Indapamide belongs to the group netiazidnyh sulfonamides. for pharmacologically similar to thiazide diuretics.
Reduces the tone of smooth muscles of arteries, reduces the total peripheral vascular resistance. The drug has moderate salureticheskim and diuretic effects, which are associated proviron hair loss to the blockade of sodium ion reabsorption, chlorine and hydrogen. to a lesser extent potassium ions in the proximal tubule and cortical kidney distal tubule segment. With the ability to selectively block the “slow” calcium channels, increases the elasticity of the artery walls and reduces the total peripheral vascular resistance. It helps to reduce hypertrophy of the left ventricle of the heart. No effect on plasma lipids (triglycerides, low density lipoproteins, high density lipoproteins) does not affect carbohydrate metabolism (including patients with concomitant diabetes). The decrease in total peripheral vascular proviron hair loss resistance is also due to a decrease in the sensitivity of adrenergic receptors of the vascular wall to norepinephrine and angiotensin II of, an increase in the synthesis of prostaglandins that have vasodilating activity (prostaglandin and prostacyclin PgE2 PgI2). It reduces production of free and stable oxygen radicals.When administered in high doses, does not affect the degree of decrease in blood pressure, despite the increase in diuresis.
Antihypertensive effect manifested by the end of the first week, it maintained for 24 hours on a background of a single administration, reaching a maximum at 8-12 weeks after dosing started.
Following oral administration indapamide rapidly and completely absorbed from the gastrointestinal tract, high bioavailability (93%). Food intake slows down the absorption rate, but does not affect the completeness of absorption. Following proviron hair loss oral administration at a dose of 2.5 mg of the maximum blood concentration reached in 1-2 hours. Binding to plasma proteins is approximately 75%. Associated also with elastin smooth muscles of the vascular wall. It has a high volume of distribution, passes through the blood-tissue barriers (including placental) passes into breast milk.
It is metabolized in the liver. The half-life is on average 14-18 hours. Shown mainly via the kidney – 60-80% (in most cases – as metabolites, about 5% – unchanged) through the intestine – 20-23%. In patients with renal insufficiency The pharmacokinetics does not change. Not accumulates.
- Hypersensitivity to indapamide, to other sulfonamides derivatives and components of the drug;
- acute cerebrovascular accident
- severe hepatic (including with encephalopathy) and / or renal failure, anuria;
- concomitant use of drugs prolonging proviron hair loss the QT interval;
- lactose intolerance, galactosemia, a syndrome of glucose malabsorption, galactose;
- pregnancy and lactation;
- age of 18 years (effectiveness and safety have been established).Precautions: diabetes in decompensation stage, hyperuricemia (especially accompanied by gout and urate nephrolithiasis), hyponatremia, and other violations of water-electrolyte metabolism, moderate hepatic and / or renal failure, ascites, coronary artery disease, chronic heart failure, lengthening the interval QT, hyperparathyroidism.Dosing and Administration
Inside, in the morning, regardless of the meal, the capsule is swallowed without chewing, drinking water.
Assign to 2.5 mg (1 capsule) 1 times a day.
The drug can be used as monotherapy or in combination with other antihypertensive agents ( beta-blockers. blockers “slow” calcium channel inhibitors, angiotensin converting enzyme). If after 4-8 weeks of treatment, the desired therapeutic effect is achieved, the dose of the drug is not recommended to increase (increased risk of side effects without increasing the antihypertensive effect). Instead, the treatment regimen appropriate to add another antihypertensive drug, which is not a diuretic. In cases where treatment should begin with reception of two preparty. Indap dose is equal to 2.5 mg once daily in the morning.
Side effect From the digestive system: nausea, vomiting, anorexia. dry mouth, abdominal discomfort, gastralgia, constipation or diarrhea, hepatic encephalopathy (against the background of liver failure). On the part of the central nervous system: asthenia, headache, weakness, fatigue, lethargy, weakness, malaise, vertigo, spasms muscles, nervousness, tension, irritability, agitation; anxiety, insomnia, depression, dizziness, drowsiness. From the senses: conjunctivitis, blurred proviron hair loss vision. Respiratory system: rhinitis, rarely – cough, pharyngitis, sinusitis. Since the cardiovascular system: orthostatic hypotension, arrhythmia, palpitations, changes electrocardiogram (hypokalemia). From the mochevydelitelnoy system: nocturia, polyuria, an increase of infection frequency. Allergic reactions: itching, rash, hives, a hemorrhagic vasculitis. From the side of hematopoiesis: thrombocytopenia, leukopenia, agranulocytosis, bone marrow aplasia, hemolytic anemia. Laboratory findings: hypercalcemia, hyperuricemia, hyposalemia. hyponatremia, hyperglycemia, hypokalemia, increased blood urea nitrogen plasma hypercreatininemia, glycosuria. Other: flu-like symptoms, chest pain, back pain, reduced potency and / or libido, runny nose, sweating, weight loss, paresthesias in extremities, exacerbation of systemic lupus erythematosus, pancreatitis.
Overdosing Symptoms: nausea, vomiting, weakness, poor gastrointestinal function, fluid and electrolyte disturbances, in some cases – an excessive fall in blood pressure, respiratory depression. Patients with cirrhosis may develop hepatic coma. Treatment: gastric lavage, correction fluid and electrolyte balance, symptomatic therapy. No specific antidote.
Interaction with other medicinal products
is not recommended to use both indapamide and drugs lithium because of the possibility of toxic effects of lithium on the background of decrease in its renal clearance.
The combined use of indapamide with astemizole, erythromycin (iv), pentamidine, sultopride, terfenadine, vincamine, antiarrhythmic drugs Ia (quinidine, disopyramide), and class III (amiodarone bretilium, sotalol). may weaken the antihypertensive effect of indapamide and lead to arrhythmia development on type “pirouette” due to the synergistic effect of (extension) on the duration intervata the QT.
Nonsteroidal anti-inflammatory drugs, steroids, tetrakozaktid, adrenostimulyatorov reduce the hypotensive proviron hair loss effect of baclofen enhances.
Saluretics (loop, thiazide) cardiac glycosides. glucose and mineralokortikosteroidy, tetrakozaktid, laxatives, amphotericin B (iv) increase the risk of hypokalemia.
When concomitantly with cardiac glycosides increases the likelihood of digitalis intoxication; with calcium supplementation – hypercalcemia: metformin possible worsening lactic acidosis. The combination with potassium-sparing diuretics may be effective in a certain category of patients, but it is not completely ruled out the possibility of the development of hypo- or hyperkalemia, especially in patients with diabetes and renal failure.
Angiotensin-converting enzyme (ACE) inhibitors increase the risk of hypotension and / or acute renal failure (especially when existing renal artery stenosis).
Indapamide increases the risk of renal failure when using iodine-containing contrast agents in high doses during dehydration. Before use of iodine-containing contrast media to patients need to restore lost fluids.
Tricyclic antidepressants and antipsychotic drugs may increase the antihypertensive effect of the drug and increase the risk of orthostatic hypotension. When used together with cyclosporine may increase the level of creatinine in the blood plasma.
Reduces the effect of indirect anticoagulants (coumarin derivatives or indandiona) due to increased concentration of clotting factors by reducing blood volume and increase their production by the liver (may require dose adjustment).
Enhances the blockade of neuro muscle transfer, developing under the influence of non-depolarizing muscle relaxants.
indapamide is effective for the treatment of hypertensive patients “at risk”, ie with concomitant diseases:. diabetes mild and moderate or chronic renal failure, patients with hyperlipidemia
With prolonged use of indapamide may sometimes occur electrolyte metabolism disorders such as hyponatremia, hypokalemia. hypercalcemia and alkalosis gipohloremichesky. These disorders are more common in patients with chronic heart failure, liver disease, vomiting and diarrhea, as well as in those on a salt-free diet, which leads to the need to monitor blood electrolytes.
Indapamide increases the excretion of magnesium in the urine, which can lead to hypomagnesemia.
In use of indapamide should also regularly monitor the content of uric acid and residual nitrogen in the blood plasma.
may cause orthostatic hypotension, which can be provoked by alcohol, barbiturates, narcotic drugs, as well as -. other proviron hair loss antihypertensive agents
in the case of hypokalemia caused by indapamide, may increase the toxicity of cardiac glycosides. Patients receiving cardiac glycosides. laxatives, with hyperaldosteronism, as well as in the elderly shows a close monitoring of potassium and creatinine.
The most careful control shown in patients with liver cirrhosis (especially with edema or ascites – the risk of metabolic alkalosis, increase the expression of hepatic encephalopathy), coronary heart disease, chronic heart failure, as well as in the elderly. The group of high risk include patients with an increased QT interval on the electrocardiogram (congenital or develop on the background of a pathological process).
The first measurement of the concentration of potassium in the blood should be performed within 1 week of treatment.
Hypercalcemia in patients receiving indapamide may be due to previously undiagnosed hyperparathyroidism.
diabetic patients is extremely important to control glucose levels in blood, especially in the presence of hypokalemia.
considerable dehydration may lead to acute renal failure (decreased glomerular filtration). Patients need to compensate for the loss of water and at the beginning of treatment carefully monitor renal function.
Indapamide may give a positive result during the doping control.
In patients with hypertension and hyponatremia (due to diuretics) must be 3 days before you start taking ACE inhibitors stop taking diuretics (for need diuretics can be resumed later) or they are assigned the initial low dose of ACE inhibitors.
indapamide may worsen systemic lupus erythematosus.
Despite the fact that indapamide virtually no effect on carbohydrate metabolism in patients with insulin-dependent diabetes may increase the required insulin dose and with latent diabetes blood glucose monitoring should be implemented.
10 capsules 2.5 mg in blister.
Three blisters in a carton box with instructions for use.
Store in a dry, dark place at a temperature of 15-25 ° C.
Keep out of reach of children.
Do not use beyond the proviron hair loss expiration date.
Conditions of supply of pharmacies