Indopres

Indopress is a sulfanilamide diuretic drug with a minimal degree of action and an active hypotensive effect.

Indications Indopresa

It is used when blood pressure values increase due to various reasons.

Release form

The drug is released in tablet form (volume 2.5 mg), inside blister packs, 10 pieces each. There are 3 packs of tablets in a box.

Pharmacodynamics

At the renal level, the drug has an effect on the cortical zone of the ascending limb in the area of the loop of Henle, as well as the initial phase of the distal tubules.

The basis of the drug structure is the indole ring. The drug mainly has the function of vasodilating peripheral arteries, which leads to the development of a hypotensive effect. It has a high degree of lipophilicity, due to which it passes well into many tissues with organs.

Hypotensive effect:

• a change in the transmembrane movement of the Ca element causes a decrease in the number of contractions of vascular smooth muscles, due to which vasodilation occurs;
• participation in processes that stimulate the production of prostacyclins, as well as PG E2 - these components also have vasodilating activity;
• development of antagonism in relation to the potassium channels of the smooth muscle layer of the vessel, due to which an antihypertensive effect also develops.

The diuretic effect develops when the reabsorption of sodium ions is blocked, as well as the excretion of potassium, sodium, chloride and water ions.

Antiatherogenic effect – is the only diuretic drug that can slightly increase HDL levels by affecting prostacyclin binding, which leads to a decrease in platelet aggregation and, at the same time, to the development of an antioxidant effect (by reducing destruction and increasing the level of bioavailability of NO).

It demonstrates hypotensive activity both in people with healthy renal function and in those with impaired renal function, slightly increasing the values of SCF when using average medicinal doses.

The drug does not pass through the blood-brain barrier. Peak drug activity develops in case of prolonged use of indapamide.

Pharmacokinetics

Indopres is well absorbed in the gastrointestinal tract, and its Cmax values are recorded after 2 hours from the moment of administration. The half-life is 14-18 hours. Synthesis with blood protein is 70-80%. The high level of lipophilicity contributes to good distribution of the substance in tissues with organs (except for the central nervous system). Metabolic processes occur in the liver, and excretion is carried out through the kidneys (by 75%) and with feces (20% of metabolic products).

When taken in minimal doses, the medicine causes vascular dilation in the arteries. The required medicinal effect develops after 3 months of regular use of indapamide.

Dosing and administration

The medication should be taken orally – daily, once a day, in the morning, in a dose of 2.5 mg of the substance.

The effect of the drug develops gradually. If monotherapy does not produce the desired effect, complex treatment is used together with other antihypertensive medications. It is not necessary to increase the dose to obtain a more pronounced effect, because the use of large doses does not lead to increased hypotensive activity.

The duration of the treatment cycle is determined individually for each patient. Withdrawal of the drug does not cause rebound hypertension.

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Use Indopresa during pregnancy

It is prohibited to use the medication during breastfeeding or pregnancy.

Contraindications

Main contraindications:

• the presence of severe intolerance associated with indapamide or other components of the medication;
• problems with liver function;
• severe chronic renal failure (SCF values below 30 ml/minute);
• hypokalemia;
• lactase deficiency, glucose-galactose malabsorption or hypolactasia.

Side effects Indopresa

When using standard doses, patients do not experience any complications. The development of side effects is usually observed when the drug is administered in large doses:

• changes in EBV parameters: hyponatremia or -kalemia, as well as hypercalcemia, which cause orthostatic collapse. Due to the loss of chloride ions after the administration of indapamide, metabolic alkalosis may occasionally develop;
• a weak effect of the drug on blood glucose levels and an increase in uric acid levels in people with gout or diabetes mellitus is possible;
• disorders associated with blood function: a decrease in the number of leukocytes and platelets with neutrophils, as well as the development of hemolytic or aplastic anemia;
• disorders of the nervous system: headaches, depression, paresthesia, dizziness, as well as a feeling of drowsiness, asthenia and emotional instability;
• problems associated with the activity of the cardiovascular system: decreased blood pressure or arrhythmia;
• symptoms affecting the gastrointestinal tract: dry mouth, nausea, bowel disorders, vomiting and inflammation of the pancreas. In addition, problems with the liver or its inflammation, as well as encephalopathy;
• urinary dysfunction: increased frequency of urination with a large volume of urine excreted, as well as problems with kidney function;
• disorders affecting the respiratory system: irritation in the trachea, nasal mucosa and bronchi, as well as inflammation associated with the pulmonary alveoli and of a non-specific nature;
• signs of allergy: rashes, dermatitis or urticaria, as well as symptoms of a toxic-allergic nature (TEN or Stevens-Johnson syndrome). Photosensitivity occasionally develops;
• Others: impotence, color vision disorder, vasculitis, exacerbation of SLE and conjunctivitis.

Overdose

When consuming large doses of Indopres (40+ mg), there is a disorder of the EBV level, accompanied by symptoms of hyponatremia and -kalemia. Vomiting, abdominal pain, nausea and convulsive syndrome (may be accompanied by suppression of the respiratory center) also appear, and the blood pressure indicator decreases. When the blood pressure level drops, a feeling of confusion or drowsiness occurs, as well as dizziness. In severe disorders, problems with the kidneys with signs of anuria and oliguria appear.

To eliminate the disorders, gastric lavage is performed, sorbents are prescribed, electrolyte disorders are corrected, and symptomatic measures are carried out.

Interactions with other drugs

When indapamide is combined with antihypertensive drugs, an increase in therapeutic activity is observed.

Combination of the drug with lithium causes weakening of lithium reabsorption and increases its volumes in the blood, leading to the development of toxic effects. When using drugs together, it is necessary to carefully monitor plasma lithium values.

Salicylates, substances that inhibit COX-2 activity, and NSAIDs weaken the medicinal properties of indapamide.

In people with hyponatremia, the use of ACE inhibitors together with the drug leads to a sharp drop in blood pressure or the development of acute renal failure. Because of this, with such a drug combination, it is necessary to stop the administration of the diuretic that caused hyponatremia before starting to use the ACE inhibitor, and then, after 3 days, gradually begin taking the ACE inhibitor (starting with small portions and bringing it to the required medicinal dosage). A similar tactic with such a combination should be used in case of stenosis affecting the arteries inside the kidneys, as well as heart failure.

In case of kidney disease, it is necessary to monitor creatinine values at the initial stage of therapy with the simultaneous administration of Indopres and ACE inhibitors.

The combination of the drug with baclofen may cause an increase in the hypotensive effect. If such a situation develops, it is necessary to perform rehydration, necessarily monitoring the values of urea and creatinine.

Administration of the drug with SG leads to potentiation of the toxic properties of glycosides. It is necessary to monitor the ECG values and blood potassium levels.

Triamterene, spironolactone, and amiloride can alter blood potassium levels (either decreasing or increasing them). This is especially true for people with chronic renal failure or diabetes.

The use of the drug with metformin leads to the development of lactic acidosis, because it affects the functioning of the kidneys.

Iodinated contrast agents when used with indapamide in people with dehydration increase the risk of developing ARF (if hypokalemia is also present).

Administration together with calcium salts leads to a decrease in the excretion of the Ca element in the urine, and also increases its blood values.

Imipramine-like antidepressants and neuroleptics in combination with the drug cause the development of orthostatic collapse.

Concomitant use with cyclosporines increases the level of blood creatinine.

Estrogens and steroids reduce the antihypertensive effect because they have the ability to retain sodium and water in the body.

The drug should be used with great caution together with phenothiazines, antiarrhythmic agents of subtypes IA and III, butyrophenones, astemizole and benzamides, as well as with erythromycin, terfenadine, cisapride and bepridil. The list also includes diphemanil, vincamine with pentamidine, mizolastine with halofantrine and moxifloxacin with sparfloxacin. Such drug combinations can lead to arrhythmias or ventricular tachycardia if Indopres causes the development of hypokalemia.

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Storage conditions

Indopress must be stored in a place closed to small children. The temperature level should not exceed 25°C.

Shelf life

Indopres can be used within a 4-year period from the date of manufacture of the therapeutic agent.

Application for children

Indopres is not used in pediatrics.

Analogues

Analogues of the drug are Inapen, Ravel SR, Indapamide, Ionic with Arifon Retard and Enzix.