpine + Dihydralazine + Hydrochlorothiazide)

Group Affiliation:
Hypotensive combined tool

Description of the active substance (INN):
+ Reserpine + Hydrochlorothiazide Digidralazin

Dosage form:
Tablets

Mode of action:
Combined medication. Reserpine - sympatholytic, penetrating into the presynaptic end postganglionic fibers releases norepinephrine from vesicles with a simultaneous violation of its reverse neuronal capture and amplification process of inactivation of MAO. Cause depletion of the neurotransmitter and sustained reduction in blood pressure. Helps reduce the concentration in the neurons of dopamine, serotonin and other neurotransmitters, exerting antipsychotic action. Weakens the influence of sympathetic innervation in the SCA, reduces heart rate and TPVR; remains active parasympathetic nervous system deepens and strengthens the physiological sleep, inhibits interoretseptivnye reflexes. Increases peristalsis of the digestive tract, increases the production of stomach HCl; slows metabolic processes in the body, slows and deepens breathing movements, causes miosis, hypothermia, reduces the intensity of metabolism. Has a positive effect on the lipid and protein metabolism in patients with arterial hypertension, and coronary atherosclerosis, increases renal blood flow, increases the glomerular filtration. Digidralazin - arterial vasodilator, lowers resistance in the vessels of the heart, brain, kidney (to a lesser extent - the skin and skeletal muscle) are not effect on renal blood flow; hypotensive effect is not accompanied by orthostatic hypotension. Hydrochlorothiazide - thiazide diuretics, acting at the cortical segment of the loop of Henle, increases the excretion of Na +, K +, Mg2 +, Cl-and water, increases the reabsorption of Ca2 +; maximum diuretic effect - after 6 h, duration of - 12 h. The drug does not cause reflex tachycardia, typical digidralazina and hydrochlorothiazide (leveled reserpine), and fluid retention characteristic of reserpine and digidralazina (eliminated hydrochlorothiazide).

Indications:
Hypertension.

Contraindications:
Hypersensitivity, depression (including history), Parkinson's disease, epilepsy, electroconvulsive therapy, pheochromocytoma, concomitant or recent medication MAO inhibitors, peptic ulcer and 12 duodenal ulcer (exacerbation), ulcerative colitis, SLE, recent myocardial infarction, marked tachycardia, CH, coupled with a high cardiac output (including with thyrotoxicosis) or due to mechanical obstruction (aortic, mitral stenosis, constrictive pericarditis), isolated right ventricular failure due to pulmonary hypertension (pulmonary, heart); anuria, severe chronic renal failure (CC less than 30 ml / min), hepatic failure, refractory hypokalemia, hyponatremia, hypercalcemia, hyperuricemia with clinical manifestations, pregnancy, lactation, age 18 let.C caution. CHF, bradycardia, slowing AV and intraventricular conduction, recent myocardial infarction, cerebral and coronary atherosclerosis, diabetes mellitus, peptic ulcer and 12 duodenal ulcer (in history), erosive gastritis, calculous cholecystitis.

Side effects:
On the part of the digestive system: diarrhea, dry mouth, hypersecretion of gastric juice, hyperptyalism, nausea, vomiting, bulimia, gastrointestinal bleeding, jaundice, increased activity of "liver" enzymes, hepatitis. On the part of the SSA: lowering blood pressure, arrhythmia, angina "tides" of blood to the skin of the face, cerebrovascular accident. On the part of the nervous system: dizziness, depression, irritability, nightmares, dreams, fatigue, extrapyramidal disorders (including Parkinson's), headache, anxiety, reduced ability to concentrate, stupor, disorientation, very rarely - swelling of the brain. the respiratory system: swelling of nasal mucosa, dyspnoea, epistaxis. On the part of the urogenital system: reduced potency and / or libido, ejaculation disorder, dysuria, glomerulonephritis . On the part of the endocrine system: weight gain, hyperprolactinemia, galactorrhea, gynecomastia. From the senses: blurred vision, conjunctival hyperemia, lacrimation, hearing loss. Allergies: eczema, skin rash, itching, volchanochnopodobny syndrome, photosensitization, fever, purpura. From the side of blood: anemia, leukopenia, thrombocytopenia. Laboratory indicators: hypokalaemia, hyperlipidemia, hyponatremia, gipomagniemiya, hyperuricemia, hypercalcemia, hyperglycemia, Glycosuria, increased metabolic abnormalities in diabetes mellitus, gipohloremichesky alkalosis. Other: edema dairy zhelez.Peredozirovka. Symptoms: orthostatic hypotension, headache, dizziness, drowsiness, confusion, coma, extrapyramidal disorders, convulsions, paresthesia, miosis, vomiting, diarrhea, tachycardia, bradycardia, myocardial ischemia, angina, arrhythmias, depression of the respiratory center, water-electrolyte disturbances, myasthenia gravis, cramps in the calf muscles, oliguria. Treatment: gastric lavage, inside - activated charcoal, while lowering blood pressure - plazmozameschayuschie solutions, correction of electrolyte disturbances, vasoconstrictors, diarrhea - anticholinergic drugs, epilepsy and convulsions - antiepileptic drugs, with respiratory depression - AV.

Dosage and administration:
Ext. Initial dose - 1 tablet per day, with gradual increase to 3 tablets, maximum daily dose - 3 tablets; maintenance therapy - the minimum effective dose. In the liver, renal failure (CC 30 ml / min or a serum creatinine 2.5 mg/100 ml = 221 micromol / l) increase the interval between doses or reduce the dose.

Cautions:
7 days before the start of electroconvulsive therapy, elective surgery should be abolished drug, in case of emergency operations - preliminary enter atropine. Elderly patients and patients suffering from chronic diseases and cirrhosis of the liver should regularly monitor the concentration of blood electrolytes, in patients with hyperlipidemia - concentration of lipids in blood serum. If you suspect depression, arthralgia drug immediately overturned. MAO inhibitors should be lifted no later than 2 weeks before the start of drug treatment. In the appointment of diabetics receiving insulin or other hypoglycemic drugs, may require correction of dosing regimen these drugs. Be careful when using eye drops, nose drops and other drugs, which include alpha-adrenostimulyatorov. During the period of treatment must be careful when driving and occupation of other potentially hazardous activities that require increased attention and concentration quickness of psychomotor reactions.

Interaction:
Enhances Neurotoxicity salicylates, reduces the effect of oral hypoglycemic drugs, norepinephrine, epinephrine, antiepileptic drugs, and levodopa, holinoblokatorov, drugs that reduce the concentration of uric acid reduces the analgesic effect of morphine, enhances the effects (including spin), cardiac glycosides, cardiotoxic and neurotoxic effects of drugs Li +, the efficiency nondepolarizing muscle relaxants, reduces excretion of quinidine; enhances the central action of barbiturates, ethanol, drugs for inhalation anesthetics, antihistamine drugs, tricyclic antidepressants. increases the risk of allergic reactions to allopurinol, amantadine, reduces the kidney excretion of cytotoxic drugs, increasing their mielodepressivnoe action. Methyldopa increases the risk of depression, tricyclic antidepressants impair hypotensive effect; MAO inhibitors increase the risk of hyperactivity, hypertension, SCS, ACTH, amphotericin, karbenoksolon, laxatives, drugs - hypokalemia; NSAIDs weaken the diuretic and antihypertensive effects; kolestiramin reduces absorption. Guanetidin, methyldopa, beta-blockers , vasodilators, BCCI, ACE inhibitors enhance the hypotensive effect. Vitamin D, drugs Ca2 + increase the risk of hypercalcemia, cyclosporine - hyperuricemia, gout.