Indapamide is a diuretic of moderate action, belongs to the group of non-thiazide sulfamides, has an antihypertensive effect. the antihypertensive effect is manifested only with an initially elevated blood pressure. reduces the tone of the smooth muscle tissue of the arteries, opss. has a moderate saluretic and diuretic effect due to the blockade of reabsorption of sodium, chlorine, water and, to a lesser extent, potassium in the proximal tubules and the cortical segment of the distal nephron tubules.
Indapamide reduces left ventricular hypertrophy. Indapamide does not affect the metabolism of lipids (TG, LDL cholesterol and HDL cholesterol), also does not affect the metabolism of carbohydrates, even in patients with hypertension and diabetes, reduces microalbuminuria.
The antihypertensive effect of the preparation persists in patients on hemodialysis.
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Assign 2.5 mg once a day (in the morning). the maximum daily dose is 2.5 mg (1 capsule). the capsules are swallowed without chewing, washed down with water. can be used with other antihypertensive preparations, with the exception of diuretics. in case of insufficient effectiveness of treatment, the dose of the preparation should not be increased; it is better to supplement therapy with another antihypertensive agent. when using indapamide in a higher dose, the antihypertensive effect does not increase, only the saluretic effect increases.
Hypersensitivity to sulfamides or any component of the preparation, severe liver failure, hepatic encephalopathy, severe liver disease, pregnancy and lactation, severe renal failure, hypokalemia, childhood.
Most of the side effects are dose-dependent and occur when the dosage is exceeded.
Sometimes changes in the water-electrolyte balance are noted:
Very rare: hypercalcemia.
From the gastrointestinal tract: rarely - nausea, vomiting, constipation, dry mouth; very rarely - pancreatitis, liver dysfunction. In patients with hepatic impairment, hepatic encephalopathy.
From the kidneys and urinary tract: renal failure.
From the side of the central nervous system: rarely - dizziness, asthenia, paresthesia, fatigue, headache.
From the side of the cardiovascular system: arrhythmia, arterial hypotension.
Allergic reactions: most - in the form of dermatological reactions, especially in patients prone to allergies: maculopapular skin rash, purpura, itching, exacerbation of systemic lupus erythematosus; very rarely - urticaria.
Hematological disorders: very rarely - thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia, hemolytic anemia.
Other: in some cases - angioedema, toxic epidermal necrolysis, Stevens-Johnson syndrome, photosensitivity reactions.
The preparation can be used as monotherapy or in combination with other antihypertensive agents (β-adrenergic receptor blockers, calcium channel blockers, APF inhibitors).
If liver function is impaired, thiazide diuretics can cause hepatic encephalopathy. In this case, they should be canceled immediately.
There have been reports of cases of photosensitivity reactions when taking thiazides and thiazide diuretics. If a photosensitivity reaction occurs during treatment, it is recommended to discontinue treatment. If it is necessary to re-use indapamide, it is recommended to protect vulnerable areas of the body from the sun or artificial ultraviolet radiation.
When prescribing the preparation, the advisability of using the preparation in patients with gout and diabetes mellitus should be carefully weighed.
Before and during the use of the preparation, it is necessary to control the level of potassium, sodium, calcium, glucose in the blood plasma, to monitor renal function (creatinine, urea in the blood plasma), ECG control, especially in the presence of violations of the water-electrolyte balance, with gout, diabetes mellitus, hepatic or renal failure, in elderly patients.
Plasma sodium level. The concentration of sodium in the blood plasma must be determined before starting treatment, and then monitored for changes at regular intervals. Treatment with diuretics can be accompanied by hyponatremia, sometimes with serious consequences, and a decrease in blood sodium concentration in the initial stage can be asymptomatic. Therefore, it is recommended to regularly monitor the plasma sodium level, especially in elderly patients and patients with liver cirrhosis.
Plasma potassium level. Long-term use of thiazide and similar diuretics is associated with the risk of a decrease in the concentration of potassium in the blood plasma and the development of hypokalemia. This is especially true for patients at risk (elderly people; patients who are simultaneously taking other preparations; patients with cirrhotic ascites, accompanied by edema; exhausted patients and patients with coronary artery disease and heart dysfunction, that is, predisposed to cardiac arrhythmias). Hypokalemia can cause severe arrhythmias, including life-threatening ventricular tachycardia (torsade de pointes). In connection with the above, it is necessary to control the level of potassium in the blood plasma as often as possible and to prevent the occurrence of hypokalemia.
Plasma calcium level. Thiazide and similar diuretics can reduce urinary calcium excretion, which can lead to a slight temporary increase in plasma calcium concentration. Hypercalcemia may also result from previously undiagnosed hyperparathyroidism. In this case, the treatment should be suspended and the function of the parathyroid glands should be examined.
Blood glucose level. In patients with diabetes mellitus, especially in the presence of hypokalemia, it is necessary to control the level of glucose in the blood.
Uric acid level. In patients with an increased concentration of uric acid, gout attacks are possible, therefore, the dose of the preparation should be monitored depending on the level of uric acid in the blood plasma.
Thiazide and similar diuretics are most effective only with normal or minimally reduced renal function (plasma creatinine level is 25 mg / l, that is, 20 μmol / l in adults).
In dehydrated patients, the risk of acute renal failure is noted, therefore, at the beginning of treatment, they need to drink plenty of fluids.
Hypovolemia caused by the loss of water and sodium, when treated with diuretics, reduces glomerular filtration, which is sometimes accompanied by an increase in the level of urea and creatinine in the blood plasma. In patients with normal renal function, this transient renal failure is usually not serious, but its occurrence can greatly exacerbate existing renal failure. Indapamide can give a positive reaction to doping tests.
The preparation contains lactose as an excipient, therefore, the use of the preparation is not recommended for patients with rare hereditary forms of galactose intolerance, lactase deficiency or glucose-galactose malabsorption syndrome.
Use during pregnancy and lactation. In no case should the preparation be used for physiological edema during pregnancy. Taking the preparation can cause placental ischemia, which threatens the growth of the fetus. In this regard, the preparation cannot be prescribed during pregnancy.
Indapamide passes into breast milk. If necessary, use of the preparation should stop breastfeeding.
Children. The preparation is not used in children.
The ability to influence the reaction rate when driving or working with other mechanisms. At the beginning of treatment or in combination therapy with other antihypertensive preparations, it is recommended to refrain from driving and engaging in potentially hazardous activities that require increased attention and speed of psychomotor reactions, since the level of attention may decrease with a decrease in blood pressure.
Undesirable combinations:
Combinations requiring special care
Systemic NSAIDs (antirheumatic preparations ) and high doses of salicylates can reduce the hypotensive effect of indapamide. ARF (decreased glomerular filtration) may occur in dehydrated patients. Therefore, at the beginning of treatment, it is necessary to monitor the patient's kidney function against the background of a large amount of water drunk.
Preparations that can cause hypokalemia: amphotericin (IV), glucocorticoids and mineralocorticoids, laxatives that stimulate peristalsis. It is necessary to monitor the level of potassium in the blood plasma.
GCS of systemic action (tetracosactide): a decrease in the severity of the hypotensive effect of indapamide due to the retention of water and sodium ions under the influence of GCS.
Cardiac glucosides: There is a risk of increased toxicity of cardiac glucosides and the risk of hypokalemia. Plasma potassium monitoring and ECG monitoring are required.
Baclofen: Increases the antihypertensive effect. At the beginning of treatment, the patient needs to drink plenty of water while systematically monitoring kidney function.
In hypokalemic patients using digoxin, hypokalemia may increase the risk of digoxin toxicity. In such cases, it is necessary to systematically monitor the level of potassium in the blood plasma, record an ECG, and, if necessary, change the treatment.
ACE inhibitors at the beginning of treatment and with concurrent sodium deficiency (especially in patients with renal artery stenosis) increase the risk of sudden arterial hypotension or ARF.
With essential hypertension, if previous therapy with diuretics caused sodium deficiency, it is recommended to stop using diuretics 3 days before starting treatment with an ACE inhibitor.
In patients with chronic heart failure in combination therapy of indapamide with an ACE inhibitor, it is necessary to start treatment with low doses of an ACE inhibitor and a diuretic. At the same time, during the first weeks of treatment with an ACE inhibitor, it is necessary to carry out systematic monitoring of renal function (plasma creatinine level).
Antiarrhythmic preparations of class Ia (quinidine, disopyramide) and class III (amiodarone, bretelium, sotalol): there is a risk of arrhythmogenic action, ventricular tachycardia against the background of hypokalemia, bradycardia and prolongation of the Q – T interval. It is necessary to monitor potassium, Q – T interval.
Metformin: lactic acidosis may occur due to the development of renal failure. It is not recommended to prescribe metformin when the creatinine level exceeds 15 mg / L (135 μmol / L) in men and 12 mg / L (110 μmol / L) in women.
Iodine contrast agents: high doses of iodine contrast agents in combination with indapamide with simultaneous dehydration increase the risk of developing acute renal failure. It is necessary to restore the water balance before the appointment of iodine contrast agents.
Tricyclic antidepressants (imipramine): there is an increase in the severity of the hypotensive effect of indapamide and an increased risk of orthostatic hypotension.
Calcium salts: hypercalcemia may occur.
Cyclosporine: an increase in plasma creatinine levels is possible.
Corticosteroids: a decrease in the severity of the hypotensive effect of indapamide due to the retention of water and sodium ions under the influence of corticosteroids.
Potassium-sparing diuretics (amiloride, spironolactone, triamterene): can cause hypokalemia, and in patients with kidney dysfunction or diabetes mellitus, hyperkalemia. In these cases, it is necessary to monitor the level of potassium in the blood plasma, ECG, and, if necessary, change the treatment.
Anticoagulants (coumarin derivatives): the simultaneous use of Indap reduces the effect of anticoagulants.
With prolonged use or taken in high doses, electrolyte disturbances such as hyponatremia, hypokalemia and hypochloremic alkalosis can occur. possible nausea, vomiting, arterial hypotension, convulsions, dizziness, drowsiness, confusion, polyuria, oliguria and even anuria (as a result of hypovolemia).
Treatment: gastric lavage, the use of activated carbon with further restoration of the water-electrolyte balance in a hospital setting, symptomatic therapy.
In original packaging at temperatures up to 25 ° C.
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