Antihypertensive agents , on pharmacologically similar to thiazide diuretics . Increases urinary excretion of sodium, chlorine and, to a lesser extent, potassium and magnesium ions. With the ability to selectively block the “slow” calcium channels, increases the elasticity of the artery walls and reduces the total peripheral vascular resistance. It helps to reduce hypertrophy of the left ventricle testosterone suspension of the heart. No effect on lipid and carbohydrate exchange (including patients with diabetes mellitus), does not violate the sensitivity of peripheral tissues to insulin action. It reduces the sensitivity of the vascular wall to norepinephrine and angiotensin II of, stimulates the synthesis of prostaglandin , reduces the production of free and stable oxygen radicals. The hypotensive effect is the end of the first week, it maintained for 24 hours on a background of a single dose.
After intake of rapidly and completely absorbed from the gastrointestinal tract; bioavailability – high . Food intake slows down the absorption rate, but does not affect the amount of the absorbed compound. Maximum plasma concentration – 12 hours after testosterone suspension ingestion. Repeated receptions fluctuations in drug concentration in blood plasma in the interval between receptions of two doses reduced. The equilibrium concentration is set at 7 days of regular admission. The half-life – 18 hours, connection with blood plasma proteins -. 79%. Associated also with elastin smooth muscles of the vascular wall. It has a high volume of distribution, passes through the blood-tissue barriers (including placental) passes into breast milk.
It is metabolized in the liver. The kidneys remove in the form of metabolites , through testosterone suspension the intestines. In patients with renal insufficiency The pharmacokinetics does not change. Not accumulates.
With caution is prescribed for disorders of the liver and / or kidney problems, violation of water-electrolyte balance, hyperparathyroidism, patients with an increased QT interval on an testosterone suspension electrocardiogram or receiving combination therapy, diabetes in decompensation stage, hyperuricemia (especially accompanied by gout and urate nephrolithiasis).
Dosing and Administration
Inside, not liquid, squeezed enough liquid, preferably in the morning hours at a dose of 1.5 mg (1 tablet).
From the digestive system: nausea, anorexia, dry mouth, gastralgia, vomiting, diarrhea, constipation, abdominal pain, may develop hepatic encephalopathy, rarely – pancreatitis. On the part of the central nervous system: fatigue, nervousness, headache, dizziness, somnolence , vertigo, insomnia, depression; rarely – fatigue, weakness, malaise, muscle spasm, tension, irritability, anxiety. The respiratory system: cough, pharyngitis, sinusitis, rarely – rhinitis. With the cardiovascular system: orthostatic hypotension, changes in the electrocardiogram (hypokalemia) , arrhythmia, palpitations. From the urinary system: frequent infections, nocturia, polyuria. Allergic reactions: rash, urticaria, pruritus, hemorrhagic vasculitis. Laboratory parameters: hyperuricemia, hyperglycemia, hypokalemia, hyposalemia, hyponatremia, hypercalcemia, elevated blood urea nitrogen plasma , hypercreatininemia, glycosuria. Other: exacerbation of systemic lupus erythematosus. Very rare: thrombocytopenia, leukopenia, agranulocytosis, bone marrow aplasia, and hemolytic anemia.
Symptoms include nausea, vomiting, weakness, impaired function of the gastrointestinal tract, water and electrolyte disturbance, in some cases – an excessive fall in blood pressure, respiratory depression.Patients with cirrhosis may develop hepatic coma.
Treatment: gastric lavage, correction fluid and electrolyte balance, symptomatic therapy. No specific antidote.
Interaction with other drugs
Saluretics, cardiac glycosides, gluco-and mineralocorticoid, tetrakozaktid, amphotericin B (w / w), laxatives increase the risk of hypokalemia.
When concomitantly with cardiac glycosides increases the likelihood of digitalis intoxication; with calcium supplementation – hypercalcemia; metformin -. possible worsening of lactic acidosis
increases the concentration of lithium ions in the blood plasma (reduced excretion of urine), lithium has nephrotoxic effects.
astemizole, erythromycin, a / c, pentamidine, sultopride, terfenadine, vincamine, antiarrhythmics IA class (quinidine, disopyramide ) and class III (amiodarone, bretilium, sotalol) may lead to arrhythmia type “pirouette» ( «torsades de pointes”) .
Non-steroidal anti-inflammatory drugs, glucocorticosteroid agents tetrakozaktid, sympathomimetic reduce the hypotensive effect of baclofen – strengthens.
The combination with potassium-sparing diuretics can be effective in a certain category of patients, however, this is not completely exclude the possibility of the development of hypo- or hyperkalemia, especially in patients with diabetes and renal failure.
angiotensin-converting enzyme (ACE) inhibitors increase the risk of hypotension and / or acute renal failure (especially when existing renal artery stenosis).
Increases the risk of renal dysfunction when using iodine-containing contrast agents in high doses (dehydration). Before use of iodine-containing contrast media to patients need to restore lost fluids.
Imipraminovye (tricyclic) antidepressants and antipsychotics increase the hypotensive effect and increase the risk of orthostatic hypotension.
Cyclosporin increases the risk of hypercreatininemia.
Reduces the effect of indirect anticoagulants (coumarin derivatives or indandiona) due to increased concentration of clotting factors by reducing the volume of circulating blood and to increase their production by the liver (may require dose adjustment).
Enhances the blockade of neuromuscular transmission, developing under the influence of non-depolarizing muscle relaxants.
Patients receiving cardiac glycosides, laxatives, amid hyperaldosteronism, as well as in the elderly shows a regular monitoring of the content of potassium ions and creatinine.
In patients receiving indapamide should systematically monitor the concentration of potassium ions, sodium, plasma magnesium (can develop electrolyte . disorders), pH, concentration of glucose, uric acid and residual nitrogen
most careful control shown in patients with liver cirrhosis (especially with edema or ascites – the risk of metabolic alkalosis, increase testosterone suspension the expression of hepatic encephalopathy), coronary heart disease, heart failure, as well as in the elderly.
for high risk include patients with an increased QT interval on the electrocardiogram (congenital or develop on the background of a pathological process).
The first measurement of the concentration of potassium in the blood should be held during the first week of treatment.
hypercalcemia in patients receiving indapamide could be a consequence of previously undiagnosed hyperparathyroidism.
diabetic patients is extremely important to control the level of glucose in the blood, especially in the presence of hypokalemia.
considerable dehydration may lead to acute renal failure (decreased glomerular filtration). Patients need to compensate for the loss of water and at the beginning of treatment carefully monitor renal function.
In patients with hypertension and hyponatremia (due to diuretics) should stop taking diuretics (if necessary diuretic may be resumed later) for 3 days before you start taking angiotensin-converting enzyme inhibitors or they are assigned the initial low dose of ACE inhibitors.
Indapamide may give a positive result during the doping control.
Effects on ability to drive and use other mechanisms : in some cases the individual reactions related to changes in blood pressure, especially at the beginning of treatment and with the addition of another antihypertensive agent. As a result, it may reduce the ability to drive a car and work with mechanisms that require attention.
The long-acting tablets coated tablets 1.5 mg.
10 tablets in blisters. 1, 2, 3, 4 or 5, the contour testosterone suspension of cellular packaging together with instructions for use are placed in a pile of cardboard.
List B. In dry the dark and inaccessible to children at temperature not above 25 ° C.