Composition, form of production and packaging
Tablets of white color, round, flat-cylindrical with bevelled edges; on one side an engraving "C63".
1 tab.
perindopril erbumine 2 mg
indapamide 0.625 mg
Excipients: microcrystalline cellulose (type 102) 26.605 mg, lactose monohydrate 200 mesh 15 mg, lactose monohydrate 80 mesh 45 mg, silicon dioxide colloid 0.27 mg, magnesium stearate 0.5 mg.
10 pieces. - blisters aluminum bilateral (3) - packs cardboard.
Tablets of white color, round, flat-cylindrical with bevelled edges; on one side an engraving "C64".
1 tab.
perindopril erbumine 4 mg
indapamide 1.25 mg
Excipients: microcrystalline cellulose (type 102) 23.98 mg, lactose monohydrate 200 mesh 15 mg, lactose monohydrate 80 mesh 45 mg, silicon dioxide colloid 0.27 mg, magnesium stearate 0.5 mg.
10 pieces. - blisters aluminum bilateral (3) - packs cardboard.
INSTRUCTION FOR THE SPECIALIST.
Description of the drug approved by the manufacturer for the printed edition of 2013.
PHARMACHOLOGIC EFFECT
Perindopril-Indapamide Richter is a combination of perindopril erbumine and indapamide. The combination of perindopril and indapamide has a dose-dependent antihypertensive effect on diastolic and systolic blood pressure in a supine and standing position, regardless of age. The effect of the drug persists for 24 hours. A persistent therapeutic effect develops less than 1 month after the initiation of therapy and is not accompanied by tachycardia. The termination of treatment is not accompanied by the development of the "withdrawal" syndrome.
Perindopril
The angiotensin-converting enzyme (ACE) inhibitor reduces the formation of angiotensin II from angiotensin I. Reducing angiotensin II leads to a direct reduction in the release of aldosterone. Reduces the degradation of bradykinin and increases the synthesis of prostaglandins. Reduces the overall peripheral vascular resistance, blood pressure, preload, pressure in the pulmonary capillaries, causes an increase in the minute volume of blood and increased tolerance of the myocardium to loads in patients with chronic heart failure. Expands arteries more than veins. Some effects are explained by the effect on the tissue renin-angiotensin-aldosterone system.With prolonged use, myocardial hypertrophy and the walls of arteries of resistive type decrease. Improves blood flow to the myocardium in ischemic conditions.
ACE inhibitors prolong life expectancy in patients with chronic heart failure, slow the progression of left ventricular dysfunction in patients who underwent myocardial infarction without clinical manifestations of heart failure.
The maximum antihypertensive effect develops 4-6 hours after a single dose and remains at least throughout the day: the ratio of the residual effect and the maximum is about 80%. In patients who responded to treatment, blood pressure normalizes within a month and persists for a long period of time without the development of tachycardia. After discontinuation of perindopril, the "cancellation" syndrome does not occur.
Indapamide
Indapamide refers to sulfonamide derivatives containing an indole ring. According to its pharmacological properties, it is close to thiazide diuretics, whose action is related to the inhibition of the reabsorption of sodium ions in the cortical segment of the nephron loop. Indapamide increases the excretion of sodium, chlorine and, to a lesser extent, ions of potassium and magnesium by the kidneys, which is accompanied by increased diuresis. Indapamide has an antihypertensive effect in doses that do not have a pronounced diuretic effect. In addition, the antihypertensive effect is associated with the ability of the drug to increase the elasticity of the walls of the arteries and reduce the overall peripheral vascular resistance (OPSS).
The mechanism of action of indapamide is due to the change in the transmembrane current of ions (primarily calcium), which leads to relaxation of smooth muscle cells of the vessels, and also to the increased synthesis of prostaglandins PGE 2 and prostacyclin PGI 2 (vasodilator and platelet aggregation inhibitor).
Indapamide reduces the hypertrophy of the left ventricle of the heart.
In monotherapy, a persistent antihypertensive effect develops, persisting for 24 hours; with a moderate increase in diuresis.
Regardless of the duration of use, indapamide does not affect lipid profile in the blood plasma (triglycerides, low-density lipoprotein cholesterol (LDL cholesterol), high-density lipoprotein cholesterol (HD / HDL)). Indapamide does not affect the parameters of carbohydrate metabolism (including in patients with arterial hypertension and diabetes mellitus).
Has a therapeutic effect in doses that do not have a pronounced diuretic effect.
When using indapamide in high doses, the antihypertensive effect does not increase, but diuresis increases.
Perindopril + Indapamide
The combination of perindopril and indapamide in a single drug can prevent the development of unwanted side effects caused by one of the active substances. Thus, an ACE inhibitor leads to a reduction in the risk of hypokalemia in a diuretic.
PHARMACOKINETICS
When the combined administration of perindopril and indapamide does not change their pharmacokinetic properties in comparison with the separate intake of these drugs.
Perindopril
After oral administration, perindopril is rapidly absorbed, C max in the blood plasma is reached for 1 h. T 1/2 - 1 h. Perindopril is a prodrug. 27% of the total amount of adsorbed perindopril is determined in the blood in the form of the active metabolite - perindoprilata. In addition to the active metabolite - perindoprilata - perindopril forms 5 inactive metabolites. C max perindoprilata in blood plasma is achieved 3-4 hours after ingestion. Eating food slows down the conversion of perindopril to perindoprilat, and, consequently, the bioavailability of the drug, therefore perindopril erbumin should be taken once, in the morning, before meals. Between the dose of perindopril and its concentration in the blood plasma there is a linear relationship. V d of unbound perindoprilata is approximately 0.2 l / kg. The binding of perindoprilat to plasma proteins, mainly with ACE, is 20%, but this value depends on the concentration.
Perindoprilat is excreted from the body by the kidneys. The final T 1/2 is several hours, the stage of equilibrium concentration in the blood plasma begins 4 days after the start of treatment.
The excretion of perindoprilat in elderly patients, as well as in cardiac and renal insufficiency, is slowed down. If the renal function is impaired, depending on its severity (creatinine clearance), a dose adjustment is required. The dialytic clearance of perindoprilat is 70 ml / min. The kinetics of perindopril changes in patients with cirrhosis of the liver: their hepatic clearance of perindopril is halved. Nevertheless, the amount of perindoprilat formed does not decrease, so such patients do not need to adjust the dose.
Indapamide
Indapamide is rapidly and completely adsorbed from the digestive tract. C max in blood plasma in humans is observed after 1 hour after oral administration of the drug.
T 1/2 is 14-24 hours (on average, 18 hours). When you re-take the drug cumulation in the body does not occur. Indapamide is excreted in the form of inactive metabolites, mainly by the kidneys (70%), and also through the intestine (22%). Pharmacokinetics in patients with renal insufficiency does not change.
INDICATIONS
- Essential arterial hypertension (in patients who are shown combined therapy).
DOSING MODE
Inside, preferably in the morning, on an empty stomach, 1 tablet of Perindopril-Indapamide Richter in accordance with the selected dose 1 time / day.
The appointment of a combined preparation in a certain dose is possible after titration of the dose for individual components of the drug in monotherapy. If there is a therapeutic effect, you should consider switching from monotherapy to treatment with Perindopril-Indapamid Richter.
In elderly patients
Treatment should be started taking into account the decrease in blood pressure and kidney function.
With renal insufficiency
In severe renal failure (creatinine clearance less than 30 ml / min), treatment with Perindopril-Indapamide Richter is contraindicated. With moderate renal failure (creatinine clearance of 30-60 ml / min), it is recommended to start therapy with a combination drug, depending on blood pressure. Patients with creatinine clearance above 60 ml / min do not need dose adjustment with regular monitoring of creatinine concentration and potassium content.
With hepatic insufficiency
In severe violations of liver function, treatment with this drug is contraindicated.
With moderate hepatic insufficiency, dose adjustment is not required.
Children and teenagers under 18 years old
Perindopril-Indapamide Richter should not be taken to children and adolescents because the efficacy and safety of perindopril and indapamide in this age group, alone or in combination with other active substances, have not been studied.
SIDE EFFECT
The side effects listed below are presented according to the system-organ classes according to the MedDRA classification and with the following frequency: frequent (from? 1/100 to <1/10); rare (from? 1/10000 to <1/1000); very rare (<1/10000)
From the cardiovascular system: rare - excessive reduction in blood pressure, orthostatic hypotension.
From the nervous system: rare - paresthesia, headache, weakness, dizziness, sleep disorders, mood lability.
On the part of the respiratory system, the organs of the thoracic label and the mediastinum: frequent - dry persistent cough, which disappears with the abolition of ACE inhibitors.
From the digestive system: frequent - constipation, dry mouth, nausea, abdominal pain, anorexia, a violation of taste; very rare - pancreatitis. Patients with hepatic insufficiency may develop hepatic encephalopathy.
From the skin and subcutaneous tissue: rare - in patients predisposed to allergic reactions, there may be increased sensitivity, mainly in the form of dermatological reactions: skin rash, maculopapular eruptions, purpura, exacerbation of the systemic lupus erythematosus; very rare - angioneuroticeski edema (angioedema).
From the osteomuscular system and connective tissue: rare - convulsions.
Laboratory indicators: as a result of taking perindopril in combination with indapamide, hypokalemia may develop (the content of potassium in the blood plasma is less than 3.4 mmol / l), especially in patients with diabetes mellitus or kidney failure. Possible reduction of sodium in the blood plasma and hypovolemia due to dehydration and orthostatic hypotension; increased concentrations of uric acid and glucose in the blood; a slight increase in the concentration of creatinine in urine and in blood plasma, reversible after discontinuation of the drug, most likely with stenosis of the renal arteries, treatment of arterial hypertension with diuretics, renal failure; increase in potassium content (usually temporary); rare - elevated calcium in the blood plasma; very rare - thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia, hemolytic anemia, in some patients (after kidney transplantation, in patients undergoing hemodialysis), an anemia may develop with the ACE inhibitor.
CONTRAINDICATIONS
- hypersensitivity to perindopril or other ACE inhibitors, indapamide and other sulfonamide derivatives, other components of the drug;
- angioedema (Quincke's edema) in an anamnesis with the administration of ACE inhibitors;
- hereditary / idiopathic angioedema;
- Pregnancy;
- severe renal failure (creatinine clearance less than 30 ml / min);
- hepatic encephalopathy;
severe hepatic impairment;
- hypokalemia;
- simultaneous use with antiarrhythmic drugs at risk of arrhythmia such as "pirouette";
- the period of breastfeeding;
- the preparation contains lactose. Perindopril-Indapamide Richter should not be taken in patients with lactase deficiency, lactose intolerance, galactosemia, or glucose / galactose malabsorption syndrome;
In view of the lack of therapeutic experience, the drug Perindopril-Indapamid Richter should not be prescribed:
- patients on dialysis;
- patients with chronic heart failure IV functional class according to the NYHA classification in the stage of decompensation.
Caution: Aortic stenosis / hypertrophic obstructive cardiomyopathy, bilateral stenosis of the renal arteries, stenosis of the single kidney artery, stenosis of the kidney, kidney failure (creatinine clearance more than 30 ml / min), primary hyperaldosteronism, arterial hypotension, renovascular hypertension, bone marrow hypoplasia, hyponatremia (increased risk of developing hypotension in patients on a low-salt or salt-free diet), hypovolemic conditions (including diarrhea, vomiting), systemic connective tissue diseases (including systemic lupus erythematosus, scleroderma), diabetes mellitus, gout, oppression of bone marrow hematopoiesis, hyperuricemia, hyperkalemia, coronary heart disease, cerebrovascular diseases (including cerebral circulatory insufficiency), severe chronic heart failure (NYHA class III functional class), hepatic impairment, advanced age.
PREGNANCY AND LACTATION
Pregnancy
Do not use during the first trimester of pregnancy. When identifying the fact of pregnancy or when planning it as early as possible should go to an alternative method of treatment.
Controlled studies in humans have not been carried out, however, there have been no data on the fetotoxicity of the drug and the development of pathologies described below, among the particular cases of the use of ACE inhibitors in the first trimester of pregnancy.
Application Perindopril-Indapamid Richter in the second and third trimesters of pregnancy is contraindicated.
Long-term use of ACE inhibitors in the second and third trimester of pregnancy affects the development of a growing fetus. Toxic effect in the prenatal period is expressed in a decrease in the function of the kidneys, lack of hydration, inhibition of the process of ossification of the skull; in the neonatal period, it manifests itself as a violation of kidney function, hypotension, hyperkalemia.
With continued exposure to thiazides in the third trimester of pregnancy, the volume of circulating blood in the mother can decrease, as can the uteroplacental blood circulation, resulting in fetoplacental ischemia and fetal growth.
In addition, in rare cases, neonates with short-term exposure may develop hypoglycemia and thrombocytopenia.
If it is necessary to appoint in the second trimester and later in pregnancy, the use of the drug should be accompanied by ultrasound monitoring of the state of renal function and the skull.
Breastfeeding period
The use of the drug Perindopril-Indapamid Richter during the period of breastfeeding is contraindicated.
Studies of the isolation of the drug with breast milk have not been carried out, but it is known that indapamide is excreted in breast milk. Indapamide for pharmacological properties is close to thiazide diuretics, which are known to reduce and even inhibit the production of breast milk. Also, there may be increased sensitivity to sulfonamide drugs, hypokalemia and nuclear jaundice. Possible severe adverse reactions in infants who are breastfed, whose mothers take any of the above components, so breastfeeding or treatment (given the importance for the mother) should be discontinued.
APPLICATION FOR FUNCTIONS OF THE LIVER
In severe renal failure (creatinine clearance less than 30 ml / min), treatment with Perindopril-Indapamide Richter is contraindicated. With moderate renal failure (creatinine clearance of 30-60 ml / min), it is recommended to start therapy with a combination drug, depending on blood pressure. Patients with creatinine clearance above 60 ml / min do not need dose adjustment with regular monitoring of creatinine concentration and potassium content.
APPLICATION FOR VIOLATIONS OF THE FUNCTION OF KIDNEYS
In severe violations of liver function, treatment with this drug is contraindicated.
With moderate hepatic insufficiency, dose adjustment is not required.
APPLICATION FOR CHILDREN
Perindopril-Indapamide Richter should not be taken to children and adolescents because the efficacy and safety of perindopril and indapamide in this age group, alone or in combination with other active substances, have not been studied.
APPLICATION IN ELDERLY PATIENTS
Treatment in elderly patients should be started taking into account the decrease in blood pressure and kidney function.
SPECIAL INSTRUCTIONS
Common for perindopril and indapamide
Lithium
It is not recommended to appoint perindopril and indapamide in combination with lithium preparations. Associated with perindopril
The risk of developing neutropenia / agranulocytosis in patients with immunodeficiency
The risk of developing neutropenia directly depends on the dose and on the drug taken, as well as the clinical state of the patient. In patients without comorbidities neutropenia occurs rarely, the risk of its development is increased in patients with renal insufficiency, systemic connective tissue diseases, such as systemic lupus erythematosus, scleroderma, and immunosuppressive treatment. This state is reversible after discontinuation of ACE inhibitors (including perindopril). Strict compliance with the regulations on the treatment dosage of the drug is the best way to avoid the development of complications described.
Thus, assigning these patients ACE inhibitor (including perindopril) should be carefully weighed against the expected benefit and risk.
Angioedema (Quincke's edema)
Angioedema, extremities, lips, tongue, larynx and / or the vocal cords in patients treated with ACE inhibitors (including perindopril) is rare. In such cases, treatment should cease immediately perindopril, of the patient should be monitored until the complete disappearance of edema.
Angioedema, which is localized in the face and lips are usually requires no special treatment. Antihistamines may be employed for relieving symptoms.
When combined with laryngeal edema angioedema is life-threatening. Edema tongue, laryngeal or vocal cord can develop airway obstruction. When these symptoms should immediately enter epinephrine solution subcutaneously (epinephrine) at a dilution of 1: 1000 (0.3 ml to 0.5 ml) in combination with other appropriate measures. Subsequently should be avoided in these patients ACE inhibitors.
Patients with a history of angioneurotic edema, non-reception of ACE inhibitors, development angioedema taking ACE inhibitors (including perindopril) is significantly more likely.
Anaphylactoid reactions to insect bites
In some cases, desensitization against allergens Hymenoptera therapy (ACE inhibitors accompanied by hypersensitivity reactions. Such can be avoided by previously temporarily interrupt the reception of ACE inhibitors.
Hemodialysis
Hemodialysis, which uses vysokoprotochnyh membrane (polyacryl-nitrile) can lead to anaphylactic reactions in patients taking ACE inhibitors (swelling of the tongue and lips, accompanied by shortness of breath and blood pressure reduction). It should be avoided combination with hemodialysis ispol'uet mations vysokoprotochnyh (polyacryl-nitrile) membrane treatment, and ACE inhibitors (including perindopril).
Potassium-sparing diuretics, potassium salts
Not recommended simultaneous application of perindopril and potassium-sparing diuretics with potassium salts.
Related to indapamide
If abnormal liver function receiving thiazide diuretics may cause hepatic encephalopathy. In the event of such complications diuretic should be stopped immediately.
Sultopride
not recommended to combine the use of indapamide and sultopride.
Common to perindopril and indapamide
Renal insufficiency
In severe renal failure (creatinine clearance <30 mL / min) using the product Perindopril Indapamide-Richter contraindicated.
With the development of clinical manifestations of renal function in a patient, or identifying evidence of renal failure laboratory data, treatment should cease. Subsequently, therapy may be continued or in a smaller dose or a component of the drug for regular monitoring of concentration of creatinine and potassium content - after two weeks of starting treatment and then every two months. Cases of renal failure is reported, primarily in patients with chronic heart failure or underlying disease leading to renal insufficiency, including renal artery stenosis.
In bilateral renal artery stenosis or stenosis of the artery only functioning kidney to treat drug Perindopril-indapamide Richter is not recommended.
Hypotension and disruption of water-electrolyte balance
under reduced sodium content (especially in patients with renal artery stenosis) may sudden onset of arterial hypotension. The risk of excessive reduction of blood pressure is elevated in patients with reduced circulating blood volume that is marked in compliance with a strict salt-free diet, hemodialysis, as well as vomiting and diarrhea.
It is necessary to systematically monitor the appearance of the symptoms and reduce the BCC violations of water-electrolyte balance, on a regular basis to determine the content of electrolytes in the blood serum.
Transient hypotension when first taking the drug-Perindopril Indapamide Richter is not a contraindication to further continue the therapy.
After restoration of blood pressure and BCC can resume therapy using low dose combinations of perindopril and indapamide or drugs used in monotherapy.
The content of potassium ions
when taken concomitantly drug-Perindopril Indapamide Richter possible development of hypokalemia, especially in patients with diabetes and renal failure. As with any admission combined antihypertensive preparation containing diuretic should regularly monitor the content of potassium in the blood plasma.
lactose monohydrate
Note that Perindopril-indapamide Richter contains lactose monohydrate. Consequently Perindopril Indapamide-Richter should not be taken in patients with lactase deficiency, lactose intolerance syndrome glucose / galactose malabsorption.
Perindopril
Cough
Against the background of ACE inhibitor therapy may be a dry cough. Cough is long preserved in patients receiving drugs in this group and disappears after their withdrawal. When the patient dry cough be aware of a possible connection with reception of this symptom ACE inhibitor. If the doctor believes that the ACE inhibitor is necessary patient taking the drug can be continued (this is important in the differential diagnosis of cough!).
Perindopril (and other ACE inhibitors), has a less pronounced hypotensive effect in blacks compared to patients with other races.
Children and adolescents under 18 years of
data on the efficacy and safety of perindopril and indapamide in this age group, both separately and in combination with other active ingredients, have not been studied.
Gipotepzii risk of arterial and / or renal insufficiency (in cases of chronic heart failure, disorders of water-eletrolitnogo balance, etc.):
In patients with an initial decrease in blood pressure and the presence of renal artery stenosis, congestive heart failure or cirrhosis of the liver accompanied by edema and ascites, there is activation of the renin-angiotensin-aldosterone system. This activation is particularly pronounced with hypovolemia and fluid and electrolyte disturbances (subject to strict low sodium diet or prolonged treatment with diuretics).
As a result, there may be a marked reduction of blood pressure and / or increase in plasma creatinine concentration, which is evidence of renal failure. In rare cases, the disease can occur acutely and long lasting. Treatment should start with a low dose and gradually increase them.
Elderly patients
Treatment should begin after a preliminary study of potassium and renal function. The initial dose is selected taking into account the degree of decrease in blood pressure, considering the possible reduction in the circulating blood volume and disturbance of water-electrolyte balance. These measures will help to avoid a sharp decrease in blood pressure.
Atherosclerosis
risk of hypotension exists in all patients but particular attention to his demand patients with ischemic heart disease or cerebrovascular insufficiency. In this case, treatment should be initiated at a lower dose.
renovascular hypertension
Treatment for renovascular hypertension is revascularisation. However, the use of ACE inhibitors has a beneficial effect in patients is expected to surgical intervention, and in the case where surgical intervention is impossible. Treatment should start with a low dose of the drug, in the hospital for regular monitoring of renal function and potassium content, because the acute renal failure may occur in some patients. This condition was reversible cases of treatment.
Other risk groups
Patients with severe heart failure (IV NYHA functional class classification) or to patients with type I diabetes mellitus (danger of the spontaneous increase of potassium content) treatment should be started with a low dosage and under constant medical supervision. Patients with hypertension and chronic heart failure should not stop taking beta-blockers: ACE inhibitors should be used in combination with beta-blockers.
Anemia
Anemia can develop in patients after renal transplantation or in patients undergoing dialysis.
Decrease in hemoglobin is greater, the higher its initial figure. This effect was not dose-dependent, but may be related to the mechanism of action of ACE inhibitors.
The slight decrease in hemoglobin observed for 1-6 months, at which it remains stable and fully recovers after drug withdrawal. Treatment may be continued, subject to regular monitoring of blood hemoglobin.
Surgery / general anesthesia
ACE inhibitors can cause a marked reduction of blood pressure during general anesthesia, especially when administered anesthetic potentially has hypotensive properties. It is recommended to stop taking ACE inhibitors, long-acting, including perindopril, 12 hours before surgery.
Aortic stenosis, hypertrophic obstructive cardiomyopathy
Precautions should be prescribed ACE inhibitors in patients with left ventricular obstruction of the excretory tract.
Liver failure
In rare cases, ACE inhibitors is associated with a syndrome that starts with cholestatic jaundice transformed into fulminant hepatitis, necrotizing (sometimes) is fatal. The mechanism of this condition is not detected. Patients receiving ACE inhibitors who revealed jaundice, or a significant increase in the activity of "liver" enzymes, should stop taking the ACE inhibitor and receive appropriate medical examination.
hyperkalemia
In some patients treated with ACE inhibitors, including perindopril, there was an increase potassium in the blood serum. In patients with renal insufficiency, diabetes mellitus, and those receiving concomitant treatment with potassium-sparing diuretics, potassium-supplements or potassium-containing salt substitutes, there is the risk of hyperkalemia. At risk are also patients (take other medicines that raise the potassium content (e.g., heparin). Simultaneous use of the aforementioned drugs is permitted (in case of extreme need for regular monitoring the potassium content in the blood serum. The drug is not recommended for use in cases of high contents potassium I blood.
Indapamide
Hyponatremia
Before and during treatment is necessary to control the plasma sodium content in the future, such studies should be conducted regularly. Taking any diuretic medications may reduce the sodium content in the blood plasma, in some cases without symptoms, which in turn contributes to the development of a number of serious complications. Hyponatremia most commonly occurs in patients at risk, such as elderly patients or patients with liver cirrhosis.
potassium content
In the treatment of thiazide and thiazide diuretics should consider the possibility of hypokalemia. Do not allow the reduction of potassium content below 3.4 mmol / l in the elderly and / or infirm people, regardless of their use of several drugs, cirrhosis patients accompanied by edema and ascites of patients with coronary artery disease or cardiac insufficiency. This category of patients are at increased risk.
Reducing potassium content increases the risk of cardiac arrhythmias. For high-risk group includes patients with elongated QT interval on the electrocardiogram. Hypokalemia as bradycardia, promotes the development of severe cardiac rhythm until arrhythmia type "pirouette" which may lead to death. In any case, regular monitoring of potassium in the blood plasma, the first study carried out a week after the start of treatment. In identifying the reduction of potassium content in blood plasma is required dose correction.
The calcium content
Receiving thiazide and thiazide diuretics can decrease calcium excretion by the kidneys, which leads to a temporary and moderately pronounced increase in calcium in the blood plasma. In the case of undiagnosed hyperparathyroidism increase of calcium in the blood plasma can be significant. In this case, treatment should be discontinued before the end of the research function of the parathyroid glands.
Blood glucose
monitoring this indicator is important for patients with diabetes, especially against the background of hypokalemia.
Uric acid
in patients with high concentrations of uric acid in the blood plasma increased likelihood of developing gout or worsening its latent form.
Renal function and diuretics
The full effectiveness of thiazide and thiazide diuretics occurs only under normal renal function. They are also effective in creatinine level below 25 mg / L, i.e., 220 m mol / l in adults.
When calculating creatinine clearance (CC) in the blood plasma of elderly by Cockcroft taken into consideration the age, weight and sex of the patient:
QC = (140 - age) x weight / 0.814 x creatinine concentration in blood plasma,
where: age expressed in years, body weight - in kilograms creatinine concentration in plasma - in mmol / l.
This formula is suitable for patients of elderly male. When calculating the index for women used a correction factor of 0.85.
Early treatment of hypovolemia due to loss of water and sodium marked decrease in glomerular filtration rate. As a result, this can increase the concentration of urea and creatinine in serum.
This temporary functional renal failure has no effect on renal function in patients with normal renal function, but, nevertheless, may exacerbate an existing renal dysfunction.
Athletes
Indapamide may give a positive reaction to the doping control.
Effects on ability to drive vehicles and working with machinery
Neither indapamide or perindopril as monotherapy, or in combination with each other does not adversely influence the reaction rate. However, some patients may experience episodes of hypotension, which may adversely affect the ability to operate machinery that require high speed physical and mental reactions (especially at the beginning of treatment or in combination with other antihypertensive drugs).
OVERDOSE
Symptoms: marked decrease in blood pressure, nausea, vomiting, cramps, dizziness, insomnia, oliguria (due to hypovolemia may go into anuria), electrolyte disturbances.
Treatment: gastric lavage, administration of activated charcoal. In case of significant decrease in blood pressure to the patient should be given a horizontal position with legs elevated. Correction fluid and electrolyte balance. If necessary, take place in / infusion IZOTON
