Composition, form of production and packaging
Tablets covered with a film membrane of red-brown color, round, biconcave; the core is white or almost white in cross section.
1 tab.
indapamide 625 Ојg
perindopril erbumine 2 mg
Excipients: microcrystalline cellulose - 44.1125 mg, lactose monohydrate - 86.8 mg, silicon colloidal dioxide - 0.45 mg, magnesium stearate - 0.75 mg.
The composition of the film shell: dye Winkout WT-01985 brown - 5 mg (hypromellose - 2.8 mg, macrogol 400 - 0.45 mg, titanium dioxide - 0.77 mg, talc - 0.23 mg, macrogol 6000 - 0.27 mg, iron oxide red oxide - 0.5 mg) .
10 pieces. - blisters (1) - packs of cardboard.
10 pieces. - blisters (2) - packs of cardboard.
10 pieces. - blisters (3) - packs of cardboard.
14 pcs. - blisters (1) - packs of cardboard.
14 pcs. - blisters (2) - packs of cardboard.
14 pcs. - blisters (3) - packs of cardboard.
The tablets covered with a film cover of orange color, round, biconcave; the core is white or almost white in cross section.
1 tab.
indapamide 1.25 mg
perindopril erbumine 4 mg
Excipients: microcrystalline cellulose - 43.425 mg, lactose monohydrate - 84.6 mg, silicon colloidal dioxide - 0.45 mg, magnesium stearate - 0.75 mg.
The composition of the film shell: dye Wunkout WT-01097 orange 5 mg (hypromellose 2.22 mg, macrogol 400 0.35 mg, titanium dioxide 0.61 mg, talc 0.18 mg, macrogol 6000 0.22 mg, dye sunset yellow 1.43 mg) .
10 pieces. - blisters (1) - packs of cardboard.
10 pieces. - blisters (2) - packs of cardboard.
10 pieces. - blisters (3) - packs of cardboard.
14 pcs. - blisters (1) - packs of cardboard.
14 pcs. - blisters (2) - packs of cardboard.
14 pcs. - blisters (3) - packs of cardboard.
INSTRUCTION FOR THE SPECIALIST.
Description of the drug approved by the manufacturer for the printed edition of 2012.
PHARMACHOLOGIC EFFECT
Combined drug containing an ACE inhibitor - perindopril and a thiazide-like diuretic - indapamide. The drug has antihypertensive, diuretic and vasodilating effect.
Perindid has a pronounced dose-dependent antihypertensive effect, independent of the age and position of the patient's body and not accompanied by reflex tachycardia. Does not affect the metabolism of lipids (total cholesterol, LDL, VLDL, HDL, triglycerides and carbohydrates), incl. in patients with diabetes mellitus.Reduces the risk of hypokalemia due to monotherapy with a diuretic.
The antihypertensive effect persists for 24 hours.
A stable decrease in blood pressure is achieved within 1 month against the background of the Perindid drug without an increase in heart rate. Termination of treatment does not lead to the development of the "withdrawal" syndrome.
Perindopril is an ACE inhibitor whose mechanism of action is associated with inhibition of ACE activity, leading to a decrease in the formation of angiotensin II, eliminates the vasoconstrictive effect of angiotensin II, reduces the secretion of aldosterone.
The use of perindopril does not lead to the retention of sodium and liquid, does not cause reflex tachycardia in long-term treatment. The antihypertensive effect of perindopril is developed in patients with low or normal renin activity of blood plasma.
Perindopril acts via its main active metabolite, perindoprilat. Its other metabolites are inactive.
The action of Perindid leads to:
- the expansion of veins, caused by a change in the metabolism of prostaglandins (decreased preload on the heart);
- decrease in OPSS (decrease in postload on the heart).
In patients with heart failure, perindopril contributes to:
- lowering the filling pressure of the left and right ventricles;
- increased cardiac output and cardiac index;
- Increased regional blood flow in the muscles.
Perindopril is active in arterial hypertension of any severity: mild, moderate and severe. The maximum antihypertensive effect develops 4-6 hours after a single oral intake and persists throughout the day. Termination of therapy does not lead to the development of the "withdrawal" syndrome.
Has vasodilating properties and restores the elasticity of large arteries. The addition of a thiazide diuretic enhances the antihypertensive (additive) effect of perindopril.
Indapamide belongs to the sulfonamide derivatives, it is a thiazide diuretic. Indapamide inhibits sodium reabsorption in the cortical segment of the renal tubules, which increases the excretion of sodium and chlorine by the kidneys, and leads to increased diuresis. To a lesser extent increases the excretion of potassium and magnesium. Possessing the ability to selectively block "slow" calcium channels, indapamide increases the elasticity of the walls of the arteries and reduces the OPSS.Has hypotensive effect in doses that do not have a pronounced diuretic effect. An increase in the dose of indapamide does not entail an increase in the antihypertensive effect, but increases the risk of developing undesirable phenomena. Indapamide in patients with hypertension has no effect on:
- metabolism of lipids: TG, LDL and HDL.
- the metabolism of carbohydrates, even in patients with diabetes mellitus and arterial hypertension.
PHARMACOKINETICS
The combined use of perindopril and indapamide does not change their pharmacokinetic parameters as compared to the separate administration of these drugs.
Perindopril
Suction and distribution
After oral administration, it is rapidly absorbed from the digestive tract. Bioavailability is 65-70%. Eating food reduces the conversion of perindopril to perindoprilat. T1/2 of blood plasma is 1 hour.
C max in the blood plasma is achieved 3-4 hours after ingestion. Since the intake with food reduces the conversion of perindopril to perindoprilat and the bioavailability of the drug, perindopril must be taken 1 time / day in the morning, before breakfast. When taking perindopril 1 time / day, a steady concentration is achieved within 4 days.
The connection with plasma proteins is dose-dependent and is 20%. Perindoprilat easily passes through the histohematological barriers, excluding the BBB, a small amount penetrates the placenta and into the breast milk.
Metabolism and excretion
In the liver is metabolized with the formation of the active metabolite perindoprilata.
In addition to the active metabolite perindoprilata, perindopril forms 5 more inactive metabolites. It is excreted by the kidneys, T 1/2 perindoprilata is about 17 hours. It does not cumulate.
Pharmacokinetics in special clinical cases
In elderly patients, in patients with renal and heart failure, excretion of perindoprilate slowed down.
In renal failure, it is recommended to reduce the dose of perindopril, depending on the severity of renal failure (CC). The dialytic clearance of perindoprilat is 70 ml / min.
The kinetics of perindopril has been altered in patients with cirrhosis: the liver clearance is reduced by half. Topics no less, the amount of perindoprilate formed does not decrease, which does not require correction of the dose.
Indapamide
Suction and distribution
Quickly and almost completely absorbed in the digestive tract. Eating somewhat slows down absorption, but does not significantly affect the amount of absorbed indapamide.
C max in blood plasma is achieved 1 h after ingestion of a single dose. It binds to plasma proteins by 79%.
Metabolism and excretion
Metabolised in the liver. It is excreted by the kidneys (70%) mainly in the form of metabolites (the fraction of unchanged drug is about 5%) and the intestine with bile in the form of inactive metabolites (22%). T 1/2 is from 14 to 24 hours (on average, 18 hours). Do not cumulate.
Pharmacokinetics in special clinical cases
In patients with renal insufficiency, the pharmacokinetic parameters of the preparation do not change significantly.
INDICATIONS
- arterial hypertension (in patients who are shown combination therapy).
DOSING MODE
The drug is administered orally, 1 time / day, preferably in the morning hours before breakfast, with plenty of liquid.
The initial dose is 1 tab. preparation Perindid (0.625 mg + 2 mg) 1 time / day. If after 1 month of taking the drug it is not possible to achieve adequate control of blood pressure, the dose should be increased to 1 tablet. preparation Perindid (1.25 mg + 4 mg) 1 time / day.
Elderly patients
The initial dose is 1 tab. (0.625 mg + 2 mg) of Perindid preparation once a day.
Patients with impaired renal function
Patients with renal insufficiency (CC 60 ml / min or more) do not need dose adjustment. On the background of therapy, regular monitoring of the concentration of creatinine and potassium in the blood plasma is necessary.
For patients with KK 30-60 ml / min the maximum dose of Perindid is (0.625 mg + 2 mg) 1 time / day.
In severe violations of kidney function (QC less than 30 ml / min), therapy with Perindid is contraindicated.
Patients with impaired hepatic function
In patients with moderate dysfunction of the liver, dose adjustments are not required.
Children and teens
Perindid should not be used in children and adolescents under 18 years of age, efficiency and safety are not established.
SIDE EFFECT
The incidence of adverse reactions that may occur during therapy is given in the following gradation: very often (> 1/10), often (> 1/100 to <1/10), infrequently (> 1/1000 to <1 / 100), rarely (from> 1/10000 to <1/1000), very rarely (<1/10000, including individual messages), unspecified frequency (frequency can not be calculated from available data).
From the side cardiovascular system: infrequent - marked decrease in blood pressure, incl. orthostatic hypotension; very rarely - heart rhythm disturbances, including bradycardia, ventricular tachycardia, atrial fibrillation, as well as angina and myocardial infarction, possibly due to excessive reduction in blood pressure in patients at high risk.
On the part of the respiratory system, chest and mediastinum: often - against the background of the use of ACE inhibitors may occur a dry cough that persists long during the intake of drugs of this group and disappears after their withdrawal; dyspnea; infrequently bronchospasm; very rarely - eosinophilic pneumonia, rhinitis.
From the hemopoietic system and lymphatic system: very rarely - thrombocytopenia, leukopenia / neutropenia, agranulocytosis, aplastic anemia, hemolytic anemia. In certain clinical situations (patients after kidney transplantation, patients on hemodialysis) ACE inhibitors can cause anemia.
Co of the central and peripheral nervous system: often - paresthesia, headache, dizziness, asthenia; infrequently - sleep disturbance, mood lability, increased sweating;very rarely confusion.
On the part of the digestive system: often - dryness of the oral mucosa, nausea, vomiting, abdominal pain, epigastric pain, impaired taste, decreased appetite, indigestion, constipation, diarrhea; rarely - angioedema, intestinal edema, cholestatic jaundice; very rarely - pancreatitis; unspecified frequency - hepatic encephalopathy in patients with hepatic insufficiency.
From the skin and subcutaneous fat: often - skin rash, itching, maculopapular rash; infrequently - angioedema, swelling of the face, lips, extremities, tongue mucosa, folds and / or larynx, urticaria, hypersensitivity reactions in patients predisposed to asthmatic and allergic reactions, hemorrhagic vasculitis. In patients with acute form of systemic lupus erythematosus, the course of the disease may worsen; very rarely - erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome. Cases of photosensitivity reaction are noted.
From the musculoskeletal system: often - muscle cramps.
From the urinary system: infrequently - kidney failure; rarely - acute renal failure.
From the side of the reproductive system : infrequently - impotence.
From the sense organs: often - visual disturbances, noise in the ears.
From the laboratory indicators: hypokalemia, hyponatremia with hypovolemia, leading to a decrease in bcc and orthostatic hypotension, an increase in the concentration of uric acid and glucose in the blood serum; a slight increase in the concentration of creatinine and urea in the blood plasma, reversible after discontinuation of therapy, which often develops against the background of stenosis of the renal arteries or stenosis of the artery of a single kidney, arterial hypertension against diuretic therapy in renal failure; transient increase in sodium content in blood plasma; hypochloremia; proteinuria; rarely - hypercalcemia.
CONTRAINDICATIONS
Perindopril
- angioedema (angioedema) in history, associated with the taking of an ACE inhibitor;
- hereditary / idiopathic angioedema;
- Pregnancy;
- the period of breastfeeding;
- age under 18 years (effectiveness and safety not established);
- hypersensitivity to perindopril and other ACE inhibitors.
Indapamide
- severe hepatic insufficiency (including with encephalopathy);
- hypokalemia;
- simultaneous use with drugs that can cause arrhythmia such as "pirouette";
- Pregnancy;
- the period of breastfeeding;
- age under 18 years (effectiveness and safety not established);
- Hypersensitivity to indapamide and other sulfonamides.
Perindid
- severe renal failure (CC less than 30 ml / min);
- simultaneous reception with potassium-sparing diuretics, potassium and lithium preparations, and in patients with elevated levels of potassium ions in blood plasma;
- lactose intolerance, lactase deficiency, glucose-galactose malabsorption syndrome;
- simultaneous reception of drugs that extend the QT interval;
- hemodialysis (no experience of application);
- Chronic heart failure (in the stage of decompensation);
- age under 18 years (effectiveness and safety not established);
- Hypersensitivity to the auxiliary substances that make up the drug.
With caution should be prescribed for systemic diseases of connective tissue (including systemic lupus erythematosus, scleroderma), immunosuppressant therapy (risk of developing neutropenia, agranulocytosis), oppression of bone marrow hematopoiesis, reduced BCC (diuretics, salt-free diet, vomiting, diarrhea), CHD , cerebrovascular diseases, renovascular hypertension, diabetes mellitus, chronic heart failure (NYHA functional class IV), hyperuricemia (especially accompanied by gout and urate nephrolithiasis), the lability of blood pressure, elderly patients; when carrying out hemodialysis using high-flux membranes (for example, AN 69 В® ) or desensitization, with LDL apheresis, renal artery stenosis (including bilateral), condition after kidney transplantation, aortic valve stenosis / hypertrophic obstructive cardiomyopathy.
PREGNANCY AND LACTATION
The use of the drug Perindid is contraindicated in pregnancy. When planning pregnancy or when diagnosing it against a background of taking the drug, stop taking the drug immediately and prescribe another antihypertensive therapy. Appropriate controlled trials of ACE inhibitors in pregnant women have not been conducted. The available limited data on the effect of the drug in the first trimester of pregnancy indicate that the drug did not lead to malformations associated with fetotoxicity. It is known that prolonged exposure to ACE inhibitors on the fetus in the II and III trimesters of pregnancy can lead to disruption of its development (decreased kidney function, oligohydramnion, delayed ossification of the skull bones) and development of complications in the newborn (such as kidney failure, arterial hypotension, hyperkalemia) . Long-term use of thiazide diuretics in the III trimester of pregnancy can cause hypovolemia in the mother and a decrease in uteroplacental blood flow, which leads to fetoplacental ischemia and delayed fetal development. In rare cases, with the use of diuretics shortly before delivery, neonates develop hypoglycemia and thrombocytopenia.
If the patient received Perindid during the second or third trimesters of pregnancy, it is recommended that a fetus ultrasound be performed to assess the condition of the skull bones and the kidney function.
The use of the drug Perindid is contraindicated in the period of breastfeeding. It is not known whether perindopril is excreted in breast milk.
Indapamide is excreted in breast milk. Taking thiazide diuretics causes a decrease in the amount of breast milk or suppression of lactation. In a newborn, this may lead to increased sensitivity to sulfonamide derivatives, hypokalemia and "nuclear" jaundice.
Since the use of perindopril and indapamide during lactation can cause severe complications in the infant, it is necessary to evaluate the importance of therapy for the mother and decide whether to stop breastfeeding or stop taking these medications.
APPLICATION FOR FUNCTIONS OF THE LIVER
Patients with renal insufficiency (CC 60 ml / min or more) do not need dose adjustment. On the background of therapy, regular monitoring of the concentration of creatinine and potassium in the blood plasma is necessary.
For patients with KK 30-60 ml / min the maximum dose of Perindid is 2 mg + 0.625 mg 1 time / day.
In severe violations of kidney function (QC less than 30 ml / min), therapy with Perindid is contraindicated.
APPLICATION FOR VIOLATIONS OF THE FUNCTION OF KIDNEYS
In patients with moderate dysfunction of the liver, dose adjustments are not required. In severe hepatic insufficiency (including with encephalopathy) indapamide is contraindicated.
APPLICATION FOR CHILDREN
Perindid should not be used in children and adolescents under 18 years of age, efficiency and safety are not established.
APPLICATION IN ELDERLY PATIENTS
With caution should be used in elderly patients.
SPECIAL INSTRUCTIONS
Lithium preparations
It is not recommended simultaneous use of the drug Perindid with lithium preparations.
Impaired renal function
Therapy with Perindid is contraindicated in patients with severe renal insufficiency (CC less than 30 ml / min). In some patients with arterial gynarthhenia without previous impairment of kidney function, the symptoms of acute renal failure may appear on the background of Perindid therapy. In this case, treatment with Perindid should be discontinued. In the future, you can resume combination therapy, using low doses of Perindid, or use perindopril and indapamide in monotherapy.
Such patients need regular monitoring of potassium and creatinine in the blood serum every 2 weeks after the start of therapy and every subsequent 2 months of therapy with Perindid.
Acute renal failure often develops in patients with severe CHF or an initial impairment of kidney function, including, with bilateral renal artery stenosis or arterial stenosis, the only functioning kidney.
The drug Perindid is not recommended for patients with bilateral stenosis of the renal arteries or stenosis of the artery of a single functioning kidney.
Arterial hypotension and disturbance of water-electrolyte balance
Hyponatremia associated with the risk of sudden onset of hypotension (especially in patients with bilateral renal artery stenosis or stenosis of the artery only functioning kidney). Therefore, in the follow-up of patients should pay attention to possible symptoms of dehydration and reduction of electrolytes in the blood plasma, for example, after prolonged diarrhea or vomiting. Such patients requires regular monitoring of electrolytes in the blood plasma.
In severe arterial hypotension may be required in / in a 0.9% sodium chloride solution.
Transient hypotension is not a contraindication to further continuation of therapy. After restoration of blood pressure and BCC can resume Perindid drug therapy using low doses of drug, or to use drugs perindopril and indapamide in monotherapy.
The potassium content of
combined use of perindopril and indapamide does not prevent the development of hypokalemia, especially in patients with diabetes or renal failure. As in the case of combined use of antihypertensive and diuretic agents requires regular monitoring the potassium content in the blood plasma.
Perindopril
neutropenia / agranulocytosis
Patients taking ACE inhibitors, there may be cases of neutropenia / agranulocytosis, thrombocytopenia and anemia. In patients with normal renal function, in the absence of other complications of neutropenia is rare and takes place spontaneously after discontinuation of ACE inhibitors.
Perindopril is necessary with great caution in patients with connective tissue diseases and at the same time receiving immunosuppressive therapy, allopurinol or procainamide, especially when existing renal impairment. These patients may develop severe infections that can not be intense aptibiotikoterapii. In the case of the appointment of perindopril it is recommended to periodically monitor the white blood cells in the blood. Patients should be warned that in case of any signs of infection (sore throat, fever), you should immediately consult a doctor.
Hypersensitivity / angionevratichesky edema (Quincke's edema)
When receiving ACE inhibitors, including perindopril, in rare cases, can be observed the development of facial angioedema, lips, tongue, uvula upper palate and / or throat. When these symptoms the drug should be discontinued immediately, the patient should be observed for as long as edema symptoms do not disappear completely.
If angioedema affects only the face and lips, its manifestations are usually alone or antihistamines may be used to treat its symptoms. Angioneurotic edema, accompanied by edema of the larynx or tongue may cause airway obstruction and death.
When these symptoms should immediately enter subcutaneously epipefrin (adrenaline) (diluted 1:. 1000 (0.3 or 0.5 ml) and / or to ensure airway patency
in patients with a history of observed angioedema not associated with taking ACE inhibitors may be increased risk of developing cancer while taking the drugs in this group.
In rare cases during treatment with ACE inhibitors develop angioedema bowel edema. Thus, patients have a pain in the abdomen as an isolated symptom or in combination with nausea and vomiting in some cases without prior angioneurotic edema of the face and at normal levels of C1-esterase. Diagnosis is established via CT abdomen, ultrasound or during surgery. Symptoms disappear after discontinuation of ACE inhibitors. In patients with abdominal pain who receive ACE inhibitors in the differential diagnosis should consider the possibility of angioneurotic edema of the intestine.
Anaphylactoid reactions during desensitizing treatments
There are some reports about the development of long-term, life-threatening anaphylactoid reactions in patients receiving ACE inhibitors during desensitizing treatment with poison Hymenoptera (bees, wasps). ACE inhibitors should be used with caution in patients prone to allergic reactions, undergoing desensitization procedure. Avoid destination ACE inhibitor to patients receiving immunotherapy Hymenoptera venom. Nevertheless, development of anaphylactoid reactions can be avoided by temporary discontinuation of ACE inhibitor at least 24 hours prior to the desensitization treatment.
Anaphylactoid reactions during LDL apheresis
In rare cases, patients treated with ACE inhibitors, life-threatening anaphylactoid reactions may develop during LDL apheresis using a dextran sulfate. To prevent anaphylactoid reactions should discontinue therapy with an ACE inhibitor before every LDL apheresis procedure using vysokoprotochnyh membranes.
Hemodialysis
Patients receiving ACE inhibitors during hemodialysis using high flow membranes (for example, AN 69 В® ) anafilaktodnye reactions were noted. It is therefore desirable to use a diaphragm or other type use an antihypertensive drug other pharmacotherapeutic group.
Potassium-sparing diuretics and drugs potassium
The simultaneous use of perindopril and potassium-sparing diuretics, potassium and potassium-containing preparations substitutes edible salt is not recommended.
Cough
The therapy of ACE inhibitor, dry cough can occur which disappears after drug withdrawal in this group. When dry cough should be mindful of possible connection with this symptom receiving ACE inhibitor. If the doctor believes that ACE inhibitor therapy requires the patient receiving Perindid drug can be continued.
Use in Pediatrics
Perindid drug is contraindicated in children and adolescents under the age of 18 years due to a lack of data on efficacy and safety.
The risk of hypotension and / or renal failure (in patients with CHF, disturbance of water-electrolyte balance and other disorders)
When cirrhosis, accompanied by edema and ascites, hypotension, CHF can be observed a significant activation of the renin-angiotensin-aldosterone system (RAAS) especially in severe hypovolemia and decreased content of electrolytes in the blood plasma (in the background the salt-free diet or prolonged use of diuretics).
The use of an ACE inhibitor causes a blockade of the RAAS, in connection with the possible sharp decline in blood pressure and / or increasing the concentration of creatinine in the blood plasma, indicating the development of acute renal failure that often occurs when taking the first dose of the drug or Perindid during the first two weeks of therapy.
Elderly patients
Before taking the drug should Perindid assess renal function and potassium content in the blood plasma. Initial dose Perindid preparation is selected depending on the degree of decrease in blood pressure, particularly when reducing the bcc and CHF (IV NYHA functional class classification). Such measures make it possible to avoid a sharp decrease in blood pressure.
Atherosclerosis
risk of hypotension exists in all patients but particular care should be observed when using the drug Perindid patients with coronary artery disease and cerebrovascular insufficiency. In such patients, treatment should begin with a dose (0.625 mg В± 2 mg) Perindid formulation (initial dose).
renovascular hypertension
Treatment with Perindid patients with diagnosed or suspected renal artery stenosis should be initiated in the hospital with Perindid dose drug (0.625 mg + 2mg) monitoring renal function and potassium in the blood plasma. Have some patients may develop acute renal failure, which is reversible after discontinuation of the drug.
Other risk
patients with CHF (IV NYHA functional class classification) of patients with type 1 diabetes (risk of spontaneous increase in potassium content) is necessary to begin treatment with the initial dose (0.625 mg В± 2 mg) Perindid drug and under medical supervision.
Patients with diabetes mellitus
When assigning preparation Perindid patients with diabetes receiving hypoglycemic agents for oral or insulin, for the first month of therapy is necessary to regularly monitor the concentration of glucose in the blood.
ethnic features
Peripdopril (and other ACE inhibitors), has a less pronounced antihypertensive effect in blacks compared to patients with other races.
Surgery / General anesthesia
Use of ACE inhibitors in patients undergoing surgery with general anesthesia can lead to a marked decrease in blood pressure, particularly when using tools for general anesthesia has a hypotensive effect.
It is recommended to stop taking ACE inhibitors, including perindopril, 12 hours before surgery, alerting the anesthetist the use of ACE inhibitors.
Aortic stenosis / mitral stenosis / Hypertrophic obstructive cardiomyopathy
ACE inhibitors should be used with caution in patients with obstruction of the left ventricular outflow tract.
Liver failure
In rare cases in patients receiving an ACE inhibitor arises cholestatic jaundice, which develops in the progression of liver necrosis fudminantny, sometimes with fatal consequences. The mechanism of development is unclear syndrome. When jaundice or significant increase in liver transaminases in patients receiving an ACE inhibitor reception Perindid preparation should be discontinued.
Anemia
Anemia may develop in patients after renal transplantation or in patients undergoing hemodialysis pa.
Hyperkalemia
may occur during treatment with ACE inhibitors, including and perindopril. Risk factors for hyperkalemia is renal failure, advanced age, diabetes, some comorbid conditions (reduction of BCC, acute heart failure in the stage decompensation, metabolic acidosis), simultaneous reception of potassium-sparing diuretics (such as spironolactone, eplerenone, triamterene, amiloride), and potassium preparations or potassium-salt food substitutes and the use of other drugs that enhance the potassium content in the blood plasma (e.g., heparin). Hyperkalemia can cause serious heart rhythm abnormalities, sometimes with fatal consequences. Combined use of the above formulations must be done with caution.
indapamide
photosensitivity
There are reports of increased photosensitivity in patients receiving thiazide diuretics and tiazipodobnyh. With the development of photosensitivity reactions in patients receiving the drug Perindid treatment should be stopped. If there is a need to resume the use of the drug Perindid should protect exposed skin from direct exposure to the sun and artificial UV rays.
Water and electrolyte balance
in the blood plasma sodium content
Before starting treatment with Perindid necessary to determine the sodium content in the blood plasma and in patients receiving the drug to carry out regular monitoring of electrolytes in the blood plasma. All diuretics can cause hyponatremia, leading to serious complications.
The content of potassium in the blood plasma
Therapy thiazide and thiazide diuretics associated with the risk of hypokalemia (less than 3.4 mmol / L) in patients: the elderly, malnourished patients, patients with liver cirrhosis, peripheral edema, ascites, ischemic heart disease, chronic heart failure . Hypokalemia in these patients increases the toxic effects of cardiac glycosides and increased risk of arrhythmia. High-risk group includes patients with increased interval QTna ECG. Hypokalemia as bradycardia, promotes the development of severe heart rhythm disorders, especially arrhythmia type "pirouette", which can be lethal. In each case, requires regular monitoring of potassium in the blood plasma. The first definition of the content of potassium in the blood plasma must be held during the first weeks of starting therapy with Perindid.
The calcium content in the blood plasma of
thiazide and thiazide diuretics reduce the renal excretion of calcium, leading to a slight and temporary increase in calcium in the blood plasma. Marked hypercalcemia may be the result of hidden hyperparathyroidism.
Before examining the function of the parathyroid glands should stop taking the drug Perindid.
Concentration in plasma glucose
should monitor the concentration of glucose in patients with diabetes.
Uric acid
In patients with an increased concentration of uric acid in blood plasma during therapy with the drug Perindid may increase the frequency of acute gout.
Diuretics and renal function
Hypovolaemia by reducing the bcc or hyponatremia caused by diuretics, early treatment with Perindid may lead to a decrease in glomerular filtration rate and accompanied by increased concentrations of creatinine and urea in plasma.
Athletes
Indapamide may give a positive reaction during the doping control.
Impact on the ability to drive vehicles and manage mechanisms
Be careful when trucks and other control devices that require increased attention and psychomotor speed reactions.
OVERDOSE
Symptoms
The most likely overdose symptoms - marked reduction in blood pressure, sometimes in combination with nausea, vomiting, cramps, dizziness, drowsiness, confusion and oliguria which may progress to anuria (due to hypovolaemia). Also, there may be electrolyte disturbances (hyponatraemia, hypokalaemia).
Treatment
emergency measures to reduce the excretion of the drug from the body: prom
