Indapamide: instructions for use, indications and side effects

The main effect of the drug Indapamide, the instructions for use of which indicates that the drug belongs to the group of diuretics, is to increase the formation and excretion of urine.

In medical practice, this property is used to remove fluid in case of peripheral edema and its accumulation in various body cavities, to quickly get rid of toxins. In cardiology, Indapamide and its analogs are widely used to lower blood pressure. Why is this so important?

The fact is that hypertension is the main risk factor for an unfavorable outcome of any disease of the cardiovascular system.that has been proven by numerous clinical studies.

At the same time, the appointment of Indapamide according to the instructions for use (especially in combination with other drugs) significantly reduced the number of patients' visits to a cardiologist about exacerbations chronic heart failure and other similar symptoms.

The history of the creation of diuretics dates back to the 16th century, for this purpose various compositions based on medicinal plants (juniper, pepper, corn cobs) were used.

At the beginning of the 20th century, mercury-based organomercuril was used for this purpose, but over time its use was abandoned due to its high toxicity. In 1957, chlorothiazide was synthesized and prescribed for the treatment of heart failure. But at the same time, the doctors noted that after 2 weeks of admission, the patients noted a persistent decrease in blood pressure. Since then, diuretics have become firmly established in cardiology as one of the main drugs for combating hypertension.

Today, there are several classifications of this pharmacological group of medicines.

Taking into account the description provided in the instructions for use, Indapamide can be attributed to the following types of diuretics:

• in accordance with the chemical structure: belongs to sulfates, as it contains a sulfanamide group;
• depending on the site of action on the nephron (in more detail on the principles of the drug's operation, it will be discussed below): affecting the distal part of the tubules;
• by the percentage of excreted sodium from the total amount filtered in the tubules: with a moderately pronounced natriuretic effect.

It is known from the school biology course that urine is formed by filtering blood plasma. in the kidneys, and its excretion is carried out through the ureters, bladder and urinary channel.

The structural unit of the kidney, in which the main filtration processes take place, is the nephron. Normally, their number is about 2 million. in one organ.

Urination consists of three sequential processes:

1. Filtration through the vascular glomerulus and nephron capsule. As a result, primary urine is formed (its daily amount can reach tens of liters).
2. Reabsorption in the nephron tubule system. Most of the water, sodium ions, chlorine ions, and carbonates are absorbed back into the bloodstream.
3. Secretion takes place in the collecting ducts. Potassium and hydrogen ions enter the urine.

The collecting tubes open into the renal cups, from there urine flows into the pelvis and is further excreted from the body. The total volume of secondary urine generated per day in an adult is, on average, 1.5 liters. All these processes are regulated by a very complex system of hormones that are produced in the brain, adrenal glands.

According to the information in the instructions for use of Indapamide, the main principle of its action is to influence the functioning of the epithelium of the renal tubules.

Thus, the main effects of this medication are:

• Hypotensive, moreover, according to doctors, a decrease in blood pressure is characteristic only for patients with hypertension. In the initial stages of therapy, this occurs by reducing the volume of circulating blood and cardiac output. Across 6-8 weeks of treatment, the total peripheral vascular resistance decreases, which leads to a stable hypotensive effect.
• Dehydration.
• Influence on mineral metabolism. According to the results of clinical studies, long-term use of Indapamide caused a decrease in the manifestations of osteoporosis. Doctors attribute this to a decrease in calcium reabsorption.
• Antianginal. While taking Indapamide, the rigidity of the vascular wall decreases, intracellular magnesium is preserved, platelet aggregation decreases, and prostacyclin synthesis increases. This causes relaxation of cardiomyocytes and a decrease in the load on the heart.
• Improving kidney microcirculation and, as a consequence, the elimination of microalbuminuria (excretion of a small amount of protein in the urine).
• Antiatherogenic. With prolonged use of Indapamide in the dosage indicated in the instructions for use in the blood, the level of low density lipoproteins, triglycerides, at the same time, the concentration of "useful" high lipoproteins increases density.

In addition, the medical literature describes the ability of Indapamide to reduce the phenomena of hypertrophy of the muscle tissue of the left ventricle, to suppress the activity of aldosterone and angiotensin-converting enzyme. It also leads to the normalization of blood pressure and an improvement in the clinical picture in patients with heart failure.

This medication is favorably distinguished by its high bioavailability. She is about 90-100%. The drug is rapidly absorbed from the gastrointestinal tract. Due to its significant lipophilicity and moderate ability to bind to proteins, Indapamide penetrates deeply into organs and tissues. The drug is completely metabolized in the liver and excreted in urine and feces.

Only a small part of the active substance of the drug in unchanged form (up to 7%) is excreted by the kidneys. However, doctors emphasize that no dosage adjustment is required in patients with renal insufficiency. The peak serum concentration of the drug is reached 1 hour after ingestion, and the half-life is 15 to 25 hours (average 18 hours). This allows you to use the medication only once a day.

Indapamide is available in the form of tablets with a dosage of the active substance of the same name of 2.5 mg.

The list of auxiliary connections includes:

• ludipress (lactose);
• magnesium stearate;
• colloidal silicon dioxide;
• hydroxypropyl methylcellulose;
• titanium hydroxide;
• talc;
• polyethylene oxide.

The original drug is produced in Serbia; other foreign analogues are also available on the market, some of which differ significantly in price.

Indapamide: indications, contraindications for use, interaction with other drugs

When consulting a patient about which Indapamide helps, the doctor should mention the prolonged form of the drug "retard" (in the pharmaceutical literature this is denoted by the abbreviation SR).

This ensures its slow release: 17-27% in the first four hours, 25-55% — up to 8 hours after ingestion, more than 70% in the next 16 hours.

Due to this, when using Indapamide retard, it is possible to avoid sharp fluctuations in drug concentrations. In addition, the efficacy / tolerance ratio is improved.

That is, with a lower dose of indapamide, its diuretic and hypotensive effect does not change, however, doctors less often note side effects, especially hypokalemia, which is recommended to be treated. In particular, for the therapy of potassium deficiency, it is recommended Kalinor.

The main indication for the appointment of Indapamide is arterial hypertension. All patients with hypertension, regardless of its etiology and development mechanism, are sensitive to the action of thiazide diuretics.

Against the background of therapy for the pathology of Indapamide, the risk of chronic heart disease is reduced by almost 50%. failure, stroke (40%), coronary artery disease (20%) and sudden death from vascular pathology (by 10%). In this regard, Indapamide is not inferior to other drugs for normalizing blood pressure (beta-blockers, ACE inhibitors, calcium antagonists).

The appointment of Indapamide, like other diuretics, structurally similar to thiazides, is contraindicated in:

• intolerance to lactose and other auxiliary components that make up the medication;
• hypersensitivity to sulfonylurea derivatives;
• severe hepatic and renal failure (at the stage of complete absence of urination);
• hereditary disorders of glucose formation, disorders of its absorption;
• a decrease in the concentration of potassium in the body;
• acute or recently transferred episode of cerebrovascular accident.

If there are indications for the use of Indapamide, special attention should be paid to its simultaneous administration with such medications:

• Preparations containing lithium. It has a nephrotoxic effect, and Indapamide slows down its excretion from the body.
• Loop diuretics, laxatives, certain hormones (corticosteroids, tetracosactide), antifungal Amphotericin B (intravenous only): the risk of a decrease in potassium concentration.
• Cardiac glycosides: their ability to accumulate increases, which can lead to intoxication.
• Calcium preparations: the possibility of developing hypercalcemia.
• Hypoglycemic agents (metformin): an increase in the concentration of lactic acid (lactic acidosis).
• Astemizole and Terfenadine (drugs for the treatment of allergies), antibiotic Erythromycin (intravenous), antiparasitic agent Pentamidine, antipsychotic Sultopride used for deterioration of cerebral circulation Vincomidine, antiarrhythmic drugs (Quinidine, Amiodarone, etc.): cardiac disorders rhythm.
• Non-steroidal anti-inflammatory drugs, glucocorticosteroids and sympathomimetics reduce the antihypertensive effect of Indapamide.
• Muscle relaxant Baclofen, antidepressants, antipsychotics and drugs of the ACE inhibitor group increase antihypertensive action, in addition, the latter increase the risk of developing renal failure in violation of blood flow through the vessels organ.
• Radiopaque substances containing iodine, in combination with Indapamide, affect the kidneys, therefore, before using them, fluid loss should be replenished.
• Anticoagulants: the drug reduces the contractility of the vascular wall and increases the level of factors clotting in the blood, thereby reducing the effectiveness of anticoagulants used in therapeutic dose.

But in any case, in the first weeks after the start of taking Indapamide, for medical reasons, it is necessary control of the level of electrolytes (potassium, sodium, magnesium and chlorine), creatinine and residual nitrogen in the blood. In addition, it is important to follow the fluid intake regime in order to avoid dehydration, which is dangerous for the body.

How to take Indapamide: the possibility of using the drug in children and during pregnancy

It used to be thought that a high dosage of Indapamide provides greater efficacy due to a pronounced decrease in circulating blood volume.

However, at present, such a therapy regimen is rejected, which is associated with a high risk of abnormalities in plasma electrolyte concentrations and hypokalemia.

For the treatment of arterial hypertension, the standard daily dosage of Indapamide is 2.5 mg (that is, 1 tablet). It is recommended to take the drug in the morning. Absorption from the gastrointestinal tract does not depend on food.

If later 6-8 weeks of therapy, the patient's condition does not improve, the dosage of Indapamide is left the same, but another antihypertensive agent is added (for example, the selective beta-blocker Concor).

In diabetes mellitus and for the treatment of hypertension in elderly patients, it is recommended to use Indapamide MV Stada Retard in an amount of 1.5 mg per day. The effectiveness of the drug does not change from this, however, complications occur much less frequently. In addition, such patients need constant monitoring of the volume of diuresis. Also, with diabetes mellitus, the concentration of glucose in the blood is regularly checked.

In experiments with animals, data were obtained that indapamide crosses the placental barrier and can enter breast milk. Therefore, the use of the drug is contraindicated during pregnancy due to the risk of complications during intrauterine development of the fetus. You should also give up lactation in favor of artificial feeding.

There is currently no experience on how to use Indapamide at an early age, and there is currently no about its effect on the child's body. Therefore, it is not prescribed until reaching 18 year old age.

Indapamide: side effects, overdose, price and possible analogues of the drug

At the beginning of the use of Indapamide, the adaptive systems of the body are activated, aimed at preserving intravascular volume (short-term increase in the activity of renin-angiotensin-aldosterone and sympathetic nervous system). Salt consumption also affects the effectiveness of the drug. Its restriction in the diet improves the tolerance of Indapamide and its hypotensive effect.

The main side effect of this diuretic is electrolyte imbalance. They manifest themselves in the form of a decrease in the level of sodium, potassium, chlorine, an increase in creatinine, residual nitrogen of urea and calcium. It is advisable to determine the concentration of potassium in the blood before starting therapy with Indapamide.

If it is below 3.8 mmol / l, it is possible to co-appoint with potassium-sparing diuretics (for example, with Veroshpiron or Aldactone).

Hypokalemia also affects muscle sensitivity to insulin, leading to hyperglycemia. However, it is transient in nature, the condition returns to normal after stopping the medication.

Other side effects of Indapamide are:

• stool disorders;
• drying out of the oral mucosa;
• nausea, vomiting;
• pain in the epigastric region;
• dizziness;
• headache;
• mood swings;
• sleep disorders;
• heart rhythm disturbances;
• a decrease in the concentration of platelets and leukocytes, anemia associated with the destruction of red blood cells;
• exacerbation of gout, systemic lupus erythematosus.

As mentioned above, the recommended daily dosage of Indapamide for men and women is 2.5 mg for conventional tablets and 1.5 mg for the prolonged form. If this amount is exceeded, there is a risk of respiratory depression, severe hypotension. Often this condition is accompanied by nausea and vomiting.

To eliminate the side effects from an overdose of Indapamide, it is necessary to correct the water-electrolyte metabolism in a hospital setting. The rest of the therapy is carried out according to indications, depending on the presence of certain symptoms.

The price of a package containing 30 Indapamide tablets is 102 rubles (a domestic medicine costs about 40 rubles). The prolonged form of the drug costs 120 - 140 rubles.

Completely identical in composition, analogues of the drug are:

• Arifon, France, 370 - 390 rubles;
• Indap, Czech Republic, 120 rubles;
• Indapamid Teva, 100 rubles;
• Ravel, Slovenia, 170 - 200 rubles.

Combinations of indapamide with analogs of lisinopril are also possible, that is, agents from the group of ACE inhibitors. These are drugs such as Noriprel and Co Perineva (indapamide + perindopril), Enzix Duo (indapamide + enalapril).

The effectiveness of this diuretic is not in doubt by either doctors or patients. Dosage and antihypertensive effect practically does not depend on age. Hypertension is not a disease requiring prolonged therapy. Therefore, patients are interested in the question of how long you can take Indapamide. In most cases, the drug is well tolerated, therefore it is suitable for a long course of treatment.