Indapamide-retard

Indapamide retard is a cardiovascular drug from the category of non-thiazide diuretics with moderate intensity of action. Contains sulfonamides.

[ 1 ], [ 2 ]

Indications Indapamida-retard

It is used for primary hypertension.

[ 3 ]

Release form

The substance is released in tablets, 10 pieces each, packed in a blister plate. Inside the pack there are 2 plates with tablets.

[ 4 ], [ 5 ]

Pharmacodynamics

The drug has diuretic and hypotensive properties. It is a representative of the category of hypotensive/diuretic drugs - indolines (sulfonamide derivative). It has a moderate saluretic and diuretic effect, due to the slowing down of the processes of reabsorption of sodium ions inside the cortical loop segment of the nephron, and in addition to this, an increase in the excretion of sodium ions and chlorine, as well as, in smaller quantities, magnesium with potassium with urine, which results in an antihypertensive effect.

At the same time, when developing a hypotensive effect, the effect exerted on the transmembrane movement of ions (primarily calcium) into smooth muscle vascular cells is very important, as a result of which they relax, and peripheral vascular resistance decreases. In addition, Indapamide retard reduces the sensitivity of vascular membranes with respect to norepinephrine with angiotensin 2, helps to enhance the binding of antiaggregatory and vasodilatory PG (PGE2 and PGI2) and reduces left ventricular hypertrophy inside the heart.

When used in a dose of 0.0015 g per day, the drug causes a prolonged hypotensive effect lasting 24 hours, and along with this a weak diuretic effect. If the dosage is increased, there is no noticeable increase in the hypotensive effect, but the diuretic effect increases. Therapeutic doses of the drug have almost no effect on the processes of carbohydrate and lipid metabolism.

Pharmacokinetics

The medicinal form of the drug promotes uniform and gradual release of the substance fraction inside the gastrointestinal tract, where it is absorbed at high speed and completely. The drug reaches blood Cmax values approximately 12 hours after oral administration of a single dose of 0.0015 g. After repeated administration of the drug, the variation in plasma levels of indapamide in the interval between the use of subsequent doses decreases. Food intake reduces the rate of absorption, but does not affect its extent.

The bioavailability index is 93%, and protein synthesis inside the plasma is approximately 79%. The medicinal component can be absorbed by erythrocytes. The drug reaches equilibrium values after 1 week of continuous use. It passes through histohematic barriers (including the placenta), and also into mother's milk.

The biotransformation of the substance occurs inside the liver, and its excretion in the form of inactive metabolic products occurs to a greater extent through the kidneys - 70%. 22% of the substance is excreted through the intestines. The half-life is 14-24 hours.

[ 6 ]

Dosing and administration

It is recommended to take the medication once a day, in the morning, in the amount of 1 tablet (volume 0.0015 g). It should be swallowed whole, washed down with plain water (0.5 glass). The tablet should not be crushed or chewed. The above dosage is the maximum that is allowed to be used per day.

[ 10 ]

Use Indapamida-retard during pregnancy

Indapamide retard is not prescribed to pregnant or breastfeeding women.

Contraindications

Main contraindications:

• the presence of intolerance to the drug;
• severe renal or hepatic insufficiency;
• hepatic form of encephalopathy;
• hypokalemia.

[ 7 ]

Side effects Indapamida-retard

The use of drugs may lead to the development of certain side effects:

• water-salt imbalance: hyponatremia or -kalemia may appear occasionally, against which hypovolemia, dehydration and orthostatic collapse develop. With simultaneous loss of chlorine, a metabolic form of alkalosis may sometimes occur, which has a compensatory nature. The calcium level may also increase occasionally;
• metabolic disorders: increased levels of glucose and urea in the blood plasma;
• problems with hematopoietic function: leukopenia or thrombocytopenia, as well as agranulocytosis, occasionally appear;
• digestive disorders: constipation, nausea or dry mouth occasionally occur. Pancreatitis occurs occasionally. People with liver failure may develop liver encephalopathy;
• lesions affecting the nervous system: dizziness, asthenia, fatigue, headaches, asthenia and paresthesia occasionally appear (often disappear when the dosage is reduced);
• allergic symptoms: people with a predisposition to developing allergies or asthma attacks may develop a rash on the epidermis. Rarely, a hemorrhagic form of vasculitis or an exacerbation of DLE is observed;
• Disorders of the cardiovascular system: a decrease in blood pressure or arrhythmia is occasionally observed.

[ 8 ], [ 9 ]

Overdose

Signs of overdose: strong diuretic effect, EBV disorder (development of hypokalemia or -natremia), vomiting, convulsions, feeling of confusion or drowsiness, nausea, dizziness and decreased blood pressure, as well as polyuria or oliguria, reaching the development of anuria.

For therapy of disorders, gastric lavage is performed, activated carbon is prescribed, and further rehydration treatment with correction of electrolyte parameters is carried out. Symptomatic measures are also carried out.

[ 11 ], [ 12 ]

Interactions with other drugs

It is forbidden to combine with lithium medications, because in such cases the blood level of lithium may increase.

The drug should not be combined with vincamine, sultopril and halofantrine, as well as with terfenadine, pentamidine, astemizole and bepridil. Also on this list are intravenous erythromycin, sotalol, antiarrhythmic drugs of category 1α and amiodarone. Combined use with GCS, laxatives that have a stimulating effect on intestinal peristalsis, potassium-lowering drugs, including intravenous amphotericin B, and tetracosactide is prohibited - because this can provoke hypokalemia or severe cardiac arrhythmia.

Tetracosactide and GCS cause sodium and fluid retention, which weakens the antihypertensive effect of indapamide.

Combination of Indapamide retard with NSAIDs (systemic) or salicylates (in large doses) can reduce the antihypertensive effect of indapamide and lead to the development of renal failure in the acute stage due to a sharp decrease in glomerular filtration.

The combination of the drug with CG may potentiate the cardiotoxic properties of the latter.

The antihypertensive effect of the drug is enhanced when combined with baclofen.

An increase in the diuretic effect of indapamide, together with a potentiation of negative symptoms (hyper- and hypokalemia), is observed when combined with potassium-sparing diuretics, especially in diabetics or individuals with renal insufficiency.

The antihypertensive properties of the drug are enhanced when used simultaneously with other antihypertensive agents or tricyclics from the imipramine category.

Combination of the drug with ACE inhibitors, if the patient has hyponatremia, increases the likelihood of a sudden decrease in blood pressure or the development of acute renal failure. For this reason, such combination therapy should be started with small doses of ACE inhibitors with subsequent gradual increase. Renal function should be constantly monitored during the course of treatment.

It is prohibited to combine medications with metformin if creatinine levels are below 15 mg/l (men) or 12 mg/l (women).

Combination of Indapamide retard with calcium drugs may lead to hypercalcemia.

Combination with cyclosporines increases blood creatinine values even with optimal sodium ion and water levels.

When using radiocontrast drugs containing iodine (especially in large doses), the likelihood of renal failure increases.

[ 13 ], [ 14 ], [ 15 ], [ 16 ]

Storage conditions

Indapamide retard should be stored in a dry and dark place, out of reach of children. Temperature level – within 15-25°С.

[ 17 ], [ 18 ], [ 19 ]

Shelf life

Indapamide retard can be used within 36 months from the date of manufacture of the therapeutic agent.

[ 20 ], [ 21 ]

Application for children

The medicine is not used in pediatrics – persons under 18 years of age.

[ 22 ]

Analogues

The analogs of the drug are the drugs Indapamide, Indap, Arifon with Ravel SR, as well as Arifon retard, 5 days and Indapamide-teva with Indapamide retard-teva.

[ 23 ], [ 24 ]

Reviews

Indapamide-retard helps to normalize blood pressure indicators, and also has a mild diuretic effect. These are the advantages of the drug that are mentioned in reviews about it.

The disadvantages include the presence of negative symptoms.