Indapamide - instructions for use, reviews, analogs and formulations (tablets 2.5 mg and 1.5 mg retard, MB and Stade, capsules 2.5 mg Verte), a diuretic for the treatment of arterial hypertension in adults, children and pregnancy

In this article, you can read the instructions for using the drug Indapamide. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of diuretic Indapamide 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 Indapamide in the presence of existing structural analogs.Use for the treatment of hypertension in adults, children, as well as in pregnancy and lactation. How long it takes to take the drug.

Indapamide - an antihypertensive drug, a thiazide-like diuretic with a moderate in strength and long duration of action, a benzamide derivative. Has moderate saluretic and diuretic effects, which are associated with blockade of reabsorption of sodium, chlorine, hydrogen ions, and to a lesser extent potassium ions in the proximal tubules and cortical segment of the nephron distal tubule. The vasodilator effects and the reduction of the overall peripheral vascular resistance are based on the following mechanisms: a decrease in the reactivity of the vascular wall to norepinephrine and angiotensin 2; an increase in the synthesis of prostaglandins with vasodilating activity; oppression of calcium current in the smooth-muscle walls of blood vessels.

Reduces the tone of the smooth muscles of the arteries, reduces the overall peripheral resistance of the vessels. Helps reduce hypertrophy of the left ventricle of the heart. In therapeutic doses does not affect lipid and carbohydrate metabolism (including in patients with concomitant diabetes mellitus).

Antihypertensive effect develops at the end of the first / beginning of the second week with a constant intake of the drug and persists for 24 hours against a background of a single dose.

Pharmacokinetics

After oral administration, it is quickly and completely absorbed from the digestive tract; bioavailability is high (93%). Eating somewhat slows the rate of absorption, but does not affect the amount of absorbed substance. Has a high volume of distribution, passes through the histohematological barriers (including placental), penetrates into breast milk. Metabolised in the liver. The kidneys excrete 60-80% in the form of metabolites (in unchanged form, about 5% is excreted), through the intestine - 20%. In patients with renal insufficiency, pharmacokinetics does not change. Do not cumulate.

Indications

• arterial hypertension.

Forms of release

Tablets, film-coated 2.5 mg.

Tablets coated with 2.5 mg of Stade.

Modified release tablets coated with 1.5 mg Indapamide MB.

Tablets of prolonged action, coated with 1.5 mg retard.

Capsules 2.5 mg Verte.

Instructions for use and dosing regimen

Tablets are taken orally, without chewing.The daily dose of the drug is 1 tablet (2.5 mg) per day (in the morning). If after 4-8 weeks of treatment the desired therapeutic effect is not achieved, the dose of the drug should not be increased (an increase in the risk of side effects without strengthening the anti-neuronrhagic effect). Instead, it is recommended that another antihypertensive drug that is not a diuretic be included in the drug regimen.

In cases where treatment should start with the taking of two drugs, the dose of Indapamide remains 2.5 mg in the morning once a day.

Retard

Inside, not liquid, squeezed enough liquid, regardless of food intake, mainly in the morning hours at a dose of 1.5 mg (1 tablet) per day.

If the desired therapeutic effect is not achieved after 4-8 weeks of treatment, the dose of the drug should not be increased (the risk of side effects increases without increasing the antihypertensive effect). Instead, it is recommended that another antihypertensive drug that is not a diuretic be included in the drug regimen. In cases where treatment should begin with the taking of two drugs, the dose of Indapamide retard remains equal to 1.5 mg in the morning once a day.

In elderly patients, plasma concentration of creatinine should be monitored taking into account age, body weight and sex, the drug can be used in elderly patients with normal or slightly impaired renal function.

Side effect

• nausea, vomiting;
• anorexia;
• dry mouth;
• gastralgia;
• diarrhea;
• constipation;
• asthenia;
• nervousness;
• headache;
• dizziness;
• drowsiness;
• insomnia;
• depression;
• increased fatigue;
• general weakness;
• malaise;
• muscle spasm;
• irritability;
• conjunctivitis;
• impaired vision;
• cough;
• pharyngitis;
• sinusitis;
• rhinitis;
• orthostatic hypotension;
• arrhythmia;
• palpitation;
• nocturia;
• polyuria;
• rash;
• hives;
• itching;
• hemorrhagic vasculitis;
• Hyperglycemia, hypokalemia, hypochloraemia, hyponatremia, hypercalcemia;
• influenza-like syndrome;
• pain in the chest;
• backache;
• decreased potency;
• decreased libido;
• rhinorrhea;
• sweating;
• decreased body weight;
• tingling in the extremities.

Contraindications

• anuria;
• hypokalemia;
• expressed hepatic (including with encephalopathy) and / or renal failure;
• pregnancy;
• lactation period;
• age under 18 years (effectiveness and safety not established);
• simultaneous reception of drugs that extend the QT interval;
• hypersensitivity to the drug and other sulfonamide derivatives.

Application in pregnancy and lactation

Contraindicated in pregnancy and lactation.

special instructions

In patients taking cardiac glycosides, laxatives, against the background of hyperaldosteronism, as well as in the elderly, regular monitoring of the content of potassium and creatinine ions is shown.

On the background of taking indapamide, the concentration of potassium, sodium, magnesium ions in the blood plasma (electrolyte disturbances may develop), pH, glucose concentration, uric acid and residual Nitrogen should be systematically monitored.

The most thorough control is shown in patients with cirrhosis of the liver (especially with edema or ascites - the risk of metabolic alkalosis, increasing manifestations of hepatic encephalopathy), coronary heart disease, chronic heart failure, and also in the elderly. Patients with an increased QT interval on an electrocardiogram (congenital or developing against a background of a pathological process) also belong to the high-risk group.

The first measurement of the potassium concentration in the blood should be performed during the first week of treatment.

For a diuretic and antihypertensive effect, the drug must be taken for life, in the absence of side effects and contraindications to admission.

Hypercalcemia on the background of taking indapamide may be a consequence of previously undiagnosed hyperparathyroidism.

In patients with diabetes mellitus, it is extremely important to control the level of glucose in the blood, especially in the presence of hypokapaemia.

Significant dehydration can lead to the development of acute renal failure (reduced glomerular filtration). Patients must compensate for the loss of water and at the beginning of treatment carefully monitor the kidney function.

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

Patients with hypertension and hyponatremia (due to taking diuretics) need to stop taking diuretics 3 days before the start of taking ACE inhibitors (if necessary, diuretics can be taken a little later) or they are given initial low doses of ACE inhibitors.

Derivatives of sulfonamides can aggravate the course of systemic lupus erythematosus (it should be borne in mind when administering indapamide).

Impact on the ability to drive vehicles and manage mechanisms

During the treatment period, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Drug Interactions

Saluretics, cardiac glycosides, gluco- and mineralocorticoids, tetracosactide, amphotericin B (intravenously), laxatives increase the risk of hypokalemia.

With simultaneous admission with cardiac glycosides, the likelihood of developing digitalis intoxication increases; with preparations of Ca2 - hypercalcemia; with Metformin - may aggravate lactic acidosis.

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

Astemizole, Erythromycin intranasally, pentamidine, sultopride, terfenadine, vincamine, antiarrhythmic drugs 1a class (quinidine, disopyramide) and 3 classes (amiodarone, brethylium, sotalol) can lead to the development of torsades de pointes.

Non-steroidal anti-inflammatory drugs, glucocorticosteroid agents, tetracosactide, sympathomimetics reduce the hypotensive effect, Baclofen - strengthens.

Combination with potassium-sparing diuretics can be effective in some patients, however, the possibility of hypo- or hyperkalemia, especially in patients with diabetes mellitus and renal insufficiency, is not completely excluded.

ACE inhibitors increase the risk of arterial hypotension and / or acute renal failure (especially with existing renal artery stenosis).

Increases the risk of kidney dysfunction when using iodine-containing contrast media in high doses (dehydration of the body). Before using iodine-containing contrast agents, patients need to restore fluid loss.

Imipramine (tricyclic) antidepressants and antipsychotic drugs increase the hypotensive effect and increase the risk of developing orthostatic hypotension.

Cyclosporine increases the risk of hypercreatininaemia.

Reduces the effect of indirect anticoagulants(coumarin or indanedione derivatives) due to an increase in the concentration of coagulation factors as a result of a decrease in the volume of circulating blood and increase in their production by the liver (dose adjustment may be required).

Strengthens the blockade of the neuromuscular transmission, which develops under the action of nondepolarizing muscle relaxants.

Analogues of the drug Indapamide

Structural analogs for the active substance:

• Acrypamide;
• Acrypamide retard;
• Acuter-Sanovel;
• Arindap;
• Arifon;
• Arifon retard;
• Vero-Indapamide;
• Indap;
• Indapamide MB Stade;
• Indapamide retard;
• Indapamid Stade;
• Indapamide-OBL;
• Indapamid-Verte;
• Indapamid-Teva;
• Inder;
• Inverse;
• Indians;
• Indyur;
• Ionik;
• Ionik retard;
• Ipres Long;
• Lauras SR;
• Pamid;
• Ravel SR;
• Retapres;
• SR-Indamed;
• Tenzar.

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