Indapamide retard

Undesirable drug combinations

Lithium preparations

With the simultaneous use of indapamide and lithium preparations, an increase in the concentration of lithium in the blood plasma may be observed due to a decrease in its excretion, accompanied by the appearance of signs of overdose. If necessary, diuretic drugs can be prescribed in combination with lithium drugs, and the dose of the drugs should be carefully selected, constantly monitoring the lithium content in the blood plasma.

Combinations of drugs requiring special attention

Drugs that can cause polymorphic ventricular tachycardia of the “pirouette” type

- class IA antiarrhythmic drugs (quinidine, hydroquinidine, disopyramide);

- class III antiarrhythmic drugs (amiodarone, dofetilide, ibutilide), sotalol;

- some neuroleptics: phenothiazines (chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoroperazine), benzamides (amisulpride, sulpiride, sultopride, tiapride), butyrophenones (droperidol, haloperidol);

-others: bepridil, cisapride, diphemanil, erythromycin (iv), halofantrine, mizolastine, pentamidine, sparfloxacin, moxifloxacin, astemizole, vincamine (iv).

Increased risk of ventricular arrhythmias, especially polymorphic ventricular tachycardia of the “pirouette” type (risk factor - hypokalemia).

The potassium level in the blood plasma should be determined and, if necessary, adjusted before starting combination therapy with indapamide and the above drugs. It is necessary to monitor the patient’s clinical condition, monitor the content of blood plasma electrolytes, and ECG indicators.

Patients with hypokalemia should be prescribed drugs that do not cause polymorphic ventricular tachycardia of the torsade de pointes type.

Nonsteroidal anti-inflammatory drugs (for systemic use), including selective cyclooxygenase-2 (COX-2) inhibitors, high doses of acetylsalicylic acid (≥ 3 g/day)

The antihypertensive effect of indapamide may be reduced. With significant fluid loss, acute renal failure may develop (due to decreased glomerular filtration). Patients need to compensate for fluid loss and carefully monitor renal function at the beginning of treatment.

Angiotensin-converting enzyme (ACE) inhibitors

The use of ACE inhibitors in patients with reduced levels of sodium ions in the blood (especially patients with renal artery stenosis) is accompanied by a risk of sudden arterial hypotension and/or acute renal failure.

For patients with arterial hypertension

and possibly reduced, due to the use of diuretics, the content of sodium ions in the blood plasma is necessary:

-3 days before starting treatment with an ACE inhibitor, stop taking diuretics. In the future, if necessary, diuretics can be resumed;

-or start ACE inhibitor therapy with low doses, followed by a gradual increase in dose, if necessary.

For chronic heart failure

Treatment with ACE inhibitors should be started with low doses, with a possible preliminary reduction in diuretic doses.

In all cases, in the first week of taking ACE inhibitors in patients, it is necessary to monitor renal function (plasma creatinine concentration).

Other drugs that can cause hypokalemia: amphotericin B (iv), gluco- and mineralocorticosteroids (if used systemically), tetracosactide, laxatives that stimulate intestinal motility

Increased risk of hypokalemia (additive effect).

Regular monitoring of potassium levels in the blood plasma is necessary, and correction if necessary. Particular attention should be paid to patients concomitantly receiving cardiac glycosides.

It is recommended to use laxatives that do not stimulate intestinal motility.

Baclofen

There is an increase in antihypertensive effect. Patients need to compensate for fluid loss and, at the beginning of treatment, carefully monitor renal function.

Cardiac glycosides

Hypokalemia enhances the toxic effect of cardiac glycosides. When using the drug Indapamide retard and cardiac glycosides simultaneously, the potassium content in the blood plasma, ECG values should be monitored, and, if necessary, therapy should be adjusted.

Drug combinations requiring attention

Potassium-sparing diuretics (amiloride, spironolactone, triamterene)

Combination therapy with indapamide and potassium-sparing diuretics is advisable in some patients, but the possibility of developing hypokalemia (especially in patients with diabetes mellitus and renal failure) or hyperkalemia cannot be excluded.

It is necessary to monitor the potassium content in the blood plasma, ECG indicators and, if necessary, adjust therapy.

Metformin

Functional renal failure, which can occur against the background of diuretics, especially loop diuretics, with simultaneous use of metformin increases the risk of developing lactic acidosis.

Metformin should not be prescribed if the creatinine concentration exceeds 15 mg/L (135 µmol/L) in men and 12 mg/L (110 µmol/L) in women.

Iodinated contrast agents

Dehydration while taking diuretics increases the risk of developing acute renal failure, especially when using high doses of iodinated contrast agents.

Before using iodinated contrast agents, patients need to compensate for fluid loss.

Tricyclic antidepressants, antipsychotics (neuroleptics)

Drugs in these classes enhance the antihypertensive effect of indapamide and increase the risk of orthostatic hypotension (additive effect).

Calcium salts

With simultaneous use, hypercalcemia may develop due to a decrease in the excretion of calcium ions by the kidneys.

Cyclosporine, tacrolimus

It is possible to increase the concentration of creatinine in the blood plasma without changing the concentration of circulating cyclosporine, even with normal fluid and sodium ion levels.

Corticosteroid drugs, tetracosactide (for systemic use)

Decreased antihypertensive effect (retention of fluid and sodium ions as a result of the action of corticosteroids).

Indapamide, 1.5 mg, extended-release film-coated tablets, 30 pcs.

Not recommended combinations: when used simultaneously with lithium preparations, it is possible to increase the concentration of lithium ions in the blood plasma due to a decrease in its excretion from the body by the kidneys, accompanied by the appearance of signs of overdose (nephrotoxic effect), as well as when following a salt-free diet (reduced excretion of lithium ions by the kidneys) .

Combinations requiring special attention:

1) Drugs that can cause heart rhythm disturbances of the “pirouette” type: class IA antiarrhythmics (quinidine, hydroquinidine, disopyramide), class III antiarrhythmics (amiodarone, dofetilide, ibutilide, bretylium tosylate), sotalol, some neuroleptics: phenothiazines (chlorpromazine , cyamemazine, levomepromazine, thioridazine, trifluoperazine), benzamides (amisulpride, sulpiride, sultopride, tiapride), butyrophenones (droperidol, haloperidol), others (bepridil, cisapride, difemanil, erythromycin (intravenous (IV)), halofantrine, mizolastine , pentamidine, sparfloxacin, moxifloxacin, vincamine (iv), astemizole. Concomitant use with any of these drugs, especially against the background of hypokalemia, increases the risk of ventricular arrhythmias. Before starting combination therapy with indapamide and the above drugs, potassium levels should be monitored blood plasma and, if necessary, adjust it.

Recommended: monitoring the patient’s clinical condition, as well as the content of electrolytes in the blood plasma and ECG. In patients with hypokalemia, it is necessary to use drugs that do not provoke the development of arrhythmias.

2) With the simultaneous use of non-steroidal anti-inflammatory drugs (NSAIDs) (for systemic use), including selective inhibitors of cyclooxygenase-2 (COX-2), high doses of salicylic acid (3 g / day or more), it is possible: a decrease in the antihypertensive effect of indapamide, the development of acute renal failure in dehydrated patients (due to decreased glomerular filtration rate). At the beginning of indapamide therapy, it is necessary to restore water and electrolyte balance and monitor renal function.

3) Angiotensin-converting enzyme (ACE) inhibitors in patients with hyponatremia (especially in patients with renal artery stenosis) increase the risk of developing arterial hypotension and/or acute renal failure. Patients with arterial hypertension and possibly hyponatremia due to taking diuretics should: - stop taking the drug 3 days before starting therapy with ACE inhibitors and switch to therapy with potassium-sparing diuretics; - or start therapy with ACE inhibitors with low doses, followed by a gradual increase in dose if necessary. During the first week of therapy with ACE inhibitors, it is recommended to monitor plasma creatinine concentrations.

4) Other drugs that can cause hypokalemia: amphotericin B (iv), gluco- and mineralocorticosteroids (if administered systemically) (see also information in the section “Drug combinations requiring attention”), tetracosactide (see also information in the section “Drug combinations that require attention”), laxatives that stimulate intestinal motility. When taken simultaneously with indapamide, the above drugs increase the risk of developing hypokalemia (additive effect). If necessary, the content of potassium ions in the blood plasma should be monitored and adjusted.

5) Simultaneous therapy with baclofen enhances the antihypertensive effect of indapamide.

6) Cardiac glycosides: hypokalemia increases the toxic effect of cardiac glycosides (glycoside intoxication). With the simultaneous use of indapamide and cardiac glycosides, the content of potassium ions in the blood plasma, ECG parameters should be monitored, and, if necessary, therapy should be adjusted.

Combinations of drugs requiring attention:

1) Simultaneous use with potassium-sparing diuretics (amiloride, spironolactone, triamterene) is advisable in some patients, but the possibility of developing hypokalemia cannot be excluded. Hyperkalemia may develop against the background of diabetes mellitus or renal failure. It is necessary to monitor the content of potassium ions in the blood plasma, ECG indicators, and, if necessary, adjust therapy.

2) Metformin increases the risk of developing lactic acidosis, since renal failure may develop while taking diuretics, especially loop diuretics. Metformin should not be taken if the plasma creatinine concentration is more than 15 mg/l (135 µmol/l) in men and 12 mg/l (110 µmol/l) in women.

3) Simultaneous use of large doses of iodine-containing contrast agents against the background of hypovolemia and diuretics increases the risk of developing acute renal failure. It is recommended to restore the water and electrolyte balance of the blood before using the drugs.

4) Tricyclic antidepressants (imipramine-like) and antipsychotics increase the antihypertensive effect and the risk of developing orthostatic hypotension (additive effect).

5) Preparations containing calcium salts increase the risk of developing hypercalcemia due to a decrease in the excretion of calcium ions by the kidneys.

6) Cyclosporine, tacrolimus - the risk of increasing the concentration of creatinine in the blood plasma without changing the concentration of circulating cyclosporine.

7) Glucocorticosteroid drugs, tetracosactide (when used systemically) reduce the antihypertensive effect (retention of sodium ions and fluid).

Indapen retard tablets prolonged action p/o 1.5 mg No. 15x2

Name

Indapen retard tablet extended d-ia p/o 1.5 mg per bl. in pack No. 15x2

Main active ingredient

indapamide

Release form

Pills

Dosage

1.5 mg

special instructions

Use with caution in patients with diabetes mellitus (glucose levels need to be controlled, especially in the presence of hypokalemia), gout (an increase in the number of attacks is possible), and in patients with a history of allergic reactions to sulfonamide derivatives. During treatment, it is necessary to monitor the level of electrolytes in the blood plasma (potassium, sodium, calcium).

Indications for use

Arterial hypertension; sodium and water retention in chronic heart failure.

Directions for use and doses

Take 2.5 mg orally 1 time/day (in the morning). If the hypotensive effect is insufficient after 2 weeks of treatment, the dose is increased to 5-7.5 mg/day. The maximum daily dose is 10 mg, divided into 2 doses (in the first half of the day).

Use during pregnancy and lactation

Adequate and well-controlled studies of the safety of indapamide during pregnancy and lactation have not been conducted. Use in this category of patients is not recommended.

Interaction with other drugs

With the simultaneous use of GCS and tetracosactide for systemic use, the hypotensive effect is reduced due to the retention of water and sodium ions under the influence of GCS. When used simultaneously with ACE inhibitors, the risk of developing hyponatremia increases. When used simultaneously with NSAIDs (for systemic use), the hypotensive effect of indapamide may be reduced. With significant fluid loss, acute renal failure may develop (due to a sharp decrease in glomerular filtration). When used simultaneously with calcium supplements, hypercalcemia may develop due to decreased excretion of calcium ions in the urine. When used simultaneously with cardiac glycosides and corticosteroids, the risk of developing hypokalemia increases. With the simultaneous use of drugs that can cause hypokalemia (amphotericin B, gluco- and mineralocorticoids, tetracosactide, laxatives that stimulate intestinal motility), the risk of developing hypokalemia increases. When used simultaneously with tricyclic antidepressants (including imipramine), the hypotensive effect is enhanced and the risk of developing orthostatic hypotension increases (additive effect). When used simultaneously with astemizole, bepridil, erythromycin (iv), pentamidine, sultopride, terfenadine, vincamine, quinidine, disopyramide, amiodarone, bretylium tosylate, sotalol, there is a risk of developing ar. When used simultaneously with baclofen, the hypotensive effect is enhanced. When used simultaneously with halofantrine, the likelihood of cardiac arrhythmias (including ventricular arrhythmias) increases. When used simultaneously with lithium carbonate, the risk of developing the toxic effect of lithium increases due to a decrease in its renal clearance. With simultaneous use with metformin, the appearance of lactic acidosis is possible, which is apparently associated with the development of functional renal failure caused by the action of diuretics (mainly “loop”). When used simultaneously with cyclosporine, an increase in the creatinine content in the blood plasma is possible, which is observed even with normal levels of water and sodium ions.

Contraindications

Acute cerebrovascular accident, severe renal and/or liver dysfunction, severe forms of diabetes mellitus and gout, hypersensitivity to indapamide.

Compound

indapamide 2.5 mg Excipients: magnesium stearate, carbomer, lactose monohydrate, hydroxypropylcellulose, talc, colloidal anhydrous silicon dioxide. Shell composition: Opadry II Pink: (hypromellose, lactose monohydrate, macrogol 3000, glycerol triacetate, black iron oxide (E172), red iron oxide (E172), yellow iron oxide (E172), titanium dioxide (E171)).

Side effect

From the digestive system: nausea, feeling of discomfort or pain in the epigastrium. From the side of the central nervous system: weakness, fatigue, dizziness, nervousness. From the cardiovascular system: orthostatic hypotension. Metabolism: hypokalemia, hyperuricemia, hyperglycemia, hyponatremia, hypochloremia. Allergic reactions: skin manifestations.

Buy Indapen retard extended-release tablets p/o 1.5 mg No. 15x2 in the pharmacy

Price for Indapen retard prolonged action tablets p/o 1.5 mg No. 15x2

Instructions for use for Indapen retard extended-release tablets p/o 1.5 mg No. 15x2

Contraindications and side effects

According to the instructions for use of Indapamide, the drug is contraindicated in:

hypersensitivity to the main substance;
acute cerebrovascular accident;
severe diabetes mellitus;
advanced form of gout;
serious renal dysfunction;
severe liver diseases.

Since the substance removes fluid from the body, it can cause dehydration and a decrease in the concentration of potassium and sodium in the body. In rare cases, arrhythmia and hemolytic anemia may occur.

Main side effects:

allergies (in the form of skin itching, rash, photosensitivity);
arrhythmia or tachycardia;
dry mouth and nausea;
headache and sleep disturbances;
epigastric pain;
constipation or diarrhea.

Taking the drug may provoke changes in well-being due to a decrease in blood pressure, so it is better to avoid activities that require special care.

Composition and release form

Indapamide is produced by different pharmaceutical companies under several names (for example, Indapamide Stada or Teva) in the form:

long-acting tablets (their name contains the word retard or the letters MB);
tablets with a special film coating;
capsules

In all dosage forms, the active ingredient is the same - indapamide. In long-acting tablets, its dosage can be 1.5 mg, and in regular tablets and capsules - only 2.5 mg. Sold in cardboard boxes of 30 or 60 pieces, complete with instructions.

Auxiliary components are represented by colloidal silicon dioxide, magnesium stearate, lactose, microcrystalline cellulose. But each manufacturer has the right to produce medicine using its own technology, so the composition must be specified in the instructions for the product being purchased.

Clinical efficacy of indapamide in patients with hypertension

Hypertension (HD) is one of the leading causes of disability and mortality. A prolonged increase in blood pressure (BP) leads to target organ damage and the development of cardiovascular complications (heart failure, myocardial infarction, cerebral stroke and renal failure) [2, 3, 8].

Drugs for the treatment and prevention of complications of hypertension should have high therapeutic efficacy, a long-lasting antihypertensive effect throughout the day, and the absence of metabolic side effects [3, 4, 8].

The listed requirements are fully met by the drug belonging to the second generation of thiazide and thiazide-like diuretics, indapamide

. The mechanism of its antihypertensive action is associated with inhibition of sodium reabsorption in the distal convoluted tubules and the development of peripheral vasodilation [6]. Unlike hydrochlorothiazide, indapamide does not affect lipid and carbohydrate metabolism [7, 9]. One of the advantages of the drug is the ability to reduce the mass of hypertrophied left ventricular myocardium [5].

Indapamide has high bioavailability (90–95%) and a long half-life (15–25 hours), which allows for a stable antihypertensive effect throughout the day [4].

The purpose of the study conducted in our clinic was to evaluate the effectiveness and safety of indapamide under conditions of 24-hour blood pressure monitoring (ABPM), studying central hemodynamics under the control of a number of parameters of the biochemical spectrum of blood.

The study included 30 patients (12 men and 18 women) with stage I and II hypertension (according to WHO classification). The average age of the group was 47.1±11.5 years, the duration of the disease was 8.0±7.05 years. 10 patients had mild and 20 had moderate arterial hypertension (AH). Patients with symptomatic hypertension, unstable angina, previous myocardial infarction or acute cerebrovascular accident in the last 6 months, a history of liver and kidney diseases, and intolerance to sulfonamides were excluded from the study. The duration of observation was 8 weeks.

After an introductory period, during which patients did not receive antihypertensive therapy, indapamide (Hemofarm, Yugoslavia) was prescribed at a daily dose of 2.5 mg, once in the morning. If monotherapy was ineffective for 1 month, enalapril (Hemofarm, Yugoslavia) was added at a daily dose of 5–20 mg. At baseline and after 8 weeks of treatment, antihypertensive efficacy using ABPM, the effect on central hemodynamic parameters, and levels of electrolytes and blood lipids were assessed in all patients.

ABPM was carried out using a portable recorder ABRM-04 from Meditech (Hungary), which records blood pressure and heart rate during the decompression phase using the oscillometric method. Measurements began at 9–10 am. The intervals between blood pressure and heart rate measurements were 15 minutes during the day and 30 minutes at night. Based on ABPM data, we analyzed the average indicators of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate during periods of wakefulness, sleep and for the day as a whole, standard deviation to assess the variability of blood pressure and heart rate; degree of nocturnal reduction in blood pressure (SNS – percentage of reduction in blood pressure at night); percentage of blood pressure measurements exceeding the upper limit of normal in the total number of registrations; variability index. Blood pressure levels below 140/90 mmHg are considered normal. Art. during the day and below 120/70 mm Hg. Art. at night. Central hemodynamics were studied using an Acuson apparatus (USA).

Results and discussion

Before starting treatment, patients complained of headache (63%), dizziness (37%), pain in the heart of various types (27%), decreased performance (50%). 23% of patients had no complaints. According to ABPM data (Table 1), there was an increase in the average daytime, average nighttime and average daily values of SBP and DBP. The proportion of measurements that exceeded the norm, as well as the variability index, exceeded the permissible normative values, which indicated an increase in hypertensive load. The degree of nocturnal decrease (NNR) for SBP was 10.0±6.0%, for DBP – 13.0±7.5%, which corresponds to the “dipper” group. Initially, indicators of central hemodynamics (Table 2) such as average blood pressure per day and total peripheral vascular resistance (TPVR) were significantly increased.

After 8 weeks of therapy, clear positive dynamics were noted in the patients’ condition. The general well-being of the patients improved, dizziness decreased or disappeared (in 82%), headaches (in 58%), cardialgia (in 100%), and performance increased (in 80%). All patients had good tolerability of treatment, there were no side effects.

When assessing the data obtained, normalization of DBP (decrease to 90 mm Hg or lower) was considered a good result of treatment; a satisfactory result was a decrease in DBP by 10 mm Hg. Art. and more (but not to normal values), unsatisfactory - a decrease in DBP by less than 10 mm Hg. Art. or increased blood pressure. In 16 patients receiving monotherapy with indapamide, the antihypertensive result was assessed as good, in 2 patients - as satisfactory. Thus, 60% of patients achieved an effect during treatment with indapamide, which corresponds to the available literature data on the effectiveness of monotherapy [8].

There was a significant decrease in SBP per day, day, night by 14.5, 14.9 and 18 mm Hg. Art., respectively. Average daily, daytime, and nighttime DBP decreased by 8.8, 8.9, and 14.3 mmHg, respectively. Art. A significant decrease in the blood pressure variability index was revealed. Particularly noteworthy is the decrease in the absolute value of DBP and the DBP variability index, since changes in these indicators correlate with target organ damage [10]. During treatment, an unreliable increase in the SNS was noted, not exceeding 20%. The above indicates that a single dose of indapamide 2.5 mg is sufficient to maintain normal blood pressure throughout the day without affecting the physiological circadian rhythm of blood pressure.

When analyzing central hemodynamics during monotherapy with indapamide, a significant decrease in average blood pressure per day (p <0.01) and total peripheral resistance (p <0.05) was revealed, which largely explains the predominant effect of indapamide on DBP (Table 2). The dynamics of shock and cardio indices were statistically insignificant.

Twelve patients received combination therapy (indapamide 2.5 mg/day + enalapril 5–20 mg/day). At the same time, there was a significant decrease in SBP and DBP per day, day and night (Table 1), and the BP variability index. SNS increased slightly within the “dipper” group, that is, there was also no change in the circadian rhythm of blood pressure. According to echocardiography, there was a significant decrease in average blood pressure per day by 7.2% (p<0.01), peripheral vascular resistance by 13.3% (p<0.05), other indicators changed unreliably (Table 2). In 8 patients receiving combination therapy with indapamide and enalapril, the antihypertensive result was assessed as good, in 2 patients as satisfactory, in 2 patients as unsatisfactory, and therefore required the addition of verapamil at a dose of 120 mg per day. After 8 weeks of indapamide therapy, an insignificant decrease in the levels of sodium (from 142.4±2.9 to 140.4±2.3 mmol/l) and potassium (from 4.4±0.4 to 3.96±0.3) was noted mmol/l) in blood serum. Not a single patient had electrolyte levels (and, most importantly, potassium) that dropped below normal values. There were also no significant changes in the content of cholesterol and triglycerides compared to the initial level.

conclusions

1. Indapamide is a highly effective antihypertensive drug for the treatment of patients with mild and moderate forms of hypertension.

2. Considering the effect of indapamide on the peripheral vascular resistance, the drug can be prescribed primarily for diastolic hypertension.

3. The metabolic inertness of indapamide, unlike thiazides, makes it possible to recommend it to patients with hypertension in combination with metabolic disorders.

4. Adding enalapril to indapamide (if monotherapy is insufficiently effective) allows you to achieve the target blood pressure level.

Indapamide -

Indapamide (trade name)

(Hemofarm)
Literature:
1. Bulkina O.S., Dobrovolsky A.B., Britareva V.V., Marenich A.V., Karpov Yu.A. Ross. cardiol. magazine 1999; 1:39–42.

2. Gogin E.E. Hypertonic disease. M.; 1997.

3. Makolkin V.I., Podzolkov V.I. Hypertonic disease. – M.; 2000.

4. Sidorenko B.A., Preobrazhensky D.V. Diagnosis and treatment of arterial hypertension. Part two. Diuretics. M.; 2000.

5. Campbell DB, Brackman FJ Clin. Pharmacol. 1991; 31: 751–757.

6. Campbell DB, Moore R. Am. J. Hypertens. 1981; 57: 7–17.

7. FuJii S., Kaku K., Andou S., Nakayama H. et al. Clin. Ther. 1993; 15:6.

8. Hanson L., Hedner T. Hypertension Manual. 3rd ed., 2000.

9. Weidmann P., M. De Courten, P. Ferrari, Lorenz Bohlen. J. Cardiovasc. Pharmacol. 1993; 22(Suppl. 6): 98–105.

10. White WB, Dey HM, Schulman P. Am. Heart J 1989; 118:782–795.

Indapamide: how and in what doses to take

The method and regimen of use depend on the prescribed dosage of the drug.

A 2.5 mg tablet is taken once a day in the morning. If the hypotensive effect does not appear within 14 days, then the dose is increased to 2-3 tablets per day. The maximum daily dose is 10 mg, which should be divided into two doses;
a long-acting tablet of 1.5 mg is taken once a day in the morning, but if the effectiveness is weak, after 1.5-2 months the treatment should be supplemented with a drug that is not a diuretic. With long-term therapy, increasing the dose is not advisable due to the increased risk of side effects without normalizing blood pressure.

To eliminate edema in chronic heart failure, Indapamide is prescribed at a dose of 5-7.5 mg per day for 7-14 days.

Is Indapamide safe for pregnant women?

Due to the fact that no serious studies have been conducted on the effect of the drug on pregnant women, tablets and capsules are prohibited during pregnancy. There is a risk of fetoplacental insufficiency, leading to slower fetal development.

The substance can pass into breast milk, therefore, when treating with the drug during lactation, breastfeeding should be stopped.

Indapamide is not suitable for the treatment of physiological edema in pregnancy.

Effect of the drug

Indapamide has a triple effect:

has a diuretic effect;
reduces blood pressure;
dilates blood vessels.

When taking 1.5-2.5 mg of the drug, a hypotensive effect appears, but without a noticeable diuretic effect. This feature allows the drug to be used to lower blood pressure for a long time.

When the dosage is increased, the hypotensive effect does not increase, but the diuretic effect appears.

A noticeable decrease in blood pressure occurs only after 7 days of taking the medicine; a lasting effect can be expected no earlier than after 3 months.

Thanks to the drug, vascular resistance is reduced by reducing the force of contraction of the smooth muscles of the arteries, and the size of the left ventricle of the heart returns to normal.

Indications for use

The instructions for use contain information about what Indapamide helps with. It is prescribed for arterial hypertension, as well as for chronic heart failure caused by sodium and water retention in the body.

The drug does not affect the metabolism of carbohydrates and fats, therefore it is indicated:

people diagnosed with diabetes;
patients with high cholesterol;
people with one kidney or on hemodialysis.