Indapamide, 1.5 mg, extended-release film-coated tablets, 30 pcs.
Not recommended combinations: when used simultaneously with lithium preparations, it is possible to increase the concentration of lithium ions in the blood plasma due to a decrease in its excretion from the body by the kidneys, accompanied by the appearance of signs of overdose (nephrotoxic effect), as well as when following a salt-free diet (reduced excretion of lithium ions by the kidneys) .
Combinations requiring special attention:
1) Drugs that can cause heart rhythm disturbances of the “pirouette” type: class IA antiarrhythmics (quinidine, hydroquinidine, disopyramide), class III antiarrhythmics (amiodarone, dofetilide, ibutilide, bretylium tosylate), sotalol, some neuroleptics: phenothiazines (chlorpromazine , cyamemazine, levomepromazine, thioridazine, trifluoperazine), benzamides (amisulpride, sulpiride, sultopride, tiapride), butyrophenones (droperidol, haloperidol), others (bepridil, cisapride, difemanil, erythromycin (intravenous (IV)), halofantrine, mizolastine , pentamidine, sparfloxacin, moxifloxacin, vincamine (iv), astemizole. Concomitant use with any of these drugs, especially against the background of hypokalemia, increases the risk of ventricular arrhythmias. Before starting combination therapy with indapamide and the above drugs, potassium levels should be monitored blood plasma and, if necessary, adjust it.
Recommended: monitoring the patient’s clinical condition, as well as the content of electrolytes in the blood plasma and ECG. In patients with hypokalemia, it is necessary to use drugs that do not provoke the development of arrhythmias.
2) With the simultaneous use of non-steroidal anti-inflammatory drugs (NSAIDs) (for systemic use), including selective inhibitors of cyclooxygenase-2 (COX-2), high doses of salicylic acid (3 g / day or more), it is possible: a decrease in the antihypertensive effect of indapamide, the development of acute renal failure in dehydrated patients (due to decreased glomerular filtration rate). At the beginning of indapamide therapy, it is necessary to restore water and electrolyte balance and monitor renal function.
3) Angiotensin-converting enzyme (ACE) inhibitors in patients with hyponatremia (especially in patients with renal artery stenosis) increase the risk of developing arterial hypotension and/or acute renal failure. Patients with arterial hypertension and possibly hyponatremia due to taking diuretics should: - stop taking the drug 3 days before starting therapy with ACE inhibitors and switch to therapy with potassium-sparing diuretics; - or start therapy with ACE inhibitors with low doses, followed by a gradual increase in dose if necessary. During the first week of therapy with ACE inhibitors, it is recommended to monitor plasma creatinine concentrations.
4) Other drugs that can cause hypokalemia: amphotericin B (iv), gluco- and mineralocorticosteroids (if administered systemically) (see also information in the section “Drug combinations requiring attention”), tetracosactide (see also information in the section “Drug combinations that require attention”), laxatives that stimulate intestinal motility. When taken simultaneously with indapamide, the above drugs increase the risk of developing hypokalemia (additive effect). If necessary, the content of potassium ions in the blood plasma should be monitored and adjusted.
5) Simultaneous therapy with baclofen enhances the antihypertensive effect of indapamide.
6) Cardiac glycosides: hypokalemia increases the toxic effect of cardiac glycosides (glycoside intoxication). With the simultaneous use of indapamide and cardiac glycosides, the content of potassium ions in the blood plasma, ECG parameters should be monitored, and, if necessary, therapy should be adjusted.
Combinations of drugs requiring attention:
1) Simultaneous use with potassium-sparing diuretics (amiloride, spironolactone, triamterene) is advisable in some patients, but the possibility of developing hypokalemia cannot be excluded. Hyperkalemia may develop against the background of diabetes mellitus or renal failure. It is necessary to monitor the content of potassium ions in the blood plasma, ECG indicators, and, if necessary, adjust therapy.
2) Metformin increases the risk of developing lactic acidosis, since renal failure may develop while taking diuretics, especially loop diuretics. Metformin should not be taken if the plasma creatinine concentration is more than 15 mg/l (135 µmol/l) in men and 12 mg/l (110 µmol/l) in women.
3) Simultaneous use of large doses of iodine-containing contrast agents against the background of hypovolemia and diuretics increases the risk of developing acute renal failure. It is recommended to restore the water and electrolyte balance of the blood before using the drugs.
4) Tricyclic antidepressants (imipramine-like) and antipsychotics increase the antihypertensive effect and the risk of developing orthostatic hypotension (additive effect).
5) Preparations containing calcium salts increase the risk of developing hypercalcemia due to a decrease in the excretion of calcium ions by the kidneys.
6) Cyclosporine, tacrolimus - the risk of increasing the concentration of creatinine in the blood plasma without changing the concentration of circulating cyclosporine.
7) Glucocorticosteroid drugs, tetracosactide (when used systemically) reduce the antihypertensive effect (retention of sodium ions and fluid).
Indapamide, prolong tablets. covered. captivity. about. 1.5 mg, 30 pcs.
Liver dysfunction
In patients with liver failure, when thiazide-like diuretics are prescribed, hepatic encephalopathy may develop, especially if the water-electrolyte balance is disturbed. If it develops, diuretics should be discontinued.
Photosensitivity
When using thiazide-like diuretics, cases of photosensitivity reactions have been reported. If they develop, the drug should be discontinued. During therapy with Indapamide retard, it is necessary to protect exposed areas of the body from exposure to sunlight and artificial ultraviolet radiation.
Water and electrolyte balance
sodium ion content in blood plasma: all diuretics can cause hyponatremia. The content of sodium ions in the blood plasma should be measured before starting treatment with Indapamide retard, and then regularly during the treatment period. Determination of the content of sodium ions in the blood plasma must be carried out before starting therapy with Indapamide retard, as well as during the period of therapy. It is important to regularly monitor the content of sodium ions in the blood plasma, because Initially, hyponatremia may be asymptomatic. The most careful monitoring of sodium ion levels is indicated for elderly patients and patients with liver cirrhosis.
the content of potassium ions in the blood plasma: the greatest risk during treatment with thiazide-like diuretics is hypokalemia. Particular attention should be paid to the prevention of hypokalemia (less than 3.4 mmol/l) in the following cases: debilitated patients and/or those receiving other therapy (antiarrhythmic drugs and drugs that can prolong the QT interval on the ECG), in elderly patients, with liver cirrhosis, peripheral edema and ascites; with coronary heart disease and chronic heart failure.
Hypokalemia in such patients increases the toxic effect of cardiac glycosides and increases the risk of developing arrhythmia.
Patients with a prolonged QT interval on the ECG are also at increased risk. Hypokalemia is a predisposing factor in the occurrence of severe arrhythmias, and especially arrhythmias, which can be fatal.
In all the described cases, it is necessary to regularly monitor the potassium content in the blood plasma. The first determination of potassium in the blood plasma should be carried out during the first week of therapy with Indapamide retard.
If hypokalemia is detected, appropriate therapy should be administered.
calcium ion content in blood plasma: thiazide-like and thiazide diuretics can reduce the excretion of calcium ions by the kidneys, leading to minor and/or temporary hypercalcemia. Severe hypercalcemia while taking the drug Indapamide retard may be a consequence of previously undiagnosed hyperparathyroidism.
Diuretics should be discontinued before testing parathyroid function.
plasma glucose concentration: in patients with diabetes mellitus, especially in the presence of hypokalemia, monitoring of plasma glucose concentration is necessary.
uric acid: may increase frequency in patients with hyperuricemia
occurrence of attacks or exacerbation of gout.
Kidney function and diuretics
Thiazide and thiazide-like diuretics are fully effective only in patients with normal or slightly reduced (plasma creatinine in adults less than 25 mg/l or 220 µmol/l) renal function.
Severe hypovolemia can lead to the development of acute renal failure (decreased glomerular filtration rate), which may be accompanied by an increase in the concentration of urea and creatinine in the blood plasma. With normal renal function, transient functional renal failure usually resolves without consequences. If there is existing renal failure, the patient's condition may worsen.
Elderly patients
Regular monitoring of creatinine concentration and potassium content in blood plasma is recommended, taking into account the patient's age, body weight and gender. Indapamide retard can be prescribed to elderly patients with preserved or slightly impaired renal function (creatinine clearance above 30 ml/min).
Athletes
Indapamide retard may give a positive result during a doping control.
Impact on the ability to drive vehicles and operate machinery
The use of indapamide retard does not lead to impairment of psychomotor reactions. However, some patients may develop different individual reactions in response to a decrease in blood pressure, especially at the beginning of therapy or when other antihypertensive drugs are added to the therapy. In this regard, at the beginning of treatment with Indapamide retard, it is not recommended to drive vehicles or other complex mechanisms that require increased attention.
Indapamide retard extended-release tablets 1.5 mg 30 pcs.
NOT RECOMMENDED COMBINATIONS. Lithium preparations. With the simultaneous use of indapamide and lithium preparations, an increase in the concentration of lithium in the blood plasma may be observed due to a decrease in its excretion, accompanied by the appearance of signs of overdose. If necessary, diuretic drugs can be prescribed in combination with lithium drugs, and the dose of the drugs should be carefully selected, constantly monitoring the lithium content in the blood plasma. COMBINATIONS REQUIRING SPECIAL CAUTION. Drugs that can cause arrhythmias: class IA antiarrhythmic drugs (quinidine, hydroquinidine, disopyramide); class III antiarrhythmic drugs (amiodarone, dofetilide, ibutilide), sotalol; some neuroleptics: phenothiazines (chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoroperazine), benzamides (amisulpride, sulpiride, sultopride, tiapride), butyrophenones (droperidol, haloperidol); others: bepridil, cisapride, difemanil, erythromycin (iv), halofantrine, mizolastine, pentamidine, sparfloxacin, moxifloxacin, astemizole, vincamine (iv). Increased risk of ventricular arrhythmias, especially arrhythmias (risk factor - hypokalemia). The potassium level in the blood plasma should be determined and, if necessary, adjusted before starting combination therapy with indapamide and the above drugs. It is necessary to monitor the patient’s clinical condition, monitor the content of blood plasma electrolytes, and ECG indicators. Patients with hypokalemia should be prescribed drugs that do not cause aritis. Non-steroidal anti-inflammatory drugs (for systemic use), including selective cyclooxygenase-2 (COX-2) inhibitors, high doses of salicylates (? 3 g/day). The antihypertensive effect of indapamide may be reduced. With significant fluid loss, acute renal failure may develop (due to decreased glomerular filtration). Patients need to compensate for fluid loss and carefully monitor renal function at the beginning of treatment. Angiotensin-converting enzyme (ACE) inhibitors. The use of ACE inhibitors in patients with reduced levels of sodium ions in the blood (especially patients with renal artery stenosis) is accompanied by a risk of sudden arterial hypotension and/or acute renal failure. Patients with arterial hypertension and possibly reduced levels of sodium ions in the blood plasma as a result of taking diuretics should: stop taking diuretics 3 days before starting treatment with an ACE inhibitor. In the future, if necessary, diuretics can be resumed; or start ACE inhibitor therapy at low doses, followed by a gradual increase in dose, if necessary. In chronic heart failure, treatment with ACE inhibitors should begin with low doses with a possible preliminary reduction in the doses of diuretics. In all cases, in the first week of taking ACE inhibitors in patients, it is necessary to monitor renal function (plasma creatinine concentration). Other drugs that can cause hypokalemia: amphotericin B (iv), gluco- and mineralocorticosteroids (when used systemically), tetracosactide, laxatives that stimulate intestinal motility. Increased risk of hypokalemia (additive effect). Regular monitoring of potassium levels in the blood plasma is necessary, and correction if necessary. Particular attention should be paid to patients concomitantly receiving cardiac glycosides. It is recommended to use laxatives that do not stimulate intestinal motility. Baclofen. There is an increase in the hypotensive effect. Patients need to compensate for fluid loss and, at the beginning of treatment, carefully monitor renal function. Cardiac glycosides. Hypokalemia enhances the toxic effect of cardiac glycosides. With the simultaneous use of indapamide and cardiac glycosides, the content of potassium in the blood plasma, ECG parameters should be monitored, and, if necessary, therapy should be adjusted. COMBINATIONS OF DRUGS REQUIRING ATTENTION. Potassium-sparing diuretics (amiloride, spironolactone, triamterene). Combination therapy with indapamide and potassium-sparing diuretics is advisable in some patients, but the possibility of developing hypokalemia (especially in patients with diabetes mellitus and renal failure) or hyperkalemia cannot be excluded. It is necessary to monitor the potassium content in the blood plasma, ECG indicators and, if necessary, adjust therapy. Metformin. Functional renal failure, which can occur against the background of diuretics, especially loop diuretics, with simultaneous use of metformin increases the risk of developing lactic acidosis. Metformin should not be prescribed if the creatinine concentration exceeds 15 mg/L (135 µmol/L) in men and 12 mg/L (110 µmol/L) in women. Iodinated contrast agents. Dehydration while taking diuretics increases the risk of developing acute renal failure, especially when using high doses of iodinated contrast agents. Before using iodinated contrast agents, patients need to compensate for fluid loss. Tricyclic antidepressants, antipsychotics (neuroleptics). Drugs in these classes enhance the antihypertensive effect of indapamide and increase the risk of orthostatic hypotension (additive effect). Calcium salts. With simultaneous use, hypercalcemia may develop due to a decrease in the excretion of calcium ions by the kidneys. Cyclosporine, tacrolimus. It is possible to increase the concentration of creatinine in the blood plasma without changing the concentration of circulating cyclosporine, even with normal fluid and sodium ion levels. Corticosteroid drugs, tetracosactide (for systemic use). Reduced hypotensive effect (retention of fluid and sodium ions as a result of the action of corticosteroids).
