Triampur compositum tablets 25 + 12.5mg, No. 50

Triampur compositum tablets 25 + 12.5mg, No. 50; 'Edema syndrome (CHF, nephrotic syndrome, liver cirrhosis, toxicosis in late pregnancy, with chronic venous insufficiency); arterial hypertension.

Inside.

In case of edematous syndrome, the initial dose is 2-4 single doses daily, then they switch to maintenance therapy for 1-2 single doses every 1-2 days. In patients with impaired renal function (CC 30-50 ml / min) - 1 single dose / day.

The tablets are yellow, round, scored on one side, with beveled edges.

1 tab.

hydrochlorothiazide 12.5 mg

triamterene 25 mg

Chronic renal failure, anuria, acute glomerulonephritis, liver failure, precoma and hepatic coma, hyperkalemia, lactation period, age up to 18 years (efficacy and safety have not been established), I trimester of pregnancy; hypersensitivity (including to sulfonamides).

With caution Diabetes mellitus, gout, impaired liver and / or kidney function, folic acid deficiency (in patients with liver cirrhosis).

pharmachologic effect

Combined drug. It has a diuretic and hypotensive effect. Hydrochlorothiazide is a thiazide diuretic, a diuretic effect, which is associated with a violation of the reabsorption of sodium, chlorine, potassium, magnesium and water ions in the distal nephron: it delays the excretion of calcium and uric acid ions. Has an antihypertensive effect, which is due to the expansion of arterioles. Does not affect normal blood pressure. The diuretic effect appears after 1-2 hours and reaches a maximum after 4 hours, the duration of action depending on the dose is 10-12 hours. The antihypertensive effect develops after 3-4 days, but it may take 3-4 weeks to achieve the optimal therapeutic effect. Triamterene is a potassium-sparing diuretic,reduces the permeability of the cell membranes of the distal tubules for sodium ions and enhances their excretion in the urine without increasing the excretion of potassium ions. The secretion of potassium ions in the distal tubules is reduced. In combination with hydrochlorothiazide, triamterene is able to reduce the hypokalemia caused by thiazide diuretics and enhance the diuretic effect of hydrochlorothiazide. The diuretic effect of triamterene after oral administration is noted after 15-20 minutes. The maximum effect is after 2-3 hours, the duration of action is 12 hours.The diuretic effect of triamterene after oral administration is noted after 15-20 minutes. The maximum effect is after 2-3 hours, the duration of action is 12 hours.The diuretic effect of triamterene after oral administration is noted after 15-20 minutes. The maximum effect is after 2-3 hours, the duration of action is 12 hours.Pharmacokinetics

Hydrochlorothiazide is not completely absorbed from the gastrointestinal tract (60-80% of the oral dose), but rather quickly. Plasma protein binding - 40%, visible Vd - 3-4 l / kg. Cmax of hydrochlorothiazide in blood plasma is 2 ?g / ml. T1 / 2 - about 3-4 hours. Hydrochlorothiazide does not undergo significant metabolism. The primary route of its elimination is renal excretion (filtration and secretion) of the unchanged substance. Hydrochlorothiazide crosses the placental barrier. Triamterene is rapidly, but not completely (30-70% of the dose taken) is absorbed from the gastrointestinal tract. To a moderate extent (67%) binds to blood plasma proteins. Cmax in blood plasma is reached after 2-4 hours. It undergoes biotransformation in the liver with the formation of both active and inactive metabolites. T1 / 2 of unchanged substance is normally 1.5-2 hours (with anuria - 10 hours), metabolites - up to 12 hours.The main route of excretion of triamterene is through the intestines, the secondary route is through the kidneys.

Side effect

From the digestive system: nausea, vomiting and sometimes diarrhea (when taking the drug before meals), pain and discomfort in the epigastric region, colicky abdominal pain, constipation, dry mouth, thirst, in rare cases - hemorrhagic pancreatitis, and if present gallstones - acute cholecystitis. From the nervous system: uncoordinated movements, drowsiness, fatigue, headache, nervousness. From the musculoskeletal system: muscle tension, muscle weakness, cramps of the calf muscles. From the side of the cardiovascular system: palpitations, decreased blood pressure, heart rhythm disturbances and circulatory disorders with dizziness, confusion or a tendency to fainting.Due to the large loss of fluid and a decrease in the BCC, when using the drug in high doses and / or abundant urine output, blood clots may form, embolism may develop, in rare cases - convulsions, confusion, vascular collapse and acute renal failure. From the side of metabolism: a temporary increase in the concentration of nitrogen-containing substances excreted by the kidneys (urea, creatinine) in the blood (mainly at the beginning of treatment), disturbances in water-electrolyte balance, mainly a decrease in the content of sodium, magnesium, chlorides in the blood, a decrease or increase potassium content (with prolonged continuous use of the drug), hypercalcemia, decreased glucose tolerance. An increase in the content of uric acid in the blood is possible, on the basis of which gout attacks can be triggered in some especially predisposed patients,the formation of urinary stones may be noted. In sensitive patients, depending on the total dose taken, an increase in blood lipids may be observed. In connection with an increase in the concentration of glucose in the blood, a latent form of diabetes may appear or an already existing form of diabetes may be aggravated. The drug may contribute to the accumulation of non-volatile acids in the blood (metabolic acidosis). From the side of the organ of vision: visual impairment, worsening of existing myopia or a decrease in the production of tear fluid. From the hematopoietic system: aplastic anemia, leukopenia, thrombocytopenia, agranulocytosis, megaloblastic anemia with a previous deficiency of folic acid in the body, hemolysis,resulting from the appearance in the blood of autoantibodies to the active substance hydrochlorothiazide with the simultaneous use of methyldopa. Allergic reactions: skin redness, pruritus, urticaria, systemic lupus erythematosus, photoallergic exanthema, fever, hypersensitivity reactions (anaphylactoid reactions), severe inflammation of blood vessels and non-bacterial inflammation of kidney tissue (aseptic interstitial nephritis). In isolated cases, a sudden onset of pulmonary edema with symptoms of shock was described. The reason for this is probably the allergic reaction of patients to the active substance hydrochlorothiazide. Others: icteric coloration of the skin, mucous membranes and sclera.hypersensitivity reactions (anaphylactoid reactions), severe inflammation of the blood vessels and non-bacterial inflammation of the kidney tissue (aseptic interstitial nephritis). In isolated cases, a sudden onset of pulmonary edema with symptoms of shock was described. The reason for this is probably the allergic reaction of patients to the active substance hydrochlorothiazide. Others: icteric coloration of the skin, mucous membranes and sclera.hypersensitivity reactions (anaphylactoid reactions), severe inflammation of the blood vessels and non-bacterial inflammation of the kidney tissue (aseptic interstitial nephritis). In isolated cases, a sudden onset of pulmonary edema with symptoms of shock was described. The reason for this is probably the allergic reaction of patients to the active substance hydrochlorothiazide. Others: icteric coloration of the skin, mucous membranes and sclera.

Application during pregnancy and lactation

Contraindicated during lactation (breastfeeding), in the first trimester of pregnancy.

Application for violations of liver function

Contraindicated in liver failure.

Application for impaired renal function

Contraindicated in chronic renal failure, anuria, acute glomerulonephritis.

Application in children

Contraindicated in children under 18 years of age (efficacy and safety have not been established).

special instructions

With long-term treatment, it is necessary to periodically monitor the content of potassium, sodium, chlorine, urea, creatinine, glucose, uric acid in the blood, the picture of peripheral blood (if you suspect a lack of folic acid). Do not take two doses at the same time if the drug is missed. Influence on the ability to drive vehicles and mechanisms. At the beginning of treatment, you should avoid potentially hazardous activities that require increased attention and speed of psychomotor reactions (against the background of a decrease in blood pressure - a slowdown in the reaction rate).

Drug interactions

Medicines that intensively bind to blood proteins (indirect anticoagulants, clofibrate, NSAIDs) are displaced from the connection with the protein and enhance the diuretic effect. When combined with NSAIDs, acute renal failure may develop. The antihypertensive effect is enhanced by vasodilators, barbiturates, phenothiazines, tricyclic antidepressants, ethanol. It enhances the neurotoxicity of salicylates, the effects (including side effects) of cardiac glycosides, curariform muscle relaxants, the cardiotoxic and neurotoxic effects of lithium preparations. Weakens the action of oral hypoglycemic drugs, norepinephrine, epinephrine and anti-gout drugs; reduces the excretion of quinidine. With the simultaneous administration of methyldopa, the risk of hemolysis increases. Cholestyramine reduces absorption.Chlorpropamide can lead to the development of hypokalemia.

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