Index of drugs

Primary hypertension.

1 tabl powl. contains 2.5 mg of indapamide.

Diuretic with hypotensive effect - non-thiazide sulfonamide. Dose-related studies have shown that at a dose of 2.5 mg per day, the hypotensive effect is maximal and the sub-clinical diuretic action. The drug reduces the hyperresponsiveness of vessels to adrenaline in patients with hypertension and reduces the total peripheral resistance and arterial resistance. Vascular mechanism of action of Indapamide includes: reduction of vascular smooth muscle contraction by affecting transport (mainly calcium); vasodilatation due to stimulation of PGE prostaglandin synthesis₂ and the dilating vessel and inhibiting platelet aggregation of PGAC prostacyclin₂; intensification of the action of the dilating bradykinin. Indapamide reduces the hypertrophy of the left ventricle. The drug is quickly and completely absorbed from the digestive tract. After oral administration, the maximum concentration in the blood occurs after 1-2 h. Indapamide is accumulated in erythrocytes and in 79% bound to plasma proteins and erythrocytes. It penetrates into the smooth muscle of blood vessels due to the high solubility in fats. After a single oral dose, 70% is excreted via the kidneys and 23% in the faeces. Indapamide is extensively metabolised, with only 7% excreted unchanged in urine within 48 h after administration. T_0,5 elimination is about 15-18 h. The stationary state is reached after 4 days.

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 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 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).

Orally. Adults: 1 tabl. daily, in the morning. The effect of the drug develops gradually, the maximum pressure drop may occur only a few months after the start of treatment. Doses greater than 2.5 mg / day are not recommended, this will not further reduce blood pressure, while the diuretic effect may be increased. If the use of 1 tabl. daily will not lower enough blood pressure, your doctor may use other antihypertensive drugs. The drug can be used with beta-blockers, ACE inhibitors, methyldopa, clonidine and other adrenergic blocking drugs. The use of indapamide with diuretics that may cause hypokalaemia is not recommended. There is no phenomenon of "rebound" hypertension after discontinuation of the drug. Elderly patients may use the product when the kidney function is normal or only slightly affected.