Universal reference book for medicines
Product name: INDIPAM (INDIPAM)

Active substance: indapamide

Type: Diuretic.
Antihypertensive drug
Manufacturer: BALKANPHARMA-DUPNITSA (Bulgaria)
Description of the active substance:
This information is a reference and it is not enough that the drug has been prescribed by a doctor ..

PHARMACHOLOGIC EFFECT
A thiazide-like diuretic, an antihypertensive agent.
It causes a decrease in the tone of the smooth muscles of the arteries, a decrease in the OPSS, and also has moderate saluretic activity due to a violation of the reabsorption of sodium, chlorine and water ions in the cortical segment of the Henle loop and the proximal convoluted tubule of the nephron. The decrease in OPSS is due to several mechanisms: a decrease in the sensitivity of the vascular wall to norepinephrine and angiotensin II; increased synthesis of prostaglandins with vasodilating activity; oppression of the influx of calcium ions into the smooth muscle cells of the vascular wall. In therapeutic doses practically does not affect the lipid and carbohydrate metabolism.
The hypotensive effect is manifested only at initially elevated blood pressure, develops by the end of the first week and reaches a maximum after 3 months of systematic admission.

PHARMACOKINETICS
After oral intake quickly and completely absorbed from the gastrointestinal tract, C max in plasma is achieved after 1-2 hours. Binding to plasma proteins is 79%.Widely distributed in the body.
Do not cumulate.
T 1/2 is 18 hours. It is excreted by the kidneys mainly in the form of metabolites, 5% - in unchanged form.

INDICATIONS
Arterial hypertension;
delay sodium and water in chronic heart failure.
DOSING MODE
Take inside at 2.5 mg 1 time / day (morning).
If the hypotensive effect is insufficient, after 2 weeks of treatment, the dose is increased to 5-7.5 mg / day.
The maximum daily dose is 10 mg divided into 2 doses (in the morning).

SIDE EFFECT
From the digestive system: nausea, a feeling of discomfort or epigastric pain.

From the side of the central nervous system: weakness, fatigue, dizziness, nervousness.

From the cardiovascular system: orthostatic hypotension.

On the part of metabolism: hypokalemia, hyperuricemia, hyperglycemia, hyponatremia, hypochloraemia.

Allergic reactions: cutaneous manifestations.

CONTRAINDICATIONS
Acute cerebrovascular accident, severe renal and / or liver dysfunction, severe diabetes mellitus and gout, hypersensitivity to indapamide.

PREGNANCY AND LACTATION
Adequate and well-controlled studies of the safety of the use of indapamide during pregnancy and lactation were not conducted.
Use in this category of patients is not recommended.
APPLICATION FOR FUNCTIONS OF THE LIVER
Contraindicated in severe impairment of kidney function.

APPLICATION FOR VIOLATIONS OF THE FUNCTION OF KIDNEYS
Contraindicated in severe violations of liver function.

SPECIAL INSTRUCTIONS
They are used with caution in patients with diabetes mellitus (glucose control is necessary, especially in the presence of hypokalemia), gout (possibly an increase in the number of seizures), in patients with a history of allergic reactions to derivatives of sulfonamides.

During the treatment it is necessary to control the level of electrolytes in the blood plasma (potassium, sodium, calcium).

DRUG INTERACTION
With the simultaneous use of GCS, tetracosactide for systemic use decreases hypotensive effect due to delay in water and sodium ions under the influence of GCS.

With simultaneous use with ACE inhibitors, the risk of hyponatremia increases.

When used simultaneously with NSAIDs (for systemic use), hypotensive action of indapamide may be reduced.
With a significant loss of fluid, acute renal failure may develop (due to a sharp decrease in glomerular filtration).
With simultaneous use with calcium preparations, the development of hypercalcemia is possible due to a decrease in the excretion of calcium ions in the urine.

With simultaneous use with cardiac glycosides, corticosteroids increases the risk of hypokalemia.

With the simultaneous use of drugs that can cause hypokalemia (amphotericin B, gluco- and mineralocorticoids, tetracosactide, laxatives, stimulating intestinal peristalsis), the risk of hypokalemia increases.

When used simultaneously with tricyclic antidepressants (including imipramine), the hypotensive effect increases and the risk of developing orthostatic hypotension increases (additive effect).

With the simultaneous use with astemizole, bepridilom, erythromycin (w / w), pentamidine, sultopride, terfenadine, vincamin, quinidine, disopyramide, amiodarone, brethil tosilate, sotalol, there is a risk of arrhythmia such as "pirouette".

With simultaneous use with baclofen, the hypotensive effect is enhanced.

When used simultaneously with halofantrine, the likelihood of cardiac arrhythmias increases (including ventricular arrhythmias such as pirouettes).

With the simultaneous application of lithium carbonate, the risk of developing a toxic effect of lithium increases against the background of a decrease in its renal clearance.

With the simultaneous use of metformin, the appearance of lactic acidosis, which is associated, apparently, with the development of functional renal failure, caused by the action of diuretics (mainly "loop").

With simultaneous use with cyclosporine, an increase in creatinine in the blood plasma is possible, which is observed even with normal water content and sodium ions.

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