Buy Noliprel A film-coated tablets 2.5 mg + 0.625 mg No. 30 in pharmacies
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Noliprel A tab p.o 2.5 mg + 0.625 mg No. 30
Dosage forms tablets 2.5 mg + 0.625 mg Synonyms Co-Perineva Noliprel Noliprel A Noliprel A forte Noliprel forte Perindid Perindopril Plus Indapamide Group Combination of angiotensin-converting enzyme inhibitors and diuretics International nonproprietary name Indapamide + Perindopril Composition Active substances: perindopril and indapamide. Manufacturers Laboratories Servier Industry (France), Serdix (Russia) Pharmacological action A combined drug containing perindopril (ACE inhibitor) and indapamide (a diuretic from the group of sulfonamide derivatives). The pharmacological action of Noliprel is due to the combination of the individual properties of each component. The combination of perindopril and indapamide enhances the effect of each of them. Noliprel has a pronounced dose-dependent hypotensive effect on both systolic and diastolic blood pressure in the supine and standing position. The effect of the drug lasts 24 hours. A persistent clinical effect occurs in less than 1 month from the start of therapy and is not accompanied by tachycardia. Discontinuation of treatment is not accompanied by the development of withdrawal syndrome. Noliprel reduces the degree of left ventricular hypertrophy, improves arterial elasticity, reduces peripheral vascular resistance, does not affect the metabolism of lipids (total cholesterol, HDL, LDL, triglycerides) and does not affect the metabolism of carbohydrates (including in patients with diabetes). Side effects From the water-electrolyte balance: possible hypokalemia, decreased sodium levels, accompanied by hypovolemia, dehydration and orthostatic arterial hypotension. The simultaneous loss of chlorine ions can lead to compensatory metabolic alkalosis (the incidence of alkalosis and its severity is low). In some cases, an increase in calcium levels. From the cardiovascular system: excessive decrease in blood pressure, orthostatic hypotension; in some cases - myocardial infarction, angina, stroke, arrhythmia. From the urinary system: rarely - decreased renal function, proteinuria (in patients with glomerular nephropathy); in some cases - acute renal failure. A slight increase in the concentration of creatinine in urine and blood plasma (reversible after discontinuation of the drug) is most likely in case of renal artery stenosis, treatment of arterial hypertension with diuretics, or the presence of renal failure. From the central nervous system and peripheral nervous system: headache, increased fatigue, asthenia, dizziness, mood lability, visual disturbances, tinnitus, sleep disturbance, convulsions, paresthesia, anorexia, impaired taste perception; in some cases - confusion. From the respiratory system: dry cough; rarely - difficulty breathing, bronchospasm; in some cases - rhinorrhea. From the digestive system: abdominal pain, nausea, vomiting, constipation, diarrhea; rarely - dry mouth; in some cases - cholestatic jaundice, pancreatitis, increased activity of liver transaminases, hyperbilirubinemia; with liver failure, the development of hepatic encephalopathy is possible. From the hematopoietic system: anemia (in patients after kidney transplantation, hemodialysis); rarely - hypohemoglobinemia, thrombocytopenia, leukopenia, decreased hematocrit; in some cases - agranulocytosis, pancytopenia, aplastic anemia, hemolytic anemia. From the metabolic side: an increase in the content of urea and glucose in the blood plasma is possible. Allergic reactions: skin rashes, itching; rarely - urticaria, angioedema; in some cases - erythema multiforme, hemorrhagic vasculitis, exacerbation of SLE. Other: temporary hyperkalemia; rarely - increased sweating, decreased potency. Indications for use: Essential arterial hypertension. Contraindications: history of angioedema (including while taking ACE inhibitors); - hypokalemia; — severe renal failure (creatinine clearance less than 30 ml/min); - severe liver failure (including with encephalopathy); - simultaneous use of drugs that prolong the QT interval; - pregnancy; - lactation (breastfeeding); - hypersensitivity to perindopril and other ACE inhibitors; - hypersensitivity to indapamide and sulfonamides. Method of administration and dosage The drug is prescribed orally, 1 tablet 1 time per day, preferably in the morning, before meals. Overdose Symptoms: marked decrease in blood pressure, nausea, vomiting, convulsions, dizziness, insomnia, decreased mood, polyuria or oliguria, which can turn into anuria (as a result of hypovolemia), bradycardia, electrolyte disturbances. Treatment: gastric lavage, administration of adsorbents, correction of water and electrolyte balance. If there is a significant decrease in blood pressure, the patient should be transferred to a horizontal position with legs elevated. Perindoprilat can be removed from the body using dialysis. Interaction The simultaneous use of Noliprel and lithium preparations is not recommended. Increasing lithium concentrations may result in symptoms and signs of lithium overdose. (due to decreased excretion of lithium by the kidneys). The combination of perindopril with potassium-sparing diuretics and potassium supplements can lead to a significant increase in the concentration of potassium in the blood serum (especially against the background of renal failure) and even death. It should be taken into account that indapamide in combination with potassium-sparing diuretics or potassium supplements does not exclude the development of hypokalemia or hyperkalemia (especially in patients with diabetes mellitus and renal failure). With the simultaneous use of erythromycin (for intravenous administration), pentamidine, sultopride, vincamine, halofantrine, bepridil and indapamide, the development of arrhythmias is possible (provoking factors include hypokalemia, bradycardia or a prolonged QT interval). When using ACE inhibitors, the hypoglycemic effect of insulin and sulfonylurea derivatives may be enhanced. The development of hypoglycemia is extremely rare. With the simultaneous use of Noliprel and baclofen, the hypotensive effect is enhanced. With the simultaneous use of indapamide and NSAIDs in case of dehydration, acute renal failure may develop. It should also be taken into account that NSAIDs weaken the hypotensive effect of ACE inhibitors. NSAIDs and ACE inhibitors have been found to have an additive effect on hyperkalemia, and a decrease in renal function is also possible. With the simultaneous use of Noliprel and tricyclic antidepressants, antipsychotics, it is possible to enhance the hypotensive effect and increase the risk of developing orthostatic hypotension (additive effect). GCS, tetracosactide reduce the hypotensive effect of Noliprel. With simultaneous use of indapamide with antiarrhythmic drugs IA (quinidine, hydroquinidine, disopyramide) and class III (amiodarone, bretylium, sotalol), the development of arrhythmias is possible (provoking factors include hypokalemia, bradycardia or a prolonged QT interval). If arrhythmia develops, antiarrhythmic drugs should not be used (an artificial pacemaker must be used). With the simultaneous use of indapamide and drugs that reduce potassium levels (including intravenous amphotericin B, gluco- and mineralocorticoids for systemic use, tetracosactide, stimulant laxatives), the risk of developing hypokalemia increases. Potassium concentration should be monitored and adjusted if necessary. If it is necessary to prescribe laxatives, drugs without a stimulating effect on intestinal motility should be used. When using Noliprel simultaneously with cardiac glycosides, it should be taken into account that low potassium levels may enhance the toxic effect of cardiac glycosides. Potassium levels and ECG should be monitored and therapy adjusted if necessary. Lactic acidosis while taking metformin is apparently associated with functional renal failure, which is caused by the action of indapamide. Metformin should not be used if creatinine levels exceed 15 mg/L (135 µmol/L) in men and 12 mg/L (110 µmol/L) in women. With significant dehydration of the body, which is caused by taking diuretic drugs, the risk of developing renal failure increases due to the use of iodine-containing contrast agents in high doses. Rehydration is necessary before using iodinated contrast agents. When used simultaneously with calcium salts, it is possible to increase the calcium content in the blood plasma as a result of a decrease in its excretion in the urine. When Noliprel is used against the background of constant use of cyclosporine, the level of creatinine in plasma increases even with a normal state of water-electrolyte balance. Special instructions The use of the drug Noliprel can cause a sharp decrease in blood pressure, especially when first taking the drug and during the first 2 weeks of therapy. The risk of developing an excessive decrease in blood pressure is increased in patients with reduced blood volume (as a result of following a strict salt-free diet, hemodialysis, vomiting and diarrhea), with severe heart failure (both in the presence of concomitant renal failure and in its absence), with initially low blood pressure, with stenosis of the renal arteries or stenosis of the artery of the only functioning kidney, cirrhosis of the liver, accompanied by edema and ascites. It is necessary to systematically monitor the appearance of clinical signs of dehydration and salt loss, and regularly measure the concentration of electrolytes in the blood plasma. A pronounced decrease in blood pressure when taking the drug for the first time is not an obstacle to further prescription of the drug. After restoration of blood volume and blood pressure, treatment can be continued, using a lower dose of the drug or monotherapy with one of its components. Blocking the renin-angiotensin-aldosterone system with ACE inhibitors can lead, along with a sharp drop in blood pressure, to an increase in plasma creatinine, indicating functional kidney failure, sometimes acute. These conditions occur rarely. However, in all such cases, treatment should be started carefully and carried out gradually. When treating with Noliprel, it is necessary to systematically monitor the concentration of creatinine in the blood plasma. While taking Noliprel, it is necessary to regularly monitor the concentration of potassium in the blood plasma. In elderly or debilitated patients, it is necessary to take into account the risk of a decrease in potassium concentration below the permissible level (less than 3.4 mmol/l). This group should also include people taking several different medications, patients with liver cirrhosis, which is accompanied by the appearance of edema or ascites, patients with coronary artery disease or heart failure. A decrease in potassium levels increases the toxicity of cardiac glycosides and increases the risk of developing arrhythmias. Low potassium levels, bradycardia, and an increase in the QT interval are risk factors for the development of arrhythmias, which can be fatal. It should be borne in mind that the excipients of the drug Noliprel include lactose monohydrate. As a result, this drug is not recommended for use in persons with lactase deficiency, galactosemia, or glucose/galactose malabsorption syndrome. While taking Noliprel (especially at the beginning of the course of therapy), caution should be exercised when driving a car and performing work that requires increased attention and a high speed of psychomotor reactions. Storage conditions List B. The drug should be stored out of the reach of children at a temperature not exceeding 30°C.
Noliprel A forte, 30 pcs., 1.25 mg+5 mg, film-coated tablets
Common to perindopril and indapamide
The use of the drug Noliprel® A forte is not accompanied by a significant reduction in the frequency of side effects, with the exception of hypokalemia, compared to taking individual components of the drug in the lowest doses approved for use (see section “Side Effects”). When initiating therapy with two antihypertensive drugs that the patient has not previously received, an increased risk of idiosyncrasy cannot be excluded. Careful monitoring of the patient can minimize this risk.
Nocturnal dysfunction
Therapy is contraindicated in patients with severe renal failure (creatinine clearance less than 30 ml/min). In some patients with arterial hypertension without previous obvious renal impairment, laboratory signs of functional renal failure may appear during therapy. In this case, treatment should be stopped. In the future, you can resume combination therapy using low doses of drugs, or use only one of the drugs.
Such patients require regular monitoring of potassium levels and creatinine concentrations in the blood serum - 2 weeks after the start of therapy and every 2 months thereafter. Renal failure occurs more often in patients with severe chronic heart failure or underlying renal impairment, including renal artery stenosis. The drug Noliprel® A forte is not recommended in cases of bilateral renal artery stenosis or stenosis of the artery of a single functioning kidney.
Arterial hypotension and water-electrolyte imbalance
In the case of initial hyponatremia, there is a risk of sudden development of arterial hypotension, especially in patients with renal artery stenosis. Therefore, during dynamic monitoring of patients, attention should be paid to possible symptoms of dehydration and decreased electrolyte levels in the blood plasma, for example, after diarrhea or vomiting. Such patients require regular monitoring of blood plasma electrolyte levels.
In case of severe arterial hypotension, intravenous administration of 0.9% sodium chloride solution may be required.
Transient arterial hypotension is not a contraindication for continued therapy. After restoration of circulating blood volume and blood pressure, therapy can be resumed using low doses of drugs, or only one of the drugs can be used.
Potassium content
The combined use of perindopril and indapamide does not prevent the development of hypokalemia, especially in patients with diabetes mellitus or renal failure. As with the combination of any antihypertensive drug and a diuretic, regular monitoring of plasma potassium levels is necessary.
Excipients
It should be taken into account that the excipients of the drug include lactose monohydrate. Noliprel® A should not be prescribed to patients with hereditary galactose intolerance, lactase deficiency and glucose-galactose malabsorption.
Lithium preparations
The simultaneous use of a combination of perindopril and indapamide with lithium preparations is not recommended (see section “Interaction with other drugs”).
Childhood
The drug should not be prescribed to children and adolescents under the age of 18 years due to the lack of data on the effectiveness and safety of the use of perindopril and indapamide, both separately and together, in patients in this age group.
Perindopril
Dual blockade of the renin-angiotensin-aldosterone system (RAAS)
There is evidence of an increased risk of arterial hypotension, hyperkalemia and renal dysfunction (including acute renal failure) when ACE inhibitors are used simultaneously with ARB II or aliskiren. Therefore, double blockade of the RAAS by combining an ACE inhibitor with ARA II or aliskiren is not recommended (see sections “Interaction with other drugs” and “Pharmacodynamics”). If a double blockade is absolutely necessary, then this should be performed under the strict supervision of a specialist with regular monitoring of renal function, plasma electrolytes and blood pressure. The use of ACE inhibitors in combination with angiotensin II receptor antagonists is contraindicated in patients with diabetic nephropathy and is not recommended in other patients (see section "Contraindications").
Potassium-sparing diuretics, potassium supplements, potassium-containing table salt substitutes and food supplements
The simultaneous administration of perindopril and potassium-sparing diuretics, as well as potassium preparations, potassium-containing table salt substitutes and food additives is not recommended (see section “Interaction with other drugs”).
Neutropenia/agranulocytosis/thrombocytopenia
There are reports of the development of neutropenia/agranulocytosis, thrombocytopenia and anemia while taking ACE inhibitors. In patients with normal renal function and without concomitant risk factors, neutropenia rarely occurs. Perindopril should be used with extreme caution against the background of systemic connective tissue diseases (including systemic lupus erythematosus, scleroderma), as well as while taking immunosuppressants, allopurinol or procainamide, or a combination of these factors, especially in patients with initially impaired renal function .
Some of these patients developed severe infections, in some cases resistant to intensive antibiotic therapy. When prescribing perindopril to such patients, it is recommended to periodically monitor the number of leukocytes in the blood. Patients should tell their doctor about any signs of infectious diseases (for example, sore throat, fever) (see sections "Interaction with other drugs" and "Side effects").
Anemia
Anemia may develop in patients after kidney transplantation or in those on hemodialysis. In this case, the decrease in hemoglobin is greater, the higher its initial value. This effect does not appear to be dose-dependent, but may be related to the mechanism of action of ACE inhibitors.
A slight decrease in hemoglobin occurs during the first 6 months, then it remains stable and is completely restored after discontinuation of the drug. In such patients, treatment can be continued, but hematological tests should be carried out regularly.
Hypersensitivity/angioedema
When taking ACE inhibitors, including perindopril, in rare cases, the development of angioedema of the face, extremities, lips, tongue, vocal folds and/or larynx may occur (see section “Side effects”). This can happen at any time during therapy. If symptoms appear, the drug should be stopped immediately and the patient should be observed until signs of edema completely disappear. If the swelling affects only the face and lips, it usually goes away on its own, although antihistamines can be used as symptomatic therapy.
Angioedema, accompanied by swelling of the larynx, can be fatal. Swelling of the tongue, vocal folds, or larynx can lead to airway obstruction. If such symptoms appear, appropriate therapy should be started immediately, for example, epinephrine (adrenaline) administered subcutaneously at a dilution of 1:1000 (0.3–0.5 ml) and/or ensure patency of the airway.
A higher risk of developing angioedema has been reported in black patients.
Patients with a history of angioedema not associated with taking ACE inhibitors may have an increased risk of developing it when taking drugs of this group (see section "Contraindications").
In rare cases, angioedema of the intestine develops during therapy with ACE inhibitors.
In this case, patients experienced abdominal pain as an isolated symptom or in combination with nausea and vomiting, in some cases without previous angioedema of the face and with normal levels of C1-esterase. Diagnosis was made using abdominal computed tomography, ultrasound, or at the time of surgery. Symptoms resolved after discontinuation of ACE inhibitors. Therefore, in patients with abdominal pain receiving ACE inhibitors, when carrying out differential diagnosis, it is necessary to take into account the possibility of developing angioedema of the intestine.
mTOR (mammalian target of rapamycin) inhibitors (eg, sirolimus, everolimus, temsirolimus)
In patients receiving concomitant therapy with mTOR inhibitors, the risk of developing angioedema (including swelling of the airways or tongue with or without respiratory impairment) may be increased (see section "Interaction with other drugs").
Anaphylactoid reactions during desensitization
There are isolated reports of the development of prolonged, life-threatening anaphylactoid reactions in patients receiving ACE inhibitors during desensitizing therapy with hymenoptera venom (bees, wasps). ACE inhibitors should be used with caution in patients prone to allergic reactions undergoing desensitization procedures. Prescription of an ACE inhibitor should be avoided in patients receiving immunotherapy with hymenoptera venom. However, an anaphylactoid reaction can be avoided by temporarily discontinuing the ACE inhibitor at least 24 hours before the procedure.
Anaphylactoid reactions during LDL apheresis
In rare cases, life-threatening anaphylactoid reactions have developed in patients receiving ACE inhibitors during LDL apheresis using dextran sulfate.
To prevent an anaphylactoid reaction, ACE inhibitor therapy should be temporarily discontinued before each apheresis procedure.
Hemodialysis
Anaphylactoid reactions have been reported in patients receiving ACE inhibitors during hemodialysis using high-flux membranes (eg, AN69®). Therefore, it is advisable to use a different type of membrane or use an antihypertensive agent of a different pharmacotherapeutic group.
Cough
During therapy with an ACE inhibitor, a dry persistent cough may occur, which disappears after discontinuation of the drug. If a patient develops a dry cough, one should be aware of the possible iatrogenic nature of this symptom. If the attending physician believes that ACE inhibitor therapy is necessary for the patient, it is possible to continue taking the drug.
Risk of arterial hypotension and/or renal failure (in patients with heart failure, fluid and electrolyte imbalance, etc.)
In some pathological conditions, significant activation of the renin-angiotensin-aldosterone system may be observed, especially with severe hypovolemia and a decrease in the content of electrolytes in the blood plasma (during a salt-free diet or long-term use of diuretics), in patients with initially low blood pressure, renal artery stenosis, chronic heart failure or cirrhosis of the liver with edema and ascites.
The use of an ACE inhibitor causes a blockade of this system and therefore may be accompanied by a sharp decrease in blood pressure and/or an increase in the concentration of creatinine in the blood plasma, indicating the development of functional renal failure. These phenomena are more often observed when taking the first dose of the drug or during the first two weeks of therapy. In rare cases, these conditions develop acutely and during other periods of therapy. In such cases, when resuming therapy, it is recommended to use the drug at a lower dose and then gradually increase the dose.
Elderly age
Before starting perindopril, it is necessary to assess the functional activity of the kidneys and the potassium content in the blood plasma. At the beginning of therapy, the dose of the drug is selected taking into account the degree of reduction in blood pressure, especially in the case of dehydration and loss of electrolytes. Such measures help to avoid a sharp decrease in blood pressure.
Atherosclerosis
The risk of arterial hypotension exists in all patients, however, special care should be taken when using the drug in patients with coronary heart disease and cerebrovascular insufficiency. In such patients, treatment should begin with low doses of the drug.
Renovascular hypertension
The treatment method for renovascular hypertension is revascularization. However, the use of ACE inhibitors may have a positive effect in this category of patients, both awaiting surgery and in cases where surgery is not possible.
Treatment with Noliprel® A forte is not indicated in patients with diagnosed or suspected renal artery stenosis, since therapy should be started in a hospital setting with lower doses of the combination of perindopril and indapamide.
Heart failure/severe heart failure
In patients with severe heart failure (NYHA functional class IV), treatment should begin with a low dose of the drug and under close medical supervision.
Hypertensive patients with coronary artery disease should not stop taking beta-blockers: ACE inhibitors should be used together with beta-blockers.
Diabetes
In patients with type 1 diabetes mellitus (risk of spontaneous increase in potassium levels), treatment should begin with a low dose of the drug and under close medical supervision.
During the first month of therapy with ACE inhibitors, plasma glucose concentrations should be carefully monitored in patients with diabetes mellitus receiving oral hypoglycemic agents or insulin (see section "Interaction with other drugs").
Ethnic differences
Perindopril, like other ACE inhibitors, has a clearly less pronounced antihypertensive effect in patients of the Negroid race compared to representatives of other races. This difference may be due to the fact that black patients with arterial hypertension are more likely to have low renin activity.
Surgery/General anesthesia
The behavior of general anesthesia against the background of ACE inhibitors can lead to a pronounced decrease in blood pressure, especially when using general anesthesia agents that have an antihypertensive effect.
It is recommended, if possible, to stop taking long-acting ACE inhibitors, including perindopril, the day before surgery. It is necessary to warn the anesthesiologist that the patient is taking ACE inhibitors.
Aortic or mitral stenosis/Hypertrophic obstructive cardiomyopathy
ACE inhibitors should be prescribed with caution to patients with left ventricular outflow tract obstruction.
Liver failure
In rare cases, cholestatic jaundice occurs while taking ACE inhibitors. As this syndrome progresses, fulminant liver necrosis may develop, sometimes with death. The mechanism of development of this syndrome is unclear. If jaundice appears or if there is a significant increase in the activity of liver enzymes while taking ACE inhibitors, the patient should stop taking the ACE inhibitor and consult a doctor (see section “Side Effects”).
Hyperkalemia
Hyperkalemia may develop during treatment with ACE inhibitors, including perindopril. Risk factors for hyperkalemia are renal failure, impaired renal function, age over 70 years, diabetes mellitus, some concomitant conditions (dehydration, acute cardiac decompensation, metabolic acidosis), concomitant use of potassium-sparing diuretics (such as spironolactone and its derivative eplerenone, triamterene, amiloride ), as well as potassium preparations or potassium-containing substitutes for table salt, as well as the use of other drugs that help increase the content of potassium in the blood plasma (for example, heparins, ACE inhibitors, angiotensin II receptor antagonists, acetylsalicylic acid at a dose of 3 g/day or more, inhibitors cyclooxygenase-2 (COX-2) and non-selective NSAIDs, immunosuppressants such as cyclosporine or tacrolimus), trimethoprim.
The use of potassium supplements, potassium-sparing diuretics, and potassium-containing table salt substitutes can lead to a significant increase in potassium levels in the blood, especially in patients with reduced renal function. Hyperkalemia can cause serious, sometimes fatal, abnormal heart rhythms. If simultaneous use of the above drugs is necessary, treatment should be carried out with caution against the background of regular monitoring of potassium levels in the blood serum (see section “Interaction with other drugs”).
Indapamide
Hepatic encephalopathy
In the presence of liver dysfunction, taking thiazide and thiazide-like diuretics can lead to the development of hepatic encephalopathy. In such a situation, you should immediately stop taking the diuretic.
Water and electrolyte balance
Content of sodium ions in blood plasma
The content of sodium ions in the blood plasma must be determined before starting treatment, and then regularly monitored while taking the drug. Hyponatremia at the initial stage may not be accompanied by clinical symptoms, so regular laboratory monitoring is necessary. More frequent monitoring of sodium ion levels is indicated for patients with liver cirrhosis and elderly patients (see sections “Side effects” and “Overdose”). Treatment with any diuretics can cause hyponatremia, sometimes with very serious consequences. Hyponatremia accompanied by hypovolemia can lead to dehydration and orthostatic hypotension. A simultaneous decrease in the content of chlorine ions can lead to the development of secondary compensatory metabolic alkalosis: the frequency of its occurrence and the severity of its manifestations are insignificant.
Content of potassium ions in blood plasma
Therapy with thiazide and thiazide-like diuretics is associated with a risk of hypokalemia. Hypokalemia (less than 3.4 mmol/L) should be avoided in the following high-risk patients: elderly patients, malnourished patients (both those receiving and not receiving concomitant drug therapy), patients with cirrhosis (with edema and ascites) , coronary heart disease, heart failure. Hypokalemia in these patients increases the toxic effect of cardiac glycosides and increases the risk of developing arrhythmias.
Patients with a prolonged QT interval, either congenital or drug-induced, are also at increased risk.
Hypokalemia, like bradycardia, contributes to the development of severe heart rhythm disturbances, especially arrhythmias, which can be fatal. In all the cases described above, more frequent monitoring of the content of potassium ions in the blood plasma is necessary. The first measurement of potassium ion content should be carried out within the first week from the start of therapy.
If hypokalemia is detected, appropriate correction should be made.
Content of calcium ions in blood plasma
Thiazide and thiazide-like diuretics can reduce the excretion of calcium ions by the kidneys, leading to a slight and temporary increase in calcium levels in the blood plasma. Severe hypercalcemia may be a consequence of previously undiagnosed hyperparathyroidism. Before studying the function of the parathyroid glands, you should stop taking diuretics.
Plasma glucose concentration
It is necessary to monitor blood glucose concentrations in patients with diabetes mellitus, especially in the presence of hypokalemia.
Uric acid
When the concentration of uric acid in the blood plasma increases during therapy, the frequency of gout attacks may increase.
Diuretics and kidney function
Thiazide and thiazide-like diuretics are fully effective only in patients with normal or slightly impaired renal function (plasma creatinine concentration in adults below 25 mg/l or 220 µmol/l).
In elderly patients, plasma creatinine levels should be assessed taking into account age, weight and sex, according to the Cockroft formula:
Creatinine clearance (CC) = (140 – age × weight / 0.814 × plasma creatinine concentration
where: age in years, weight in kg, plasma creatinine concentration in µmol/l
The formula is suitable for older men; for older women, the result should be multiplied by a factor of 0.85.
At the beginning of diuretic treatment in patients, due to hypovolemia (due to the excretion of water and sodium ions), a temporary decrease in glomerular filtration rate and an increase in the concentration of urea and creatinine in the blood plasma may be observed. This transient functional renal failure is not dangerous for patients with initially normal renal function, but its severity may increase in patients with renal failure.
Photosensitivity
While taking thiazide and thiazide-like diuretics, cases of photosensitivity reactions have been reported (see section "Side effects"). If photosensitivity reactions develop while taking the drug, treatment should be discontinued. If it is necessary to continue diuretic therapy, it is recommended to protect the skin from exposure to sunlight or artificial ultraviolet rays.
Athletes
Indapamide may give a positive reaction during doping control.
Acute myopia and secondary angle-closure glaucoma
Sulfonamides and their derivatives can cause the development of idiosyncratic reactions leading to temporary (transient) myopia and acute angle-closure glaucoma. Without proper treatment, acute angle-closure glaucoma can lead to vision loss. First of all, you need to stop taking the drug as soon as possible. If intraocular pressure continues to be high, immediate medical or surgical treatment may be required. Risk factors that can lead to the development of acute angle-closure glaucoma include an allergy to sulfonamide or penicillin.
Effect on the ability to drive a car or use mechanical devices
The effect of the substances included in the drug Noliprel® A forte does not lead to disturbances in psychomotor reactions. However, in some people, in response to a decrease in blood pressure, various individual reactions may develop, especially at the beginning of therapy or when other antihypertensive drugs are added to the therapy. In this case, the ability to drive a car or operate other machinery may be reduced.
