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Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Among more than 1000 women included in the Collaborative Perinatal Project who received bendroflumethiazide (Naturetin), only 13 received this diuretic in early pregnancy (Heinonen et al., 1977). In a study of diuretics to prevent preeclampsia, no increase in the frequency of malformations or stillbirths was found in the offspring of over 1,000 women who received this diuretic after the first trimester. Among 154 infants born to women who used bendroflumethiazide during the first trimester in the Swedish Birth Defects Registry (Kallen, 2019).
Heart failure
Published in Henry J. Woodford, Essential Geriatrics, 2022
Thiazide diuretics are more effective as BP-lowering agents than loop diuretics but are less effective at reducing fluid overload. They are estimated to have 25% of the diuretic effect of loop diuretics when used alone.19 Therefore, they are not used as first-line heart failure therapy. However, in combination with loop diuretics they can be effective for people with oedema that is difficult to control. This is due to their different site of action leading to ‘sequential nephron blockade' (seeFigure 17.2). Suitable agents include bendroflumethiazide or metolazone at low doses. Their use needs to be closely monitored because fluid loss may be profound and electrolyte disturbances (i.e. hyponatraemia and hypokalaemia) are common.
Information on level of drugs into breastmilk
Published in Wendy Jones, Breastfeeding and Medication, 2018
By removing excess fluid from the body diuretics may reduce milk supply. This is more likely with furosemide than bendroflumethiazide but this category of drugs should be avoided during lactation to control blood pressure.
Interactions of antiepileptic drugs with drugs approved for the treatment of indications other than epilepsy
Published in Expert Review of Clinical Pharmacology, 2020
Kinga K. Borowicz-Reutt, Stanisław J. Czuczwar, Marta Rusek
Thiazide (bendroflumethiazide, hydrochlorothiazide), thiazide-like (chlorthalidone, indapamide), and loop (furosemide, bumetanide) diuretics are the most commonly prescribed diuretic agents used to treat hypertension, particularly in patients with heart failure, or at risk of heart failure [147]. Łukawski et al. found that hydrochlorothiazide enhanced the anticonvulsant action carbamazepine but had no impact on the antielectroshock activity of the other AEDs [176]. In addition, hydrochlorothiazide and ethacrynic acid did not have an impact on the anticonvulsant activity of levetiracetam [177]. Indapamide was found to significantly potentiate the anticonvulsant activity of carbamazepine, phenobarbital, and valproate against MES in mice and the interactions with carbamazepine and valproate were apparently pharmacodynamic. As regards phenobarbital, its total brain concentration was raised by indapamide [178]. Most important drug interactions have been shown in Table 1.
Patented therapeutic drug delivery strategies for targeting pulmonary diseases
Published in Expert Opinion on Therapeutic Patents, 2020
Ajay Kumar Thakur, Dinesh Kumar Chellappan, Kamal Dua, Meenu Mehta, Saurabh Satija, Inderbir Singh
Microparticles are defined as solid material that have their sizes ranging from 1 μm to 1000 μm. Microparticles can be prepared by encapsulating, entrapping, or dissolving the active drug within a polymer matrix. These can be employed for targeted delivery, sustained release and controlled release of therapeutic agents in the pulmonary region. Healy et al. investigated excipient-free nanoporous microparticles of bendroflumethiazide. These microparticles were prepared by a spray drying technique, where the drug bendroflumethiazide was prepared in ethanol/water and was dried in a laboratory spray drier. The obtained product was then characterized and delivered to the lungs [56]. Cook et al. reported a method for the pulmonary delivery of sustained released microspheres that were prepared by the spray drying technique. They used nanoparticles of a hydrophilic, ionized drug which was entrapped in hydrophobic microspheres. In this technique, terbutaline sulfate microspheres were successfully developed and delivered to the lungs as a sustained release formulation [57]. Fiore et al. reported the use of polyketal microparticles for pulmonary delivery. In this study, the compatibility of the polyketal microparticles to the lungs was tested, for pulmonary delivery. It was found to be highly biocompatible with the anti-inflammatory property; but, further more investigations were needed at the application level [58]. Tewes et al. prepared steroid/mucokinetic hybrid nanoporous microparticles for pulmonary delivery. Budesonide/ambroxol-HCl-loaded microparticles were developed by the spray drying method. The study reported that hybrid microparticles improved the permeability of budesonide [59].
Was it optimal to drop a diuretic as a first-line choice of drug treatment in the 2020 International Society of Hypertension Guidelines?
Published in Blood Pressure, 2020
Sverre E. Kjeldsen, Krzysztof Narkiewicz, Michel Burnier, Suzanne Oparil
In ASCOT, the diuretic, which was given as the second drug, if needed, in the atenolol + thiazide arm, was severely under-dosed early in the trial, resulting in less effective blood pressure lowering in the beta-adrenergic blocker + diuretic arm compared to the CCB + ACE-inhibitor arm. As a consequence, the study secretary, first author of the current ISH letter, contacted the Nordic leaders and requested higher dosing of bendroflumethiazide in an attempt to minimise the difference in blood pressure between the two arms. This attempt was only partly successful as lower blood pressure in the CCB + ACE-inhibitor arm sustained throughout the length of the ASCOT study [7]. Study leadership did not conclude that the diuretic component of the treatment was inferior [7], but rather that the beta-blocker atenolol was inferior to the CCB amlodipine, leaving ACCOMPLISH [6] as the only trial ever to show a diuretic to be inferior to a CCB when administered in combination with an ACE inhibitor. ACCOMPLISH included a rigid protocol with forced up-titration of blinded study drugs to achieve blood pressure targets [6]. It reached its blood pressure targets in more than 80% of study participants, but required a protocol that differed greatly from how treatment of hypertension is carried out by most health care providers around the world. The ACCOMPLISH findings [6] need to be confirmed in other similarly designed and properly powered outcome trial(s) before concluding that a diuretic is inferior to other drug classes as first or second line treatment. Besides, black patients in sub-Saharan Africa had similar blood pressure responses to amlodipine plus hydrochlorothiazide as they had to amlodipine plus perindopril [8].