Indopress

Indopres - sulfonamide diuretic drug with a minimum degree of exposure and active hypotensive effects.

Indications Indopresa

It is used to increase the values of blood pressure, which has a diverse nature.

Release form

The release of the drug is realized in tablet form (2.5 mg volume), inside cellular packages, 10 pieces each. In the box - 3 packs of pills.

Pharmacodynamics

The drug at the renal level affects the cortical zone of the ascending knee in the area of the loop of Henle, as well as the initial phase of the distal tubules.

The basis of the structure of the drug is the indole ring. The drug mainly has the function of peripheral arterial vasodilation, which leads to the development of a hypotensive effect. It has a high degree of lipophilicity, which is why it goes well inside of many tissues with organs.

Hypotensive effect:

• a change in the transmembrane movement of the Ca element causes a decrease in the number of contractions of the vascular smooth muscle, due to which vasodilation occurs;
• participation in processes that stimulate the production of prostacyclin, as well as E2 IG - these components also have vasodilating activity;
• development of antagonism with respect to the potassium channels of the smooth muscle layer of the vessel, due to which anti-hypertensive effects also develop.

The diuretic effect develops when blocking the reabsorption of sodium ions, as well as the excretion of potassium, sodium, chloride and water ions.

Antiatherogenic effect - is the only diuretic medicine that can slightly increase HDL levels, affecting the binding of prostacyclin, which leads to a decrease in platelet aggregation and at the same time to the development of antioxidant effects (by reducing the damage and increasing the level of bioavailability of NO).

Demonstrates hypotensive activity in people with healthy kidney function, as well as with its disorders, slightly increasing the values of GFR when using average dosage.

The medicine does not pass through the BBB. Peak drug activity develops in the case of prolonged use of indapamide.

Pharmacokinetics

Indopress is well absorbed inside the gastrointestinal tract, and its Cmax indices are recorded after 2 hours from the moment of administration. The half-life is 14-18 hours. Synthesis with blood protein is 70-80%. A high level of lipophilicity contributes to a good distribution of the substance inside the tissues with organs (except the central nervous system). Metabolic processes occur inside the liver, and excretion is carried out through the kidneys (75%) and with feces (20% of metabolic products).

When taking the minimum portions of the drug causes vascular expansion in the area of the arteries. The required drug result develops after 3 months of regular use of indapamide.

Dosing and administration

The drug should be taken orally - every day, 1 time per day, in the morning, in a portion of 2.5 mg of the substance.

The effects of drugs develops gradually. If monotherapy does not have the desired effect, a complex treatment is applied along with other antihypertensive drugs. It is not necessary to increase the portion in order to get a more pronounced effect, because the use of large dosages does not lead to an increase in the hypotensive activity.

The duration of the treatment cycle is determined individually by each patient. Canceling medication does not cause ricochet hypertension.

[1]

Use Indopresa during pregnancy

It is forbidden to use the drug when breastfeeding or pregnancy.

Contraindications

Main contraindications:

• the presence of severe intolerance associated with indapamide or other elements of the drug;
• problems with hepatic activity;
• flowing in severe form of chronic kidney disease (GFR values below 30 ml / minute);
• hypokalaemia;
• lactase deficiency, glucose-galactose malabsorption or hypolactasia.

Side effects Indopresa

When using standard portions of complications in patients is not observed. The development of adverse symptoms is usually marked with the introduction of the drug in large doses:

• change in EBV indicators: hyponatremia or -caliemia, as well as hyprecalcemia, due to which orthostatic collapse occurs. Due to the loss of chloride ions after the introduction of indapamide, alkalosis of a metabolic nature can rarely develop;
• perhaps a weak effect of drugs that change blood glucose levels, and an increase in uric acid levels in people with gout or diabetes mellitus;
• disorders associated with blood function: a decrease in the number of leukocytes and platelets with neutrophils, and in addition the development of anemia of a hemolytic or aplastic nature;
• Disorders in the work of the National Assembly: headaches, depression, paresthesia, dizziness, as well as drowsiness, asthenia and emotional instability;
• problems associated with the activity of the cardiovascular system: reducing blood pressure or arrhythmia;
• symptoms affecting the gastrointestinal tract: dry mouth mucous membranes, nausea, stool disorders, vomiting and inflammation of the pancreas. In addition, problems with the liver or its inflammation, as well as encephalopathy;
• urinary function disorders: increased urination with a large volume of urine, as well as problems with the work of the kidneys; 
• disorders affecting the respiratory system: irritation in the trachea, nasal mucosa and bronchi, and in addition, inflammation associated with pulmonary alveoli, and having a nonspecific character;
• signs of allergy: rash, dermatitis or urticaria, as well as symptoms that are toxic or allergic in nature (PET or Stevens-Johnson syndrome). Photosensitivity rarely develops;
• other: impotence, color perception disorder, vasculitis, worsening of SLE and conjunctivitis.

Overdose

At the use of large portions of Indopresis (40+ mg), a level of EBV occurs, accompanied by symptoms of hyponatremia and kaliemia. Vomiting, pain in the abdominal area, nausea and convulsive syndrome (may be accompanied by the suppression of the respiratory center) also appear, and the BP index decreases. When blood pressure falls, there is a feeling of confusion or drowsiness, and besides this dizziness. With severe disorders, problems appear in the work of the kidneys with signs of anuria and oliguria.

To eliminate the disorders, gastric lavage is performed, sorbents are prescribed, electrolyte disorders are corrected, and symptomatic measures are taken.

Interactions with other drugs

When combining indapamide and antihypertensive drugs, there is an increase in therapeutic activity.

The combination of a drug with lithium causes a weakening of lithium reabsorption and increases its volume inside the blood, leading to the development of a toxic effect. When sharing drugs, you need to carefully monitor the plasma values of lithium.

Salicylates, substances that slow down the activity of COX-2, as well as NSAIDs weaken the medicinal properties of indapamide.

In persons with hyponatremia, the use of an ACE inhibitor together with the drug leads to a sharp drop in blood pressure values or the development of acute renal failure. Because of this, with such a combination of drugs, it is necessary to cancel the administration of the diuretic that provoked hyponatremia before starting the use of an ACE inhibitor, and then, after 3 days, gradually begin to take ACE inhibitors (starting with small portions and adjusting to the required medication dosage). A similar tactic with this combination should also be used for stenosis affecting the arteries inside the kidneys, as well as CH.

In the case of kidney disease, it is imperative to monitor creatinine values at the initial stage of therapy with the simultaneous administration of Indopres and an ACE inhibitor.

The combination of the drug with baclofen may cause an increase in the hypotensive effect. With the development of a similar situation, it is necessary to perform rehydration, necessarily tracking the values of urea and creatinine.

The introduction of drugs with SG leads to the potentiation of the toxic properties of glycosides. It is necessary to control the ECG values and the blood level of potassium.

Triamterene, spironalactone, and amiloride can change the blood values of potassium (lowering or increasing them). This is especially true for people with chronic kidney disease or diabetes.

The use of the drug with metformin leads to the development of acidosis of lactic acid nature, because it affects the kidneys.

Iodine contrast components when used with indapamide in people with dehydration increase the likelihood of acute renal failure (if hypokalemia is also observed).

Introduction together with calcium salts leads to a decrease in the excretion of the element Ca with urine, and in addition increases its blood values.

Imipramine-like antidepressants and antipsychotics in combination with the drug cause orthostatic collapse.

Simultaneous use with cyclosporines increases the number of blood creatinine.

Estrogens and steroids reduce the antihypertensive effect, because they have the ability to retain sodium with water inside the body.

With great care, you need to use the drug along with phenothiazines, antiarrhythmic agents of the IA and III subtypes, butyrophenones, astemizole and benzamides, and in addition with erythromycin, terfenadine, cisapride and bepridil. Diffemanil, Vincamine with Pentamidine, Mizolastine with Halofantrine and Moxifloxacin with Sparfloxacin are also on the list. Such drug combinations can lead to arrhythmias or ventricular tachycardias, if Indopress causes the development of hypokalemia.

[2], [3]

Storage conditions

Indopress is required to be kept in a place closed from the penetration of small children. Temperature level is not higher than 25 ° С.

Shelf life

Indopress can be used within a 4-year period from the time the therapeutic agent is manufactured.

Application for children

Indopres does not apply in pediatrics.

Analogs

Analogues of drugs are Inapen, Ravel CP, Indapamid, Ionik with Arifon Retard and Enziks.