The drug Veroshpiron is a potassium-sparing diuretic and has a pronounced and long-lasting diuretic effect. The active ingredient of this medicinal product is spironolactone(one of the hormones of the adrenal cortex). This substance has a long-lasting effect and can prevent the retention of water and sodium in lower parts renal tubules. Veroshpiron does not have a significant effect on blood circulation in the kidneys, helps reduce the acidity of urine and reduces the excretion of potassium from the body.

The diuretic effect of this drug helps lower blood pressure. It begins to appear 2-5 days after starting to take Veroshpiron, and persists for 3 days after its discontinuation. After oral administration, spironolactone is completely absorbed from digestive tract into the blood and enters the kidneys, providing a diuretic effect. The drug is excreted from the body mainly through urine and partly through feces.

Release forms

Verospiron is produced in Hungary by GEDEON RICHTER in the following dosage forms:

• White (or almost white) tablets with a bevel, flat, round, on one side there is the marking “VEROSPIRON” - 25 mg each, 20 pieces in one blister, in a cardboard package.
• Capsules with cap yellow and white body, hard, gelatinous, with a granular fine-grained mixture white– 50 mg each, 10 pieces in a blister, 3 blisters in a cardboard package.
• Capsules with an orange cap and a yellow body, gelatin, hard, with a granular fine-grained mixture of white color - 100 mg each, 10 pieces in a blister, 3 blisters in a cardboard package.

It is recommended to take Veroshpiron simultaneously with meals or immediately after them. If you miss a dosage, if no more than 4 hours have passed since the prescribed time, you must immediately take the missed dose of the drug. In other cases, you should take the medicine in the usual dosage during your next appointment.

While taking Veroshpiron, it is recommended to avoid consuming excessive amounts of salt and foods rich in potassium (apricots, tomatoes, peaches, dates, oranges, coconuts, grapefruits, bananas, prunes). During treatment with this drug, the consumption of alcoholic beverages is prohibited.

In the initial period of taking Veroshpiron, it is necessary to abandon activities that require the speed of psychomotor reactions and increased attention(control vehicles, work with complex mechanisms etc.). The duration of such restrictions depends on individual characteristics the patient's health status.

When prescribing Veroshpiron to elderly people and patients with severe kidney and liver diseases, constant laboratory monitoring of kidney function and the level of electrolytes in the blood serum is recommended. The same monitoring is necessary for patients who are receiving non-steroidal anti-inflammatory drugs while taking this diuretic. If necessary, the doctor can adjust the dose of the drug.

Dosage
The dosage and duration of taking Veroshpiron is determined only by a doctor, and depends on the diagnosis and severity of the condition:

• Essential hypertension - 50-100 mg once a day, then the dose can be gradually increased to 200 mg (once every 2 weeks), duration of administration is at least 2 weeks.
• Idiopathic hyperaldosteronism – 100-400 mg once a day.
• Severe hyperaldosteronism and hypokalemia – 300-400 mg 2-3 times a day; then, as the condition improves, the dose can be reduced to 25 mg per day.
• Edema in nephrotic syndrome – 100-200 mg per day.
• Edema in heart failure - 100-200 mg 2-3 times a day, for 5 days in combination with thiazide diuretics; then the maintenance dosage can be reduced to 25 mg (determined individually).
• Edema in liver cirrhosis - the dose of Veroshpiron depends on the ratio of Na+/K+ ions in the urine. If this ratio is greater than 1.0, 100 mg is prescribed once a day; if the ratio is less than 1.0, 200-400 mg is recommended once a day; then the maintenance dose is determined individually.
• Diagnostic test for hyperaldosteronism - 400 mg per day, divided into several doses, taken for 4 days. For a long-term test, it may be recommended to take 400 mg per day for 3-4 weeks.
• Preoperative preparation for primary hyperaldosteronism - 100-400 mg per day, divided into 2-3 doses; The duration of treatment is determined individually.

Overdose

An overdose of Veroshpiron is manifested by the following symptoms:

• nausea and vomiting;
• diarrhea;
• skin rash;
• confusion;
• drowsiness;
• dehydration of the body.

If the above symptoms are detected, the patient should rinse the stomach (induce vomiting) and consult a doctor. There is no specific antidote for Veroshpiron. To help the patient, symptomatic therapy is carried out.

Veroshpiron for children

Veroshpiron can be used in pediatric practice as a diuretic for various diseases. The dosage and duration of its use is determined only by the doctor, and the child’s parents must strictly follow all medical recommendations.

Despite the fact that the contraindications for this drug indicate a restriction for use by children under 3 years of age, in practice the drug is in some cases prescribed to younger children (including infants). However, treatment with Veroshpiron for children of this age group carried out in a hospital setting or under strict medical supervision.

Dosage of Veroshpiron for edema in children:
1. Initial daily dose– 1-3 mg/kg for 1-4 doses.
2. After 5 days, the initial dose can be adjusted (if necessary, it can be increased 3 times).

Children under 6 years of age are recommended to take tablets of this drug. For children who cannot swallow the tablet on their own, grind it into powder and mix it with milk or baby food.

In some cases, especially in infants, vomiting occurs after taking Veroshpiron. If it appears earlier than half an hour after administration, the child must be given another dose of the drug. If more than half an hour has passed from the time of administration to the attack of vomiting, then there is no need to give another dose.

An overdose of Veroshpiron in children is especially dangerous. younger age. It is accompanied by an increase in many side effects. The child becomes increasingly drowsy, weak, and may experience disturbances. heart rate or seizures. Signs of dehydration are also detected: lack of saliva, the skin becomes dry, and there may be vomiting or diarrhea. In such cases, it is necessary to urgently stop taking the drug, rinse the child’s stomach and call a doctor or an ambulance.

Use during pregnancy and lactation

Taking Veroshpiron is contraindicated for women during pregnancy and lactation.

If it is necessary to prescribe this drug to nursing mothers, it is recommended to stop breastfeeding, since spironolactone can pass into milk and have adverse effects. negative impact on the child's body.

Veroshpiron for weight loss

On the Internet and in some media you can find recommendations for taking Veroshpiron for weight loss. Despite the fact that this diuretic drug can get rid of several kilograms by removing fluid from the body, using it for weight loss is strictly prohibited. In addition, the loss of body weight does not occur due to the loss of adipose tissue, and the fluid removed after taking Veroshpiron is easily restored in the coming days.

This diuretic helps remove sodium and calcium ions from the body and causes dehydration. Loss of electrolytes can lead to seizures and cardiac dysfunction, while dehydration can lead to disruption of all body functions. These problems can lead those who want to lose weight in this way to the intensive care unit and cause serious problems with health in the future.

Also, taking Veroshpiron for the purpose of losing weight may be accompanied by a number of side effects of this drug:

• tendency to bleed;
• liver dysfunction;
• diarrhea, vomiting and nausea;
• violations menstrual cycle in women or gynecomastia in men;
• stomach diseases, etc.

We should not forget that uncontrolled reception This diuretic in people with certain kidney diseases may cause kidney failure and cause stones to move around. urinary tract.

Remember! Taking Veroshpiron and other diuretics for the purpose of losing weight is absolutely unjustified and dangerous!

Drug interactions of Veroshpiron

When prescribing Veroshpiron, you should inform your doctor about taking other medicines, because this drug can interact with many of them.

In addition, Indapamide is effective in lowering blood pressure in people with one kidney or on hemodialysis.

The high safety and good tolerability of Indapamide allow it to be considered the drug of choice for treatment hypertension in people suffering from diabetes mellitus, chronic renal failure or hyperlipidemia ( increased content cholesterol, triglycerides, low-density lipoproteins in the blood).

Indications for use

All types of Indapamide are indicated for use in the treatment of the following diseases:

• Arterial hypertension;
• Elimination of edema syndrome in chronic heart failure (this indication is not registered in all countries).

Instructions for use

How to take Indapamide capsules and tablets

Tablets with regular duration of action and capsules contain 2.5 mg of active substance and are characterized by the same rules of administration.

Thus, tablets and capsules must be taken orally, swallowed whole, without biting, chewing or crushing in any other way, but with a sufficient amount of still water (at least half a glass). Tablets and capsules can be taken regardless of meals, that is, at any convenient time.

It is optimal to take tablets or capsules in the morning, at approximately the same time every day, to ensure that a certain concentration of the drug in the blood is constantly maintained.

At arterial hypertension Indapamide should be taken 2.5 mg (1 tablet or capsule) once a day for at least three months. In general, therapy is long-term and can last for months or years. However, it must be remembered that if after 4 to 8 weeks of taking Indapamide blood pressure does not normalize, then you should additionally start taking some other antihypertensive drug that is not a diuretic (for example, beta-blockers, ACE inhibitors, etc.).

Increasing the dosage of Indapamide to more than 2.5 mg per day is not recommended, since this will not lead to a significant increase in the hypotensive effect, but will cause diuretic effect.

Maximum permissible daily dosage Indapamide is currently considered 5 mg (2 tablets or capsules).

Indapamide can be used either alone or in combination with other antihypertensive drugs (beta-blockers, ACE inhibitors). When using the drug as part of complex therapy, its dosage, as a rule, is not reduced, leaving it at 2.5 mg per day. When combining Indapamide with beta-blockers (for example, Metoprolol, Bisoprolol, Atenolol, Timolol, etc.), both drugs can be taken simultaneously. If Indapamide needs to be combined with ACE inhibitors (for example, Captopril, Enalapril, Perindopril, etc.), then in this case it is necessary to do as follows: 3 – 4 days before the start of treatment ACE inhibitor cancel Indapamide; then, after gaining a maintenance dosage of the ACE inhibitor, Indapamide is resumed and both drugs are taken.
pressure (if it was elevated; normal blood pressure does not decrease). The drug also helps remove potassium, bicarbonate and magnesium ions from the body, but to a lesser extent.

The diuretic (diuretic) effect begins 1-2 hours after taking the drug, reaches a maximum after 4 hours and lasts 6-12 hours. Long-term use of Hypothiazide does not reduce it diuretic action. Limiting use table salt with food enhances the hypotensive effect of the drug.

Intraocular pressure is also reduced by Hypothiazide. The drug can cross the placental barrier. Excreted from the body in urine and breast milk. In case of renal failure, the release of the drug slows down significantly.

Active substance drug - hydrochlorothiazide.

Release forms

Tablets of 0.025 g (25 mg) and 0.1 g (100 mg); in a package of 20 pcs. and 200 pcs.

Diacarb is intended for short-term use, no more than 3-4 days. With more long-term use diuretic and decongestant therapeutic effect stops. Therefore, sometimes it becomes necessary to replace the drug.

What can replace Diakarb?

Main active substance Diacarba is an acetazolamide. In other countries this drug may be found under the following trade names:

• Diamox;
• Diazomid;
• Diluran;
• Glaupax;
• Diuremide.

All these medications are synonyms (absolute analogues in composition and therapeutic effect).

If it is necessary to replace Diacarb with another drug, what exactly to replace it with depends on the required therapeutic effect:

1. Diuretics. A fairly large group of drugs that accelerate the removal of fluid from the body. effective for edema of various origins. Drugs in this group are most often used to replace Diacarb.
2. Antiglaucoma drugs. Effective analogue Diacarb does not exist in tablets. Other carbonic anhydrase inhibitors are eye drops(Azopt, Trusopt).
3. Antihypertensive, cardiac and other drugs. These medications are not analogues of Diacarb, but are used to treat and relieve symptoms of diseases when it is impossible to use it.

Analogues of the drug Diakarb

In terms of effects, the main analogues of Diacarb are various diuretics. Let's look at the drugs most often used as substitutes, their advantages and disadvantages.

Which is better – Furosemide or Diacarb?

Furosemide is a potent diuretic that very quickly relieves swelling, but causes severe potassium loss and has a number of serious side effects. For those diseases for which Diacarb is prescribed, Furosemide is not very effective.

Which is better – Veroshpiron or Diakarb?

(spinolactone) - a medicine from the group of potassium-sparing diuretics that is quite mild and long-term exposure. With edema of cardiopulmonary origin there may be more more effective than Diacarb and has less negative consequences. Ineffective for glaucoma and epilepsy.

Which is better - Dichlorothiazide or Diacarb?

Dichlorothiazide is a fairly strong diuretic and remains effective in long-term use, is effective for both heart failure and glaucoma, but removes potassium from the body most strongly.

In addition, Aldactone and Diazide can be used as a substitute for Diacarb. To reduce potassium loss, it is recommended to take Panangin along with Diacarb.

Solutions) have become quite firmly established in our lives. They are used to correct acid-base balance in the body. After all, they perfectly remove excess acid and alkali from it. Diuretic tablets, the list of which is quite impressive, are used to treat poisoning and some injuries (especially if we're talking about about head injuries) to combat hypertension. But, unfortunately, not everyone knows not only the mechanism of action of these drugs, but also side effects that they can cause. And improper use of diuretics can lead to serious complications.

Brief information

Diuretic tablets are used to treat many ailments. List effective drugs and continues to increase today. Diuretics are also called diuretics.

Their main goal is to remove excess water, chemicals, and salts from the body, which tend to accumulate in the walls of blood vessels and tissues. In addition, diuretics have positive influence on water-salt balance.

If a large number of sodium ions accumulate in the body, it begins to be deposited. subcutaneous tissue. It has a very negative effect on the functioning of the kidneys, heart, and hematopoietic system. As a result, the patient develops a variety of diseases and disorders.

In addition, diuretics are in great demand in sports medicine. They are often used for weight loss. Very often diuretics (tablets) are included in complex therapy to combat various ailments.

Based on their effect on the body, modern diuretics are divided into two main forms. The first category of drugs affects the process of urine formation directly in the kidneys. The second form of diuretics is responsible for the hormonal regulation of urine production.

Important Warning

There is a lot of information that diuretic tablets, the list of which is given below, can also easily solve cosmetic problems. However, many people believe that similar drugs completely safe. Some women take these medications on their own for weight loss purposes. Athletes widely use drugs before competitions in order to lose weight. Even bodybuilders use them, trying to create artificial dehydration so that the muscles look more prominent.

However, people who take diuretics without a doctor's prescription are at great risk. After all, treatment with diuretics can lead to unpleasant consequences. You should know that diuretics can:

Quite often, even those patients who understand the risk believe that the latest drugs"Indapamide", "Torasemide", "Arifon" do not affect metabolism harmful influence. Such medications are indeed much better tolerated than older generation medications. However, they are also harmful to health. But the negative impact of these funds is revealed much later. It is enough to understand the mechanism of their action. Medicines of the new and old generation are aimed at one thing - to stimulate the kidneys to work more intensively. Consequently, they excrete more salt and water.

It is important to understand that fluid retention in the body is a symptom of a serious illness. Swelling cannot occur on its own. It is provoked by serious disruptions in the functioning of the kidneys, heart, and sometimes other reasons. Consequently, diuretics are drugs (their list is very extensive) with exclusively symptomatic action. Unfortunately, they do not get rid of the cause of the disease. Thus, medications only delay the unpleasant ending for patients. Therefore, people who want to improve their health and fight a real disease should not make do with diuretics alone, much less use them themselves.

Classification of drugs

A unified system according to which all diuretics would be divided, up to today no, since all drugs have different chemical structures and have different effects on body systems. Therefore, it is impossible to create an ideal classification.

Often the division occurs according to the mechanism of action. According to this classification, there are:

1. Thiazide drugs. They are excellent for the treatment of hypertension, perfectly reduce blood pressure. It is recommended to use them in parallel with other medications. Thiazides can negatively affect metabolism, so such diuretics are prescribed in small quantities. Drugs (a list of only the most popular ones is given in the article) from this group are “Ezidrex”, “Hydrochlorothiazide”, “Chlorthalidone”, “Indapamide”, “Hypothiazide”, “Arifon”.
2. Loop means. They remove salt and fluid from the body due to their effect on kidney filtration. These medications have a rapid diuretic effect. Loop diuretics do not affect cholesterol levels and do not create preconditions for the occurrence of diabetes mellitus. However, their biggest drawback is the many side effects. The most common drugs are Torasemide, Furosemide, Ethacrynic acid, Bumetanide.
3. Potassium-sparing agents. Quite an extensive group of drugs. Such medications help increase the excretion of chloride and sodium from the body. At the same time, the removal of potassium is minimized by such diuretic tablets. List of most popular drugs: “Amiloride”, “Triamterene”, “Spironolactone”.
4. Aldosterone antagonists. These diuretics block the natural hormone that retains salt and moisture in the body. Drugs that neutralize aldosterone promote fluid removal. At the same time, the potassium content in the body does not decrease. The most popular representative is “Veroshpiron”.

Medicines for edema

For good effect Strong drugs may be used. The following diuretic tablets are used for edema:

• "Torasemide";
• "Furosemide";
• "Piretanide";
• "Xipamide";
• "Bumetanide".

Medium-strength diuretic tablets can also be used for edema:

• "Hydrochlorothiazide";
• "Hypothiazide";
• "Chlorthalidone";
• "Klopamide";
• "Polythiazide";
• "Indapamide";
• "Met hall."

Such drugs are used for a long time and continuously. The recommended dose is determined by the attending physician. As a rule, it is about 25 mg per day.

For minor edema, potassium-sparing diuretics, such as Spironolactone, Amiloride, and Triamterene, are more suitable. They are taken in courses (2-3 weeks) at intervals of 10-14 days.

Medicines for hypertension

Diuretic medications that are used for high blood pressure, are divided into two categories:

1. Remedies that have a quick effect. Such drugs are used during a hypertensive crisis, when there is a need to quickly reduce blood pressure.
2. Products for daily use. Medicines help maintain optimal level pressure.

Potent medications can stop a hypertensive crisis. The most popular drug is Furosemide. Its price is low. The following remedies are no less effective during a crisis:

• "Torasemide";
• "Bumetanide";
• "Ethacrynic acid";
• "Piretanide";
• "Xipamide."

The duration of taking the above medications can be 1-3 days. After stopping the crisis, they switch from such potent drugs to medications that can maintain blood pressure at the required level every day.

• "Indapamide";
• "Hydrochlorothiazide";
• "Hypothiazide";
• "Klopamide";
• "Metro salon";
• "Polythiazide";
• "Chlorthalidone."

These medications are taken daily as prescribed by your doctor. They perfectly maintain the optimal pressure level.

Drugs for heart failure

As a result of this pathology, fluid retention in the body often occurs. This phenomenon creates stagnation of blood in the lungs. The patient has many unpleasant symptoms, such as shortness of breath, swelling, enlarged liver, the appearance of wheezing in the heart.

For people with diabetes, the doctor must introduce a diuretic into their therapy. It perfectly prevents severe consequences in the lungs, cardiogenic shock. At the same time, diuretics increase patients' tolerance to physical activity.

For patients with the first and second degrees of the disease, a good diuretic is a thiazide drug. In case of more serious pathology, the patient is transferred to strong remedy- loop diuretic. In some cases, the drug Spironolactone is additionally prescribed. It is especially important to take this medication if the patient has developed hypokalemia.

If the effect of using the drug Furosemide weakens, cardiologists recommend replacing it with the drug Torasemide. It has been noticed that the latter remedy has a more beneficial effect on the body when severe forms heart failure.

The drug "Furosemide"

The medicine is a fast-acting diuretic. Its effect occurs after taking it for 20 minutes. The duration of the drug's effect is about 4-5 hours.

Effectively this remedy not only for cupping hypertensive crisis. According to the instructions, the medicine helps with heart failure, swelling of the brain and lungs, poisoning chemicals. It is often prescribed for late toxicosis during pregnancy.

However, the product also has strict contraindications. The drug is not used in the first trimester of pregnancy. It should not be used by patients with renal failure, people who have hypoglycemia, or urinary tract obstruction.

The cost of the drug "Furosemide" is low. The price is approximately 19 rubles.

The drug "Torasemide"

The medicine is a fast-acting remedy. The drug "Furosemide" undergoes biotransformation in the kidneys, so it is not suitable for all patients. More effective medicine For people suffering from kidney diseases, the medicine “Torasemide” is used, since it undergoes biotransformation in the liver. But with pathologies of this organ, the medicine can cause serious harm.

After just 15 minutes, the effect on the body begins (as reported by the product accompanying the drug, the price of the product varies from 205 to 655 rubles.

Long-term studies have confirmed high efficiency medications for heart failure. In addition, the drug perfectly removes salts and liquid. At the same time, the loss of potassium by the body is insignificant, since effective remedy blocks the hormone aldosterone.

The drug "Indapamide"

The medicine is very effective for hypertension (severe and moderate severity). The product perfectly reduces blood pressure and maintains its optimal level throughout the day. In addition, it prevents an increase this indicator in the morning.

You need to take the medicine once a day, 1 tablet, as evidenced by the instructions included in the drug “Indapamide”. The price of the product varies on average from 22 to 110 rubles.

Before taking it, you should familiarize yourself with the contraindications, since this excellent remedy is not suitable for all patients suffering from hypertension. The drug is not intended for people who have problems with the kidneys or liver. Pregnant and nursing mothers are prohibited from taking the medicine. In case of failures cerebral circulation, anuria, hypokalemia, the drug is contraindicated.

The drug "Triamterene"

The medicine is a mild diuretic. It is recommended to use it in combination with another diuretic drug, Hydrochlorothiazide. Thanks to this combination, it is possible to reduce the loss of potassium by the body. The drug Triamterene has a beneficial effect. The instructions position it as a potassium-sparing agent.

The medicine should be used strictly according to the prescribed dosage. People with impaired kidney function may experience an unpleasant side effect - increased level potassium Sometimes the product can lead to dehydration. When interacting with folic acid The medicine helps increase red blood cells.

The cost of the product is 316 rubles.

The drug "Spironolactone"

The medicine is a potassium- and magnesium-sparing agent. At the same time, it effectively removes sodium and chlorine from the body. After starting to take the drug, the diuretic effect occurs approximately 2-5 days.

Medicine can be prescribed for hypertension, chronic form heart failure, liver cirrhosis. The use of Spironolactone is effective for swelling in the 2nd and 3rd trimester of pregnancy.

The drug is not intended for people diagnosed with diabetes mellitus, renal or liver failure, anuria. It is forbidden to use the product in the first trimester of pregnancy. In case of hyponatremia, hyperkalemia, hypercalcemia, the drug is contraindicated. It should not be administered to people with Addison's disease.

Can also be observed side effects when using medicine. In some cases, the drug provokes urticaria, itching, drowsiness, headache, diarrhea or constipation.

The cost of the product is about 54 rubles.

DIURETIC (DIURETIC) DRUGS

They enhance the secretion of salts and water by the kidneys, and thus eliminate swelling or accelerate the removal of chemicals from the body in case of poisoning.

Used for hypertension and edema. Not possible - if there is obstruction of the urinary tract (kidney and ureter stones).

CLASSIFICATION BY STRENGTH OF DIURETIC ACTION

1. “Powerful” or strong diuretics: mannitol (Mannitol), furosemide (Lasix), bumetanide (Bufenox), ethacrynic acid (Uregit).

2. Moderate or moderate strength: hydrochlorothiazide (hypothiazide), cyclomethiazide, chlorthalidone (oxodoline), clopamide (brinaldix), indapamide (arifon).

3. Weak diuretics: acetazolamide (diacarb), spironolactone (veroshpiron), triamterene, amiloride.

4. Herbal diuretics: bearberry leaves, lingonberries, kidney tea, juniper fruits, horsetail grass, blue cornflower flowers, birch buds.

CLASSIFICATION OF DIURETICS BY PREFERENCE

INFLUENCE ON NEPHRON PARTS

I. Diuretics with a predominant effect on the glomerulus are xanthine derivatives.

EUPHYLLINE – The diuretic effect is associated with improved renal blood flow and increased glomerular filtration when fluid is retained as a result of heart failure. For a diuretic effect, 1-2 ml of 24% solution or 5-10 ml of 2.4% solution are administered intramuscularly.

II. Diuretics with a predominant effect on the proximal tubules.

1. Osmotic diuretics (mannitol, urea) are metabolically inert substances. Mechanism of action: Hypertonic solutions of these substances are administered intravenously (urea solutions 30%, mannitol – 10-20%). At the same time, the osmotic pressure of the blood plasma increases and fluid from the tissues passes into the blood. Dehydration (dehydration) of tissues occurs. In the kidneys, urea and mannitol are not reabsorbed and are almost completely excreted in the urine, carrying water and Na+. Contraindicated in cases of impaired renal excretory function or urinary tract obstruction. Urea should not be prescribed for liver and cardiovascular failure.

MANNITOL (mannitol)- refers to strong diuretics. Used in emergency care:

Dehydration therapy for cerebral edema;

Acute renal failure;

Forced diuresis in case of poisoning;

Relief of an acute attack of glaucoma.

The diuretic effect appears after 10-20 minutes, maximum after 30-60 minutes, duration of action is 4-5 hours.

FV: bottle 30.0 of the drug; amp 200 and 400 ml 15% solution.

UREA (UREAPURA) - a strong diuretic. Application: dehydration therapy for cerebral edema and lowering intraocular pressure. Better than mannitol, it penetrates into tissues and can cause hydration of the brain and increase intracranial pressure. Duration of action 12 hours.

FV: 30-45-60-90 g of sterile preparation with the addition of 10% glucose solution (75-115-150-225 ml) to prepare a 30% solution.

2. Carbonic anhydrase inhibitors.

DIACARB (fonurite)– saluretic, inhibitor of carbonic anhydrase, an enzyme involved in the hydration of carbonic acid. In the epithelium of the renal tubules, diacarb blocks carbonic anhydrase, therefore inhibiting the formation of carbonic acid, followed by its dissociation and the release of hydrogen ions. The reabsorption of sodium ions decreases, because there is no exchange with H+ and HCO3-. The excretion of sodium and potassium ions increases. Sodium is excreted with water in the form of bicarbonates. At the same time, extrarenal carbonic anhydrase, contained in various tissues, is inhibited: in the ciliary body of the eye (as a result, the formation of intraocular fluid decreases); in the brain and its membranes (as a result, the production of cerebrospinal fluid decreases, drowsiness may occur); in the gastric mucosa (as a result, secretion decreases gastric juice); in red blood cells (hemolytic anemia). Side effect:

After 1-2 days it causes acidosis associated with depletion of sodium ion reserves, therefore it is prescribed with a break of 1-3 days or alternated with diuretics that cause alkalosis;

Hypokalemia.

Application: glaucoma, epilepsy, barbiturate poisoning.

Contraindications: urinary tract obstruction, tendency to acidosis, Addison's disease, diabetes mellitus, liver damage.

FV: tab 0.25.

III. Diuretics acting on the ascending limb of the loop of Henle (loop diuretics).

Powerful, strong diuretics, significantly remove salts, incl. ions of sodium, potassium, calcium, magnesium and chlorine, therefore called saluretics.

The main side effects: alkalosis and hypokalemia, its prevention consists of simultaneous administration of potassium preparations (potassium chloride, asparkam, panangin). Dyspepsia, hyponatremia, deficiency of calcium and magnesium ions, hyperglycemia, impaired renal function (irreversible changes in the epithelium of the renal tubules), and hearing impairment also occur.

Application:

A) emergency care in a hospital setting (iv or intramuscular furosemide or bufenox) for acute renal failure, pulmonary edema, hypertensive crisis, acute heart failure, cerebral edema, glaucomatous crisis, acute poisoning technical liquids, poisons, medicinal substances;

B) treatment of chronic patients: edema of various origins, hypertension, chronic heart failure, in contrast to hypothiazide - chronic renal failure.

Contraindications: urinary tract obstruction, hypokalemia, diabetes mellitus, Addison's disease, liver damage, torasemide is also contraindicated in cases of hypersensitivity to sulfonamides, pregnancy, lactation, and persons whose work requires increased physical and mental reactions.

FUROSEMIDE (Lasix)– one of the most active, fast and short active drugs. Unlike hypothiazide, it increases the release of calcium from the body.

FV tab 0.04 and solution 1%, 2 ml. When taken orally, the effect occurs after 20-30 minutes and lasts for 3-4 hours; when administered intravenously, it acts after 3-4 minutes and for 1.5-2 hours.

Combination drug furesis(furosemide + triamterene).

TORASEMIDE (diuver)– causes kalemia less than furosemide, but is more active and lasts longer. F.V. tablet 0.005 and 0.01 once, after meals.

BUMETANIDE (bufenox)– tablet 0.001 and solution 0.025%, 2 ml.

BRINALDIX (clopamide)– combination drug Brinerdine.

K-TA ETHACRINE (uregit)– when treating chronic patients with edema of various origins, one or several courses of 3-5 days are prescribed, with breaks to normalize the electrolyte balance, then switch to more mildly acting diuretics. 0.05 tablet – taken in the morning, after meals.

IV. Diuretics. acting on the initial part of the distal tubule - this group includes most modern diuretics and saluretics.

Mechanism of action: enhance the excretion of potassium, sodium, chlorine, and magnesium ions from the body. They reduce the excretion of calcium and uric acid ions in the urine, therefore increasing their content in the blood.

Used orally for long-term treatment various chronic diseases: Hypertension, edema associated with kidney disease and cardiovascular failure, toxicosis of pregnancy, diabetes insipidus, glaucoma. Prescribed orally in the morning before meals.

DICHLOTHIAZIDE (hypothiazide)– a moderate-strength thiazide diuretic, unlike furosemide, reduces urinary excretion of calcium and cannot be prescribed for renal failure. The action develops after 1-2 hours and lasts 10-12 hours.

Side effect:

Hypokalemia (prevention: taking potassium supplements);

Alkalosis;

Exacerbation of gout (reduces the secretion of uric acid);

Exacerbation of diabetes (increases blood sugar);

Increases blood cholesterol levels;

Hypercalcemia;

Fatigue, weakness, hypotension;

Dyspepsia.

FV tab 0.025 and 0.1.

Combined drugs:

adelfan-esidrex,

trirezide-K (reserpine + dihydralazine + hydrochlorothiazide + potassium chloride), moduretic (amiloride + hypothiazide),

triampur-compositum (triamterene + hydrochlorothiazide),

Korenitek (hypothiazide + enalapril),

coaprovel (irbesartan + hypothiazide).

INDAPAMIDE (ariphon)– main use – hypertension and edema in heart failure. FV tab and caps 0.0025; tab-retard 0.00125 (1.25 mg).

CYCLOMETHIAZIDE– thiazide diuretic, according to chemical structure and properties are close to hypothiazide, but 50 times more active. Tab 0.0005.

CHLORTALIDONE (oxodoline)– more long action than hypothiazide - up to a day or more, tab 0.05 and 0.1.

V. Diuretics with a predominant effect in the area of ​​the distal tubules and collecting ducts (potassium-sparing).

1. Competitive aldosterone antagonists. Aldosterone is a hormone of the adrenal cortex. Reduces the release of sodium ions and increases the release of potassium ions in the renal tubules. An increase in aldosterone concentration leads to the development of edema. This occurs during congestion in the liver in chronic heart failure, when the inactivation of aldosterone in the liver is impaired.

SPIRONOLACTONE (veroshpiron)– aldosterone antagonist. Eliminates the influence of aldosterone. It only works for aldosteronism. Promotes the removal of sodium, chlorine and water ions. Reduces the excretion of potassium ions, their concentration in the blood increases (potassium-sparing diuretic). The acid-base balance is not disturbed. Does not cause accumulation of uric acid in the body. The effect develops slowly: 1-2 days after the start of use, the duration of action is 2-3 days, after stopping use, a weak diuretic effect remains for 2-3 days.

Application: edema associated with the accumulation of aldosterone (HD, chronic heart failure). Because itself inactive, it is prescribed with other diuretics to prevent hypokalemia. Contraindications: kidney disease, first trimester of pregnancy. Side effects: hyperkalemia (cannot be used with potassium supplements), hypernatremia, nausea, drowsiness, skin rash, gynecomastia (reversible). FV tab 0.025.

2. Sodium channel blockers. Sodium channels in the collecting ducts are blocked, the reabsorption of sodium and chlorine ions is disrupted. They are excreted in the urine. They retain potassium in the body, reduce the release of hydrogen and magnesium ions, like veroshpiron. The effect occurs in 1-2 hours, lasts 12-24 hours. Potassium-sparing diuretics reduce the toxicity of cardiac glycosides. Often used with other stronger diuretics to reduce their doses and side effects (see combination drugs). Independent use: hypertension, chronic heart failure, edema of pregnant women. Side effects: hyperkalemia, dyspepsia, azotemia.

TRIAMTEREN– caps 0.05; combination drug triampur-compositum.

AMILORIDE- tab 0.005; combination drug moduretic.