Index of drugs

Primary hypertension.

1 tabl sustained release contains 1.5 mg of indapamide. The preparation contains lactose.

A diuretic with hypotensive effect - a sulphonamide derivative with pharmacological properties similar to thiazide diuretics. It works in the proximal part of the distal tubules of the tortuous nephrons, where it increases the secretion of sodium and chloride, and to a lesser extent, potassium and Magnesium, thus increasing the volume of excreted urine and lowering blood pressure. The hypotensive effect of Indapamide lasts for 24 h. This effect occurs when using doses that cause a mild diuretic effect. The antihypertensive properties of indapamide are associated with improved susceptibility of arteries and a decrease in arterial resistance and total peripheral resistance. Indapamide reduces the hypertrophy of the left ventricle. After oral administration, the maximum plasma concentration occurs after about 12 hours. Indapamide binds to plasma proteins in 79%. T_0,5 in the elimination phase, it is 14-24 h (average 18 h). Steady state is reached after 7 days. Repeating the dose does not lead to drug accumulation. Indapamide is mainly excreted in the urine (70%) and faeces (22%) in the form of inactive metabolites. Only 5 to 7% of the dose is excreted unchanged in urine.

Hypersensitivity to Indapamide, other sulfonamides or to any of the excipients. Severe renal failure (creatinine clearance below 30 ml / min). Hepatic encephalopathy or other severe liver problems. Hypokalemia.

In patients with impaired hepatic function, diuretic drugs similar to thiazides may cause hepatic encephalopathy, particularly in the case of electrolyte imbalance. The use of diuretics should be discontinued immediately if signs of hepatic encephalopathy develop. If a hypersensitivity reaction occurs during treatment, discontinuation of the drug is recommended. If re-application of the diuretic proves necessary, it is recommended to protect the skin surface exposed to sunlight or artificial UVA radiation. Before starting treatment, the plasma levels of sodium should be evaluated and regularly monitored. Due to the risk of hyponatremia, regular monitoring of sodium is required, more frequent in elderly patients or in patients with liver cirrhosis. Loss of potassium with hypokalaemia is the main risk associated with the use of thiazide diuretics and other drugs with similar effects. Special precautions should be taken in patients who are at greatest risk of developing hypokalemia (<3.4 mmol / l), e.g. in geriatric, malnourished, multiple-drug, cirrhotic patients with edema and ascites, with coronary heart disease and heart failure. In the case of hypokalemia, the risk of cardiotoxicity of digitalis preparations and the risk of arrhythmias are increased. The risk group also includes patients with prolonged QT interval, regardless of whether it is congenital or iatrogenic. Hypokalemia, like bradycardia, contributes to the development of severe cardiac arrhythmias, particularly to potentially fatal tachycardiatorsade de pointes. More frequent determination of potassium in plasma is necessary in all the above situations. The first determination of potassium plasma concentration should be made in the first week of treatment. If hypokalemia is diagnosed, it is necessary to supplement potassium. Thiazide diuretics and other medicines with a similar effect may reduce urinary Calcium excretion, causing a slight and transient increase in plasma calcium. Significant hypercalcemia may be the result of unrecognized hyperparathyroidism. In this case, treatment should be discontinued and parathyroid function tests should be performed. In diabetic patients, especially those with hypokalemia, blood Glucose monitoring should be monitored.In patients with hyperuricaemia, there is a tendency to increase the incidence of gout attacks. Thiazide diuretics and other medicines with similar effects are only fully effective if the renal function is normal or minimally disturbed (creatinine concentration below 25 mg / l, ie 220 μmol / l in adults). When assessing renal function based on creatinine concentration, the age, weight and sex of the patient should be taken into account. Hypovolaemia, secondary to loss of water and sodium, induced by diuretics at the beginning of treatment, causes a reduction in glomerular filtration. This may result in increased levels of urea in the blood and plasma creatinine. This transient functional renal failure has no consequences in patients with normal renal function, but may exacerbate existing renal failure. Due to the lack of data on safety and efficacy, the drug is not recommended for children and adolescents. The preparation contains lactose - should not be used in patients with rare hereditary galactose intolerance, lactase deficiency (Lapp type) or malabsorption of glucose-galactose.

The use of diuretics in pregnant women should be avoided. They should never be used to treat physiological edema that occurs during pregnancy. Diuretics can cause fetal-placental ischaemia with the risk of fetal growth disturbance. Indapamide may be used during pregnancy only if clearly necessary, however, before the patient is used, the doctor should gather a patient's interview about pregnancy or planning. Indapamide is excreted in human milk - breast-feeding is not recommended.

Hypokalaemia (blood potassium <3.4 mmol / l) occurred in 10% of patients; in 4% of patients potassium levels were <3.2 mmol / l after 4-6 weeks of treatment. After 12 weeks of treatment, the average reduction in potassium was 0.23 mmol / l. Common: maculopapular rashes. Uncommon: vomiting, purpura. Rarely: dizziness, tiredness, headache, paresthesia, nausea, constipation, dry mouth. Very rare: thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia, haemolytic anemia, arrhythmia, hypotension, pancreatitis, renal failure, liver dysfunction, angioneurotic edema and / or urticaria, toxic epidermal necrolysis, Stevens-Johnson syndrome , hypercalcemia. Frequency unknown: fainting,torsade de pointes (potentially fatal), hepatitis, risk of hepatic encephalopathy in patients with hepatic impairment, risk of exacerbation of pre-existing systemic lupus erythematosus, hypersensitivity to light, prolonged QT interval in ECG, increased glucose and uric acid levels during treatment (purposefulness of use of these diuretics in patients with gout or diabetes should be carefully considered), increased liver enzymes, potassium loss with hypokalemia particularly severe in high-risk patients, hypovolemia with hypovolaemia causing dehydration and orthostatic hypotension (concomitant loss of chloride ions can lead to secondary, compensatory metabolic alkalosis, the frequency and severity of this effect is not significant).

Oral. Adults: 1 tabl. daily, preferably in the morning. At higher doses, indapamide shows no stronger antihypertensive effect, while saluretic effects are increased. In the elderly, the medicine can be used when the kidney function is normal or only slightly affected. The tablets should be swallowed whole with water and should not be chewed.