Indapamide, 30 pcs., 2.5 mg, film-coated tablets
Undesirable combination of drugs
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 used in combination with lithium drugs, and the dose of the drugs should be carefully selected, regularly monitoring the lithium content in the blood plasma.
Combination of drugs requiring special attention
Drugs that can cause aritis:
- class IA antiarrhythmic drugs (hydroquinidine (quinidine), 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, difemanil, erythromycin (iv), halofantrine, mizolastine, pentamidine, sparfloxacin, moxifloxacin, astemizole, vincamine (iv).
Increased risk of ventricular arrhythmias, especially arrhythmias (risk factor: hypokalemia)
The potassium content 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 blood plasma electrolytes, and electrocardiogram (ECG) indicators.
In patients with hypokalemia, drugs that do not cause ari should be used.
Non-steroidal anti-inflammatory drugs (when administered systemically), including selective COX-2 (cyclooxygenase-2) inhibitors, high doses of salicylates (≥3 g/day)
The antihypertensive effect of indapamide may be reduced.
With significant fluid loss, acute renal failure may develop (due to a decrease in glomerular filtration rate). Patients need to compensate for fluid loss and carefully monitor renal function at the beginning of treatment.
Angiotensin-converting enzyme (ACE) inhibitors
Prescribing ACE inhibitors to patients with a reduced concentration 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.
Patients with arterial hypertension and possibly reduced levels of sodium ions in the blood plasma as a result of taking diuretics should: stop taking diuretics 3 days before starting treatment with an ACE inhibitor. 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.
In chronic heart failure, treatment with ACE inhibitors should begin with low doses with a possible preliminary reduction in the doses of diuretics.
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 administered systemically), tetracosactide), laxatives that stimulate intestinal motility
Increased risk of hypokalemia (additive effect).
Regular monitoring of potassium levels in blood plasma is necessary; if necessary, its correction. 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 the antihypertensive effect.
Patients need to compensate for fluid loss and carefully monitor renal function at the beginning of treatment.
Cardiac glycosides
Hypokalemia enhances the toxic effect of cardiac glycosides.
With the simultaneous use of indapamide and cardiac glycosides, the content of potassium in the blood plasma, ECG indicators should be monitored, and, if necessary, therapy should be adjusted.
Combination of drugs requiring attention
Potassium-sparing diuretics (amiloride, spironolactone, triamterene, eplerenone (spironolactone derivative))
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 patients with 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 administration of metformin increases the risk of developed lactic acidosis.
Metformin should not be used 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 administration, 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 (if administered systemically)
Decreased antihypertensive effect (retention of fluid and sodium ions as a result of the action of corticosteroids).
Indapamide
UNDESIRABLE DRUG COMBINATIONS
— Lithium preparations:
with the simultaneous use of indapamide and lithium preparations, as well as when following a salt-free diet, 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 lithium overdose. If necessary, diuretics can be used in combination with lithium preparations, and the dose of the drugs should be carefully selected, regularly monitoring the concentration of lithium in the blood plasma.
DRUG COMBINATIONS REQUIRING SPECIAL ATTENTION
— Drugs that can cause aritis:
- class IA antiarrhythmic drugs (quinidine, hydroquinidine, disopyramide);
- class III antiarrhythmic drugs (amiodarone, sotalol, dofetilide, ibutilide);
- some neuroleptics: phenothiazines (chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoroperazine), benzamides (amisulpride sulpiride, sultopride, tiapride), butyrophenones (droperidol, haloperidol);
- others: bepridil, cisapride, difemanil, erythromycin (iv), halofantrine, mizolastine, pentamidine, sparfloxacin, moxifloxacin, astemizole, vincamine (iv).
Increased risk of ventricular arrhythmias, especially arrhythmias (risk factor - hypokalemia).
The concentration of potassium in the blood plasma should be determined and, if necessary, adjusted before starting combination therapy with indapamide with the above drugs. It is necessary to monitor the patient’s clinical condition, monitor the content of blood plasma electrolytes, and ECG indicators.
In patients with hypokalemia, drugs that do not cause ari should be used.
— Non-steroidal anti-inflammatory drugs (when administered systemically), including selective COX-2 inhibitors, high doses of acetylsalicylic acid (≥3 g/day):
the antihypertensive effect of indapamide may be reduced.
There is a risk of developing acute renal failure 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:
Prescribing ACE inhibitors to patients with an initially reduced concentration 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 content of sodium ions in the blood plasma due to diuretics, it is necessary to:
- 3 days before starting treatment with an ACE inhibitor, stop taking the diuretic. In the future, if necessary, the use of a non-potassium-sparing diuretic 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 the lowest doses, with a possible preliminary reduction in diuretic doses.
In all cases
In the first weeks of taking ACE inhibitors in patients, it is necessary to monitor renal function (plasma creatinine content).
— Other drugs that can cause hypokalemia: amphotericin B (iv), gluco- and mineralocorticosteroids (when administered systemically), tetracosactide, laxatives that stimulate intestinal motility:
increased risk of hypokalemia (additive effect).
Regular monitoring of the concentration of potassium in the blood plasma is necessary, and, if necessary, its correction. Particular attention should be paid to patients concomitantly receiving cardiac glycosides. It is recommended to use laxatives that do not stimulate intestinal motility.
— Baclofen:
it is possible to enhance the antihypertensive effect.
Patients need to compensate for fluid loss and carefully monitor renal function at the beginning of treatment.
— Cardiac glycosides:
hypokalemia enhances the toxic effect of cardiac glycosides.
With the simultaneous use of indapamide and cardiac glycosides, the concentration of potassium in the blood plasma, ECG readings should be monitored, and, if necessary, therapy should be adjusted.
COMBINATION OF DRUGS REQUIRING ATTENTION
— Potassium-sparing diuretics (amiloride, spironolactone, triamterene):
Co-administration of indapamide with potassium-sparing diuretics is advisable in some patients, but the possibility of developing hypokalemia or hyperkalemia cannot be excluded (especially in patients with diabetes mellitus or in patients with renal failure).
It is necessary to monitor the concentration of potassium in the blood plasma, ECG indicators and, if necessary, adjust therapy.
— Metformin:
functional renal failure, which can occur while taking diuretics, especially loop diuretics, with simultaneous administration of metformin increases the risk of developing lactic acidosis.
Metformin should not be used 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 iodine-containing contrast agents.
Before using iodinated contrast agents, patients need to compensate for fluid loss.
Tricyclic antidepressants, antipsychotics (neuroleptics):
drugs of these classes enhance the antihypertensive effect of indapamide and increase the risk of orthostatic hypotension (additive effect).
— Calcium salts:
with simultaneous administration, hypercalcemia may develop due to a decrease in the excretion of calcium ions by the kidneys.
— Cyclosporine, tacrolimus:
it is possible to increase the creatinine content in the blood plasma without changing the concentration of circulating cyclosporine, even with normal fluid and sodium ion levels.
— Corticosteroids (mineral and glucocorticosteroids), tetracosactide (if administered systemically):
decreased antihypertensive effect (retention of fluid and sodium ions as a result of the action of corticosteroids).
