Indapamide Hemofarm pills coated 2,5mg N30
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Active ingredients
Indapamide
Release form
Pills
Composition
Indapamide 2.5 mg Auxiliary substances: lactose monohydrate, povidone K-30, crospovidone, magnesium stearate, sodium lauryl sulfate, talc. Coat composition: hypromellose, macrogol 6000, talc, titanium dioxide (E171).
Pharmacological effect
Antihypertensive agent (diuretic, vasodilator). Pharmacologically similar to thiazide diuretics (impaired reabsorption of sodium ions in the cortical segment of the loop of Henle). Increases urinary excretion of sodium, chlorine and, to a lesser extent, potassium and magnesium ions. Possessing the ability to selectively block slow calcium channels, it increases the elasticity of artery walls and reduces total peripheral vascular resistance. Helps to reduce left ventricular hypertrophy. Does not affect plasma lipids (triglycerides, low density lipoproteins, high density lipoproteins); does not affect carbohydrate metabolism (including in patients with diabetes mellitus). Reduces the sensitivity of the vascular wall to noradrenaline and angiotensin II, stimulates the synthesis of prostaglandin E2, reduces the production of free and stable oxygen radicals. The antihypertensive effect develops by the end of the first week, persists for 24 hours against a single dose.
Pharmacokinetics
After ingestion is rapidly and completely absorbed from the gastrointestinal tract; bioavailability - high (93%). Meal somewhat slows down the rate of absorption, but does not affect the amount of absorbed substance. Cmax in blood plasma - 1-2 hours after ingestion. With repeated administration, fluctuations in the concentration of the drug in the blood plasma in the interval between administration of two doses are reduced. Equilibrium concentration is established after 7 days of regular intake. T1 / 2 of the drug is 14-24 hours (average 18 hours), the bond with plasma proteins is 79%. Also associated with elastin smooth muscle of the vascular wall. It has a high Vd, passes through histohematogenous barriers (including placental), penetrates into breast milk. Metabolized in the liver. 60-80% are excreted by the kidneys as metabolites (about 5% are excreted unchanged), through the intestine - 20%. In patients with renal insufficiency, pharmacokinetics do not change. Does not accumulate.
Indications
- arterial hypertension.
Contraindications
- lactose intolerance; - galactosemia; - glucose / galactose absorption disorder syndrome; - severe renal failure (anuria stage); - hypokalemia; - severe hepatic (including encephalopathy) failure; - pregnancy; - lactation period; - age up to 18 years old (efficacy and safety have not been established); - simultaneous administration of drugs prolonging the QT interval; - hypersensitivity to the drug and other sulfonamide derivatives. With caution prescribed for abnormal liver function and / or kidney, impaired water-electrolyte deleterious balance giierparatireoze, patients with increased QT interval on an electrocardiogram or receiving combination therapy with other anti-arrhythmic drugs, diabetes decompensated, hyperuricemia (especially accompanied urate gout and nephrolithiasis).
Precautionary measures
During treatment, psoriasis may worsen. During pheochromocytoma, propranolol can only be used after taking an alpha blocker. After a long course of treatment, propranolol should be discontinued gradually, under the supervision of a physician. during anesthesia, you must stop taking propranolol or find a remedy for anesthesia with minimal negative inotropic effects. The impact on the ability to drive vehicles and control mechanisms of patients whose activities require increased attention, the question of the use of propranolol on an outpatient basis should be addressed only after evaluating the individual response of the patient.
Use during pregnancy and lactation
Contraindicated.
Dosage and administration
Inside, regardless of the meal, squeezed enough liquid. Take the drug preferably in the morning. The dose is 2.5 mg (1 tab.) / Day. If after 4-8 weeks of treatment the desired therapeutic effect is not achieved, the dose of the drug is not recommended to be increased (the risk of side effects increases without increasing the antihypertensive effect). Instead, it is recommended to include another antihypertensive agent that is not a diuretic in the scheme of drug treatment.In cases where treatment must begin with taking two drugs, the dose of indapamide remains equal to 2.5 mg in the morning 1 time / day.
Side effects
On the part of the digestive system: nausea, anorexia, dry mouth, gastralgia, vomiting, diarrhea, constipation, abdominal pain, may develop hepatic encephalopathy; rarely - pancreatitis. For the central nervous system: asthenia, nervousness, headache, dizziness, drowsiness, vertigo, insomnia, depression; rarely - increased fatigue, general weakness, malaise, muscle spasm, tension, irritability, anxiety. On the respiratory system: cough, pharyngitis, sinusitis; rarely - rhinitis. From the cardiovascular system: orthostatic hypotension, ECG changes (hypokalemia), arrhythmia, palpitations. From the urinary system: frequent infections, nocturia, polyuria. Allergic reactions: rash, urticaria, pruritus, hemorrhagic vasculitis. indicators: hyperuricemia, hyperglycemia, hypokalemia, hypochloremia, hyponatremia, hypercalcemia, increased urea nitrogen in the blood plasma, hypercreatininemia, glycosuria. From the hematopoietic system: very rarely - thrombocytopenia, leukopia Niya, agranulocytosis, bone marrow aplasia, and hemolytic anemiya.Prochie: exacerbation of systemic lupus erythematosus.
Overdose
Symptoms: nausea, vomiting, weakness, dysfunction of the gastrointestinal tract, water and electrolyte disturbances, in some cases - an excessive reduction in blood pressure, respiratory depression. Hepatic coma may develop in patients with cirrhosis. Treatment: gastric lavage, correction of water and electrolyte balance, symptomatic therapy. There is no specific antidote.
Interaction with other drugs
Saluretics, cardiac glycosides, gluco- and mineralocorticoid drugs, tetrakozaktid, amphotericin B (w / w), laxatives increase the risk of hypokalemia. If taken simultaneously with cardiac glycosides, the likelihood of digitalis intoxication increases; with calcium preparations - hypercalcemia; with metformin - aggravation of lactic acidosis is possible. It increases the concentration of lithium ions in the blood plasma (decreased excretion with urine), lithium has a nephrotoxic effect. Astemizol, erythromycin IV, pentamidine, sultoprid, terfenadine, vincamine,IA class antiarrhythmic drugs (quinidine, disopyramide) and class III (amiodarone, Bretillia tosilat, sotalol) can lead to the development of pirouette arrhythmias ”(torsades de pointes). NSAID, GCS, tetrakozaktid, sympathomimetics reduce the hypotensive effect, baclofen strengthens. The combination with potassium-sparing diuretics may be effective in a certain category of patients, however, this does not completely exclude the possibility of the development of hypo-or hyperkalemia, especially in patients with diabetes mellitus and renal failure. The ACE inhibitors increase p lawsuit for development of arterial hypotension and / or acute renal failure (especially with existing renal artery stenosis). Increases the risk of developing renal dysfunction when using iodine-containing contrast media in high doses (dehydration of the body). Patients need to restore fluid loss before using iodine-containing contrast agents. Imipramine (tricyclic) anti depressants and neuroleptics increase the hypotensive effect and increase the risk of orthostatic hypotension. Cyclosporin increases the risk of hypercreatininemia. Reduces the effect of indirect anticoagulants (coumarin or indanedione derivatives) due to an increased concentration of coagulation factors as a result of a decrease in circulating blood volume and an increase in their production by the liver (dose adjustment may be required). Increases the blockade of neuromuscular transmission developing under the action of non-depolarizing muscle relaxants .
special instructions
Patients taking cardiac glycosides, laxatives, against the background of hyper aldosteronism, as well as in elderly people show regular monitoring of the content of potassium and creatinine ions. Against the background of administration of indapamide, the concentration of potassium, sodium, magnesium ions in the blood plasma should be monitored (electrolyte ions can develop violations), pH, glucose, uric acid and residual nitrogen concentrations. The most careful control is shown in patients with cirrhosis (especially with edema or ascites) - the risk of developing metabolic whom alkalosis, which increases the manifestations of hepatic encephalopathy), ischemic heart disease, heart failure,as well as in the elderly. Patients with an increased QT interval on an ECG (congenital or developed on the background of any pathological process) also belong to the high-risk group. The first measurement of potassium concentration in the blood should be carried out within 1 week of treatment. taking indapamide may be a consequence of previously undiagnosed hyperparathyroidism. In patients with diabetes, it is extremely important to control the level of glucose in the blood, especially in the presence of hypokalemia. Considerable dehydration can lead to the development of acute renal failure (reduction of glomerular filtration). Patients need to compensate for the loss of water and at the beginning of treatment to carefully monitor kidney function. Indapamide can give a positive result when conducting doping control. 3 days before the start of taking angiotensin-converting enzyme inhibitors, stop taking diuretics (if necessary, you can resume taking diuretics a little later), or they are prescribed initial low doses of ACE inhibitors. The sulfonamide derivatives can aggravate the course of systemic lupus erythematosus (must be kept in mind when prescribing indapamide). Efficiency and safety in children has not been established. with changes in blood pressure, especially at the beginning of treatment and with the addition of another antihypertensive agent. As a result, the ability to drive and work with mechanisms requiring increased attention may be reduced.