Indapamid

General characteristics. Structure:

Active ingredient: 0,0025 g of an indapamid.

Excipients: potato starch, sugar milk (lactose), calcium phosphate, коллидон 30, magnesium stearate, talc.

Structure of a cover: oksipropiltsellyuloza Klutsel LF, коллидон VA 64, titanium dioxide, talc.

Diuretic means with the expressed hypotensive action.

Pharmacological properties:

Pharmacodynamics. An antihypertensive, tiazidopodobny diuretic with moderated on force and action, long on duration, derivative benzamides. Reduces a tone of smooth muscles of arteries, reduces the general peripheric resistance of vessels.

Has moderate saluretichesky and diuretic effects which are connected with blockade of a reabsorption of ions of sodium, chlorine, hydrogen, and to a lesser extent potassium ions in proximal tubules and a cortical segment of a distal tubule of nephron. Vasodilating effects and decrease in the general peripheric resistance of vessels have the following mechanisms in the basis: decrease in reactivity of a vascular wall to noradrenaline and angiotensin II; increase in synthesis of prostaglandins having vasodilating activity; oppression of current of calcium in smooth muscle cells of vessels. Promotes reduction of a hypertrophy of a left ventricle of heart.

In therapeutic doses does not influence lipidic and carbohydrate metabolism (including, at patients with the accompanying diabetes mellitus). The anti-hypertensive effect develops at the end of the first / the beginning of the second week at constant administration of drug and remains within 24 hours against the background of a single dose. Read here in more detail how to accept индапамид from supertension.

Pharmacokinetics. After intake it is quickly and completely soaked up from digestive tract. The Bidostupnost - high (93%). Meal slows down speed a little, but does not influence completeness of absorption. The maximum concentration in blood is reached in 1-2 hours after intake. Equilibrium concentration is reached in 7 days of regular reception.

Drug for 70-80% contacts proteins of a blood plasma. Has the high volume of distribution, passes through gistogematichesky (including placental), barriers, gets into breast milk. It is metabolized in a liver. The elimination half-life of an indapamid averages 14-18 hours. It is brought out of an organism by kidneys (to 80%) preferential in the form of metabolites, through intestines - 20%. At patients with a renal failure the pharmacokinetics does not change. Does not kumulirut

Indications to use:

Arterial hypertension

Route of administration and doses:

Inside, irrespective of meal, washing down with enough liquid. It is preferable to accept drug in the morning. The dose makes 2,5 mg (1 tablet) a day.

If in 4-8 weeks of treatment do not reach desirable therapeutic effect, the dose of drug is not recommended to be raised (the risk of emergence of side effects without strengthening of anti-hypertensive effect increases). Instead it is recommended to include other anti-hypertensive drug which is not diuretic in the scheme of drug treatment.

In cases when treatment needs to be begun with reception of two drugs, Indapamid's dose remains equal 2,5 mg in the morning once in days

Features of use:

At prolonged use or at Indapamid's reception in big dosages electrolytic disturbances, such as a hyponatremia, a hypopotassemia, a gipokhloremichesky alkalosis can develop. These disturbances are more often observed at patients with chronic heart failure (II-IV ф.к. on NYHA classification), liver diseases, at vomiting and diarrhea, and also at the persons which are on an electrolyte-deficient diet. Co-administration of Indapamid with cardiac glycosides and corticosteroids increases risk of emergence of a hypopotassemia. Besides, release of magnesium with urine can increase that can lead to a hypomagnesiemia.

Emergence of orthostatic hypotension which can be provoked by alcohol intake, barbituyorata, narcotic drugs and a concomitant use of other antihypertensives is possible. At the patients accepting cardiac glycosides, purgatives against the background of a hyper aldosteronism, and also at elderly people tshchatelyyony control of keeping of the qadi and creatinine is shown.

The most careful control is shown at patients with cirrhosis, coronary heart disease, chronic heart failure. Patients with the increased QT interval on an elektrokardiogramyoma also treat group of the increased risk (inborn or developed against the background of any pathological process).

The first measurement of potassium concentration in blood should be taken within the I week of treatment. The hypercalcemia against the background of Indapamid's reception can be a consequence of earlier not diagnosed hyperparathyreosis. At patients with a diabetes mellitus it is extremely important to control glucose level in blood, especially in the presence of a hypopotassemia. Considerable dehydration can lead to development of an acute renal failure (decrease in a glomerular filtrayotion). Patients need to offset loss of liquid and in an initiation of treatment carefully to control function of kidneys. Indapamid can yield a positive take when carrying out doning-control.

It is necessary for patients with arterial hypertension and a hyponatremia (owing to reception of diuretics) in 3 days prior to reception of inhibitors of an angiotensin-converting enzyme to stop reception of diuretics (if necessary reception of diuretics can be resumed a bit later), or by it appoint initial low doses of inhibitors of an angiotensin-converting enzyme. Derivatives of sulfonamide can aggravate a current of a system lupus erythematosus (it must be kept in mind at Indapamid's appointment).

Side effects:

From a metabolism: a hypopotassemia, a hyponatremia, a gipokhloremichesky alkalosis, increase in an urea nitrogen in a blood plasma, a giperkreatininemiya, a glyukozouriya, a hypercalcemia.

From the alimentary system: a lock or diarrhea, nausea, vomiting,  dryness in a mouth, feeling of discomfort in a stomach, anorexia.

From the central nervous system: adynamy, headache, dizziness, nervousness, adynamy, drowsiness, sleeplessness, depression, increased fatigue, indisposition, spasm of muscles, tension, irritability, alarm.

From sense bodys: konjyuktivit, a vision disorder.

From respiratory system: cough, pharyngitis, sinusitis, rhinitis.

From cardiovascular system: orthostatic hypotension, arrhythmia, changes on the ECG characteristic of a hypopotassemia, heartbeat.

From urinogenital system: nocturia, polyuria, development of frequency of infections. Allergic reactions: skin itch, small tortoiseshell, hemorrhagic vasculitis.

From bodies of a hemopoiesis: thrombocytopenia, leukopenia, agranulocytosis, marrow aplasia, hemolitic anemia.

Others: grippopodobny syndrome, thorax pain, dorsodynia, decrease in a libido and potentiality, rhinorrhea, perspiration, decrease in body weight, parestenziya, pancreatitis, aggravation of a system lupus erythematosus.

Interaction with other medicines:

At simultaneous use of an iidanamid with drugs of lithium increase in concentration of lithium in a blood plasma is possible.

Astemizol, erythromycin (at in introduction), pentamidine, сультоприд, Vincaminum, the antiarrhytmic drugs Ia (quinidine, Disopyramidum) and the III class (Amiodaronum, бретилиум, соталол) increase probability of emergence of disturbances of a cordial rhythm on torsades de pointes ooze (ventricular tachycardia like "pirouette").

Non-steroidal anti-inflammatory drugs, glucocorticosteroids, тетракоактид, sympathomimetics reduce hypotensive action, Baclofenum – increases.

Saluretics, cardiac glycosides, glyuko-and mineralokortikosteroida, тетракозактид, Amphotericinum In (at in introduction), purgatives increase risk of development of a hypopotassemia.

At simultaneous use with cardiac glycosides the probability of development of digitalis intoxication, with calcium drugs - hypercalcemias, with Metforminum - possibly aggravation of lactic acidosis increases. The combination with kaliysberegayushchy diuretics can be effective at some categories of patients, however, at the same time the probability of development hypo - and hyperpotassemias, especially at patients with a diabetes mellitus and a renal failure completely is not excluded.

Inhibitors of an angiotensin-converting enzyme increase risk of development of arterial hypotension and/or acute pochechyony insufficiency (especially at the available renal artery stenosis). Contrast yodosoderzhashchy means in high doses increase risk of development of renal failures (organism dehydration).

Before use of contrast yodosoderzhashchy means by the patient it is necessary to recover liquid loss. Tricyclic antidepressants and antipsychotic drugs strengthen hypotensive action and increase risk of development of orthostatic hypotension. Cyclosporine increases risk of development of a giperkreatininemiya.

Reduces effect of indirect anticoagulants (any coumarin or an indandion) owing to increase in concentration of factors of coagulation as a result of reduction of volume of the circulating blood and increase in their products liver (dose adjustment can be required).

Strengthens the neuromuscular transmission blockade developing under the influence of not depolarizing muscle relaxants.

Contraindications:

Hypersensitivity to an indapamid, other derivatives of sulfonamide or other components of drug, a decompensation of function of kidneys (anury) and/or a liver (including with encephalopathy), a hypopotassemia, a concomitant use of the drugs extending QT interval, pregnancy, the lactation period, age up to 18 years (efficiency and safety are not established) ю

With care. A diabetes mellitus in a decompensation stage, the hyperuricemia (which is especially shown gout or an uratny nephrolithiasis).

Overdose:

Symptoms: nausea, vomiting, weakness, dysfunction of digestive tract, water and electrolytic disturbances, lowering of arterial pressure, respiratory depression, dizziness, confusion of consciousness, drowsiness. At patients with an abnormal liver function development of a hepatic coma is possible.

Treatment: gastric lavage, correction of water and electrolytic balance, symptomatic therapy. There is no specific antidote.

Storage conditions:

In the dry, protected from light place at a temperature not above 25 °C. In the place, unavailable to children, the Period of validity 2 years. Not to use after the expiry date specified on packaging

Issue conditions:

According to the recipe

Packaging:

Tablets coated 2,5 mg. On 10 tablets in a blister strip packaging. 2, 3 planimetric packagings together with the instruction put in a pack from a cardboard.