Rapid pressure reduction with indapamide. Indapamide: instructions, price, reviews and analogues

The drug "Indapamide" acts on the vascular walls, relaxing them and normalizing the elasticity of the muscles. Thanks to this drug, arterioles increase, which leads to the unhindered movement of blood in the body. Tablets "Indapamide" - This is a vasodilator, pharmacodynamically similar to a thiazide diuretic. During the day, the amount of urine produced increases slightly. Together with it, the predominant ions of sodium, chlorine, and potassium are removed from the body. While taking the drug, carbohydrate and fat metabolism remain normal, which makes it possible for patients suffering from obesity or diabetes to take the drug. With a pronounced drug "Indapamide" significantly reduces the level of hypertrophy. With regular use of the drug, the effect is achieved after 2 weeks, and after 10 weeks, the maximum beneficial effect is noted. A single dose of the drug "Indapamide" retains its therapeutic properties for up to 24 hours.

Pharmacokinetics

The pressure drug "Indapamide" is rapidly absorbed in the gastrointestinal tract and excreted from the body mainly with urine. The content of inactive metabolites in feces is about 20%. The diuretic interacts with plasma and red blood cells, penetrates into breast milk. With regular use of the drug, cumulation was not observed. Patients with hepatic insufficiency should use this medicine with caution to avoid the formation of

Indications for use

What does the medicine "Indapamide" help from? Indications for its use are:

Arterial hypertension.
(sodium and water retention in the body).

Contraindications

The drug is limited to the following diseases:

Liver dysfunction.
Impaired kidney function.
Intolerance to the components of the drug.
Hypokalemia.
Violation of blood circulation in the system of the brain and spinal cord.
Gout.

In what cases can there be complications with the use of the drug "Indapamide"

Lactose intolerance.
Pregnancy and lactation.
Age up to 18 years.
Unstable water and electrolyte balance.

Method of application, dosage

The drug is taken orally 1 time per day, 2.5 mg. Morning intake is more effective, since a large amount of food slows down the absorption of the drug. Tablets should be swallowed without chewing, drinking plenty of water. An increase in the dose of the drug "Indapamide" does not lead to an acceleration of the therapeutic effect, but causes a number of side effects. Patients suffering from heart failure, in the absence of improvement, are prescribed a dose of 5 mg per day.

Adverse reactions

When taking the drug "Indapamide" (from which it is prescribed, we already know) a side effect may occur. First of all, this happens when using an increased dose of the drug, intolerance to the substance by the body, the impact of individual components on a specific organ system. Side effects can manifest themselves in different ways.

Central nervous system: headache, drowsiness, asthenia, insomnia, irritability.
Respiratory system: pharyngitis, acute cough.
Digestive system: nausea, vomiting, diarrhea.
Urinary system: nocturia, infectious inflammations.
Cardiovascular system: arrhythmia, palpitations, hypokalemia.
Skin diseases: itching, urticaria, rash.

Price

The average price of the drug "Indapamide" in Russia is 12 rubles. The package contains 30 tablets of 2.5 mg.

Interaction with other drugs

Anti-inflammatory drugs reduce the effect of the drug "Indapamide", quickly consume fluid in the body, which is why it has to be constantly replenished. When taking Indapamide tablets, what determines the compatibility with other drugs? The composition of the diuretic is quite complex, so complex treatment is selected by a specialist strictly individually, based on the prescribed drugs.

Preparations containing lithium are rapidly excreted in the urine, so it is necessary to control the level of the substance in the blood serum.
GCS, on the contrary, retain water in the body, reducing the antihypotensive effect.
reduce the amount of potassium in the body, which can lead to hypokalemia.
Calcium: an increase in the content of salts in the body.
Radiopaque preparations containing a significant amount of iodine can lead to the development of renal failure.
Tricyclic antidepressants are at risk for orthostatic hypotension.

special instructions

Which patients need careful monitoring of their condition while taking the drug "Indapamide"? What do they need to watch out for? Patients with cirrhosis of the liver, heart, kidney, liver failure are required to undergo treatment with the drug "Indapamide" strictly under the supervision of doctors. The possible occurrence of dehydration in the body leads to an exacerbation of organ dysfunction. It is important to control the fluid content in the body and compensate for it in time.

P N014730/01

Trade name of the drug: Indapamide

International non-proprietary name:

Indapamide

Dosage form:

film-coated tablets

Compound
1 film-coated tablet contains active substance: indapamide 2.5 mg; Excipients: lactose monohydrate, povidone-K30, crospovidone, magnesium stearate, sodium lauryl sulfate, talc; shell: hypromellose, macrogol 6000, talc, titanium dioxide E 171.

Description
Round, biconvex, film-coated white tablets.

Pharmacotherapeutic group:

diuretic agent.

ATX code: .

Pharmacological properties
Pharmacodynamics.
Antihypertensive agent (diuretic, vasodilator). By pharmacological properties, it is close to thiazide diuretics (impaired reabsorption of sodium ions in the cortical segment of the loop of Henle). Increases urinary excretion of sodium, chloride and, to a lesser extent, potassium and magnesium ions. Possessing the ability to selectively block "slow" calcium channels, it increases the elasticity of arterial walls and reduces overall peripheral vascular resistance. Helps to reduce hypertrophy of the left ventricle of the heart. Does not affect the content of lipids in blood plasma (triglycerides, low density lipoproteins, high density lipoproteins); does not affect carbohydrate metabolism (including in patients with concomitant diabetes mellitus). Reduces the sensitivity of the vascular wall to norepinephrine and angiotensin II, stimulates the synthesis of prostaglandin E2, reduces the production of free and stable oxygen radicals.
The hypotensive effect develops by the end of the first week, persists for 24 hours on the background of a single dose.
Pharmacokinetics.
After oral administration, it is rapidly and completely absorbed from the gastrointestinal tract; bioavailability - high (93%). Eating somewhat slows down the rate of absorption, but does not affect the amount of absorbed substance. The maximum concentration in blood plasma is 1-2 hours after ingestion. With repeated doses, fluctuations in the concentration of the drug in the blood plasma in the interval between taking two doses are reduced. The equilibrium concentration is established after 7 days of regular intake. The half-life of the drug is 14-24 hours (average 18 hours), the relationship with plasma proteins is 79%. It also binds to the elastin of the smooth muscles of the vascular wall. Has a high volume of distribution, passes through histohematic barriers (including placental), penetrates into breast milk. Metabolized in the liver. The kidneys excrete 60–80% as metabolites (about 5% is excreted unchanged), and 20% through the intestines. In patients with renal insufficiency, the pharmacokinetics do not change. Does not accumulate.

Indications for use
Arterial hypertension.

Contraindications
Hypersensitivity to the drug and other sulfonamide derivatives, lactose intolerance, galactosemia, glucose / galactose malabsorption syndrome; severe renal failure (anuria stage), hypokalemia, severe hepatic (including with encephalopathy) insufficiency, pregnancy, lactation, age up to 18 years (efficacy and safety have not been established); concomitant use of drugs that prolong the QT interval.

Carefully: is prescribed for violations of the liver and / or kidneys, impaired water and electrolyte balance, hyperparathyroidism, patients with an increased QT interval on the ECG or receiving combined therapy with other antiarrhythmic drugs, diabetes mellitus in the stage of decompensation, hyperuricemia (especially accompanied by gout and urate nephrolithiasis ).

Dosage and administration
Inside, regardless of the meal, drinking plenty of fluids. Take the drug preferably in the morning. The dose is 2.5 mg (1 tablet) per day. If after 4-8 weeks of treatment the desired therapeutic effect is not achieved, it is not recommended to increase the dose of the drug (the risk of side effects increases without increasing the antihypertensive effect). Instead, it is recommended to include another antihypertensive drug that is not a diuretic in the drug regimen. In cases where treatment must be started with two drugs, the dose of Indapamide remains equal to 2.5 mg in the morning once a day.

Side effect
From the digestive system: nausea, anorexia, dry mouth, gastralgia, vomiting, diarrhea, constipation, abdominal pain, hepatic encephalopathy may develop, rarely pancreatitis.
From the side of the central nervous system: asthenia, nervousness, headache, dizziness, drowsiness, vertigo, insomnia, depression; rarely - increased fatigue, general weakness, malaise, muscle spasm, tension, irritability, anxiety.
From the respiratory system: cough, pharyngitis, sinusitis, rarely - rhinitis.
From the side of the cardiovascular system: orthostatic hypotension, changes in the electrocardiogram (hypokalemia), arrhythmias, palpitations.
From the urinary system: frequent infections, polyuria.
Allergic reactions: skin rash, itching, urticaria, hemorrhagic vasculitis.
Laboratory indicators: hyperuricemia, hyperglycemia, hypokalemia, hypochloremia, hyponatremia, hypercalcemia, increased plasma urea nitrogen, hypercreatininemia, glucosuria.
From the side of the hematopoietic organs: thrombocytopenia, leukopenia, agranulocytosis, bone marrow aplasia and hemolytic anemia.
Others: exacerbation of the course of systemic lupus erythematosus.

Overdose
Symptoms: nausea, vomiting, weakness, dysfunction of the gastrointestinal tract, water and electrolyte disturbances, in some cases - an excessive decrease in blood pressure, respiratory depression. Patients with cirrhosis of the liver may develop hepatic coma.
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 mineralocorticoids, tetracosactide, amphotericin B (iv), laxatives increase the risk of hypokalemia. When taken simultaneously with cardiac glycosides, the likelihood of developing digitalis intoxication increases; with calcium preparations - hypercalcemia; with metformin - aggravation of lactic acidosis is possible.
Increases the concentration of lithium ions in the blood plasma (decreased excretion in the urine), lithium has a nephrotoxic effect.
Astemizole, IV erythromycin, pentamidine, sultopride, terfenadine, vincamine, class I A antiarrhythmic drugs (quinidine, disopyramide) and class III (amiodarone, bretylium, sotalol) can lead to the development of torsades de pointes arrhythmias .
Non-steroidal anti-inflammatory drugs, glucocorticosteroids, tetracosactide, sympathomimetics reduce the hypotensive effect, baclofen enhances.
The combination with potassium-sparing diuretics may be effective in some categories of patients, however, the possibility of developing hypo- or hyperkalemia is not completely excluded, especially in patients with diabetes mellitus and renal insufficiency.
Angiotensin-converting enzyme (ACE) inhibitors increase the risk 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 agents in high doses (dehydration). Before using iodine-containing contrast agents, patients need to restore fluid loss. Imipramine (tricyclic) antidepressants and antipsychotic drugs (neuroleptics) increase the hypotensive effect and increase the risk of orthostatic hypotension.
Cyclosporine increases the risk of developing hypercreatininemia.
Reduces the effect of indirect anticoagulants (coumarin or indandione derivatives) due to an increase in the 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).
It enhances the blockade of neuromuscular transmission, which develops under the influence of non-depolarizing muscle relaxants.

special instructions
In patients taking cardiac glycosides, laxatives, on the background of hyperaldosteronism, as well as in the elderly, control of the content of potassium ions and creatinine is indicated.
While taking indapamide, the concentration of potassium, sodium, magnesium ions in the blood plasma should be systematically monitored (electrolyte disturbances may develop), pH, concentration of glucose, uric acid and residual nitrogen.
The most careful monitoring is indicated in patients with cirrhosis of the liver (especially with developed edema or ascites - the risk of developing metabolic alkalosis, which increases the manifestations of hepatic encephalopathy), coronary heart disease, heart failure, and also in the elderly.
The high-risk group also includes patients with an increased QT interval on the electrocardiogram (congenital or developed against the background of any pathological process).
The first measurement of potassium concentration in the blood should be carried out during the first week of treatment.
Hypercalcemia while taking indapamide may be due to 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.
Significant dehydration can lead to the development of acute renal failure (reduced glomerular filtration rate).
Patients need to compensate for the loss of water and carefully monitor kidney function at the beginning of treatment.
Indapamide may give a positive result in a doping test.
Patients with arterial hypertension and hyponatremia (due to diuretics) should stop taking diuretics 3 days before starting angiotensin-converting enzyme inhibitors (if necessary, diuretics can be resumed a little later), or they are prescribed initial low doses of ACE inhibitors.
Sulfonamide derivatives can exacerbate the course of systemic lupus erythematosus (must be borne in mind when prescribing indapamide).
Efficacy and safety in children have not been established.

Influence on the ability to drive a car and other mechanisms
In some cases, individual reactions associated with changes in blood pressure are possible, especially at the beginning of treatment and when another antihypertensive agent is added. As a result, the ability to drive a car and work with mechanisms that require increased attention may decrease.

Release form
Film-coated tablets 2.5 mg.
10 film-coated tablets in a blister pack made of polyvinyl chloride film and printed lacquered aluminum foil. 3 blisters, together with instructions for use, are placed in a cardboard box.

Storage conditions
List B.
Store in a dry, dark place at a temperature of 15 to 25 °C.
Keep out of the reach of children.

Best before date
3 years.
Do not use after the expiry date stated on the packaging.

Terms of dispensing from pharmacies
On prescription.

Manufacturer
1. Manufacturer
Hemofarm A.D., Serbia
26300 Vrsac, Beogradsky way bb, Serbia
Representative office in the Russian Federation / organization that accepts claims from consumers:
107023, Moscow, st. Elektrozavodskaya, 27 building 2.
In the case of packaging at Hemofarm LLC, Russia:
Produced by: Hemofarm A.D., Vrsac, Serbia
Packed by: Hemofarm LLC, 249030, Russia, Kaluga region, Obninsk, Kyiv shosse, 62.
Organization accepting complaints from consumers:
Hemofarm LLC, 249030, Russia, Kaluga region, Obninsk, Kyiv shosse, 62.

Indapamide is a diuretic that helps to bring blood pressure back to normal. The drug, along with urine, sodium is excreted, accelerates the work of calcium channels, helps to ensure that the arterial walls become more elastic. It belongs to thiazide diuretics. It is used to treat hypertension and as a remedy for edema caused by heart failure.

Pharmacological action and pharmacokinetics

Diuretic agent with active ingredient - indapamide.

The latter resembles a thiazide diuretic in its structure. Indapamide is a sulfonylurea derivative.

Due to the peculiarities of the mechanism of action, the drug does not significantly affect the amount of urination.

So all the same, what is the medicine indapamide for? The action of the active substance reduces the load on the heart, dilates the arterioles, and reduces blood pressure. And at the same time, it does not affect carbohydrate and lipid metabolism, even in patients with diabetes.

Another of its abilities is to reduce peripheral vascular resistance. Able to reduce the volume and mass of the left ventricle. The hypotensive effect is felt even by patients requiring chronic hemodialysis.

Pharmacokinetics

The bioavailability of the drug is 93%. In the blood for 1-2 hours, the period of maximum concentration of the substance begins. Indapamide is well distributed in the body. Able to pass through the placental barrier and stand out in breast milk.

The drug is 71-79% bound to blood proteins - a high rate. The metabolic process takes place in the liver with the formation of inactive metabolites. The active substance is excreted from the body with urine - 70%, the remaining 30% - with feces.

The half-life of indapamide is 14-18 hours. It is not known whether this time varies with renal and hepatic insufficiency.

Indapamide belongs to the pharmacological groups:

Thiazide-like and thiazide diuretics;
Drugs that affect the renin-angiotensin system.

Mechanism of action of indapamide

Increased synthesis of prostacyclin and prostaglandin;
Relaxes vascular smooth muscle cells - the result of a change in the transmembrane current of calcium and other ions.

Indapamide: indications for use

Essential arterial hypertension

Application

Drink no more than one capsule a day, take it orally: you need to swallow whole, do not chew. Drink a small amount of liquid.

It is possible to increase the dosage only after consulting a doctor. You need to be prepared for a greater diuretic effect, but at the same time, there is no increase in the hypotensive effect.

Side effects of indapamide

Using the drug in recommended therapeutic doses, there are rare cases of side effects. In long-term clinical studies, side effects were recorded in only 2.5% of patients. Among them, electrolyte disturbances are common. Other side effects include:

Skin and allergic reactions: Lyell's syndrome, Stevens-Johnson syndrome, anaphylactic shock, urticaria, photodermatosis, skin rashes, purpura, Quincke's edema.
Influence on the nervous system: dizziness, paresthesia, nervousness, body aches, vertigo, weakness may occur.
The effect on the digestive system is manifested by nausea, vomiting, dry mouth, impaired liver function, pancreatitis, constipation.
From the side of the heart and blood vessels are possible: arrhythmia, prolongation of the QT interval on the electrocardiogram, orthostatic arterial hypotension.
Influence on laboratory tests: rare cases of thrombocytopenia, anemia, leukopenia, agranulocytosis, hypercalcemia, hyponatremia, hypokalemia, hyperglycemia, increased levels of urea and creatinine in the blood.
Respiratory effects: cough, rare cases of pharyngitis, sinusitis.

Indapamide pressure pills: contraindications

Violations in the liver.
Anuria.
Allergy to the active substance.
Gout.
Children under 18 - no experience in this age group.
Pregnancy, lactation period. During the bearing of a child, the use of the drug is unjustified. Indapamide can lead to fetal hypotrophy. If during breastfeeding the use is extremely necessary, then it is worth weaning the baby from mother's milk. The medicine will pass through it to the baby.
Circulatory disorders in the brain (recent or acute).
Hypokalemia.
Use with drugs that increase the Q-T interval.

Before prescribing the drug, the patient often takes all kinds of tests. Especially if there is a suspicion that the medicine can provoke water-salt changes. If the drug is nevertheless prescribed, then it is worth periodically taking tests for the content in the blood plasma devoid of fibrinogen, sodium, potassium and magnesium.

It also requires constant monitoring of the level of residual nitrogen, glucose, uric acid, pH. The doctor is obliged to take under his supervision patients with cardiovascular insufficiency (chronic form), coronary heart disease, cirrhosis of the liver. These patients are more likely than all the others to develop metabolic alkalosis and hepatic alkalosis.

Indapamide + other drugs

The hypotensive effect of the drug is impaired under the influence of salicylates in high dosages and systemic non-steroidal anti-inflammatory drugs.
If the patient is dehydrated, the use of indapamide will lead to renal failure. The solution is fluid replenishment in the body.
The combination with drugs that contain lithium salts increases the amount of lithium in the blood due to reduced excretion of the element. If such a connection is unavoidable, the patient needs to monitor the level of lithium in the blood.
Glucocorticosteroids and tetracosactides neutralize the hypotensive effect of the drug. The reason is that water and sodium ions are retained in the body.
Laxatives based on intestinal peristalsis are provocateurs of hypokalemia. If such drugs are used in parallel, it is necessary to monitor potassium in the blood serum in order to diagnose hypokalemia in a timely manner.
Hyperkalemia is caused by a combination of the described diuretic with diuretics, which provide potassium conservation.
The risk of developing acute renal failure and arterial hypotension increases with the use of ACE inhibitors.
Cyclosporine with indapamide lead to an increase in plasma creatinine.
The radiopaque substance causes kidney failure.
Estrogen-containing drugs neutralize the hypotensive effect. The reason is that it lingers in the body.
Hypercalcemia is possible due to the intake of calcium salts.
Tricyclic antidepressants lead to a severalfold increase in hypotensive action.

If there is no result within a month, in no case increase the dosage of indapamide - it will lead to side effects. Instead, it is worth reviewing the treatment regimen.
This drug is often prescribed as part of a complex treatment.
Indapamide is a drug for long-term use. A stable effect is noticeable after two weeks. The maximum effect is after 12 weeks. The action from a single application occurs in one to two hours.
The best time to take the drug is in the morning on an empty stomach.

With the manifestation of side effects, doctors talk about two possible options for action. The first is to stop using the drug. The second is to reduce the dose. The second option is rarely considered, since the side effects of the drug are dangerous. Indapamide will lead to impaired liver function, changes in the chemical composition of the blood, anorexia.

What to replace?

If the pharmacy does not have the described drug, then it can be replaced with another one with a similar effect. In this case, they can have a different form: dragees, tablets, capsules. But this does not affect the pharmacological properties.

An analogue of Indapamide is the drug Indopres.

Overdose

A dosage of 40 mg is toxic - it exceeds the permissible single dose by almost 30 times. Overdose symptoms are: oliguria / polyuria, constant desire to sleep, hypotension, / vomiting, dizziness. A toxic dose upsets the balance of salt and water in the body.

You can remove the drug from the body by washing the stomach and drinking enterosorbents (activated charcoal). Further actions are symptomatic treatment, which is carried out exclusively at the hospital.

Note to athletes

Although indapamide tablets are not directly drugs that can be used as doping to improve athletic performance. But at the same time, the World Anti-Doping Agency banned the use of any diuretics by athletes. The reason is that they help to hide the fact of doping. And the detection of indapamide in the body of an athlete during the competition can cause him to be disqualified.

Influence on reaction

You need to be careful when taking the medicine if you are a driver of a vehicle or are engaged in one of the potentially dangerous activities. It is forbidden to prescribe the medicine to those who work in constant tension, in a state of increased concentration of attention, for whom the speed of reaction is important.

Latin name: Indapamide
ATX code: CO3BA11
Active substance:
Manufacturer: Hemofarm, Serbia;
Ozon, Russia, etc.
Pharmacy leave condition: On prescription

Indications for use

The drug is prescribed for:

Chronic arterial hypertension of various origins
Hypertension at all stages of development
In chronic heart failure to eliminate water and sodium retention in the body (treatment of edematous syndrome).

The latest indications are unregistered, but in these diseases, "Indapamide" gives a quick and lasting positive effect.

You can find out everything about the stagnation of fluid in the body in the article:.

Release form and method of administration

The drug is available in the form:

Tablets that are film-coated, round in shape and convex on both sides, the drug in tablet form has a rather unpleasant aftertaste
Long acting tablets
Capsule
Modified release tablets.

The dosage of 2.5 (0.0025) can be either in one tablet or in a capsule. 1.5 mg (0.0015) - in tablets with prolonged action. The drug is produced in blisters of 10 tablets in a cardboard box.

Indapamide tablets and dosage

The average price is from 40 to 70 rubles.

Indapamide tablet: round, film-coated tablet, white. Contains indapamide 2.5 mg. The composition of each tablet, in addition to the active substance, includes:

Lactose monohydrate
Crosspovidone
magnesium stearate
Povidone K 30
Sodium lauryl sulfate
Talc.

The shell consists of macrogol, hypromellose, talc and titanium dioxide.

Adults (including the elderly) are prescribed 1 tablet. The tablet is taken once a day (regardless of when the last meal was). Preferred time of use is in the morning.

The average price for capsules and modified tablets is from 100 to 480 rubles.

Capsules "Indapamide" and dosage

The capsule is transparent, while the color of natural gelatin is observed. The contents of the capsules are powder or a mixture of powder and granules from white to white with a creamy tint. The method of taking the drug in the form of capsules completely coincides with the scheme of administration in the form of tablets.

It is worth remembering that it is not necessary to chew the drug, it is swallowed whole and washed down with at least half a glass of pure non-carbonated water.

Duration of treatment

The course of treatment on average can be from 4 to 8 weeks. If during this time a positive result is not achieved, the regimen cannot be changed (the daily dose of the drug is not increased), it is better to choose a drug that has an antihypertensive effect and is not a diuretic in addition to therapy.

Terms and conditions of storage

Store in a dark place out of the reach of small children. The shelf life is up to two years.

Pharmacological group and mechanism of action

Refers to antihypertensive drugs with diuretic and vasodilating effects. The main action of "Indapamide" is manifested in the vessels and tissues of the kidneys. The drug inhibits the reverse absorption of sodium in the cortical part of the nephron loop, which ensures an increase in the excretion of sodium, magnesium, calcium and chlorine in the urine. This feature of the mechanism of action of "Indapamide" stimulates a decrease in blood pressure, and does not affect the volume of urine excreted.

In addition, the drug significantly reduces the sensitivity of the walls of blood vessels to the effects of angiotensin and norepinephrine, inhibits the penetration of calcium into the smooth muscle cells of the walls of vessels of various calibers, which increases their elasticity and reduces peripheral resistance.

Indapamide does not affect the metabolism of carbohydrates and lipids, and also reduces the synthesis of oxygen radicals (both free and stable).

When taken orally, it is quickly and completely absorbed into the bloodstream. The maximum concentration in the blood is reached two hours after the use of a conventional tablet or capsule and 12 hours after taking the drug with prolonged action.

Metabolized in hepatocytes (liver cells). A larger percentage of the drug is excreted in the urine (up to 80%), the rest is in the faeces. Completely excreted from the body within 26 hours.

Contraindications

The tool has a fairly wide range of contraindications, which include:

Severe disorders of the functioning of the liver
Chronic renal failure, especially in the case of anuria
Individual intolerance to the components of the drug
Acute cerebrovascular accident
Decompensated stage of diabetes
Presence of gout
The period of pregnancy and lactation
Age under 18
Insufficient concentration of potassium or nitrogen in the blood.

It is not recommended to take the drug after drinking alcohol. Professional athletes for the period of competition requiring doping control should also refuse "Indapamide" and its analogues, since they can give a positive test result.

For diabetes, pregnancy and lactation

Since the drug does not change the level of insulin and glucose in the blood, it is approved for use in diabetes (if the disease is in the decompensation stage).

For pregnant women and nursing mothers, the appointment of "Indapamide" is also contraindicated, since the active substance is able to penetrate the placental barrier and enter the composition of breast milk.

Side effects and overdose

When taking the drug, undesirable reactions from various organs and systems may develop:

Cardiovascular system - changes in the cardiogram, the development of arrhythmia, accelerated heartbeat, hypotension
Digestive tract - nausea, vomiting, stomach pain, stool disorders
Nervous system - headache, nervousness, sleep disorders
Urinary system - development of polyuria
Visual apparatus - visual impairment, development of conjunctivitis
The appearance of skin manifestations of allergic reactions (urticaria, itching, vasculitis)
Changes in some indicators of laboratory tests.

In addition, pain in the back and chest, decreased libido and potency, increased sweating, a sharp weight loss, the development of exacerbations of chronic diseases, the body becomes more susceptible to infection.

An overdose is characterized by the appearance of nausea and vomiting, a sharp decrease in pressure, drowsiness, and impaired functioning of the urinary system. If you suspect an overdose of Indapamide, you should consult a doctor for symptomatic therapy.

Interaction with other drugs

When taken together with "Indapamide" anticoagulants and sympathomimetic agents, a weakening of their effectiveness is observed.

The hypotensive property of the drug increases with the simultaneous appointment of neuroleptics and tricyclic antidepressants with it. Simultaneous reception with ACE inhibitors causes the risk of severe hypotension.

It is forbidden to use "Indapamide" in conjunction with drugs that include lithium - it is possible to develop intoxication of the body.

What is better to take with Losartran - Indapamide or Hypothiazid

Losartran is an antihypertensive agent prescribed for arterial hypertension of various origins. The use of this drug with antihypertensive drugs increases the effect of its administration.

Unlike Indapamide, Hypothiazid can be taken by women during pregnancy to lower blood pressure, relieve edema and symptoms of toxicosis.

Analogues and synonyms

All the features of some analogues of "Indapamide" are presented below:

Balkanpharma, Bulgaria
Price from 60 to 150 rubles.

Indications for use: arterial hypertension, as well as water and sodium retention in chronic heart failure. Available in capsule form and tablets with a dosage of 0.0025.

pros

Has no bad taste
The capsule dissolves when it enters the digestive tract

Minuses

Contraindicated in patients with impaired renal function
Prohibited during pregnancy and lactation.

ZAO Canonpharma Production, Russia
Price from 100 to 130 rubles

Biconvex tablets with a dosage of 0.015, have a prolonged action. They are taken in the morning, the tablet is swallowed without chewing, and washed down with plenty of water.

The tool has a long-term effect
The effect is visible immediately after use.

When the dose is exceeded, the hypotensive effect does not increase.
When used together with preparations containing lithium, symptoms of an overdose may appear (nephrotoxic effect - damage to the kidneys by a toxin).

"Indapamid MV Shtada"

Marquis Pharma, Russia
Price from 45 to 135 rubles.

Diuretic antihypertensive agent of prolonged action, which has the ability to reduce and stabilize high blood pressure. Round, yellow coated tablets with modified release.

pros

When taking the drug, sharp jumps in blood pressure to critically low levels and back are almost impossible
It has a protective effect on the vessels of target organs, which are most often affected in hypertension

Minuses

The drug works slowly
The first week of admission is due to many side effects (nausea, abdominal pain, etc.).

Pro.Med.CS, Czech Republic
Price from 65 to 120 rubles.

Reduces the tone of the smooth muscles of the arteries and the total peripheral resistance. Available in capsule form (hard gelatin)

pros

Effectively used to treat hypertension in people with comorbidities (renal failure, hyperlipidemia)
Increases the elasticity of arterial walls and helps to reduce left ventricular hypertrophy

Minuses

Use with caution in diabetes mellitus (increases the required dose of insulin)
Shown in doping tests.

Servier, France
Price from 280 to 470 rubles.

They have a diuretic and hypotensive effect. Tablets with a dosage of 0.0025 and 0.0015

pros

When the dose is exceeded (up to 40 mg, i.e. 27 times more than the therapeutic dose), the drug does not have a toxic effect
The positive effect after the course of treatment lasts up to six months

Minuses

Not to be taken during pregnancy and lactation
Dries mucous membranes and causes thirst
It should not be taken by people with lactose intolerance (this substance is included in the composition).

Active ingredient: indapamide - 2.5 mg;

Excipients: microcrystalline cellulose, farmatose del 15 (lactose for direct compression), sodium starch glycolate, magnesium stearate, talc, hydroxypropyl methylcellulose 15 cps, titanium dioxide, propylene glycol, orange yellow dye (E 110).

Description

Tablets are orange, round, biconvex, film-coated.

pharmachologic effect

Antihypertensive agent (diuretic, vasodilator). In terms of pharmacological properties, it is close to thiazide diuretics (impaired reabsorption of Na + in the cortical segment of the loop of Henle). Increases urinary excretion of Na + ions, SG and, to a lesser extent, K + and Mg 2+ ions. Possessing the ability to selectively block "slow" calcium channels, it increases the elasticity of arterial walls and reduces overall peripheral vascular resistance. Helps to reduce hypertrophy of the left ventricle of the heart. Does not affect the content of lipids in blood plasma (TG, low density lipoprotein, high density lipoprotein); does not affect carbohydrate metabolism (including in patients with concomitant diabetes mellitus), but in the presence of hypokalemia it can increase blood glucose levels .. Reduces the sensitivity of the vascular wall to norepinephrine and angiotensin II, stimulates the synthesis of prostaglandin E2 and prostacyclin reduces the production of free and stable oxygen radicals.

When administered in high doses, it does not affect the degree of reduction in blood pressure, despite an increase in diuresis.

When taken systematically, the therapeutic effect is observed after 1-2 weeks, reaches a maximum by 8-12 weeks and lasts up to 8 weeks; after taking a single dose, the maximum effect is observed after 24 hours.

The hypotensive effect develops by the end of the first week, persists for 24 hours on the background of a single dose.

Pharmacokinetics

After oral administration, it is rapidly and completely absorbed from the gastrointestinal tract; bioavailability - high (93%). Eating somewhat slows down the rate of absorption, but does not affect the amount of absorbed substance. The maximum concentration in blood plasma is 1-2 hours after ingestion. With repeated doses, fluctuations in the concentration of the drug in the blood plasma in the interval between taking two doses are reduced. The equilibrium concentration is established after 7 days of regular intake. The half-life is 14-18 hours, the relationship with plasma proteins is 71-79%. It also binds to the elastin of the smooth muscles of the vascular wall. : high volume of distribution, penetrates through histohematic barriers (in, hch, placental), penetrates into breast milk.

Metabolized in the liver. 60 - 80% is excreted by the kidneys as metabolites (about 5% is excreted unchanged), through the intestine - 20%. In patients with renal insufficiency, the pharmacokinetics do not change. Does not accumulate.

Indications for use

As monotherapy or in combination with other antihypertensive agents for the treatment of arterial hypertension.

Contraindications

Hypersensitivity to indapamide, other sulfonamide derivatives and components of the drug, severe renal failure (creatinine clearance less than 30 ml / min), severe liver failure (including with encephalopathy), hypokalemia, lactase deficiency, lactose intolerance, glucose-galactose malabsorption , pregnancy, lactation, age up to 18 years (efficacy and safety have not been established); concomitant use of drugs that prolong the QT interval.

Pregnancy and lactation

The use of diuretics, including Indapamide, is unjustified from a pathogenetic point of view in the treatment of edema and arterial hypertension during pregnancy. Taking Indapamide can cause insufficiency of placental-fetal blood flow with the development of fetal malnutrition. It is not recommended to prescribe the drug during pregnancy. If the drug must be taken during lactation, breastfeeding is stopped, since the active substance passes into breast milk.

Dosage and administration

Tablets are taken orally without chewing. With arterial hypertension, 2.5 mg (1 tablet) is prescribed 1 time per day in the morning. With insufficient effectiveness after 4-8 weeks, it is advisable to add antihypertensive drugs with a different mechanism of action to therapy (increasing the dose is impractical - in the absence of a significant increase in the effect, an increase in side effects is noted). Elderly patients may take indapamide if renal function is normal or slightly reduced. The maximum daily dose is 5 mg.

Side effect

From the side of the cardiovascular system - orthostatic hypotension, changes in the electrocardiogram (hypokalemia), arrhythmia, palpitations.

From the nervous system - asthenia, nervousness, headache, dizziness, drowsiness, vertigo, insomnia, depression; rarely - increased fatigue, malaise, muscle spasm, tension, irritability, anxiety.

On the part of the digestive system: nausea, vomiting, diarrhea or constipation, loss of appetite, dry mouth, abdominal pain, hepatic encephalopathy (against the background of liver failure), pancreatitis are possible.

On the part of the respiratory system - cough, pharyngitis, sinusitis, rarely - rhinitis.

From the urinary system - infections, nocturia, polyuria

Allergic reactions - urticaria, pruritus, hemorrhagic vasculitis, maculopapular rash.

On the part of the hematopoietic organs: thrombocytopenia, leukopenia, agranulocytosis, bone marrow aplasia, hemolytic anemia.

Laboratory indicators - hyperuricemia, hyperglycemia, hypokalemia, hypochloremia, hyponatremia, hypercalcemia, increased plasma urea nitrogen, hypercreatininemia, glucosuria.

Others - exacerbation of systemic lupus erythematosus.

Overdose

Symptoms: nausea, vomiting, weakness, dysfunction of the gastrointestinal tract, water and electrolyte disturbances, in some cases - an excessive decrease in blood pressure, respiratory depression. Patients with cirrhosis of the liver may develop hepatic coma.

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

Interaction with other drugs

Saluretics (loop, thiazide), cardiac glycosides, gluco- and mineralocorticoids, tetracosactide, amphotericin B (iv), laxatives increase the risk of hypokalemia. When taken simultaneously with cardiac glycosides, the likelihood of developing digitalis intoxication increases; with drugs Ca 2+ - hypercalcemia; with metformin - aggravation of lactic acidosis is possible.

Increases the concentration of Li + ions in the blood plasma (decreased excretion in the urine), lithium has a nephrotoxic effect.

With the simultaneous appointment of indapamide and drugs that can cause arrhythmia of the "pirouette" type, incl. class 1a antiarrhythmics (quinidine, hydroquinidine, disopyramide), class III antiarrhythmics (amiodarone, sotalol, dofetilide, ibutilide), antipsychotics - phenothiazines (chlorpromazine, cyamemazine, levomepromazine, thioridizine, trifluoperazine), benzamides (amisulpiride, the risk of such arrhythmia increases, especially against the background of hypokalemia, bradycardia, initially increased QT interval.If necessary, the appointment of these combinations should control the content of potassium in the blood plasma and the QT interval, adjusting the dosing regimen.

Non-steroidal anti-inflammatory drugs, glucocorticosteroids, tetracosactide, sympathomimetics reduce the hypotensive effect, baclofen enhances.

The combination with potassium-sparing diuretics may be effective in some categories of patients, however, the possibility of developing hypo- or hyperkalemia, especially in patients with diabetes mellitus and renal insufficiency, cannot be completely ruled out.

Angiotensin-converting enzyme inhibitors increase the risk 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 agents in high doses (dehydration). Before using iodine-containing contrast agents, patients need to restore the loss of liquid in.

Imipramine (tricyclic) antidepressants and antipsychotics increase the hypotensive effect and increase the risk of orthostatic hypotension.

Cyclosporine increases the risk of developing hypercreatininemia.

Reduces the effect of indirect anticoagulants (coumarin or indandione derivatives) due to an increase in the 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).

Storage conditions

Store in a place protected from light, at a temperature not exceeding 25 ° C.

Keep out of the reach of children.

Best before date

Do not use after the date indicated on the package.