Pharmacodynamics and pharmacokinetics
Pharmacodynamics
It has an unexpressed saluretic (removal of salts) and diuretic effect. Suppresses the absorption of sodium in the renal tubules, this leads to the excretion of chlorine and sodium in the urine and increased diuresis . Slightly increases the excretion of potassium and magnesium. Reduces the tone of the muscles of the arteries, reduces peripheral vascular resistance and generally has a vasodilating effect. The antihypertensive effect occurs in doses that do not cause a pronounced diuretic effect. blood pressure reduction in high doses. After taking the tablet, the maximum effect is observed after 24 hours. Reduces left ventricular hypertrophy.
Pharmacokinetics
Rapidly absorbed into the gastrointestinal tract . There is a slowdown in absorption after eating. The maximum concentration in plasma is determined after 12 hours. 79% protein bound. The half-life is 14-24 hours. After repeated administration, no accumulation is observed. Metabolized in the liver. 70% is excreted by the kidneys and 20% in feces. In renal failure, the pharmacokinetics remain virtually unchanged.
Pharmacological properties of the drug Ravel SR
Ravel SR is an antihypertensive drug, a sulfonamide derivative. The pharmacological properties of Ravel SR are similar to thiazide diuretics. Indapamide acts by inhibiting sodium absorption in the cortical nephron, increasing renal excretion of sodium and chloride ions and increasing urine output. It has a pronounced antihypertensive effect and a slight diuretic effect. The hypotensive effect lasts 24 hours. Indapamide also affects vascular tone, reducing arteriolar resistance and peripheral vascular resistance, and reduces left ventricular hypertrophy. The hypotensive effect of indapamide persists in patients with hypertension (arterial hypertension) and impaired renal function. Indapamide has virtually no effect on the concentration of lipids in the blood plasma (total cholesterol, LDL cholesterol, HDL cholesterol, TG).
Contraindications
- simultaneous administration of drugs that prolong the QT interval ;
- increased sensitivity;
- severe renal failure ;
- persons under 18 years of age;
- hypokalemia;
- hepatic encephalopathy.
Use with caution for diabetes mellitus , impaired renal and liver function, hyperparathyroidism , hyperuricemia , and increased QT .
Drug interactions Ravel SR
It is not recommended to use lithium preparations in combination with Ravel SR (the excretion of lithium by the kidneys is reduced), astemizole, bepridil, erythromycin for intravenous administration, halofantrine, pentamidine and vincamine (the risk of arrhythmias increases, especially with hypokalemia, bradycardia and an increase in the QT ) , NSAIDs for systemic use, especially salicylates in high doses (risk of developing acute heart failure in patients with significant fluid deficiency as a result of decreased glomerular filtration). The risk of developing hypokalemia increases (additive effect) when using Ravela SR with amphotericin B for intravenous administration, gluco- and mineralocorticoids for systemic use, tetracosactide, and stimulant laxatives. Prescribe with caution to patients taking digitalis preparations. Baclofen enhances the hypotensive effect of Ravel SR. Use Ravel SR with caution with potassium-sparing diuretics (amiloride, spironolactone, triamterene), especially in patients with renal failure or diabetes mellitus due to the risk of developing hyperkalemia. It is necessary to monitor the concentration of potassium in the blood plasma and ECG parameters. When used simultaneously with ACE inhibitors in patients with reduced sodium levels (especially in patients with renal artery stenosis), arterial hypotension and/or acute renal failure may develop. Class Ia antiarrhythmic drugs (quinidine, hydroquinine, disopyramide), amiodarone, bretylium, sotalol can cause the development of polymorphic ventricular tachycardia of the torsade de pointes type, especially with hypokalemia, bradycardia and an increased QT . In functional renal failure associated with the use of diuretics, metformin can cause the development of lactic acidosis. Metformin should not be prescribed if the plasma creatinine level is 15 mg/l (135 µmol/l) in men and 12 mg/l (110 µmol/l) in women. In patients with dehydration due to the use of diuretics, the risk of developing acute renal failure increases when using iodinated contrast agents, especially in high doses. With simultaneous use of indapamide with tricyclic antidepressants and antipsychotics, the hypotensive effect is enhanced and the risk of developing orthostatic hypotension increases (additive effect); with calcium salts - the risk of developing hypercalcemia increases due to a decrease in calcium excretion by the kidneys; with cyclosporine - the concentration of creatinine in the blood plasma increases; with corticosteroids, estrogens, tetracosactide (when used systemically) - the hypotensive effect (water and sodium retention in the body) may be reduced.
Side effects
- orthostatic hypotension , palpitations, arrhythmia ;
- headache , nervousness, dizziness ;
- constipation ( diarrhea ), nausea, dyspepsia , abdominal pain;
- nocturia , urinary tract infections, polyuria ;
- itching, urticaria , rash, hemorrhagic vasculitis ;
- cough, sinusitis , pharyngitis ;
- hypercalcemia , hypochloremia , hyperuricemia , hyperglycemia , hyponatremia .
Overdose
An overdose is manifested by nausea, vomiting, convulsions , decreased blood pressure , dizziness , lethargy, polyuria , turning into anuria . Blood tests show hyponatremia and hypokalemia . sorbents are taken . specific antidote . In the hospital, water and electrolyte metabolism is restored.
Interaction
When taken with lithium drugs, its concentration increases and symptoms of overdose appear. The likelihood of cardiac dysfunction occurs when taken with astemizole , erythromycin , bepridine , pentamidine , halofantrine , terfenadine , sultopride , quinidine , disopyramide , hydroquinidine , bretylium , amiodarone , sotalol . The following factors contribute to this: hypokalemia , prolongation of the QT interval and bradycardia . The risk of renal failure appears with the simultaneous administration of non-steroidal drugs and high doses of salicylates .
of hypokalemia increases significantly when taken with amphotericin B , cardiac glycosides , glucocorticosteroids , and laxatives. Neuroleptics , baclofen , tricyclic antidepressants , ACE inhibitors cause increased hypotensive effect and orthostatic hypotension . Dehydration of the body is observed when used with contrast agents containing iodine. Taking calcium salts leads to an increase in its concentration in the blood. Use with other diuretics causes the development of hypokalemia .
Side effects of the drug Ravel SR
Hypokalemia may develop. In clinical studies, hypokalemia after 4–6 weeks of treatment with indapamide was observed in 10% of patients (plasma potassium level ≤3.4 mmol/L) and 4% of patients (plasma potassium level ≤3.2 mmol/L). After 12 weeks, the average decrease in plasma potassium concentration was 0.23 mmol/L. Hyponatremia with hypovolemia is possible, which can lead to dehydration and orthostatic hypotension; Due to the concomitant loss of chloride, compensatory metabolic alkalosis may develop. The development of hyperuricemia and hyperglycemia is possible, so the drug should be prescribed with caution to patients with diabetes mellitus or gout. Hypercalcemia, thrombocytopenia, leukopenia, agranulocytosis, bone marrow aplasia and hemolytic anemia are observed in isolated cases. Patients with liver failure may develop hepatic encephalopathy. Allergic reactions (maculopapular rash, purpura) occur mainly in patients with a tendency to hypersensitivity reactions. Possible exacerbation of systemic lupus erythematosus. Dizziness, headache, paresthesia, increased fatigue, constipation and dry mouth, nausea are rarely noted. In rare cases, pancreatitis may develop.
Analogues of Ravel SR
Level 4 ATC code matches:
Chlorthalidone
Klopamide
Indapamide
Arifon
Indap
Arifon , Indap , Indapamide , Ionic , Lorvas , Pamid .
Reviews about Ravel SR
extended-release tablets is that they ensure a constant required level of indapamide in the blood to achieve a therapeutic effect. Sustained release is important for sustained antihypertensive effect in hypertension .
However, there are not many reviews about the drug, since in case of severe arterial hypertension it is not used as monotherapy, but is prescribed in combination with antihypertensive drugs of other groups. Considering that this is a diuretic (by the way, with medium potency), while taking it you need to include foods rich in potassium in your diet. In addition, studies have proven that long-term use of Ravel SR together with an ACE inhibitor ( Enap ) improves the lipid spectrum ( TC and LDL cholesterol ).
While taking this drug, there is also a decrease in glucose , which is important when prescribing it to patients with diabetes mellitus . It was noted that treatment with it improves vascular elasticity, which was assessed by pulse wave speed.
- “...Effective, convenient to take once a day.”
- “... Ravel SR helps my mother well; her blood pressure is not very high.”
The patients did not report any side effects.
Special instructions for the use of the drug Ravel SR
In patients with impaired liver function, thiazide diuretics can cause the development of encephalopathy. In this case, the diuretic should be discontinued immediately. Long-term use of diuretics can cause the development of hyponatremia. The concentration of sodium in the blood plasma must be determined before the start of treatment and at regular intervals during the treatment period. In elderly people and patients with liver cirrhosis, determination of sodium concentration in blood plasma should be carried out more often. In patients with malnutrition, when taking several drugs simultaneously, in the elderly, patients with liver cirrhosis and ascites, coronary artery disease and heart failure, patients with an increased QT on the ECG, it is necessary to prevent the development of hypokalemia (≤3.4 mmol/l ). In these patients, hypokalemia increases the cardiotoxicity of digitalis preparations and the risk of developing arrhythmias. Hypokalemia contributes to the development of dangerous arrhythmias, in particular polymorphic ventricular tachycardia of the pirouette type. These patients should have their plasma potassium levels monitored more frequently. Thiazide and thiazide-like diuretics may reduce urinary calcium excretion and cause mild transient hypercalcemia. Persistent hypercalcemia may be due to the presence of hyperparathyroidism. Therefore, diuretic treatment should be discontinued until parathyroid function is assessed. In patients with diabetes, it is important to control blood glucose levels, especially if there is hypokalemia. Patients with hyperuricemia may experience gout attacks. Thiazide and thiazide-like diuretics are most effective when renal function is normal or slightly impaired (plasma creatinine level in adults ≤25 mg/l or 220 µmol/l). Hypovolemia that occurs at the beginning of diuretic use due to loss of water and sodium can cause a decrease in glomerular filtration. This may lead to increased levels of urea and creatinine in the blood plasma. In patients with normal renal function, such transient functional renal failure resolves without any consequences, but in patients with pre-treatment renal insufficiency, the condition may worsen. Ravel SR may cause a positive reaction during doping control in athletes taking this drug. The drug should not be prescribed during pregnancy, as this may cause placental ischemia and impair fetal development. During the treatment period, it is recommended to stop breastfeeding.
Price for Ravel SR, where to buy
You can buy the drug at any pharmacy. The cost of 30 tablets ranges from 170-211 rubles.
- Online pharmacies in RussiaRussia
- Online pharmacies in KazakhstanKazakhstan
LuxPharma* special offer
- Ravel SR 1.5 mg tab.
No. 30 1690 rub. order
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