Noliprel - reviews of the drug for blood pressure

Indications for use

Noliprel is considered one of the best drugs for essential hypertension. For those who do not know, doctors understand this term as a disease characterized by a chronic increase in blood pressure. The most unpleasant thing is that the deterioration of the condition often occurs slowly and the person simply does not have time to respond to his illness in time. The same thing happened to me.

I noticed the first symptoms of pathology quite a long time ago. I often had noise in my ears, a headache, and spots in my eyes. I thought it was just manifestations of fatigue. I work hard, so I couldn’t find time for normal rest.

I decided to go to the doctor after my friends started saying that my face was constantly red. At the hospital, the therapist referred me to a cardiologist.

“Despite your relatively young age, you have all the signs of essential hypertension.
You need to resolve the issue now, otherwise you will end up with complications. I recommend starting with ACE inhibitors, diuretics and potassium antagonists. The list of such drugs is quite long...” Grigory Sergeevich, cardiologist, arrhythmologist, Moscow

After talking with the doctor, I began to look for medications that would relieve my symptoms. And, in the end, I opted for Noliprel tablets. Now I will try to explain why.

Customer reviews about Noliprel

Returning home from the clinic, I started looking for descriptions of drugs for hypertension on the Internet. The choice of tablets, injections and powders was really huge. The doctor recommended a couple of names, but judging by the reviews of patients, there were more interesting options. The cardiologist prescribed the most affordable means, but I didn’t want to save money, but to actually eliminate the problem (or at least keep it under control).

While reading different opinions about medications, I came across a description of Noliprel tablets. Some people wrote that this drug reduces blood pressure very quickly. Moreover, the remedy sometimes has an overly strong effect. This is exactly what interested me - it means it definitely works! I went online to specifically look for reviews on a specific substance.

“Hypertension is a real punishment. It was especially difficult in the fall. Any overexertion, both physical and mental, caused severe headaches and nausea. I was worried that I would have a heart attack or stroke. I started taking Noliprel on the advice of a colleague. Great pills. I drink them in advance and no longer suffer from weather changes...”

We often came across reviews of people who started drinking Noliprel after trying a bunch of its analogues. As far as I understand, these tablets are quite strong, which is why the price is high.

“I couldn’t cope with the swelling on my face and legs. Doctors said that it was because of chronic high blood pressure that the kidneys were not working well and fluid was accumulating in the body. I tried many different drugs, but the results were not impressive. I accidentally overheard a conversation between two pensioners about Noliprel. I decided to buy it for testing and realized that I had finally found what I needed..."

There were, of course, negative reviews. They concerned the side effects of the drug. Most often, people complained that after a course of Noliprel they had sleep disturbances and dry mouth. It didn't really scare me, so I decided to ignore it.

Noliprel A forte tablets 1.25 mg+5 mg 30 pcs.

From the circulatory and lymphatic system. Very rare: thrombocytopenia, leukopenia/neutropenia, agranulocytosis, aplastic anemia, hemolytic anemia. Anemia: In certain clinical situations (kidney transplant patients, hemodialysis patients), ACE inhibitors may cause anemia. From the central nervous system. Common: paresthesia, headache, dizziness, asthenia, vertigo. Uncommon: sleep disturbance, mood lability. Very rare: confusion. Unspecified frequency: fainting. From the side of the organ of vision. Common: blurred vision. From the side of the hearing organ. Common: tinnitus. From the cardiovascular system. Often: marked decrease in blood pressure, including orthostatic hypotension. Very rare: cardiac arrhythmias, including bradycardia, ventricular tachycardia, atrial fibrillation, as well as angina pectoris and myocardial infarction, possibly due to an excessive decrease in blood pressure in high-risk patients. Unspecified frequency: ari (possibly fatal). From the respiratory system, chest organs and mediastinum. Often: while using ACE inhibitors, a dry cough may occur, which persists for a long time while taking drugs of this group and disappears after their discontinuation. Dyspnea. Uncommon: bronchospasm. Very rare: eosinophilic pneumonia, rhinitis. From the digestive system. Often: dryness of the oral mucosa, nausea, vomiting, abdominal pain, epigastric pain, impaired taste perception, decreased appetite, dyspepsia, constipation, diarrhea. Very rare: angioedema of the intestine, cholestatic jaundice, pancreatitis. Unspecified frequency: hepatic encephalopathy in patients with liver failure, hepatitis. From the skin and subcutaneous fat. Common: skin rash, pruritus, maculopapular rash. Uncommon: angioedema of the face, lips, extremities, mucous membrane of the tongue, vocal folds and/or larynx; hives; hypersensitivity reactions in patients predisposed to broncho-obstructive and allergic reactions; purpura. In patients with acute form of systemic lupus erythematosus, the course of the disease may worsen. Very rare: erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome. Cases of photosensitivity reactions have been reported. From the musculoskeletal system and connective tissue. Common: muscle spasms. From the urinary system. Uncommon: renal failure. Very rare: acute renal failure. From the reproductive system. Uncommon: impotence. General disorders and symptoms. Often: asthenia. Uncommon: increased sweating.

How do blood pressure pills work?

I honestly tried to figure out the composition and carefully studied the available information on each component of the drug. Fortunately, there are only two of them, so you can describe these elements separately.

Perindopril is an inhibitor that converts angiotensin 1 into angiotensin 2. I understand that for many this is a meaningless set of letters. Now I’ll try to decipher the terms. The substance works on the principle of feedback, that is, if necessary, it expands or, conversely, constricts blood vessels, equalizing blood pressure. In reviews of people who have undergone treatment, Noliprel read that, if used correctly, the tablets have a positive effect on the heart, reducing pre- and afterload. All this thanks to perindopril.

Indapamide is considered one of the best diuretics. Such drugs inhibit the reabsorption of water and salts in the kidneys. Again, complex “gibberish” - in fact, everything is extremely simple. Noliprel accelerates the removal of fluid from tissues, while swelling disappears and the load on internal organs is significantly reduced.

That's the entire composition of the drug. A small number of components in the composition significantly reduces the list of contraindications. The description of the medicine states that it should not be taken if:

renal failure;
liver problems;
pregnancy, lactation;
hypersensitivity to the elements of the drug.

In the reviews I came across another feature of the product. It is very important to be as careful as possible for people suffering from lactose intolerance. This element is also included in Noliprel.

Special instructions and analogues of the drug

It was very important to me that the pills did not affect the reaction. I have to drive a lot, so I specifically checked this parameter. I did not find any side effects related to driving. I’ll write a few words about the possible replacement of Noliprel with analogues. I came across reviews from people who were looking for an alternative to the product (usually due to allergies). The list was not very long. The most frequently mentioned were "Perindid" and "Co-Perineva".

Well, at the end of my review I will write about my feelings. At first I didn’t notice any special effect from taking Noliprel, I was even a little upset. It’s good that I didn’t give up treatment, since positive changes in my condition began to appear after about 2 weeks. I noticed the absence of sock marks on my feet in the evening (which means the swelling disappeared) and a clear improvement in my sleep. The dizziness stopped and the nausea went away. The doctor said that most likely later I will have to buy a larger dosage, but so far everything is fine.

Instructions for use NOLIPREL® FORTE A (NOLIPREL FORTE A)

Perindopril

Neutropenia, agranulocytosis

Neutropenia/agranulocytosis, thrombocytopenia and anemia were observed while taking ACE inhibitors. In patients with normal liver function and in the absence of other complicating factors, neutropenia rarely develops. Perindopril should be used with extreme caution in patients with diffuse connective tissue diseases, while taking immunosuppressants, allopurinol or procainamide, especially in patients with pre-existing liver dysfunction. Some of these patients developed severe infections, in some cases resistant to intensive antibiotic therapy. When prescribing perindopril to such patients, it is recommended to periodically monitor the number of leukocytes in the blood. Patients should report any signs of infectious diseases (eg, sore throat, fever) to their doctor.

Hypersensitivity/angioedema

When taking ACE inhibitors, incl. and perindopril, in rare cases, the development of angioedema of the face, extremities, lips, mucous membranes, tongue, vocal cords and/or larynx may occur. These reactions may occur at any time during therapy. In such cases, the drug should be stopped immediately and the necessary monitoring should be carried out until the symptoms disappear completely. If the swelling affects only the face and lips, it usually goes away on its own, although antihistamines can be used to treat symptoms.

Angioedema, accompanied by swelling of the larynx, can be fatal. Swelling of the tongue, vocal cords, or larynx can lead to airway obstruction. If these symptoms appear, you should immediately administer epinephrine solution 1:

1000 (0.3-0.5 ml) subcutaneously and/or ensure airway patency.

There are reports that black patients are more likely to experience angioedema when taking ACE inhibitors than white patients.

Patients who have had angioedema not associated with taking ACE inhibitors may have an increased risk of developing it when taking drugs of this group.

In rare cases, angioedema of the intestine develops during therapy with ACE inhibitors. In this case, patients experience abdominal pain (with or without nausea and vomiting), in some cases, without previous angioedema of the face and with normal C1-esterase levels. The diagnosis is made using computed tomography of the abdominal region, ultrasound, or at the time of surgery. Symptoms disappear after stopping ACE inhibitors. Therefore, in patients with abdominal pain receiving ACE inhibitors, when carrying out differential diagnosis, it is necessary to take into account the possibility of developing angioedema of the intestine.

Anaphylactoid reactions during desensitization

There are isolated reports of the development of persistent, life-threatening anaphylactoid reactions in patients receiving ACE inhibitors during desensitizing therapy with hymenopteric venom (including bee and aspen). ACE inhibitors should be prescribed with extreme caution to patients prone to allergic reactions and undergoing desensitization; their use should be avoided in patients undergoing immunotherapy with insect venom allergens. However, if the patient requires both treatment with ACE inhibitors and desensitization, then the onset of such reactions can be prevented by temporarily stopping the use of ACE inhibitors at least 24 hours before starting the course of desensitization therapy.

Anaphylactoid reactions during LDL apheresis

In rare cases, life-threatening anaphylactoid reactions may occur in patients receiving ACE inhibitors during LDL apheresis using dextran sulfate. To prevent an anaphylactoid reaction, ACE inhibitor therapy should be temporarily discontinued before each apheresis procedure.

Patients on hemodialysis

Anaphylactoid reactions have been reported in some patients undergoing hemodialysis using high-flux membranes (eg, AN69®) and concomitantly receiving one of the ACE inhibitors. For such patients, the use of a different type of membrane or a different class of antihypertensive drug should be considered.

Cough

Taking an ACE inhibitor may cause a dry cough. The cough persists for a long time while taking the drug, but disappears when the drug is discontinued. This symptom may have an iatrogenic etiology. If the need to take an ACE inhibitor remains, then continued treatment should be considered.

Risk of arterial hypotension and/or renal failure (in case of heart failure, water and electrolyte deficiency)

With significant loss of water and electrolytes (strict salt-free diet or long-term treatment with diuretics), especially in patients with initially low blood pressure, with renal artery stenosis, congestive heart failure or cirrhosis of the liver, accompanied by edema and ascites, pronounced stimulation of the RAAS occurs. Therefore, inhibition of RAAS activity when taking an ACE inhibitor may lead to a sudden decrease in blood pressure and/or an increase in serum creatinine, indicating functional renal failure. This is most likely when you first take the drug and during the first 2 weeks of treatment. In some, albeit very rare cases, such a disorder develops acutely, and the onset of the process is difficult to predict. In such cases, treatment should be resumed with a lower dose, gradually increasing it.

Elderly patients

Before starting treatment, kidney function and potassium levels should be monitored. To avoid sudden arterial hypotension, the initial dose of the drug is adjusted depending on the degree of decrease in blood pressure, especially in the case of dehydration and loss of electrolytes.

Patients with established atherosclerosis

The risk of arterial hypotension exists in all patients, but the drug should be used with extreme caution in patients with coronary artery disease or cerebrovascular insufficiency. In such cases, treatment should be started with a low dose.

Renovascular hypertension

Renovascular hypertension is treated by revascularization. However, the use of ACE inhibitors may be beneficial in patients with renovascular hypertension awaiting surgery or when surgery is not available.

In patients with an established diagnosis of renal artery stenosis or if it is suspected, treatment with Noliprel® forte A should begin in the hospital with a small dose under monitoring of renal function and potassium levels, because Some patients developed renal failure, which was reversible when treatment was discontinued.

Other risk groups

In patients with severe acute heart failure (grade IV) and in patients with insulin-dependent diabetes mellitus (a tendency to spontaneously increase potassium levels), treatment with Noliprel® forte A should be started with low doses and carried out under constant medical supervision.

Patients with arterial hypertension and coronary insufficiency should not stop taking beta-blockers:

An ACE inhibitor should be used in addition to a beta blocker.

Diabetes

In diabetic patients already taking oral hypoglycemic agents or insulin, glycemic levels should be carefully monitored, especially during the first month of taking an ACE inhibitor.

Ethnic differences

Perindopril, like other ACE inhibitors, may have a less pronounced hypotensive effect in patients of black race compared to representatives of other races. Perhaps this difference is due to the fact that arterial hypertension in black patients very often occurs against the background of low renin activity.

Surgery/anesthesia

ACE inhibitors can cause a drop in blood pressure during anesthesia, especially if the anesthetic used has a hypotensive effect. Therefore, long-acting ACE inhibitors such as perindopril should, if possible, be discontinued 24 hours before surgery.

Aortic or mitral valve stenosis/hypertrophic cardiomyopathy

Use ACE inhibitors with caution in patients with left ventricular outflow tract obstruction.

Liver dysfunction

In rare cases, ACE inhibitors have been associated with a syndrome that begins with cholestatic jaundice and progresses to fulminant hepatic necrosis and (sometimes) death. The mechanism of this syndrome is not yet clear. In patients receiving ACE inhibitors, if jaundice or a marked increase in liver enzyme activity develops, the ACE inhibitor should be discontinued and a thorough medical examination should be performed.

Hyperkalemia

Elevated serum potassium levels have been reported in some patients treated with ACE inhibitors, including perindopril. Risk factors for the development of hyperkalemia include renal failure, deterioration of renal function, age (> 70 years), diabetes mellitus, intercurrent events such as dehydration, acute heart failure, metabolic acidosis, concomitant use of potassium-sparing diuretics (eg, spironolactone, eplerenone, triamterene or amiloride), potassium supplements or potassium-containing salt substitutes, or taking other drugs that cause increases in serum potassium (eg, heparin). Taking potassium supplements, potassium-sparing diuretics, or potassium-containing salt substitutes, especially in patients with impaired renal function, may result in significant increases in serum potassium levels. Hyperkalemia can cause serious arrhythmias, sometimes fatal. If concomitant administration of perindopril or the above drugs is considered necessary, they should be taken with caution and with regular monitoring of serum potassium levels.

Indapamide

In patients with impaired liver function, taking thiazide and thiazide-like diuretics can cause hepatic encephalopathy. In this case, the diuretic should be stopped immediately.

Photosensitivity

Cases of photosensitivity have been reported with the use of thiazide and thiazide-like diuretics. If photosensitivity is noted during treatment, it is recommended to stop taking the drug. If re-administration of a diuretic is considered necessary, it is recommended to protect the skin from the sun and artificial UV radiation.

Water and electrolyte balance

Sodium level.

Before starting treatment, it is necessary to evaluate the sodium content, and further such studies should be carried out regularly. Taking any diuretic medication can cause a decrease in sodium levels, which sometimes leads to a number of serious complications. Initially, a decrease in sodium levels may be asymptomatic, which is why it is necessary to regularly monitor its content. In elderly patients and patients with liver cirrhosis, monitoring should be carried out even more often.

Potassium level.

The main danger when taking thiazide and thiazide-like diuretics is potassium deficiency and, accordingly, hypokalemia. Consideration of the risk of potassium levels falling below acceptable levels (< 3.4 mmol/L) is necessary in persons at increased risk, such as elderly patients and/or patients with impaired or malnutrition, regardless of whether they are taking one or more medications drugs, in patients with liver cirrhosis, which is accompanied by edema and ascites, in patients with coronary artery disease and in patients with heart failure. In such cases, hypokalemia increases the toxicity of cardiac glycosides and increases the risk of developing arrhythmias. Patients with congenital or iatrogenic prolongation of the QT interval are also at risk. Hypokalemia, like bradycardia, is a risk factor for the development of serious cardiac arrhythmias, especially torsade de pointes (TdP), which can be fatal. In any case, potassium levels should be monitored as often as possible. The first determination of plasma potassium should be carried out within the first week after the start of treatment. If potassium levels decrease, dose adjustment is necessary.

Calcium level.

Thiazide and thiazide-like diuretics can reduce the excretion of calcium in the urine, which leads to a temporary and slight increase in the concentration of calcium in the blood. A marked increase in calcium levels may be associated with undiagnosed hyperparathyroidism. In this case, treatment should be stopped until the function of the parathyroid gland is examined.

Blood glucose level

In patients with diabetes mellitus, it is necessary to constantly monitor blood glucose levels, especially if potassium levels are simultaneously low.

Uric acid

Patients with high levels of uric acid in the blood may be predisposed to developing gout.

Effect on kidney function

Thiazide and thiazide-like diuretics are most effective when renal function is normal or only slightly impaired (serum creatinine is below approximately 2.5 mg/dL, i.e. 220 µmol/L for an adult patient). In elderly patients, plasma creatinine levels should be adjusted for age, weight and gender using the Cockcroft formula:

For women:

the calculation result should be multiplied by 0.85.

At the beginning of treatment, taking diuretics can lead to loss of water and sodium, which in turn leads to hypovolemia. Hypovolemia causes a decrease in glomerular filtration rate. It may be accompanied by an increase in creatinine and urea in the blood. This renal failure is temporary and does not cause undesirable consequences in patients with normal renal function, but in cases of existing impairment, renal failure may worsen.

Athletes

Please note that indapamide may cause a positive reaction during doping control.

Noliprel® forte A

The combination of lithium and the combination of perindopril with indapamide is generally not recommended.

Kidney failure.

In patients with severe renal failure (creatinine clearance <30 ml/min), this combination is contraindicated. Treatment should be discontinued if a patient suffers from arterial hypertension without visible kidney damage, but in whom renal failure is detected during a blood test (renal complex). Treatment can be resumed either with this combination at lower doses or with only one component. Such patients should usually undergo frequent monitoring of serum creatinine and potassium levels for the first time - after 2 weeks of treatment, then once every 2 months during the period of therapeutic stability.

Renal failure was mainly observed in patients with acute heart failure and was also observed in renal artery stenosis. This drug is generally not recommended for patients with bilateral renal artery stenosis or for patients with only one kidney.

Arterial hypotension, deficiency of water and electrolytes.

The risk of a sudden drop in blood pressure increases with low sodium levels (especially in patients with renal artery stenosis). Therefore, during treatment, the state of water and electrolyte balance should be periodically monitored, which may be disturbed due to diarrhea or vomiting. In case of severe arterial hypotension, intravenous infusion of an isotonic solution may be necessary.

Transient arterial hypotension is not a contraindication for continued treatment. After restoration of adequate blood volume and blood pressure, treatment can be resumed either with this combination at lower doses, or with only one component.

Potassium content.

The combination of perindopril and indapamide does not prevent the onset of hypokalemia, especially in patients with diabetes mellitus and in patients with renal failure. As with any antihypertensive drug taken in combination with a diuretic, plasma potassium levels should be regularly monitored during treatment with this combination.

Excipients.

Noliprel® forte A should not be prescribed to patients with lactose intolerance, lapp lactase deficiency or impaired absorption of glucose-galactose.

Use in pediatrics

The effectiveness and tolerability of perindopril in children and adolescents as mono- or as part of combination therapy has not been sufficiently studied.

Impact on the ability to drive vehicles and operate machinery

Perindopril and indapamide in the form of monotherapy or in combination as part of the drug Noliprel® forte A do not affect the ability to concentrate and the speed of psychomotor reactions. However, in some patients, especially at the beginning of treatment or when combined with another antihypertensive drug, individual reactions may develop with a decrease in blood pressure. This leads to impaired ability to drive vehicles or other mechanisms.

Results of preclinical safety studies

The toxicity of the perindopril/indapamide combination is slightly higher than the toxicity of each component. No renal toxicity was detected in rats. However, this combination causes gastrointestinal toxicity in dogs; in rats, the toxic effect on the maternal body increases (compared to perindopril). These undesirable effects occurred at doses with a very high safety margin compared to the therapeutic doses used.

Preclinical studies conducted separately with perindopril and indapamide revealed neither genotoxic nor teratogenic potential.