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Arifon - instructions for use, reviews, analogs and formulations (2.5 mg and 1.5 mg retard tablets) of a diuretic drug for the treatment of arterial hypertension in adults, children and pregnancy. Interaction with alcohol

Arifon - instructions for use, reviews, analogs and formulations (2.5 mg and 1.5 mg retard tablets) of a diuretic drug for the treatment of arterial hypertension in adults, children and pregnancy. Interaction with alcohol

In this article, you can read the instructions for using a diuretic medicine Arifon. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Arifon in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Arifon in the presence of existing structural analogs.Use for the treatment of hypertension and heart failure in adults, children, as well as in pregnancy and lactation. Interaction of the drug with alcohol.

 

Arifon - Thiazide-like diuretic, antihypertensive agent. It causes a decrease in the tone of the smooth muscles of the arteries, a decrease in the OPSS, and also has moderate saluretic activity due to a violation of the reabsorption of sodium, chlorine and water ions in the cortical segment of the Henle loop and the proximal convoluted tubule of the nephron. The decrease in OPSS is due to several mechanisms: a decrease in the sensitivity of the vascular wall to norepinephrine and angiotensin 2; increased synthesis of prostaglandins with vasodilating activity; oppression of the influx of calcium ions into the smooth muscle cells of the vascular wall. In therapeutic doses practically does not affect the lipid and carbohydrate metabolism.

 

The hypotensive effect is manifested only at initially elevated blood pressure, develops by the end of the first week and reaches a maximum after 3 months of systematic admission.

 

Composition

 

Indapamide + excipients.

 

Pharmacokinetics

 

After oral administration, it is quickly and completely absorbed from the digestive tract.The binding with plasma proteins is 79%. Widely distributed in the body. Do not cumulate. It is excreted by the kidneys mainly in the form of metabolites, 5% - in unchanged form.

 

Indications

  • arterial hypertension
  • delay sodium and water in chronic heart failure.

 

Forms of release

 

Tablets, coated with a coating of 2.5 mg.

 

Controlled-release tablets coated with 1.5 mg (Arifon retard or how erroneously they sometimes say forte).

 

Instructions for use and dosing regimen

 

Take inside 2.5 mg once a day (in the morning). If the hypotensive effect is insufficient, after 2 weeks of treatment, the dose is increased to 5-7.5 mg per day.

 

The maximum daily dose is 10 mg divided into 2 doses (in the morning).

 

Arifon retard

 

Assign inside 1 tablet a day, preferably in the morning. The tablet should be swallowed whole, not liquid, squeezed with water.

 

In the treatment of patients with arterial hypertension, an increase in the dose of the drug does not lead to an increase in antihypertensive action, but enhances the diuretic effect.

 

In elderly patients, plasma levels of creatinine should be monitored, taking into account age, body weight and sex.

 

Arifon retard in a dose of 1.5 mg per day (1 tablet) can be administered to elderly patients with normal or slightly impaired renal function.

 

Side effect

  • asthenia;
  • paresthesia;
  • headache;
  • fainting;
  • arrhythmia;
  • marked decrease in blood pressure;
  • Arrhythmia of the "pirouette" type (possibly fatal);
  • increasing the QT interval on the ECG;
  • nausea, vomiting;
  • constipation;
  • dry mouth;
  • pancreatitis;
  • Thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia, hemolytic anemia;
  • kidney failure;
  • maculopapular rash;
  • hemorrhagic vasculitis;
  • angioedema and / or urticaria;
  • toxic epidermal necrolysis;
  • in patients with acute form of systemic lupus erythematosus, the course of the disease may worsen.

 

Contraindications

  • renal failure of severe degree (QC less than 30 ml / min);
  • hepatic encephalopathy;
  • severe violations of liver function;
  • hypokalemia;
  • hypersensitivity to indapamide, other sulfonamide derivatives or to any of the excipients;
  • It is not recommended for use in children under 18 years of age (due to the lack of clinical data on use).

 

Application in pregnancy and lactation

 

As a rule, during pregnancy, do not prescribe diuretic drugs. Do not use these drugs to treat physiological swelling in pregnancy. Diuretic drugs can cause fetoplacental ischemia and lead to impaired fetal development.

 

Due to the fact that Indapamide is excreted in breast milk, it is not recommended that the drug be administered during the period of breastfeeding.

 

special instructions

 

Dysfunction of the liver

 

In the appointment of thiazide and thiazide-like diuretics in patients with impaired hepatic function, it is possible to develop hepatic encephalopathy, especially in the case of electrolyte imbalance. In this case, the taking of diuretics should be stopped immediately.

 

Photosensitivity

 

Against the background of taking thiazide and thiazide-like diuretics, cases of development of photosensitivity reactions were reported. In the case of developing photosensitivity reactions against the background of taking the drug should stop treatment. If it is necessary to continue therapy with diuretics, it is recommended to protect the skin from exposure to sunlight or artificial ultraviolet rays.

 

Content of sodium ions in blood plasma

 

Before the start of treatment it is necessary to determine the content of sodium ions in the blood plasma. Against the background of taking the drug should regularly monitor this figure. All diuretics can cause hyponatremia, which sometimes leads to extremely serious consequences. It is necessary to constantly monitor the content of sodium ions. initially a decrease in the concentration of sodium in the blood plasma may not be accompanied by the appearance of pathological symptoms. The most thorough control of sodium ions is indicated for patients with cirrhosis of the liver and elderly people.

 

The content of potassium ions in the blood plasma

 

With thiazide and thiazide-like diuretics, the main risk is a sharp decrease in the level of potassium in the blood plasma and the development of hypokalemia. It is necessary to avoid the risk of developing hypokalemia (<3.4 mmol / l) in patients of the following categories: elderly, weakened or receiving concomitant drug therapy with other antiarrhythmic drugs and drugs that may increase the QT interval, patients with cirrhosis, peripheral edema or ascites, CHD , heart failure.Hypokalemia in these patients increases the toxic effect of cardiac glycosides and increases the risk of arrhythmias. In addition, patients with an increased QT interval are at increased risk, but it does not matter whether this increase is due to congenital causes or effects of drugs.

 

Hypokalemia, as well as bradycardia, is a condition that contributes to the development of severe arrhythmias and, especially, ventricular arrhythmias such as pirouettes, which can lead to death. In all the cases described above, it is necessary to regularly monitor the potassium content in the blood plasma. The first measurement of the concentration of potassium ions in the blood should be done within the first week from the start of treatment. When hypokalemia occurs, appropriate treatment should be prescribed.

 

Calcium in the blood plasma

 

It should be borne in mind that Arifon can reduce the excretion of calcium ions by the kidneys, leading to a slight and temporary increase in the concentration of calcium in the blood plasma. Expressed hypercalcemia may be a consequence of previously not diagnosed hyperparathyroidism.It is necessary to cancel the reception of diuretic drugs before the study of the function of parathyroid glands.

 

The content of glucose in the blood plasma

 

It is necessary to monitor the blood glucose level in patients with diabetes mellitus, especially in the presence of hypokalemia.

 

Uric acid

 

In patients with gout, the frequency of seizures may increase or the course of gout may worsen.

 

Diuretic drugs and kidney function

 

Arifon is effective only in patients with normal or slightly impaired renal function (creatinine levels in adults in adults below 25 mg / L or 220 μmol / L). In elderly patients, the normal level of creatinine in the blood plasma is calculated taking into account age, body weight and sex.

 

It should be borne in mind that at the beginning of treatment, patients may experience a decrease in glomerular filtration rate due to hypovolemia, which in turn is caused by loss of fluid and sodium ions on the background of taking diuretic drugs. As a consequence, the blood plasma can increase the concentration of urea and creatinine. If the kidney function is not impaired, such a temporary functional kidney failure, as a rule,passes without consequences, but with the existing renal failure the patient's condition may worsen.

 

Athletes

 

Arifon can give a positive result in the conduct of doping control in athletes.

 

Impact on the ability to drive vehicles and manage mechanisms

 

The action of the substances that make up Arifon does not lead to a disturbance in psychomotor reactions. However, in some people, in response to a decrease in blood pressure, various individual reactions may develop, especially at the onset of therapy or when other antihypertensive agents are added to therapy. In this case, the ability to drive a car or other mechanisms can be reduced.

 

Drug Interactions

 

An unrecommended combination of drugs

 

With simultaneous use of indapamide and lithium preparations, an increase in the concentration of lithium in blood plasma can be observed due to a decrease in its excretion, accompanied by the appearance of signs of an overdose. If necessary, diuretic drugs can be used in combination with lithium preparations, while carefully selecting the dose of drugs, constantly monitoring the lithium content in blood plasma.

 

Combinations that require special control

 

Preparations that can cause arrhythmia of the "pirouette" type:

  • antiarrhythmic drugs of class 1 A (quinidine, hydroquinidine, disopyramide);
  • antiarrhythmic drugs of class 3 (amiodarone, sotalol, dofetilide, ibutilide);
  • some antipsychotics: phenothiazines (chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoroperazine), benzamides (amisulpride, sulpiride, sultopride, tiaprid), butyrophenones (droperidol, haloperidol);
  • others: bepridil, cisapride, difemanyl, erythromycin (intravenously), halofantrine, misolastine, pentamidine, sparfloxacin, moxifloxacin, astemisole, vincamine (intravenously).

 

Hypokalemia increases the risk of developing ventricular arrhythmias, especially arrhythmias such as pirouettes. It is necessary to determine the level of potassium in the blood plasma and, if necessary, adjust it before starting the combination therapy with indapamide and the above drugs. It is necessary to monitor the clinical state of the patient, control the level of electrolytes of blood plasma, ECG parameters.

 

Patients with hypokalemia should use drugs that do not cause piruet-type arrhythmia.

 

When used simultaneously with nonsteroidal anti-inflammatory drugs (NSAIDs) (for systemic use), including selective COX-2 inhibitors, high doses of salicylates (more than 3 g per day), it is possible to reduce the hypotensive effect of Arifone. With a significant loss of fluid, acute renal failure may develop (due to a decrease in glomerular filtration). If it is necessary to prescribe NSAIDs against the background of Arifon therapy, you should compensate for the loss of water and carefully monitor the kidney function.

 

With simultaneous use of indapamide with ACE inhibitors, hyponatremia in patients receiving ACE inhibitors increases the risk of sudden arterial hypotension and / or acute renal failure (especially with renal artery stenosis). Patients with arterial hypertension and reduced by the intake of diuretics with the content of sodium ions in blood plasma should:

  • 3 days before the start of treatment with ACE inhibitors, stop taking diuretics. In the future, if necessary, taking diuretics to resume;
  • or initiate therapy with ACE inhibitors from low, gradually increasing doses of ACE inhibitors.

 

In chronic heart failure treatment should start with low doses of ACE inhibitors, previously lowering the dose of diuretics. In all cases, in the first week of taking ACE inhibitors, kidney function (creatinine content in the blood plasma) should be monitored.

 

With the simultaneous use of indapamide with other drugs that can cause hypokalemia, incl. with amphotericin B (intravenously), gluco- and mineralocorticoids (with systemic application), tetracosactide, laxatives stimulating intestinal peristalsis, the risk of hypokalemia increases due to additive effect (constant monitoring of potassium level in blood plasma and, if necessary, appropriate treatment ). Particular attention should be given to patients who simultaneously receive cardiac glycosides. It is recommended to use laxatives that do not stimulate intestinal motility.

 

With the simultaneous use of indapamide with baclofen, there is an increase in the hypotensive effect (it is necessary to compensate for the loss of water and carefully monitor the kidney function at the beginning of the treatment).

 

With simultaneous use with cardiac glycosides, the toxic effect of the latter may be increased due to hypokalemia (it is necessary to monitor the level of potassium in the blood plasma and the parameters of the ECG and, if necessary, adjust the therapy).

 

Combinations that require special attention

 

Simultaneous therapy with indapamide and potassium-sparing diuretics is advisable in some patients, but the possibility of hypokalemia (especially in patients with diabetes mellitus and patients with renal insufficiency) or hyperkalemia is not ruled out. It is necessary to monitor the level of potassium in the blood plasma, the parameters of the ECG and, if necessary, adjust the therapy.

 

Functional renal failure, which can occur against the background of diuretics, especially "loop", with the simultaneous appointment of Metformin increases the risk of lactic acidosis. It is not recommended to use metformin in combination with Arifon at a creatinine level of more than 15 mg / L (135 μmol / L) in men and 12 mg / L (110 μmol / L) in women.

 

Dehydration of the body against the background of taking diuretic drugs increases the risk of acute renal failure, especially when using high doses of iodine-containing contrast agents.Before using iodine-containing contrast agents, patients should compensate for fluid loss.

 

Ethanol (alcohol) increases the risk of developing orthostatic hypotension when taken together with Arifon.

 

With simultaneous use of indapamide and tricyclic antidepressants, antipsychotics observed increased hypotensive action of indapamide and increased risk of orthostatic hypotension (additive effect).

 

With the simultaneous use of thiazide diuretics and calcium salts, the development of hypercalcemia is possible due to a decrease in the excretion of calcium ions in the urine.

 

With simultaneous application ArifOn cyclosporin and tacrolimus may increase in creatinine content in a blood plasma concentration of unchanged circulating cyclosporine, even with normal fluid and sodium ions.

 

With simultaneous use of thiazide diuretics from glucocorticosteroids (GCS) tetrakozaktidom for systemic use a decrease in hypotensive effect due to water retention and sodium ions under the influence of SCS.

 

Analogues of the drug Arifon

 

Structural analogs for the active substance:

  • Acrypamide;
  • Acrypamide retard;
  • Acutor Sanovel;
  • Arindap;
  • Arifon retard;
  • Vero Indapamide;
  • Indap;
  • Indapamide;
  • Indapamide retard;
  • Inder;
  • Inverse;
  • Indians;
  • Indyur;
  • Ionik;
  • Ionik retard;
  • Ipres Long;
  • Lauras;
  • Pamid;
  • Ravel SR;
  • Retapres;
  • SR Indamed;
  • Tenzar.

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Reviews (9):
Guests
Alinka
Good diuretic. The first time I tried on the advice of the therapist, to reduce blood pressure with lisinopril. I took the retard arithmone pill and waited, there was no effect, but drank an hour before going to work to work. I think, okay, maybe some kind of dummy. I went to work and took the subway in a little way, a little daterpel, ran after half a day at work, probably my colleagues noticed my running around. After a week, the truth all settled and ran very much stopped, although the pressure decreased, as promised by the doctor.Then I went to a consultation with a cardiologist and he approved my therapist's choice.
Guests
Gennady Viktorovich
I do not know yet. I try 2 days, but the pressure from 175 \ 94 dropped to 143 \ 88.
Guests
Hypertensive
Fucking drug.
Visitors
musche
musche, Moved your question to the Concor preparation, which was mentioned in the commentary.
admin

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Guests
Irina
A wonderful drug.
Visitors
nabbr
Good afternoon. The cardiologist has appointed or nominated a preparation arifon retard 1t. in a day. The reason: pressure jumps 1-3 times a month to 160-100, which can lead to migraine attacks. Now the pressure fluctuates from 106/69 to 123-80 (I take a month), is it possible to divide the pill and take 1/2? To me 54 years, weight of 56 kg.
Administrators
admin
nabbr, No, Arifon retard tablets can not be divided, because they are film-coated and with modified release, that is, after separation, another mechanics of the process of action on the body is possible.I would use drugs on the active substance Arifona indapamide: Indap, Indapamide and others. Perhaps they will have a milder effect on your body.
Guests
nagima
How long does the preparation use Arifon?
Administrators
admin
nagima, Prior to the occurrence of side effects, ineffective treatment as such, complete recovery or life, if required by the scheme of treatment (with hypertension or heart failure).

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