Indapamide, 2.5mg 30 pcs

Indapamide is a thiazide-like diuretic, an antihypertensive agent.

Indapamide causes reduction of arterial smooth muscle tone, decreases PPS, also has moderate saluretic activity due to impaired reabsorption of sodium, chlorine and water ions in the cortical segment of the loop of Genle and proximal convoluted tubule of nephron.

The decrease of RPS is caused by several mechanisms: a decrease in the sensitivity of the vascular wall to noradrenaline and angiotensin II; increased synthesis of prostaglandins, which have vasodilatory activity; inhibition of the influx of calcium ions into the smooth muscle elements of the vascular wall.

In therapeutic doses has almost no effect on lipid and carbohydrate metabolism.

Hypotensive effect appears only at initially elevated BP, develops by the end of the first week and reaches a maximum after 3 months of systematic use.

After oral administration, it is quickly and completely absorbed from the gastrointestinal tract, Cmax in plasma is reached after 1-2 hours. Binding to plasma proteins is 79%. Widely distributed in the body. It does not cumulate.

T1/2 is 18 hours. It is excreted by the kidneys mainly as metabolites, 5% – unchanged.

Indications

Arterial hypertension; sodium and water retention in chronic heart failure.

Active ingredient

Composition

Active ingredient:

Indapamide 2.5 mg;

Associates:

Pregelatinized starch;

MCC;

Silicon dioxide colloidal (aerosil);

Magnesium stearate;

Hypromellose;

Macrogol;

Lactose monohydrate;

Titanium dioxide

How to take, the dosage

Take orally 2.5 mg once daily (in the morning). If hypotensive effect is not sufficiently pronounced after 2 weeks of treatment, the dose is increased to 5-7.5 mg/day.

The maximum daily dose is 10 mg divided into 2 doses (in the morning).

Interaction

Concomitant use of GCS, tetracosactide for systemic use decreases the hypotensive effect due to water and sodium ion retention under the influence of GCS.

Concomitant use with ACE inhibitors increases the risk of hyponatremia.

Concomitant use with NSAIDs (for systemic use) may reduce the hypotensive effect of indapamide. If significant fluid loss occurs, acute renal failure may develop (due to a sharp decrease in glomerular filtration).

In concomitant use with calcium preparations hypercalcemia may occur due to decreased excretion of calcium ions in urine.

Concomitant use with cardiac glycosides, corticosteroids increases the risk of hypokalemia.

Concomitant use of agents that may cause hypokalemia (amphotericin B, gluco- and mineralocorticoids, tetracosactide, laxatives that stimulate intestinal peristalsis) increases the risk of hypokalemia.

Concomitant use with tricyclic antidepressants (including imipramine) increases the hypotensive effect and increases the risk of orthostatic hypotension (additive effect).

Concomitant use with astemizole, napridil, erythromycin (IV), pentamidine, sultopride, terfenadine, vincamine, quinidine, disopyramide, amiodarone, brettilia tozilate, sotalol increases the risk of pirouette arrhythmia.

Concomitant use with baclofen increases the hypotensive effect.

Concomitant use with halofantrine increases the risk of cardiac arrhythmias (including pirouette-type ventricular arrhythmias).

Simultaneous use with lithium carbonate increases the risk of lithium toxicity with decreased renal clearance.

Concomitant use with metformin may lead to lactic acidosis, which appears to be associated with the development of functional renal failure due to the action of diuretics (mainly loop diuretics).

In concomitant use with cyclosporine an increase in plasma creatinine is possible, which is observed even with normal water and sodium ions.

Special Instructions

In patients taking cardiac glycosides, laxatives, against a background of hyperaldosteronism, as well as in the elderly, regular monitoring of K + ions and creatinine is indicated.

The plasma concentrations of K +, Na +, Mg 2+ ions should be monitored regularly while taking indapamide (electrolyte disturbances may develop), pH, concentration of glucose, uric acid, and residual nitrogen.

The most careful control is indicated in patients with cirrhosis (especially with edema or ascites – risk of metabolic alkalosis intensifying manifestations of hepatic encephalopathy), coronary heart disease, heart failure, and in the elderly.

The increased risk group also includes patients with prolonged QT interval on electrocardiogram (congenital or developed against a background of some pathological process).

The first measurement of blood K + concentration should be done during the first week of treatment.
Hypercalcemia on indapamide administration may be due to previously undiagnosed hyperparathyroidism.

In diabetic patients it is extremely important to control blood glucose levels, especially in the presence of hypokalemia.

Significant dehydration can lead to acute renal failure (decreased glomerular filtration) Patients need to compensate for water loss and carefully monitor renal function at the beginning of treatment.

Result in doping control.

Patients with arterial hypertension and hyponatremia (due to diuretics) should discontinue diuretics 3 days before starting angiotensin-converting enzyme inhibitors./p>

(if necessary, diuretics may be resumed somewhat later), or an initial low dose of angiotensin-converting enzyme inhibitors is prescribed.

Sulfonamide derivatives may exacerbate systemic lupus erythematosus (this should be kept in mind when prescribing indapamide).

Pediatric use: efficacy and safety in children have not been established.

Synopsis

Features

Contraindications

Side effects

Overdose

Symptoms: nausea, vomiting, weakness, GI dysfunction, water-electrolyte balance disorders, in some cases – excessive decrease of BP, respiratory depression. In patients with cirrhosis liver may develop hepatic coma.

The treatment: gastric lavage, correction of the water-electrolyte balance; symptomatic therapy if necessary. There is no specific antidote.

Pregnancy use

Indapamide is not recommended during pregnancy and lactation.

Similarities