Description
Indapamide Pharmacodynamics
Hypotensive agent, thiazide-like diuretic with moderate potency and long duration of action, benzamide derivative. It has moderate saluretic and diuretic effects, which are associated with blockade of reabsorption of sodium, chloride, hydrogen and, to a lesser extent, potassium ions in proximal tubules and cortical segment of distal tubule of nephron. The vasodilatory effects and reduction of total peripheral vascular resistance have in their basis the following mechanisms: reduction of reactivity of the vascular wall to noradrenaline and angiotensin II; increased synthesis of prostaglandins with vasodilatory activity; inhibition of calcium flow in the smooth muscle walls of blood vessels.
Reduces arterial smooth muscle tone, reduces total peripheral vascular resistance. Helps reduce left ventricular hypertrophy of the heart. In therapeutic doses does not affect lipid and carbohydrate metabolism (including in patients with concomitant diabetes mellitus).
Antihypertensive effect develops at the end of the first/beginning of the second week when taking the drug continuously and lasts for 24 hours on a single dose.
Thiazide and thiazide-like diuretics reach a plateau of therapeutic effect at a certain dose, while the frequency of side effects continues to increase with further increasing of the drug dose. Therefore, the drug dose should not be increased if the therapeutic effect has not been achieved at the recommended dose.
Indications
Arterial hypertension.
Contraindications
Hypersensitivity to indapamide, other sulfonamide derivatives or other drug components, severe renal (creatinine clearance less than 30 ml/min) and/or hepatic disorders (including encephalopathy), hypokalemia, pregnancy, lactation, age less than 18 years (effectiveness and safety are not established). The coating of the tablet contains lactose, in this regard, the drug should not be taken by patients with rare hereditary diseases, such as lactose intolerance, lactase deficiency or glucose-galactose malabsorption.
With caution:
Diabetes mellitus, hyperuricemia (especially accompanied by gout and urate nephrolithiasis), hyponatremia and other disorders of water-electrolyte balance, moderate hepatic and/or renal insufficiency, ascites, coronary heart disease, chronic heart failure, concomitant use of drugs that prolong the QT interval, hyperparathyroidism, in weakened patients and patients with prolonged QT interval on ECG or receiving concomitant therapy with other antiarrhythmic agents.
Pregnancy and lactation:
The drug is not recommended for use during pregnancy, since diuretics may cause fetoplacental ischemia with the risk of fetal hypotrophy.
Indapamide is excreted with breast milk. Taking into account the possibility of occurrence of adverse effects in infants, breastfeeding during treatment is not recommended.
Dosage and administration
- 2.5 mg (1 tablet) per day by mouth, preferably in the morning, regardless of meals, with plenty of fluids.
- If the desired therapeutic effect is not achieved after 4 to 8 weeks of treatment, it is not recommended to increase the dose (there is an increased risk of side effects without increasing the antihypertensive effect). Instead, it is recommended to include another hypotensive drug that is not a diuretic in the drug regimen. In cases where it is necessary to start treatment with two drugs, the dose of indapamide remains equal to 2.5 mg in the morning once a day.
