Indapamide

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Available since: 2019-09-19

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Clinical Pharmacology

Thiazide-like diuretic, antihypertensive agent. It causes a decrease in the tone of the smooth muscles of the arteries, a decrease in OPSS, also has a moderate saluretic activity, due to impaired reabsorption of sodium, chlorine and water ions in the cortical segment of the loop of Henle and the proximal convolution of the nephron tubule. The decrease in OPSS is due to several mechanisms: a decrease in the sensitivity of the vascular wall to noradrenaline and angiotensin II; increased synthesis of prostaglandins with vasodilating activity; by inhibiting the influx of calcium ions into the smooth muscle elements of the vascular wall. In therapeutic doses, virtually no effect on lipid and carbohydrate metabolism. The hypotensive effect is manifested only with initially elevated blood pressure, develops by the end of the first week and reaches a maximum after 3 months of systematic administration.

Indications

Arterial hypertension.

Composition

1 tab. indapamide 2.5 mg.

Excipients: lactose monohydrate - 72 mg, microcrystalline cellulose - 10 mg, corn starch - 10.1 mg, magnesium stearate - 0.9 mg, polyvinylpyrrolidone - 3.6 mg, talc - 0.9 mg.

The composition of the shell: hypromellose - 1.873 mg, polysorbate 80 - 0.828 mg, titanium dioxide - 0.728 mg, castor oil - 0.23 mg, talc - 0.728 mg, macrogol 4000 - 0.613 mg.

Indapamide is marketed under different brands and generic names, and comes in different dosage forms:

Brand name	Manufacturer	Country	Dosage form
Indapamide	Teva	Israel	pills
Indapamide	Canonpharma	Russia	pills
Indapamid-Teva	Teva	Israel	capsules
Indapamid-Teva	Teva	Israel	pills
Ravel CP	Krka dd Novo mesto AO	Slovenia	pills
Indapamide	Makiz-Pharma	Russia	pills
Indapamide	Hemofarm	Serbia	pills
Indap	PRO.MED.CS Praha a.s	Czech	capsules
Arifon retard	Servier	France	pills
Arifon	Servier	France	pills

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Dosage and Administration

pills are taken orally, without chewing. Daily dose - 1 tablet of the drug Indapamide 1 time per day (in the morning), drinking plenty of fluids.

When treating patients with arterial hypertension, the dose of the drug should not exceed 2.5 mg (an increase in the risk of side effects without enhancing the antihypertensive effect).

Elderly patients. In elderly patients, plasma concentration of creatinine should be monitored with regard to age, body weight and sex.

The drug Indapamide at a dose of 2.5 mg / day (1 tablet) can be administered to elderly patients with normal or slightly impaired renal function ..

Severe renal failure: The drug is contraindicated

Adverse reactions

Most adverse reactions (laboratory and clinical indicators) are dose-dependent.

The frequency of adverse reactions that may be caused by thiazide-like diuretics, including indapamide, is given in the form of the following gradation: very often (> 1/10); often (> 1/100, <1/10); infrequently (> 1/1000, <1/100); rarely (> 1/10000, <1/1000); very rarely (<1 10="" 000="" unspecified="" frequency="" cannot="" be="" calculated="" from="" available="" data="" the="" of="" adverse="" reactions="" is="" given="" in="" accordance="" with="" classification="" world="" health="" organization="" p="">

On the part of the circulatory and lymphatic systems: very rarely - thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia, hemolytic anemia.

From the side of the central nervous system: rarely - dizziness, increased fatigue, headache, asthenia, paresthesia; specified frequency - syncope.

Since the cardiovascular system: very rare: arrhythmia, marked reduction in blood pressure; unspecified pirouette-type arrhythmia (possibly fatal), an increase in the QT interval on the ECG.

On the part of the digestive system: infrequently - vomiting; rarely - nausea, clearance, dryness of the oral mucosa; very rarely - pancreatitis.

On the part of the urinary system: very rarely - renal failure.

On the part of the liver and biliary tract: very rarely - abnormal liver function. Unspecified frequency: the possibility of developing hepatic encephalopathy in case of liver failure, hepatitis.

On the part of the skin: hypersensitivity reactions, mainly dermatological, in patients with a predisposition to allergic and asthmatic reactions: often - maculopapular rash; infrequently - hemorrhagic vasculitis; very rarely - angioedema and / or urticaria, toxic epidermal necrolysis, Stevens-Johnson syndrome; of unspecified frequency - possible worsening of the course of the disease if patients have an acute form of disseminated lupus erythematosus. Cases of photosensitivity reactions are described.

Laboratory indicators: Very rare: hypercalcemia. increased activity of liver transaminases; reduction of potassium and the development of hypokalemia, especially significant for patients at risk; hyponatremia with hypovolemia, dehydration and orthostatic hypotension. The simultaneous loss of chlorine ions can lead to a compensatory metabolic alkalosis, however, the frequency of alkalosis and its severity is insignificant; increasing the concentration of uric acid and glucose in the blood plasma. Cyazide and thiazide-like diuretics should be used with caution in patients with gout and diabetes.

Contraindications

Hypersensitivity to indapamide and other components of the drug, as well as to other sulfonamide derivatives, severe renal failure (creatinine clearance less than 30 ml / mi), hypokalemia, hepatic encephalopathy or severely impaired liver function, acute cerebral circulation, pregnancy, lactation, during - age under 18 years (efficacy and safety not established); lactose intolerance, lactase deficiency, glucose galactose malabsorption syndrome (the product contains lactose).With caution: in disorders of the liver and / or kidneys, disorders of water and electrolyte balance, hyperparathyroidism, in debilitated patients or in patients receiving combined therapy with other antiarrhythmic drugs, while taking drugs that prolong the QT interval, diabetes mellitus, hyperuricemia (especially accompanied by gout and urate nephrolithiasis). Use during pregnancy and during breastfeeding. But during pregnancy you should not prescribe diuretic drugs. You can not use these drugs for the treatment of physiological edema during pregnancy. Diuretic drugs can cause placental and hemorrhage and lead to impaired fetal development (malnutrition). Use of the drug Indapamide is not recommended during pregnancy. Indapamide is excreted in breast milk. Given the possibility of adverse events in infants, breastfeeding during treatment with Indapamide is not recommended.

Drug interactions

An undesirable combination of drugs.

Lithium preparations: with simultaneous use of indapamide and lithium preparations, an increase in plasma concentration of lithium may be observed due to a decrease in its excretion, accompanied by the appearance of signs of overdose. If necessary, diuretic drugs can be used in combination with lithium preparations, and you should carefully select the dose of drugs, regularly monitoring the content of lithium in the blood plasma.

The combination of drugs that require special attention.

Drugs that can cause arrhythmia type "pirouette":

- class IA antiarrhythmic drugs (hydroquinidine (quinidine), disopyramide), class III antiarrhythmic drugs (amiodarone, dofetilide, ibutilide), sotalol;
- Some neuroleptics: phenothiazines (chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoroperazine), benzamides (amisulpride, sulpiride, sultopride, Tiapride), butyrophenones (droperidol, haloperidol);
- Others: bepridil, cisapride, difemanil, erythromycin (i.v.), halofantrine, mizolastine, pentamidine, sparfloxacin, moxifloxacin, astemizol, vincamine (i.v.).

Overdosage

Symptoms Signs of acute drug poisoning are primarily associated with impaired water and electrolyte balance (hyponatremia, hypokalemia). Of the clinical symptoms of an overdose, nausea, vomiting, dysfunction of the gastrointestinal tract, convulsions, dizziness, drowsiness, confusion, polyuria or oliguria, leading to anuria (due to hypovolemia), in some cases - an excessive decrease in blood pressure, respiratory depression. Patients with liver cirrhosis may develop hepatic coma.
Treatment. Emergency measures are reduced to the removal of the drug from the body: gastric lavage and / or the appointment of Activated charcoal with subsequent restoration of water and electrolyte balance. There is no specific antidote.

Brand name: Indapamide
Active ingredient: Indapamide
Dosage form: pills, film-coated white, round, biconvex, without risks; on the cross-section - white or almost white.
Manufacturer: Teva