Diuretics are one of the groups of drugs used in the treatment of hypertension. Indapamide is often prescribed in the complex treatment of arterial hypertension and some cardiovascular diseases; it allows achieving stable and long-term results, including in the elderly.
Composition and release form
Indapamide is produced by different pharmaceutical companies under several names (for example, Indapamide Stada or Teva) in the form:
- long-acting tablets (their name contains the word retard or the letters MB);
- tablets with a special film coating;
- capsules
In all dosage forms, the active ingredient is the same - indapamide. In long-acting tablets, its dosage can be 1.5 mg, and in regular tablets and capsules - only 2.5 mg. Sold in cardboard boxes of 30 or 60 pieces, complete with instructions.
Auxiliary components are represented by colloidal silicon dioxide, magnesium stearate, lactose, microcrystalline cellulose. But each manufacturer has the right to produce medicine using its own technology, so the composition must be specified in the instructions for the product being purchased.
Pharmacodynamics and pharmacokinetics
The main component is indapamide . The drug has a hypotensive effect . The pharmacological properties of the drug Indap are similar to thiazide diuretics; the principle of action is based on a violation of the reabsorption of sodium ions in the cortical region in the loop of Henle. The drug increases the excretion of sodium, chlorine, magnesium, and potassium ions from the body in the urine. The drug selectively blocks “slow” calcium channels, reduces peripheral vascular resistance, and increases the elasticity of vascular walls.
Indap does not affect the level of lipids in the blood plasma or carbohydrate metabolism, which is important in the treatment of patients with diabetes mellitus . Under the influence of indap, the sensitivity of the vascular wall to the action of angiotensin-2 and norepinephrine .
The drug stimulates the production of prostacyclin PgI2, PgE2, reduces the synthesis of stable oxygen and free radicals. High dosages of the drug cause increased diuresis, but do not affect the degree of drop in blood pressure.
With repeated, stable use, the effectiveness of the drug is registered in the second week.
Effect of the drug
Indapamide has a triple effect:
- has a diuretic effect;
- reduces blood pressure;
- dilates blood vessels.
When taking 1.5-2.5 mg of the drug, a hypotensive effect appears, but without a noticeable diuretic effect. This feature allows the drug to be used to lower blood pressure for a long time.
When the dosage is increased, the hypotensive effect does not increase, but the diuretic effect appears.
A noticeable decrease in blood pressure occurs only after 7 days of taking the medicine; a lasting effect can be expected no earlier than after 3 months.
Thanks to the drug, vascular resistance is reduced by reducing the force of contraction of the smooth muscles of the arteries, and the size of the left ventricle of the heart returns to normal.
Pharmacological properties of the drug Indap
Indapamide is a diuretic of moderate action, belongs to the group of non-thiazide sulfonamides, has an antihypertensive effect. The antihypertensive effect occurs only when blood pressure is initially elevated. Reduces the tone of smooth muscle tissue of the arteries, peripheral vascular resistance. It has a moderate saluretic and diuretic effect due to the blockade of reabsorption of sodium, chlorine, water and, to a lesser extent, potassium in the proximal tubules and the cortical segment of the distal tubules of the nephron. In therapeutic doses does not affect lipid and carbohydrate metabolism; does not increase the sensitivity of peripheral tissues to the action of insulin. After oral administration, it is quickly absorbed from the intestines. Bioavailability of the drug is 93%. The half-life is 16 hours. The drug is slowly eliminated, mainly by the kidneys, mainly in the form of metabolites. The antihypertensive effect develops during the first week with systematic use of the drug.
Indications for use
The instructions for use contain information about what Indapamide helps with. It is prescribed for arterial hypertension, as well as for chronic heart failure caused by sodium and water retention in the body.
The drug does not affect the metabolism of carbohydrates and fats, therefore it is indicated:
- people diagnosed with diabetes;
- patients with high cholesterol;
- people with one kidney or on hemodialysis.
Overdose of the drug Indap, symptoms and treatment
With long-term use or high doses, electrolyte disturbances such as hyponatremia, hypokalemia and hypochloremic alkalosis may occur. Possible nausea, vomiting, hypotension, convulsions, dizziness, drowsiness, polyuria, oliguria and even anuria (as a result of hypovolemia). Treatment: gastric lavage, use of activated carbon with further restoration of water and electrolyte balance in a medical institution, symptomatic therapy.
Indapamide: how and in what doses to take
The method and regimen of use depend on the prescribed dosage of the drug.
- A 2.5 mg tablet is taken once a day in the morning. If the hypotensive effect does not appear within 14 days, then the dose is increased to 2-3 tablets per day. The maximum daily dose is 10 mg, which should be divided into two doses;
- a long-acting tablet of 1.5 mg is taken once a day in the morning, but if the effectiveness is weak, after 1.5-2 months the treatment should be supplemented with a drug that is not a diuretic. With long-term therapy, increasing the dose is not advisable due to the increased risk of side effects without normalizing blood pressure.
To eliminate edema in chronic heart failure, Indapamide is prescribed at a dose of 5-7.5 mg per day for 7-14 days.
Drug interactions Indap
The simultaneous use of Indap and anticoagulants (coumarin derivatives) reduces the effect of the latter. The hypotensive effect is enhanced when taken simultaneously with other antihypertensive drugs. Concomitant use with cardiac glycosides and corticosteroids increases the risk of hypokalemia. Increased hypokalemia is possible when Indap is taken in combination with terfenadine. When taken simultaneously with antiarrhythmic drugs of class Ia (quinidine, disopyramide) and class III (amiodarone, sotalol), there is a risk of arrhythmogenic action against the background of hypokalemia and an increase in the QT . NSAIDs may reduce the antihypertensive effect of indapamide. ACE inhibitors at the beginning of treatment with simultaneous sodium deficiency increase the risk of sudden hypotension or acute renal failure. When taking metformin, there is a risk of lactic acidosis associated with possible renal failure. It is not recommended to prescribe metformin when creatinine levels exceed 15 mg/L in men and 12 mg/L in women. Iodinated contrast agents in high doses in combination with indapamide and with simultaneous dehydration increase the risk of acute renal failure. Imipramine (tricyclic) antidepressants and antipsychotics increase the antihypertensive effect and the risk of orthostatic hypotension. It is not recommended to use Indap in combination with lithium preparations due to the risk of developing the toxic effect of lithium against the background of a decrease in its renal clearance. When taking calcium salts, there is a risk of hypercalcemia. Cyclosporine leads to a risk of increasing plasma creatinine levels.
Is Indapamide safe for pregnant women?
Due to the fact that no serious studies have been conducted on the effect of the drug on pregnant women, tablets and capsules are prohibited during pregnancy. There is a risk of fetoplacental insufficiency, leading to slower fetal development.
The substance can pass into breast milk, therefore, when treating with the drug during lactation, breastfeeding should be stopped.
Indapamide is not suitable for the treatment of physiological edema in pregnancy.
Analogs
Level 4 ATC code matches:
Chlorthalidone
Klopamide
Ravel SR
Indapamide
Arifon
There are a large number of analogues: Arifon , Vazopamide , Indapamide , Indapen , Indapres , Indiur , Lorvas , Ravel , Hemopamide .
Contraindications and side effects
According to the instructions for use of Indapamide, the drug is contraindicated in:
- hypersensitivity to the main substance;
- acute cerebrovascular accident;
- severe diabetes mellitus;
- advanced form of gout;
- serious renal dysfunction;
- severe liver diseases.
Since the substance removes fluid from the body, it can cause dehydration and a decrease in the concentration of potassium and sodium in the body. In rare cases, arrhythmia and hemolytic anemia may occur.
Main side effects:
- allergies (in the form of skin itching, rash, photosensitivity);
- arrhythmia or tachycardia;
- dry mouth and nausea;
- headache and sleep disturbances;
- epigastric pain;
- constipation or diarrhea.
Taking the drug may provoke changes in well-being due to a decrease in blood pressure, so it is better to avoid activities that require special care.
Special instructions for the use of the drug Indap
The drug can be used as monotherapy or in combination with other antihypertensive drugs (beta-adrenergic receptor blockers, calcium channel blockers, ACE inhibitors). If liver function is impaired, thiazide diuretics can cause hepatic encephalopathy. In this case, they must be canceled immediately. Plasma sodium levels Plasma sodium concentrations should be determined before starting treatment and then monitored for changes at regular intervals. Treatment with diuretics may be accompanied by hyponatremia, sometimes with serious consequences, while the decrease in sodium concentration in the blood in the initial stage may be asymptomatic. Therefore, it is recommended to regularly monitor plasma sodium levels, especially in elderly patients and patients with liver cirrhosis. Plasma potassium levels Long-term use of thiazide and similar diuretics is associated with a risk of decreased plasma potassium concentrations and the development of hypokalemia. This is especially true for older people; patients who are simultaneously taking another drug; patients with cirrhotic ascites accompanied by edema; exhausted patients and patients with coronary vascular diseases and cardiac dysfunction, that is, predisposed to cardiac arrhythmia. Hypokalemia can cause severe arrhythmias, including fatal ventricular tachycardia (torsade de pointe). In connection with the above, it is necessary to monitor the level of potassium in the blood plasma as often as possible and prevent the occurrence of hypokalemia. Plasma calcium levels Thiazide and similar diuretics may reduce urinary calcium excretion, which may result in a slight temporary increase in plasma calcium concentrations. Hypercalcemia may also be a consequence of previously undiagnosed hyperparathyroidism. In this case, treatment should be suspended and the function of the parathyroid glands should be examined. Blood glucose levels In patients with diabetes, especially in the presence of hypokalemia, it is necessary to control blood glucose levels. Uric acid level In patients with elevated concentrations of uric acid, gout attacks are possible, so the dose of the drug should be controlled depending on the level of uric acid in the blood plasma. Thiazide and similar diuretics are most effective only with normal or minimally reduced renal function (plasma creatinine level ≤25 mg/l, i.e. 20 µmol/l in adults). Dehydrated patients are at risk of developing acute renal failure, so the patient needs to drink plenty of fluids at the beginning of treatment. Hypovolemia caused by loss of water and sodium, when treated with diuretics, reduces glomerular filtration, which is sometimes accompanied by an increase in plasma urea and creatinine levels. In patients with normal renal function, such temporary renal failure usually does not lead to serious consequences, however, its occurrence can significantly worsen existing renal failure. Indapamide may give a positive reaction to doping tests.
