{"id":51688,"date":"2023-09-20T09:24:27","date_gmt":"2023-09-20T09:24:27","guid":{"rendered":"https:\/\/medsname.com\/divret\/"},"modified":"2026-05-01T10:49:11","modified_gmt":"2026-05-01T10:49:11","slug":"divret","status":"publish","type":"product","link":"https:\/\/medsbase.com\/ro\/product\/divret\/","title":{"rendered":"Divret"},"content":{"rendered":"<p><!-- medsbase-tldr-answer --><\/p>\n<div style=\"background:#fff8e1;border-left:4px solid #f5a623;padding:18px 22px;margin:0 0 24px 0;border-radius:4px;\">\n<h3 class=\"wp-block-heading\" style=\"margin:0 0 8px 0;font-size:16px;font-weight:700;\">\u26a1 R\u0103spuns rapid \u2014 Ce este Divret?<\/h3>\n<p style=\"margin:0;\"><strong>Divret<\/strong> este un <strong>comprimat de indapamid\u0103 1,5 mg cu eliberare prelungit\u0103<\/strong> de la Sun Pharma \u2014 un <strong>diuretic de tip tiazidic (indolin\u0103\/clorosulfonamid\u0103)<\/strong> care ac\u021bioneaz\u0103 asupra <strong>NCC (cotransportorul de sodiu-clorur\u0103) \u00een tubulul distal, cu activitate vasodilatatoare direct\u0103 adi\u021bional\u0103<\/strong>. Indapamida a fost introdus\u0103 de Servier \u00een 1977 ca <strong>Natrilix<\/strong>. Structural distinct de tiazide (inel indolinic vs benzotiadiazin\u0103), dar \u00eemp\u0103rt\u0103\u0219e\u0219te mecanismul inhibitor NCC; clasificat clinic ca un diuretic \u201casem\u0103n\u0103tor tiazidelor\u201d al\u0103turi de clortalidon\u0103 \u0219i metolazon\u0103. Timp de \u00eenjum\u0103t\u0103\u021bire 14-18 ore (IR) \/ 18 ore (SR); debut 1-2 ore; efect maxim la 2 ore; durat\u0103 24-36 ore. Indica\u021bie principal\u0103: <strong>hipertensiune arterial\u0103 (de prim\u0103 inten\u021b\u0103; \u00een special la v\u00e2rstnici)<\/strong>. Dozaj tipic: <strong>Hipertensiune arterial\u0103:<\/strong> 1,25-2,5 mg o dat\u0103 pe zi (eliberare imediat\u0103) sau 1,5 mg o dat\u0103 pe zi (eliberare prelungit\u0103). Doza mic\u0103 de 1,25-1,5 mg ofer\u0103 un efect aproape complet asupra TA cu perturb\u0103ri metabolice minime; 2,5 mg adaug\u0103 pu\u021bin efect asupra TA dar cre\u0219te riscul de hipokaliemie. <strong>Agent preferat asem\u0103n\u0103tor tiazidelor la pacien\u021bii v\u00e2rstnici<\/strong> dat fiind dovezile HYVET. Contraindica\u021bii cheie: consulta\u021bi lista complet\u0103 de mai jos. Monitoriza\u021bi electroli\u021bii, creatinina \u0219i glicemia. <strong>Nu combina\u021bi cu litiu<\/strong> (diureticele tiazidice\/de ans\u0103 pot precipita toxicitatea litiului). <strong>Utilizarea \u00een sarcin\u0103 este specific\u0103 cazului<\/strong> (consulta\u021bi nota despre sarcin\u0103). Pentru majoritatea pacien\u021bilor hipertensivi, diureticele func\u021bioneaz\u0103 cel mai bine ca <strong>al doilea sau al treilea agent<\/strong> \u2014 de obicei combinat cu un BRA, inhibitor ACE sau blocant al canalelor de calciu, mai degrab\u0103 dec\u00e2t utilizat singur.<\/p>\n<\/div>\n<div class=\"medsbase-trust-strip\" style=\"background:#f4f8fb;border:1px solid #d8e3eb;padding:12px 16px;margin:16px 0;border-radius:4px;font-size:14px;\">\n<strong>Ce beneficii ofer\u0103 MedsBase:<\/strong> Produc\u0103tor certificat WHO-GMP \u00b7 Ambalaj discret \u00b7 Livrare la nivel mondial \u00b7 Peste 1.400 de recenzii verificate <a href=\"https:\/\/medsbase.com\/ro\/reviews\/\">ale clien\u021bilor<\/a>\n<\/div>\n<p class=\"medsbase-reship-line\" style=\"font-size:14px;color:#444;margin:8px 0 18px;\">\ud83d\udce6 Fiecare comand\u0103 este acoperit\u0103 de politica noastr\u0103 de <a href=\"https:\/\/medsbase.com\/ro\/medsbase-re-shipment-assurance-policy\/\"><strong>Politica noastr\u0103 de Reexpediere Garantat\u0103<\/strong><\/a> \u2014 dac\u0103 coletul dumneavoastr\u0103 nu sose\u0219te \u00een 20 de zile lucr\u0103toare, \u00eel relivr\u0103m.<\/p>\n<h3>De ce s\u0103 comanzi de la MedsBase<\/h3>\n<p>Medicamentele noastre generice sunt procurate de la produc\u0103tori certifica\u021bi WHO-GMP \u0219i expediate la nivel mondial \u00een ambalaje discrete \u0219i simple \u2014 f\u0103r\u0103 denumirea medicamentului pe exteriorul coletului. Pl\u0103\u021bile cu cardul sunt procesate printr-un procesor reglementat (descrierile de pe extrasul de cont includ un procesor de pl\u0103\u021bi cu card reglementat \u2014 niciodat\u0103 \u201cMedsBase\u201d sau numele vreunui medicament). Accept\u0103m \u0219i criptomonede \u0219i transferuri bancare SEPA. Fiecare comand\u0103 este sus\u021binut\u0103 de Politica noastr\u0103 de Asigurare pentru Relivrare.<\/p>\n<h2 class=\"wp-block-heading\">Ce este Divret?<\/h2>\n<p>Divret este un comprimat oral de 1,5 mg PR de indapamid\u0103 de la Sun Pharma, furnizat \u00een cutii de 30-90 de comprimate. Indapamida a fost introdus\u0103 de Servier \u00een 1977 ca <strong>Natrilix<\/strong>. Structural distinct de tiazide (inel indolinic vs benzotiadiazin\u0103), dar \u00eemp\u0103rt\u0103\u0219e\u0219te mecanismul inhibitor NCC; clasificat clinic ca un diuretic \u201casem\u0103n\u0103tor tiazidelor\u201d al\u0103turi de clortalidon\u0103 \u0219i metolazon\u0103.<\/p>\n<h2 class=\"wp-block-heading\">Cum ac\u021bioneaz\u0103 Indapamida<\/h2>\n<p>Indapamida inhib\u0103 <strong>NCC (cotransportorul de sodiu-clorur\u0103) \u00een tubulul distal, cu activitate vasodilatatoare direct\u0103 adi\u021bional\u0103<\/strong>. Efectele secundare:<\/p>\n<ul>\n<li><strong>Reducerea reabsorb\u021biei de sodiu la nivelul tubulului distal<\/strong> \u2014 mecanismul specific clasei tiazidelor<\/li>\n<li><strong>Activitate vasodilatatoare direct\u0103<\/strong> \u2014 mai pronun\u021bat\u0103 dec\u00e2t la tiazidele pure (HCTZ); contribuie la un control mai uniform al TA pe 24 de ore<\/li>\n<li><strong>Modularea canalelor de calciu<\/strong> \u00een mu\u0219chiul neted vascular la doze mai mari<\/li>\n<li><strong>Efect antihipertensiv prelungit<\/strong> \u2014 Acoperire 24 de ore cu dozare o dat\u0103 pe zi (timp de \u00eenjum\u0103t\u0103\u021bire 14-18 ore)<\/li>\n<li><strong>Eficacitate p\u0103strat\u0103 la insuficien\u021b\u0103 renal\u0103 cronic\u0103 u\u0219oar\u0103-moderat\u0103<\/strong> (eGFR 30-60) \u2014 mai bun dec\u00e2t HCTZ \u00een acest interval de GFR<\/li>\n<li><strong>Mai pu\u021bine efecte metabolice adverse la doze mici<\/strong> (1,25-1,5 mg) dec\u00e2t HCTZ la doza tipic\u0103 de 25 mg \u2014 acela\u0219i efect asupra tensiunii arteriale cu impact mai mic asupra glicemiei \u0219i lipidelor<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Utiliz\u0103ri aprobate \u0219i bazate pe dovezi<\/h2>\n<ul>\n<li><strong>Hipertensiune arterial\u0103 (linia \u00eent\u00e2i; \u00een special la v\u00e2rstnici)<\/strong> \u2014 indica\u021bie principal\u0103<\/li>\n<li><strong>Hipertensiune la fo\u0219tii v\u00e2rstnici (\u226580 de ani)<\/strong> \u2014 dovezi HYVET, agent tiazidic de prim\u0103 alegere<\/li>\n<li><strong>Hipertensiune \u00een diabetul zaharat de tip 2<\/strong> \u2014 dovezi ADVANCE (combinat cu perindopril)<\/li>\n<li><strong>Preven\u021bie secundar\u0103 a accidentului vascular cerebral<\/strong> \u2014 dovezi PROGRESS (combinat cu perindopril)<\/li>\n<li><strong>Hipertensiune sistolic\u0103 izolat\u0103<\/strong><\/li>\n<\/ul>\n<p><strong>Dovezile din studiile pivotale:<\/strong> <strong>HYVET (2008)<\/strong> \u2014 studiu pivotal la pacien\u021bii hipertensivi foarte \u00een v\u00e2rst\u0103 (\u226580 de ani); indapamida 1,5 mg SR \u00b1 perindopril a redus mortalitatea general\u0103 cu 21%, accidentul vascular cerebral cu 30% \u0219i insuficien\u021ba cardiac\u0103 cu 64% fa\u021b\u0103 de placebo. A stabilit terapia bazat\u0103 pe indapamid\u0103 ca tratament de prim\u0103 linie la hipertensivi foarte \u00een v\u00e2rst\u0103. <strong>ADVANCE (2007)<\/strong> \u2014 indapamida + perindopril au redus evenimentele macrovascular \u0219i decesul cardiovascular cu 18% la 11.140 pacien\u021bi cu diabet tip 2. <strong>PROGRESS (2001)<\/strong> \u2014 aceea\u0219i combina\u021bie a redus recidiva accidentului vascular cerebral cu 28% la pacien\u021bii cu antecedente de AVC.<\/p>\n<h2 class=\"wp-block-heading\">Divret Dozaj<\/h2>\n<p><strong>Doza pentru hipertensiune:<\/strong> <strong>Hipertensiune arterial\u0103:<\/strong> 1,25-2,5 mg o dat\u0103 pe zi (eliberare imediat\u0103) sau 1,5 mg o dat\u0103 pe zi (eliberare prelungit\u0103). Doza mic\u0103 de 1,25-1,5 mg ofer\u0103 un efect aproape complet asupra TA cu perturb\u0103ri metabolice minime; 2,5 mg adaug\u0103 pu\u021bin efect asupra TA dar cre\u0219te riscul de hipokaliemie. <strong>Agent preferat asem\u0103n\u0103tor tiazidelor la pacien\u021bii v\u00e2rstnici<\/strong> pe baza dovezilor HYVET.<\/p>\n<p><strong>Alte indica\u021bii:<\/strong> Indapamida este utilizat\u0103 aproape exclusiv pentru hipertensiune. Nu este utilizat\u0103 \u00een mod obi\u0219nuit pentru edemul din insuficien\u021b\u0103 cardiac\u0103 (se prefer\u0103 diureticele de ans\u0103) sau pentru ascit\u0103.<\/p>\n<p><strong>Administrare:<\/strong> o dat\u0103 pe zi (sau de dou\u0103 ori pe zi pentru doze mari de diuretice de ans\u0103 \u00een insuficien\u021b\u0103 cardiac\u0103), diminea\u021ba. Administrarea seara provoac\u0103 nicturie \u0219i ar trebui evitat\u0103 c\u00e2nd este posibil. Lua\u021bi la aceea\u0219i or\u0103 \u00een fiecare zi. Alimenta\u021bia nu afecteaz\u0103 semnificativ absorb\u021bia pentru niciunul dintre aceste diuretice.<\/p>\n<p><strong>Program de monitorizare:<\/strong><\/p>\n<ul>\n<li><strong>Valori ini\u021biale:<\/strong> uree, electroli\u021bi (\u00een special potasiu \u0219i sodiu), creatinin\u0103, eGFR, glucoz\u0103, acid uric seric. Tensiunea arterial\u0103 acas\u0103 sau \u00een clinic\u0103 \u0219i greutatea zilnic\u0103 pentru pacien\u021bii cu insuficien\u021b\u0103 cardiac\u0103.<\/li>\n<li><strong>la 1-2 s\u0103pt\u0103m\u00e2ni dup\u0103 \u00eenceperea sau modificarea dozei:<\/strong> repetarea electroli\u021bilor \u0219i a creatininei. A\u0219tepta\u021bi modific\u0103ri minore ale electroli\u021bilor; investiga\u021bi modific\u0103ri substan\u021biale.<\/li>\n<li><strong>4-6 s\u0103pt\u0103m\u00e2ni:<\/strong> evaluarea tensiunii arteriale \u0219i panelul metabolic complet.<\/li>\n<li><strong>Continuu:<\/strong> electroli\u021bi anuali, acid uric, glucoz\u0103 \u0219i panel lipidic odat\u0103 stabilizat. Mai frecvent \u00een insuficien\u021b\u0103 renal\u0103 cronic\u0103, insuficien\u021b\u0103 cardiac\u0103 sau la terapie combinat\u0103.<\/li>\n<li><strong>\u00centrerupe\u021bi sau reduce\u021bi doza la:<\/strong> sodiu &lt;130 cu simptome, potasiu 5,5, cre\u0219tere creatinin\u0103 &gt;30%, gut\u0103 nou\u0103, simptome severe de deshidratare.<\/li>\n<\/ul>\n<p><strong>\u00centrerupere:<\/strong> nu exist\u0103 sindrom de sevraj, dar \u00eentreruperea brusc\u0103 poate provoca reten\u021bie de volum de tip rebound la pacien\u021bii cu IC sub doze cronice mari de diuretice de ans\u0103 \u2014 reduce\u021bi progresiv doza acolo unde este posibil \u0219i monitoriza\u021bi greutatea.<\/p>\n<ul>\n<li><strong>Activitate vasodilatatoare direct\u0103<\/strong> dincolo de inhibarea NCC \u2014 contribuie la un control mai uniform al TA pe parcursul a 24 de ore.<\/li>\n<li><strong>Profil metabolic u\u0219or mai bun<\/strong> dec\u00e2t HCTZ la acela\u0219i efect antihipertensiv (impact mai mic asupra glicemiei \u0219i lipidelor la doze mici).<\/li>\n<li><strong>R\u0103m\u00e2ne eficient \u00een IRC u\u0219oar\u0103-moderat\u0103<\/strong> (TFG 30-60) \u2014 mai bun dec\u00e2t HCTZ, similar cu clortalidona.<\/li>\n<li><strong>Alegere validat\u0103 de HYVET la pacien\u021bii foarte \u00een v\u00e2rst\u0103<\/strong>, \u00een combina\u021bie cu perindopril.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Efecte Secundare<\/h2>\n<p><strong>Frecvente (&gt;1%):<\/strong><\/p>\n<ul>\n<li><strong>Hipokaliemie<\/strong> (dependent de doz\u0103; de obicei u\u0219oar\u0103 la 1,25-1,5 mg)<\/li>\n<li><strong>Hiponatremie<\/strong> \u2014 femeile \u00een v\u00e2rst\u0103 cu diete s\u0103race \u00een sare sunt deosebit de susceptibile; poate fi sever\u0103<\/li>\n<li><strong>Hiperuricemie<\/strong> \u2014 rareori poate declan\u0219a gut\u0103 la doze mici<\/li>\n<li><strong>Erup\u021bie fotosensibil\u0103<\/strong><\/li>\n<li><strong>Disfunc\u021bie erectil\u0103<\/strong> (mai pu\u021bin frecvent\u0103 dec\u00e2t cu HCTZ)<\/li>\n<li><strong>Hiperglicemie u\u0219oar\u0103<\/strong> (mai pu\u021bin pronun\u021bat\u0103 dec\u00e2t cu HCTZ)<\/li>\n<li><strong>Prelungirea intervalului QT<\/strong> \u2014 de obicei nesemnificativ\u0103 clinic la doze terapeutice; preocupare dac\u0103 este combinat\u0103 cu alte medicamente care prelungesc QT \u0219i hipokaliemie<\/li>\n<\/ul>\n<p><strong>Pu\u021bin frecvente, dar clinic importante:<\/strong><\/p>\n<ul>\n<li><strong>Hiponatremie sever\u0103<\/strong> \u2014 \u00een special la persoanele \u00een v\u00e2rst\u0103 cu diete s\u0103race \u00een sare, st\u0103ri predispuse la SIADH sau \u00een combina\u021bie cu SSRI. Se poate manifesta prin confuzie, c\u0103deri sau convulsii.<\/li>\n<li><strong>Pancreatit\u0103<\/strong> \u2014 efect rar al clasei de tiazide\/loop; \u00eentrerupe\u021bi imediat la apari\u021bia durerii abdominale superioare cu cre\u0219tere a lipazei<\/li>\n<li><strong>Trombocitopenie, leucopenie, agranulocitoz\u0103<\/strong> \u2014 reac\u021bii rare de hipersensibilitate (mai frecvente la tiazide dec\u00e2t la diureticele de ans\u0103)<\/li>\n<li><strong>Miopie acut\u0103 \u0219i glaucom cu unghi \u00eenchis<\/strong> \u2014 reac\u021bie rar\u0103 din clasa sulfonamidelor, care apare \u00een c\u00e2teva ore sau zile de la \u00eenceperea tratamentului; \u00eentrerupe\u021bi imediat dac\u0103 apar dureri oculare sau modific\u0103ri ale vederii<\/li>\n<li><strong>Sindromul Stevens-Johnson \/ necroliz\u0103 epidermic\u0103 toxic\u0103<\/strong> \u2014 extrem de rar, dar raportat<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Contraindica\u021bii<\/h2>\n<ul>\n<li>Anurie sau insuficien\u021b\u0103 renal\u0103 sever\u0103 (eGFR &lt;30)<\/li>\n<li>Hipersensibilitate la sulfonamide<\/li>\n<li>Hiponatremie sau hipokaliemie simptomatic\u0103 la evaluarea ini\u021bial\u0103<\/li>\n<li>Insuficien\u021b\u0103 hepatic\u0103 sever\u0103 (Child-Pugh C) \u2014 risc de encefalopatie hepatic\u0103<\/li>\n<li>Prelungire cunoscut\u0103 a intervalului QT sau istoric de torsade de pointes (precau\u021bie)<\/li>\n<\/ul>\n<p><strong>Sarcina:<\/strong> \u00een general evitate \u2014 tiazidele trec placenta \u0219i pot provoca icter fetal sau neonatal \u0219i trombocitopenie. Utiliza\u021bi numai dac\u0103 beneficiul dep\u0103\u0219e\u0219te clar riscul (hipertensiune rezistent\u0103 \u00een sarcin\u0103 t\u00e2rzie), sub \u00eendrumare specializat\u0103.<\/p>\n<p><strong>Al\u0103ptarea:<\/strong> \u00een general acceptabile la doze mici; dozele mari pot suprima lacta\u021bia (\u00een special tiazidele). Antihipertensive alternative (propranolol, nifedipin\u0103) sunt preferate atunci c\u00e2nd este posibil.<\/p>\n<h2 class=\"wp-block-heading\">Interac\u021biuni medicamentoase<\/h2>\n<ul>\n<li><strong>Litiu \u2014 INTERAC\u021aIUNE CRITIC\u0102.<\/strong> Diureticele tiazidice \u0219i cele de ans\u0103 reduc clearance-ul renal al litiului \u0219i pot precipita toxicitatea acestuia. Evita\u021bi combina\u021bia dac\u0103 este posibil; dac\u0103 este inevitabil, monitoriza\u021bi nivelurile de litiu s\u0103pt\u0103m\u00e2nal \u00een prima lun\u0103 \u0219i reduce\u021bi doza de litiu cu 25-50%.<\/li>\n<li><strong>AINS<\/strong> \u2014 reduc efectul diuretic (prin blocarea prostaglandinelor) \u0219i cresc substan\u021bial riscul de insuficien\u021b\u0103 renal\u0103 acut\u0103 atunci c\u00e2nd sunt combinate cu ACEi\/ARB (\u201ctripla lovitur\u0103\u201d). Utiliza\u021bi paracetamol preferen\u021bial pentru durerea cronic\u0103.<\/li>\n<li><strong>Inhibitori ACE \u0219i ARB<\/strong> \u2014 combina\u021bia este standard \u0219i benefic\u0103 \u00een HTA; ad\u0103ugarea de ACEi\/ARB blocheaz\u0103 activarea compensatorie a sistemului RAAS \u0219i poten\u021beaz\u0103 efectul diuretic. Monitoriza\u021bi potasiul \u0219i creatinina.<\/li>\n<li><strong>Suplimente de potasiu \u0219i diuretice economisitoare de potasiu<\/strong> \u2014 adesea necesare pentru a compensa hipokaliemia indus\u0103 de diureticele de tip loop\/tiazidic. Monitoriza\u021bi potasiul; evita\u021bi corec\u021bia excesiv\u0103.<\/li>\n<li><strong>Digoxin\u0103<\/strong> \u2014 hipokaliemia poten\u021beaz\u0103 toxicitatea digoxinului (diureticele loop \u0219i tiazidice); spironolactona reduce direct clearance-ul digoxinului. Monitoriza\u021bi nivelurile de digoxin \u0219i potasiu la \u00eenceperea sau modificarea diureticului.<\/li>\n<li><strong>Corticoesteroide orale, amfotericina B, laxative stimulante<\/strong> \u2014 hipokaliemie aditiv\u0103 (diuretice loop\/tiazidice) sau necesitate mascat\u0103 de potasiu (spironolacton\u0103).<\/li>\n<li><strong>Antidiabetice orale, insulin\u0103<\/strong> \u2014 diureticele tiazidice \u0219i (\u00een mai mic\u0103 m\u0103sur\u0103) cele loop \u00eenr\u0103ut\u0103\u021besc toleran\u021ba la glucoz\u0103; poate fi necesar\u0103 ajustarea dozei.<\/li>\n<li><strong>Colestiramin\u0103 \/ colestipol<\/strong> \u2014 reduce absorb\u021bia tiazidelor \u0219i a diureticelor de ans\u0103 cu 40-85%. Administrarea trebuie separat\u0103 cu 4 ore.<\/li>\n<li><strong>Alcool<\/strong> \u2014 hipotensiune postural\u0103 aditiv\u0103.<\/li>\n<\/ul>\n<h2 class=\"wp-block-heading\">Pozi\u021bia lui Divret \u00een Clasa Diureticelor<\/h2>\n<table style=\"width:100%;border-collapse:collapse;margin:14px 0;\">\n<thead>\n<tr style=\"background:#2c7cb0;color:#fff;\">\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">Clas\u0103<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">Reprezentan\u021bi<\/th>\n<th style=\"padding:10px;border:1px solid #ddd;text-align:left;\">Utilizare tipic\u0103<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Tiazid\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><a href=\"https:\/\/medsbase.com\/ro\/aquazide\/\">HCTZ<\/a>, clortalidon\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">HTN prim-line, pietre de calciu, DI nefrogen<\/td>\n<\/tr>\n<tr style=\"background:#fff3cd;\">\n<td style=\"padding:10px;border:1px solid #ddd;\">Asem\u0103n\u0103tor tiazidelor<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><a href=\"https:\/\/medsbase.com\/ro\/natrilix-sr\/\">Indapamid\u0103<\/a>, metolazon<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">HTN (v\u00e2rstnici, dovezi HYVET), blocaj secven\u021bial al nefronului<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Diuretic de ans\u0103 (scurt)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><a href=\"https:\/\/medsbase.com\/ro\/lasix\/\">Furosemid\u0103<\/a>, bumetanid\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Edem pulmonar acut, ICC, ascit\u0103, hipercalcemie<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px;border:1px solid #ddd;\">Bucl\u0103 (lung\u0103)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><a href=\"https:\/\/medsbase.com\/ro\/dytor\/\">Torasemid\u0103<\/a><\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">IC cronic\u0103, HTA (singura bucl\u0103 cu dovezi pentru HTA), edem la BCR<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Antagonist de aldosteron\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\"><a href=\"https:\/\/medsbase.com\/ro\/aldactone\/\">Spironolacton\u0103<\/a>, eplerenon\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">IC-FER (RALES), HTA rezistent\u0103 (PATHWAY-2), sindrom Conn, ascit\u0103 cirotic\u0103<\/td>\n<\/tr>\n<tr style=\"background:#f9f9f9;\">\n<td style=\"padding:10px;border:1px solid #ddd;\">Alte economizoare de potasiu<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Amilorid\u0103, triamteren (de obicei \u00een combina\u021bii)<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Prevenirea hipokaliemiei atunci c\u00e2nd se adaug\u0103 la bucl\u0103\/tiazidic\u0103<\/td>\n<\/tr>\n<tr>\n<td style=\"padding:10px;border:1px solid #ddd;\">Anhidraz\u0103 carbonic\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Acetazolamid\u0103<\/td>\n<td style=\"padding:10px;border:1px solid #ddd;\">Mal de altitudine, glaucom, alcaloz\u0103 metabolic\u0103<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 class=\"wp-block-heading\">Depozitare<\/h2>\n<p>P\u0103stra\u021bi Divret la temperaturi sub 25\u00b0C \u00een ambalajul original. Depozita\u021bi \u00eentr-un loc inaccesibil copiilor.<\/p>\n<h2 id=\"faqs\">\u00centreb\u0103ri frecvente<\/h2>\n<h3 class=\"wp-block-heading\">C\u00e2nd ar trebui s\u0103 iau Divret \u2014 diminea\u021ba sau seara?<\/h3>\n<p><strong>Diminea\u021ba<\/strong> \u00een aproape toate cazurile. Efectul diuretic produce o cre\u0219tere a produc\u021biei de urin\u0103 timp de 2-8 ore dup\u0103 administrare. Administrarea seara provoac\u0103 nicturie \u0219i perturb\u0103 somnul. Pacien\u021bii care iau diuretice de ans\u0103 de dou\u0103 ori pe zi le administreaz\u0103 de obicei la micul dejun \u0219i la pr\u00e2nz (nu la culcare).<\/p>\n<h3 class=\"wp-block-heading\">Este Divret un medicament de prim\u0103 linie pentru hipertensiune?<\/h3>\n<p>Da \u2014 tiazidele (HCTZ, clortalidon\u0103) \u0219i agen\u021bii asem\u0103n\u0103tori tiazidelor (indapamida) sunt una dintre <strong>cele patru clase de antihipertensive de prim\u0103 linie<\/strong> al\u0103turi de BRA, inhibitori ACE \u0219i blocante ale canalelor de calciu. Pentru majoritatea pacien\u021bilor cu hipertensiune nou diagnosticat\u0103, o tiazid\u0103 este un agent rezonabil de prim\u0103 sau a doua linie, iar aproape to\u021bi pacien\u021bii afla\u021bi \u00eentr-un regim cu mai multe medicamente includ unul.<\/p>\n<h3 class=\"wp-block-heading\">Va afecta Divret nivelul meu de potasiu?<\/h3>\n<p>Da \u2014 Divret <strong>scade<\/strong> potasiul prin cre\u0219terea excre\u021biei de potasiu la nivelul tubului distal. Monitoriza\u021bi la ini\u021biere, dup\u0103 1-2 s\u0103pt\u0103m\u00e2ni \u0219i periodic. Riscul de hipokaliemie este <strong>minimizat prin combinarea<\/strong> Divret cu un ARB sau inhibitor ACE \u2014 care este combina\u021bia standard \u00een hipertensiune oricum. Dac\u0103 potasiul scade sub 3,5 \u00een cazul utiliz\u0103rii izolate a diureticului, ad\u0103uga\u021bi suplimente de potasiu, o diet\u0103 bogat\u0103 \u00een potasiu sau o doz\u0103 mic\u0103 de un agent care economise\u0219te potasiu (spironolacton\u0103, eplerenon\u0103 sau o combina\u021bie care con\u021bine <a href=\"https:\/\/medsbase.com\/ro\/amifru\/\">amilorid\u0103<\/a>).<\/p>\n<h3 class=\"wp-block-heading\">Am gut\u0103 \u2014 pot lua Divret?<\/h3>\n<p>Cu precau\u021bie. Diureticele tiazidice \u0219i (\u00een mai mic\u0103 m\u0103sur\u0103) cele de tip bucl\u0103 cresc acidul uric seric prin competi\u021bia pentru excre\u021bia la nivelul tubului proximal. La pacien\u021bii predispu\u0219i la gut\u0103: prefera\u021bi combina\u021biile pe baz\u0103 de losartan (<a href=\"https:\/\/medsbase.com\/ro\/cosart-h\/\">Cosart H<\/a>, <a href=\"https:\/\/medsbase.com\/ro\/cozartan-h\/\">Cozartan H<\/a>) al c\u0103rui component losartan este unic uricosuric \u0219i contracareaz\u0103 cre\u0219terea uratelor cauzat\u0103 de tiazid\u0103. Dac\u0103 Divret este deja utilizat \u0219i apar accese de gut\u0103, ad\u0103uga\u021bi sau continua\u021bi terapia de sc\u0103dere a uratelor (alopurinol) \u00een loc s\u0103 \u00eentrerupe\u021bi Divret complet.<\/p>\n<h3 class=\"wp-block-heading\">Sunt diabetic \u2014 este Divret sigur?<\/h3>\n<p>Da \u2014 indapamida este <strong>bine sus\u021binut\u0103 \u00een diabetul zaharat de tip 2<\/strong> de studiul ADVANCE (indapamid\u0103 + perindopril au redus evenimentele cardiovasculare cu 18% la 11.140 diabetici). Indapamida \u00een doze mici (1,25-1,5 mg) are un impact mai mic asupra glicemiei dec\u00e2t 25 mg HCTZ la un efect echivalent asupra tensiunii arteriale. Monitoriza\u021bi HbA1c anual.<\/p>\n<h3 class=\"wp-block-heading\">Pot lua ibuprofen cu Divret?<\/h3>\n<p>Utilizarea ocazional\u0103 pe termen scurt este de obicei \u00een regul\u0103. NSAID-urile utilizate zilnic pe termen lung (ibuprofen, diclofenac, naproxen) <strong>reduc efectul diuretic \u0219i antihipertensiv<\/strong> al Divret (blocarea prostaglandinelor) \u0219i cresc substan\u021bial riscul de insuficien\u021b\u0103 renal\u0103 acut\u0103 atunci c\u00e2nd sunt combinate cu un inhibitor ACE sau ARB \u2014 \u201ctriplul impact\u201d. Utiliza\u021bi paracetamol preferen\u021bial pentru durerea cronic\u0103.<\/p>\n<h3 class=\"wp-block-heading\">Voi urina mai mult noaptea?<\/h3>\n<p>De obicei nu, dac\u0103 lua\u021bi Divret diminea\u021ba. Efectul diuretic atinge maximul la 2-8 ore dup\u0103 administrare \u0219i se diminueaz\u0103 \u00een mare parte p\u00e2n\u0103 seara. Nocturia este o pl\u00e2ngere frecvent\u0103 atunci c\u00e2nd pacien\u021bii trec la administrarea seara; reveni\u021bi la administrarea diminea\u021ba \u0219i nocturia se rezolv\u0103 \u00een 1-3 zile.<\/p>\n<h3 class=\"wp-block-heading\">Pot lua Divret \u00een timpul sarcinii?<\/h3>\n<p>Evitat \u00een mod obi\u0219nuit. Indapamida traverseaz\u0103 placenta \u0219i poate afecta f\u0103tul. Pentru hipertensiunea arterial\u0103 \u00een sarcin\u0103, trece\u021bi la <a href=\"https:\/\/medsbase.com\/ro\/labebet\/\">labetalol<\/a>, metildopa sau nifedipin\u0103. Diureticele sunt utilizate \u00een sarcin\u0103 doar pentru indica\u021bii specifice (edem pulmonar, insuficien\u021b\u0103 cardiac\u0103 rezistent\u0103) sub supraveghere specializat\u0103.<\/p>\n<h3 class=\"wp-block-heading\">Ce fac dac\u0103 uit o doz\u0103?<\/h3>\n<p>Lua\u021bi-l c\u00e2t mai cur\u00e2nd v\u0103 aminti\u021bi, cu excep\u021bia cazului \u00een care este aproape timpul pentru urm\u0103toarea doz\u0103 \u2014 \u00een acest caz omite\u021bi doza ratat\u0103. Nu dubla\u021bi doza. O singur\u0103 doz\u0103 ratat\u0103 nu afecteaz\u0103 semnificativ controlul tensiunii arteriale pe termen lung sau al fluidelor.<\/p>\n<h3 class=\"wp-block-heading\">Unde pot cump\u0103ra Divret online?<\/h3>\n<p>Pute\u021bi cump\u0103ra Divret (1,5 mg PR indapamid\u0103, 30-90 comprimate) de la MedsBase cu ambalaj discret \u0219i livrare la nivel mondial.<\/p>\n<p><!-- medsbase-related-alts-v1 --><\/p>\n<h2 class=\"wp-block-heading\">Antihipertensive \u0219i Diuretice Asem\u0103n\u0103toare pe MedsBase<\/h2>\n<ul>\n<li><a href=\"https:\/\/medsbase.com\/ro\/aldactone\/\">Aldactone \u2014 Spironolacton\u0103 25 mg (antagonist al aldosteronului)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/amifru\/\">Amifru \u2014 Furosemid\u0103 + Amilorid\u0103 (diuretic de ans\u0103 + economisitor de potasiu)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/dytor\/\">Dytor \u2014 Torasemid\u0103 (diuretic de ans\u0103, biodisponibilitate mai predictibil\u0103)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/losar\/\">Losar \u2014 Losartan (ARB asociat cu diuretic)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/natrilix-sr\/\">Natrilix SR \u2014 Indapamid\u0103 1,5 mg SR (asem\u0103n\u0103tor tiazidelor)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/silectone\/\">Silectone \u2014 Spironolacton\u0103 (antagonist al aldosteronului)<\/a><\/li>\n<li><a href=\"https:\/\/medsbase.com\/ro\/high-blood-pressure-medication\/\"><strong>R\u0103sfoi\u021bi toate medicamentele pentru hipertensiune arterial\u0103<\/strong><\/a><\/li>\n<\/ul>\n<div style=\"background:#fff3f3;border-left:4px solid #d9534f;padding:16px 20px;margin:24px 0;border-radius:4px;\"><strong>\u2695 Dezaprobare medical\u0103.<\/strong> Aceast\u0103 pagin\u0103 are scop informativ \u0219i nu \u00eenlocuie\u0219te sfatul medical al unui medic calificat. Hipertensiunea, insuficien\u021ba cardiac\u0103 \u0219i aritmiile necesit\u0103 diagnostic, monitorizare \u0219i individualizarea dozei de c\u0103tre un medic \u2014 utiliza\u021bi \u00eentotdeauna beta-blocante sub \u00eendrumare medical\u0103.<\/div>","protected":false},"excerpt":{"rendered":"<p>Divret este comprimatul cu eliberare prelungit\u0103 de indapamid\u0103 1,5 mg al Sun Pharma \u2014 un diuretic de tip tiazidic cu activitate vasodilatatoare direct\u0103. Validat \u00een studiul HYVET la pacien\u021bii foarte \u00een v\u00e2rst\u0103 (\u226580 de ani): reducere a mortalit\u0103\u021bii cu 21%, reducere a accidentelor vasculare cerebrale cu 30% atunci c\u00e2nd este combinat cu perindopril. Studiul ADVANCE extinde beneficiile la pacien\u021bii cu diabet zaharat de tip 2; PROGRESS la preven\u021bia secundar\u0103 a accidentelor vasculare cerebrale. Impact metabolic mai mic dec\u00e2t 25 mg HCTZ la acela\u0219i efect hipotensiv. Durat\u0103 de ac\u021biune de 24-36 de ore; administrare o dat\u0103 pe zi diminea\u021ba. Nu zdrobi\u021bi sau mesteca\u021bi comprimatul cu eliberare prelungit\u0103.<\/p>","protected":false},"featured_media":51689,"comment_status":"open","ping_status":"open","template":"","meta":[],"product_brand":[],"product_cat":[3141,3223,3260,3356],"product_tag":[3393,3394],"class_list":{"0":"post-51688","1":"product","2":"type-product","3":"status-publish","4":"has-post-thumbnail","6":"product_cat-category-overview","7":"product_cat-chronic-conditions","8":"product_cat-heart-blood-pressure","9":"product_cat-high-blood-pressure-medication","10":"product_tag-divret","11":"product_tag-indapamide","13":"first","14":"outofstock","15":"shipping-taxable","16":"purchasable","17":"product-type-variable","18":"has-default-attributes"},"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product\/51688","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/comments?post=51688"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/media\/51689"}],"wp:attachment":[{"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/media?parent=51688"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_brand?post=51688"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_cat?post=51688"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/medsbase.com\/ro\/wp-json\/wp\/v2\/product_tag?post=51688"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}