Buy Noliprel A forte film-coated tablets 5mg+1.25mg No. 30 in pharmacies
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Noliprel A forte tab p.o 5mg+1.25mg No. 30
Dosage forms
tablets 5 mg + 1.25 mg Synonyms Co-Perineva Noliprel Noliprel A Noliprel A forte Noliprel forte Perindide Perindopril Plus Indapamide Group Combination of angiotensin-converting enzyme inhibitors and diuretics International nonproprietary name Indapamide + Perindopril Composition Active substances: perindopril and indapamide. Manufacturers Laboratories Servier Industry (France), Serdix (Russia) Pharmacological action A combined drug containing perindopril (ACE inhibitor) and indapamide (a diuretic from the group of sulfonamide derivatives). The pharmacological action of Noliprel is due to the combination of the individual properties of each component. The combination of perindopril and indapamide enhances the effect of each of them. Noliprel has a pronounced dose-dependent hypotensive effect on both systolic and diastolic blood pressure in the supine and standing position. The effect of the drug lasts 24 hours. A persistent clinical effect occurs in less than 1 month from the start of therapy and is not accompanied by tachycardia. Discontinuation of treatment is not accompanied by the development of withdrawal syndrome. Noliprel reduces the degree of left ventricular hypertrophy, improves arterial elasticity, reduces peripheral vascular resistance, does not affect the metabolism of lipids (total cholesterol, HDL, LDL, triglycerides) and does not affect the metabolism of carbohydrates (including in patients with diabetes). Side effects From the water-electrolyte balance: possible hypokalemia, decreased sodium levels, accompanied by hypovolemia, dehydration and orthostatic arterial hypotension. The simultaneous loss of chlorine ions can lead to compensatory metabolic alkalosis (the incidence of alkalosis and its severity is low). In some cases, an increase in calcium levels. From the cardiovascular system: excessive decrease in blood pressure, orthostatic hypotension; in some cases - myocardial infarction, angina, stroke, arrhythmia. From the urinary system: rarely - decreased renal function, proteinuria (in patients with glomerular nephropathy); in some cases - acute renal failure. A slight increase in the concentration of creatinine in urine and blood plasma (reversible after discontinuation of the drug) is most likely in case of renal artery stenosis, treatment of arterial hypertension with diuretics, or the presence of renal failure. From the central nervous system and peripheral nervous system: headache, increased fatigue, asthenia, dizziness, mood lability, visual disturbances, tinnitus, sleep disturbance, convulsions, paresthesia, anorexia, impaired taste perception; in some cases - confusion. From the respiratory system: dry cough; rarely - difficulty breathing, bronchospasm; in some cases - rhinorrhea. From the digestive system: abdominal pain, nausea, vomiting, constipation, diarrhea; rarely - dry mouth; in some cases - cholestatic jaundice, pancreatitis, increased activity of liver transaminases, hyperbilirubinemia; with liver failure, the development of hepatic encephalopathy is possible. From the hematopoietic system: anemia (in patients after kidney transplantation, hemodialysis); rarely - hypohemoglobinemia, thrombocytopenia, leukopenia, decreased hematocrit; in some cases - agranulocytosis, pancytopenia, aplastic anemia, hemolytic anemia. From the metabolic side: an increase in the content of urea and glucose in the blood plasma is possible. Allergic reactions: skin rashes, itching; rarely - urticaria, angioedema; in some cases - erythema multiforme, hemorrhagic vasculitis, exacerbation of SLE. Other: temporary hyperkalemia; rarely - increased sweating, decreased potency. Indications for use: Essential arterial hypertension. Contraindications: history of angioedema (including while taking ACE inhibitors); - hypokalemia; — severe renal failure (creatinine clearance less than 30 ml/min); - severe liver failure (including with encephalopathy); - simultaneous use of drugs that prolong the QT interval; - pregnancy; - lactation (breastfeeding); - hypersensitivity to perindopril and other ACE inhibitors; - hypersensitivity to indapamide and sulfonamides. Method of administration and dosage The drug is prescribed orally, 1 tablet 1 time per day, preferably in the morning, before meals. Overdose Symptoms: marked decrease in blood pressure, nausea, vomiting, convulsions, dizziness, insomnia, decreased mood, polyuria or oliguria, which can turn into anuria (as a result of hypovolemia), bradycardia, electrolyte disturbances. Treatment: gastric lavage, administration of adsorbents, correction of water and electrolyte balance. If there is a significant decrease in blood pressure, the patient should be transferred to a horizontal position with legs elevated. Perindoprilat can be removed from the body using dialysis. Interaction The simultaneous use of Noliprel and lithium preparations is not recommended. Increasing lithium concentrations may result in symptoms and signs of lithium overdose. (due to decreased excretion of lithium by the kidneys). The combination of perindopril with potassium-sparing diuretics and potassium supplements can lead to a significant increase in the concentration of potassium in the blood serum (especially against the background of renal failure) and even death. It should be taken into account that indapamide in combination with potassium-sparing diuretics or potassium supplements does not exclude the development of hypokalemia or hyperkalemia (especially in patients with diabetes mellitus and renal failure). With the simultaneous use of erythromycin (for intravenous administration), pentamidine, sultopride, vincamine, halofantrine, bepridil and indapamide, the development of arrhythmias is possible (provoking factors include hypokalemia, bradycardia or a prolonged QT interval). When using ACE inhibitors, the hypoglycemic effect of insulin and sulfonylurea derivatives may be enhanced. The development of hypoglycemia is extremely rare. With the simultaneous use of Noliprel and baclofen, the hypotensive effect is enhanced. With the simultaneous use of indapamide and NSAIDs in case of dehydration, acute renal failure may develop. It should also be taken into account that NSAIDs weaken the hypotensive effect of ACE inhibitors. NSAIDs and ACE inhibitors have been found to have an additive effect on hyperkalemia, and a decrease in renal function is also possible. With the simultaneous use of Noliprel and tricyclic antidepressants, antipsychotics, it is possible to enhance the hypotensive effect and increase the risk of developing orthostatic hypotension (additive effect). GCS, tetracosactide reduce the hypotensive effect of Noliprel. With simultaneous use of indapamide with antiarrhythmic drugs IA (quinidine, hydroquinidine, disopyramide) and class III (amiodarone, bretylium, sotalol), the development of arrhythmias is possible (provoking factors include hypokalemia, bradycardia or a prolonged QT interval). If arrhythmia develops, antiarrhythmic drugs should not be used (an artificial pacemaker must be used). With the simultaneous use of indapamide and drugs that reduce potassium levels (including intravenous amphotericin B, gluco- and mineralocorticoids for systemic use, tetracosactide, stimulant laxatives), the risk of developing hypokalemia increases. Potassium concentration should be monitored and adjusted if necessary. If it is necessary to prescribe laxatives, drugs without a stimulating effect on intestinal motility should be used. When using Noliprel simultaneously with cardiac glycosides, it should be taken into account that low potassium levels may enhance the toxic effect of cardiac glycosides. Potassium levels and ECG should be monitored and therapy adjusted if necessary. Lactic acidosis while taking metformin is apparently associated with functional renal failure, which is caused by the action of indapamide. Metformin should not be used if creatinine levels exceed 15 mg/L (135 µmol/L) in men and 12 mg/L (110 µmol/L) in women. With significant dehydration of the body, which is caused by taking diuretic drugs, the risk of developing renal failure increases due to the use of iodine-containing contrast agents in high doses. Rehydration is necessary before using iodinated contrast agents. When used simultaneously with calcium salts, it is possible to increase the calcium content in the blood plasma as a result of a decrease in its excretion in the urine. When Noliprel is used against the background of constant use of cyclosporine, the level of creatinine in plasma increases even with a normal state of water-electrolyte balance. Special instructions The use of the drug Noliprel can cause a sharp decrease in blood pressure, especially when first taking the drug and during the first 2 weeks of therapy. The risk of developing an excessive decrease in blood pressure is increased in patients with reduced blood volume (as a result of following a strict salt-free diet, hemodialysis, vomiting and diarrhea), with severe heart failure (both in the presence of concomitant renal failure and in its absence), with initially low blood pressure, with stenosis of the renal arteries or stenosis of the artery of the only functioning kidney, cirrhosis of the liver, accompanied by edema and ascites. It is necessary to systematically monitor the appearance of clinical signs of dehydration and salt loss, and regularly measure the concentration of electrolytes in the blood plasma. A pronounced decrease in blood pressure when taking the drug for the first time is not an obstacle to further prescription of the drug. After restoration of blood volume and blood pressure, treatment can be continued, using a lower dose of the drug or monotherapy with one of its components. Blocking the renin-angiotensin-aldosterone system with ACE inhibitors can lead, along with a sharp drop in blood pressure, to an increase in plasma creatinine, indicating functional kidney failure, sometimes acute. These conditions occur rarely. However, in all such cases, treatment should be started carefully and carried out gradually. When treating with Noliprel, it is necessary to systematically monitor the concentration of creatinine in the blood plasma. While taking Noliprel, it is necessary to regularly monitor the concentration of potassium in the blood plasma. In elderly or debilitated patients, it is necessary to take into account the risk of a decrease in potassium concentration below the permissible level (less than 3.4 mmol/l). This group should also include people taking several different medications, patients with liver cirrhosis, which is accompanied by the appearance of edema or ascites, patients with coronary artery disease or heart failure. A decrease in potassium levels increases the toxicity of cardiac glycosides and increases the risk of developing arrhythmias. Low potassium levels, bradycardia, and an increase in the QT interval are risk factors for the development of arrhythmias, which can be fatal. It should be borne in mind that the excipients of the drug Noliprel include lactose monohydrate. As a result, this drug is not recommended for use in persons with lactase deficiency, galactosemia, or glucose/galactose malabsorption syndrome. While taking Noliprel (especially at the beginning of the course of therapy), caution should be exercised when driving a car and performing work that requires increased attention and a high speed of psychomotor reactions. Storage conditions List B. The drug should be stored out of the reach of children at a temperature not exceeding 30°C.
Compound
The drug Noliprel is offered in several different forms. All variations of the drug include perindopril and indapamide . Combined Noliprel contain 2 mg of perindopril and 0.625 mg of indapamide. The composition of Noliprel Forte includes 4 mg of perindopril and 1.25 mg of indapamide. Noliprel A contains 2.5 mg of perindopril and 0.625 mg of indapamide.
In this drug, perindopril is associated with the amino acid arginine, which has a beneficial effect on the condition of the cardiovascular system. Noliprel A Forte tablets contain 5 mg of perindopril and 1.25 mg of indapamide. Noliprel A Bi-forte contains 10 mg of perindopril and 2.5 mg of indapamide.
As additional substances in the composition of the drug Noliprel there is magnesium stearate, lactose monohydrate, colloidal hydrophobic silicon dioxide, microcrystalline cellulose.
Pharmacokinetics and pharmacodynamics
The pharmacokinetics of perindopril and indapamide when used in combination is the same as when used separately. After oral administration, perindopril is rapidly absorbed. Bioavailability level - 65-70%. About 20% of total absorbed perindopril is later converted to perindoprilat (the active metabolite). The maximum concentration of perindoprilate in plasma is observed after 3-4 hours. Less than 30% binds to blood proteins, depending on the concentration in the blood plasma. The half-life is 25 hours. The substance penetrates the placental barrier. Perindoprilat is excreted from the body through the kidneys. Its half-life is 3-5 hours. There is a slower administration of perindoprilate in older people, as well as in patients with heart failure and renal failure.
Indapamide is completely and relatively quickly absorbed from the gastrointestinal tract. The maximum concentration of the substance in plasma is observed one hour after oral administration.
The substance binds to plasma proteins by 79%. Half-life is 19 hours. The substance is excreted in the form of inactive metabolites by the kidneys (approximately 70%) and intestines (approximately 22%). In people with renal failure, no changes in the pharmacokinetics of the substance are observed.
Overdose
In case of an overdose of the drug, there is a severe decrease in blood pressure, nausea, vomiting, dizziness , mood instability, symptoms of renal failure, and electrolyte imbalance. In this case, you need to immediately bring the water-electrolyte balance back to normal, rinse the stomach, and take enterosorbents. Noliprel metabolites can be removed using dialysis. If necessary, intravenous saline is administered.
Instructions for use of Noliprel (Method and dosage)
It is advisable to take Noliprel tablets in the morning. The medicine is prescribed one tablet per day. The instructions for Noliprel Forte provide for a similar treatment regimen. Noliprel A and Noliprel A Bi Forte are prescribed to patients 1 tablet per day. If patients have creatinine clearance equal to or greater than 30 ml/min, then there is no need to reduce the dose. If clearance equals or exceeds 60 ml per day, then during treatment it is necessary to carefully monitor the level of potassium and creatinine in the blood.
If necessary, after several months of treatment, the doctor may increase the dose by prescribing Noliprel A Forte or another type of this drug instead of Noliprel.
pharmachologic effect
Noliprel is a combination drug that contains perindopril (an angiotensin-converting factor inhibitor) and indapamide (a diuretic that is part of the sulfonamide group).
The pharmacological effect of a drug is determined by a combination of some of the effects of these components. In this combination, both components mutually increase the effect. Noliprel is an antihypertensive drug that effectively lowers both diastolic and systolic blood pressure. The severity of the effect depends on the dose. After taking the drug, there is no rapid heartbeat. The clinical effect is observed 1 month after treatment was started. The antihypertensive effect lasts for one day. After therapy is suspended, the patient does not experience withdrawal symptoms. During treatment, the severity of left ventricular hypertrophy decreases, and the degree of total precardiac and postcardiac load decreases. Large vessels become more elastic, the walls of small vessels are restored. The medicine has no effect on the metabolic processes that occur in the body.
Perindopril reduces the level of aldosterone secretion, resulting in increased renin activity in the blood. Blood pressure decreases in people with different levels of renin . Under the influence of this component, blood vessels dilate.
When taking the drug, the likelihood of hypokalemia . The mechanism of action of indapamide is similar to thiazide diuretics: urination and excretion of sodium and chloride ions in the urine will increase.
Vascular hyperreactivity decreases under the influence of adrenaline. The amount of lipids in the blood does not change.
special instructions
People who have been prescribed treatment with Noliprel need adequate dehydration of the body to prevent a sharp decrease in blood pressure.
People with heart failure may be treated with beta blockers at the same time.
When treated with Noliprel, a positive reaction is observed during a doping test.
In the first weeks of treatment, it is important to drive vehicles or operate precision machinery carefully when treating with Noliprel.
If during treatment there is a significant decrease in pressure, it may be necessary to administer 0.9% sodium chloride intravenously.
Treatment of patients with cerebral circulatory insufficiency or coronary heart disease should begin with small doses of Noliprel.
In people who have very high levels of uric acid in the blood, when treated with varieties of the drug Noliprel, the risk of developing gout .
During pregnancy and lactation
For pregnant women and mothers while breastfeeding , the use of Noliprel is contraindicated. Systematic treatment with these drugs can lead to the development of abnormalities and diseases in the fetus, as well as lead to fetal death. If a woman finds out she is pregnant during treatment, there is no need to terminate the pregnancy, but the patient should be aware of the possible consequences. If blood pressure increases, other antihypertensive therapy is prescribed. If a woman took this drug in the second and third trimesters, an ultrasound of the fetus should be performed to evaluate the condition of its skull and kidney function.
Newborns whose mothers took the drug may suffer from manifestations of arterial hypotension, so they need to be constantly monitored by specialists.
When feeding with breast milk, the drug is contraindicated, so lactation should be stopped during therapy or another drug should be selected.
Noliprel's analogs
Level 4 ATX code matches:
Akkuzid
Enap-N
Iruzid
Co-Diroton
Enalozide
Enap NL
Enapril-N
Capozide
Tritace Plus
Enzix
Liprazid
Co-Renitec
Hartil N
Hartil D
Ko-Perineva
Kaptopres
Analogs of Noliprel, as well as the drugs Noliprel A Bi Forte, Noliprel A Forte, are other drugs that are used to lower blood pressure and contain similar active ingredients, that is, perindopril and indapamide. Such drugs are Co-prenesa , Prestarium , etc. The price of analogues may be lower than the cost of Noliprel and its varieties.
Interaction
Noliprel should not be taken at the same time as lithium medications. If it is impossible to discontinue one of the drugs, the lithium level in the blood should be closely monitored.
With simultaneous treatment with potassium-sparing diuretics or drugs with potassium, the concentration of potassium in the blood may increase. This combination is recommended only for hypokalemia.
When indapamide with vincamine, bepridil, sultopride, halofantrine, as well as with simultaneous intravenous administration of erythromycin , arrhythmia and bradycardia may occur.
Sometimes, with simultaneous treatment with Insulin and Noliprel, hypoglycemia may develop.
When taking non-steroidal anti-inflammatory drugs, the antihypertensive properties of Noliprel are inhibited. If you are dehydrated, this combination of medications can cause kidney problems or kidney failure.
When treated with Noliprel and antipsychotics or tricyclic antidepressants, orthostatic hypotension may develop.
Due to the retention of water and electrolytes in the body, with simultaneous treatment with Noliprel and mineralocorticoids, glucocorticosteroids, stimulant laxatives, tetracosactide, amphotericin B, the hypotensive effect is reduced and the likelihood of hypokalemia increases.
Due to the possibility of developing hypokalemia, the risk of toxic effects of cardiac glycosides increases.
When combined with Metformin, acidosis may develop .
Before using iodine-containing X-ray contrast agents with Noliprel, the body must be adequately hydrated.
The simultaneous use of calcium salts can provoke hypercalcemia.
Concomitant treatment with cyclosporine may increase blood creatinine levels.
