Nefrix - General Information:

A thiazide diuretic often considered the prototypical member of this class. It reduces the reabsorption of electrolytes from the renal tubules. This results in increased excretion of water and electrolytes, including sodium, potassium, chloride, and magnesium. It has been used in the treatment of several disorders including edema, hypertension, diabetes insipidus, and hypoparathyroidism. [PubChem]

    Pharmacology:

    Thiazides such as hydrochlorothiazide promote water loss from the body (diuretics). They inhibit Na+/Cl- reabsorption from the distal convoluted tubules in the kidneys. Thiazides also cause loss of potassium and an increase in serum uric acid. Thiazides are often used to treat hypertension, but their hypotensive effects are not necessarily due to their diuretic activity. Thiazides have been shown to prevent hypertension-related morbidity and mortality although the mechanism is not fully understood. Thiazides cause vasodilation by activating calcium-activated potassium channels (large conductance) in vascular smooth muscles and inhibiting various carbonic anhydrases in vascular tissue.

    Nefrix for patients

    General

    All patients receiving diuretic therapy should be observed for evidence of fluid or electrolyte
    imbalance: namely, hyponatremia, hypochloremic alkalosis, and hypokalemia. Serum and urine
    electrolyte determinations are particularly important when the patient is vomiting excessively or
    receiving parenteral fluids. Warning signs or symptoms of fluid and electrolyte imbalance,
    irrespective of cause, include dryness of mouth, thirst, weakness, lethargy, drowsiness,
    restlessness, confusion, seizures, muscle pains or cramps, muscular fatigue, hypotension,
    oliguria, tachycardia, and gastrointestinal disturbance such as nausea or vomiting.

    Hypokalemia may develop, especially with brisk diuresis, when severe cirrhosis is present or
    after prolonged therapy.

    Interference with adequate oral electrolyte intake will also contribute to hypokalemia.
    Hypokalemia may cause cardiac arrhythmia and may also sensitize or exaggerate the response of
    the heart to the toxic effects of digitalis (e.g., increased ventricular irritability).
    Hypokalemia may be avoided or treated by use of potassium sparing diuretics or potassium
    supplements such as foods with a high potassium content.

    Although any chloride deficit is generally mild and usually does not require specific treatment
    except under extraordinary circumstances (as in liver disease or renal disease), chloride
    replacement may be required in the treatment of metabolic alkalosis.

    Dilutional hyponatremia may occur in edematous patients in hot weather; appropriate therapy is
    water restriction, rather than administration of salt, except in rare instances when the
    hyponatremia is life threatening. In actual salt depletion, appropriate replacement is the
    therapy of choice.

    Hyperuricemia may occur or acute gout may be precipitated in certain patients receiving thiazides.

    In diabetic patients dosage adjustments of insulin or oral hypoglycemic agents may be required.
    Hyperglycemia may occur with thiazide diuretics. Thus latent diabetes mellitus may become manifest
    during thiazide therapy.

    The antihypertensive effects of the drug may be enhanced in the post-sympathectomy patient.

    If progressive renal impairment becomes evident, consider withholding or discontinuing diuretic therapy.

    Thiazides have been shown to increase the urinary excretion of magnesium; this may result in hypomagnesemia.

    Thiazides may decrease urinary calcium excretion. Thiazides may cause intermittent and slight elevation
    of serum calcium in the absence of known disorders of calcium metabolism. Marked hypercalcemia may be
    evidence of hidden hyperparathyroidism. Thiazides should be discontinued before carrying out tests for
    parathyroid function.

    Increases in cholesterol and triglyceride levels may be associated with thiazide diuretic therapy.

    Laboratory Tests

    Periodic determination of serum electrolytes to detect possible electrolyte imbalance should be done
    at appropriate intervals.

    Nefrix Interactions

    When given concurrently the following drugs may interact with thiazide diuretics.

    Alcohol, barbiturates, or narcotics: potentiation of orthostatic hypotension may occur.

    Antidiabetic drugs: (oral agents and insulin) - dosage adjustment of the antidiabetic drug may be required.

    Other antihypertensive drugs: additive effect or potentiation.

    Cholestyramine and colestipol resins: Absorption of hydrochlorothiazide is impaired in the presence of anionic exchange resins. Single doses of either cholestyramine or colestipol resins bind the hydrochlorothiazide and reduce its absorption from the gastrointestinal tract by up to 85 and 43 percent, respectively.

    Corticosteroids, ACTH: intensified electrolyte depletion, particularly hypokalemia.

    Pressor amines (e.g., norepinephrine): possible decreased response to pressor amines but not sufficient to preclude their use.

    Skeletal muscle relaxants, nondepolarizing (e.g., tubocurarine): possible increased responsiveness to the muscle relaxant.

    Lithium: generally should not be given with diuretics. Diuretic agents reduce the renal clearance of lithium and add a high risk of lithium toxicity. Refer to the package insert for lithium preparations before use of such preparations with Hydrochlorothiazide.

    Non-steroidal Anti-inflammatory Drugs: In some patients, the administration of a non-steroidal anti-inflammatory agent can reduce the diuretic, natriuretic, and antihypertensive effects of loop, potassium-sparing and thiazide diuretics. Therefore, when Hydrochlorothiazide and non-steroidal anti-inflammatory agents are used concomitantly, the patient should be observed closely to determine if the desired effect of the diuretic is obtained.

    Nefrix Contraindications

    Anuria.

    Hypersensitivity to this product or to other sulfonamide-derived drugs.

    Nefrix more info

    Indication, Mechanism Of Action, Drug Interactions, Food Interactions, etc..