Description of the drug INDAPEN RETARD
If liver function is impaired, thiazide and thiazide-like diuretics can lead to the development of hepatic encephalopathy. In this case, the use of diuretics must be stopped immediately.
Cases of photosensitivity reactions have been reported when taking thiazide and thiazide-like diuretics. If photosensitivity reactions develop during therapy, you should immediately stop taking indapamide. If it is necessary to continue diuretic therapy, it is recommended to protect the skin from exposure to sunlight or artificial ultraviolet rays.
The concentration of sodium ions in the blood plasma must be determined before starting treatment and then regularly monitor this indicator. Hyponatremia and hypovolemia can lead to dehydration and orthostatic hypotension. A concomitant decrease in the concentration of chloride ions can lead to secondary metabolic alkalosis. For patients with liver cirrhosis and elderly patients, more frequent monitoring of the concentration of sodium ions in the blood plasma is indicated.
Long-term use of thiazide and thiazide-like diuretics poses a risk of decreasing plasma potassium concentrations and developing hypokalemia. It is necessary to prevent the risk of developing hypokalemia (<3.4 mmol/l), especially in elderly patients, debilitated or receiving concomitant drug therapy, in patients with liver cirrhosis accompanied by edema and ascites, in patients with coronary vascular diseases and heart failure, since hypokalemia entails the likelihood of arrhythmia (hypokalemia in patients of these groups enhances the toxic effect of cardiac glycosides). The risk of hypokalemia is also possible in patients with a prolonged QT interval. Hypokalemia predisposes to the occurrence of severe arrhythmias, especially the deadly polymorphic ventricular tachycardia of the “pirouette” type. It is necessary to regularly monitor the potassium content in the blood plasma in all of the above cases.
Thiazide and thiazide-like diuretics may reduce the excretion of calcium ions by the kidneys, which may lead to a moderate and temporary increase in plasma calcium concentrations.
It is necessary to regularly monitor the concentration of glucose in the blood plasma in patients with diabetes mellitus, especially in the presence of hypokalemia.
If the concentration of uric acid is elevated, attacks of gout may occur; in such cases, it is necessary to adjust the dose of indapamide accordingly.
Hypovolemia caused by loss of fluid and sodium ions, when treated with diuretics, can cause a decrease in glomerular filtration, which may result in an increase in the concentrations of urea and creatinine in the blood plasma.
Impact on the ability to drive vehicles and machinery
During the treatment period, patients who experience dizziness, fatigue, headache, or decreased blood pressure should refrain from driving vehicles and other activities that require high concentration and speed of psychomotor reactions.
Indapamide retard
Undesirable drug 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 of drugs requiring special attention
Drugs that can cause polymorphic ventricular tachycardia of the “pirouette” type
- 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, diphemanil, erythromycin (iv), halofantrine, mizolastine, pentamidine, sparfloxacin, moxifloxacin, astemizole, vincamine (iv).
Increased risk of ventricular arrhythmias, especially polymorphic ventricular tachycardia of the “pirouette” type (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 polymorphic ventricular tachycardia of the torsade de pointes type.
Nonsteroidal anti-inflammatory drugs (for systemic use), including selective cyclooxygenase-2 (COX-2) inhibitors, high doses of acetylsalicylic acid (≥ 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.
For patients with arterial hypertension
and possibly reduced, due to the use of diuretics, the content of sodium ions in the blood plasma is necessary:
-3 days before starting treatment with an ACE inhibitor, stop taking diuretics. In the future, if necessary, diuretics can be resumed;
-or start ACE inhibitor therapy with low doses, followed by a gradual increase in dose, if necessary.
For chronic heart failure
Treatment with ACE inhibitors should be started with low doses, with a possible preliminary reduction in diuretic doses.
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 (if 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 antihypertensive 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. When using the drug Indapamide retard and cardiac glycosides simultaneously, the potassium content in the blood plasma, ECG values should be monitored, and, if necessary, therapy should be adjusted.
Drug combinations 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)
Decreased antihypertensive effect (retention of fluid and sodium ions as a result of the action of corticosteroids).
