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Pharmacy/DYTOR or NATRILIX (indapamide -request for guidance


Thak u very much for offering such an opportunity.My wife aged 64 yrs had almost nothing remarkable except dislipideamia. Family H/O; Mother- DM-CAD-Cardiac arrest. Father- HTN. Brother- DM-CAD-cardiac arrest in the midle age. 2nd Brother- no DM- CAD- had bypass surgery.
In the last August she started coughing-common cold symptoms, but worsening day by day. Only thing which was maarked- respiration sleep during was quite abnormal. She didnt Woke up for breathing but snoring sound was different time to time and sometimes it becoming dadly SLOW as if silent! 1st X Ray 5th Sept read- MILD CARDIOMAGALY WITH PROMINENT B/V MARKINGS IN THE LUNGS.Only complaint severe persistant distressing DRY cough. Very MILD shortness of breath. NO-fever, chest pain,pedal oedema, headache, anoraxia, nothing.sPo2;84% roomair. B/L harsh bronchai,Occ.roonchi, B/L basal fine creps. BP- 136/84. P-84. Wt.62kg. Sugar normal.
Primerily thought either pulmonary oedema/ pul. hypertension with mild obstructive airways.2D Echo;- EF- 65% Diastolic Dysfunction.
R/- Montelukast,-unicarbazan-Dytor plus 5mg-Prednisolone 10mg tds,-bds,-od. 15 days after discont of steroids the followup showed BP 146/96; puls 88; sPo2 98% wt. 65kg. Haemogram normal CBC; CRP; creat; electrolyte; only Vit D insufficient 11.20 ng/ml.Osteopenia with spondylolisthesis,sacralisation L5; PPBS 300 FIRST time blood sugar; Glipizide 5mg Metformin 500mg.
CT Thorax:- Bilateral patchy areas of ground glass haziness with intervening low attenuating areas showing vascular prunning, more appereciable on expiratory scan- air traping suggest P/O distal small airway disease. Subplural linear fibrotic opacities in apical segments both upper lobes. Normal respimetry c mild reduction in DLCO;
R/- Acetylcystine 600mg; codliver oil;arjin; folicacid; vit D 60000 iu; dytor plus 10mg. PREDNISOLONE 20mg tds bds od 10mg 5mg alt day; Blood sugar normal under control;Glipizide 5mg metformin500mg.LOSARTAN 25 mg.
F/up;-Bp 130/80; p 100; spo2 96% B/L crepts; no ronchi; Ausculatory sounds varies time to time. Sleep during respiration almost normal. occl shortness of breath. PPBS 131;
2D Echo:-LEVF 70%; insgnicant PAH; RVSP 32mm of HG; NORMAL LV size n normal syst function;
R/- Prednisolone 5 alt day. ACETYLCYSTINE 600 LOSARTAN 25;codliver;glipizide 5; metformin; atorvastatin EZ 10mg; INDAPAMIDE 400(NATRILIX);Vit D biweekly;DOXOFYLLIN 400 OD; fOLICACID; CALCIUM c mang; Bcomplex; vit AEC  
sUDDENLY 3 days back relapse common cold with coghing and respiratory abnormality during sleep; BP 120/72; p 105; spo2 92% B?l harsh br; Occl ronchi; crepts+
R/- Predni 10mg bd 3D; 5mg td 3D; then to 5mg bd ;od; n alt day. Rest all contd. montelukast added.but discontd for trembling.
Coughing lessened with 10mg 3d.resp; near to normal; steroid tappering;
Losartan 25; Atorvas EZ 10; glipizide 5/ metf 500; doxofyllin;is OK. BUT Dytor plus alt day/twice a week- is very distressing - frequency of washroom calls are unbearale;
Whether Dytor can b replaced with Natrilix; BP is normal n under control. To protact the cardiac picture which will b beneficial? if the disease was ? pul. oedema/ pul.HTN/bRONCHIOLOLITIS WITH SMALL AIRWAY disease/ restrictive-obstructive resp/???? Is it  such diuretics required for life long? BP is undercontrl; 2D echo is also normal; no effusion; EF 70%; only insignificant PAH; RVSP 32'; wHAT IS REQUIRED pulmonary n czrdiac protection.
Ausculatory sounds harsh; bronchai; ronchy; varying all the time. Symptomatic nothing remarkable!
CAN Acetylcystine 600 be discotd or lifetime.
codliver caps; vit D; folicacid;;vit AEC;(contd since Oct)

Hi Yunus,
Natrilix ans Dytor Plus are both diuretics and either will cause increases urination. That is their purpose, to rid the body of excess fluid and decrease the load of the heart. Dytor Plus will also preserve potassium which diuretics can deplete.
Acetylcysteine breaks up mucous collected in the lungs and makes breathing easier.
Duration of therapy needs to be discussed with your doctor.
Thank you for using Allexperts
Eric Brandt, B.Sc. Pharm


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Eric Brandt


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