NOLIPREL A FORTE film-coated tablets

NOLIPREL A FORTE film-coated tablets 5mg+1.25mg No. 30

The use of Noliprel® A forte 5 mg + 1.25 mg is not accompanied by a significant reduction in the frequency of side effects, with the exception of hypokalemia, compared with perindopril and indapamide at the lowest approved doses (see “Side effects”). When starting therapy with two antihypertensive drugs that the patient has not previously received, an increased risk of developing idiosyncrasies cannot be excluded. Careful monitoring of the patient can minimize this risk. Impaired renal function Therapy is contraindicated in patients with severe renal failure (Cl creatinine less than 30 ml/min). In some patients with arterial hypertension without previous obvious renal impairment, laboratory signs of functional renal failure may appear during therapy. In this case, treatment should be stopped. In the future, you can resume combination therapy using low doses of drugs, or use drugs in monotherapy. Such patients require regular monitoring of potassium and creatinine levels in the blood serum - 2 weeks after the start of therapy and every 2 months thereafter. Renal failure occurs more often in patients with severe chronic heart failure or underlying renal impairment, incl. with renal artery stenosis. Hypotension and fluid and electrolyte imbalance Hyponatremia is associated with a risk of sudden development of arterial hypotension (especially in patients with arterial stenosis of a solitary kidney and bilateral renal artery stenosis). Therefore, during dynamic monitoring of patients, attention should be paid to possible symptoms of dehydration and decreased levels of electrolytes in the blood plasma, for example, after diarrhea or vomiting. Such patients require regular monitoring of plasma electrolyte levels. In case of severe arterial hypotension, intravenous administration of 0.9% sodium chloride solution may be required. Transient arterial hypotension is not a contraindication for continued therapy. After restoration of blood volume and blood pressure, therapy can be resumed using low doses of drugs, or drugs can be used as monotherapy. Potassium levels The combined use of perindopril and indapamide does not prevent the development of hypokalemia, especially in patients with diabetes mellitus or renal failure. As in the case of the combined use of an antihypertensive drug and a diuretic, regular monitoring of the level of potassium in the blood plasma is necessary. Excipients It should be taken into account that the excipients of the drug include lactose monohydrate. Noliprel® A forte should not be prescribed to patients with hereditary galactose intolerance, lactase deficiency and glucose-galactose malabsorption. Lithium preparations The simultaneous use of a combination of perindopril and indapamide with lithium preparations is not recommended (see “Contraindications”, “Interaction”). Perindopril Neutropenia/agranulocytosis The risk of developing neutropenia while taking ACE inhibitors is dose-dependent and depends on the drug taken and the presence of concomitant diseases. Neutropenia rarely occurs in patients without concomitant diseases, but the risk increases in patients with impaired renal function, especially against the background of systemic connective tissue diseases (including systemic lupus erythematosus, scleroderma). After discontinuation of ACE inhibitors, signs of neutropenia disappear on their own. To prevent the development of such reactions, it is recommended to strictly follow the recommended dose. When prescribing ACE inhibitors to this group of patients, the benefit/risk factor should be carefully assessed. Angioedema (Quincke's edema) When taking ACE inhibitors, incl. and perindopril, in rare cases, the development of angioedema of the face, extremities, lips, tongue, glottis and/or larynx may occur. If symptoms appear, perindopril should be discontinued immediately and the patient should be observed until signs of edema completely disappear. If the swelling affects only the face and lips, it usually resolves on its own, although antihistamines may be used to treat symptoms. Angioedema, accompanied by swelling of the larynx, can be fatal. Swelling of the tongue, glottis, or larynx can lead to airway obstruction. If such symptoms appear, you should immediately administer subcutaneous epinephrine (adrenaline) at a dilution of 1:1000 (0.3 or 0.5 ml) and/or ensure airway patency. Patients with a history of angioedema, not associated with taking ACE inhibitors, may have an increased risk of developing it when taking drugs of this group (see “Contraindications”). In rare cases, angioedema of the intestine develops during therapy with ACE inhibitors. Anaphylactoid reactions during desensitization There are isolated reports of the development of long-term life-threatening anaphylactoid reactions in patients receiving ACE inhibitors during desensitizing therapy with the venom of hymenoptera insects (bees, wasps). ACE inhibitors should be used with caution in patients prone to allergic reactions undergoing desensitization procedures. Prescription of an ACE inhibitor should be avoided in patients receiving immunotherapy with hymenoptera venom. However, an anaphylactoid reaction can be avoided by temporarily discontinuing the ACE inhibitor at least 24 hours before the procedure. Anaphylactoid reactions during LDL apheresis In rare cases, life-threatening anaphylactoid reactions may develop in patients receiving ACE inhibitors during LDL apheresis using dextran sulfate, or in patients undergoing hemodialysis using high-flow membranes. To prevent an anaphylactoid reaction, ACE inhibitor therapy should be temporarily discontinued at least 24 hours before the apheresis procedure. Cough During therapy with an ACE inhibitor, a dry cough may occur. The cough persists for a long time while taking drugs of this group and disappears after their discontinuation. If a patient develops a dry cough, one should be aware of the possible iatrogenic nature of this symptom. If the attending physician believes that ACE inhibitor therapy is necessary for the patient, the drug may be continued. Children and adolescents The drug should not be prescribed to children and adolescents under the age of 18 years due to the lack of data on the effectiveness and safety of the use of perindopril as monotherapy or as part of combination therapy in patients of this age group. Risk of arterial hypotension and/or renal failure (in patients with heart failure, water-electrolyte imbalance, etc.) In some pathological conditions, significant activation of the RAAS system may be observed, especially with severe hypovolemia and a decrease in the level of electrolytes in the blood plasma (against the background of salt-free diet or long-term use of diuretics), in patients with initially low blood pressure, with bilateral renal artery stenosis or with stenosis of the artery of a single kidney, chronic heart failure or cirrhosis of the liver with edema and ascites. The use of an ACE inhibitor causes a blockade of this system and therefore may be accompanied by a sharp decrease in blood pressure and/or an increase in plasma creatinine levels, indicating the development of functional renal failure. These phenomena are more often observed when taking the first dose of the drug or during the first two weeks of therapy. Sometimes these conditions develop acutely and during other periods of therapy. In such cases, when resuming therapy, it is recommended to use the drug at a lower dose and then gradually increase the dose. Elderly patients Before starting to take the drug, it is necessary to assess the functional activity of the kidneys and the concentration of potassium in the blood plasma. At the beginning of therapy, the dose of the drug is selected taking into account the degree of reduction in blood pressure, especially in the case of dehydration and loss of electrolytes. Such measures help to avoid a sharp decrease in blood pressure. Atherosclerosis The risk of arterial hypotension exists in all patients, however, special care should be taken when using the drug in patients with coronary artery disease and cerebrovascular insufficiency. In such patients, treatment should be started with low doses. Patients with renovascular hypertension The treatment method for renovascular hypertension is revascularization. However, the use of ACE inhibitors has a beneficial effect in this category of patients, both awaiting surgery and in cases where surgery is not possible. Treatment with Noliprel® A forte in patients with diagnosed or suspected bilateral renal artery stenosis or stenosis of the artery of a single kidney should be started with a low dose of the drug in a hospital setting, monitoring renal function and potassium concentration in the blood plasma. Some patients may develop functional renal failure, which disappears when the drug is discontinued. Other risk groups In persons with severe heart failure (stage IV) and patients with insulin-dependent diabetes mellitus (risk of spontaneous increase in potassium concentration), treatment should begin with a low dose of the drug and under constant medical supervision. Patients with arterial hypertension and coronary artery disease should not stop taking beta-blockers: ACE inhibitors should be used together with beta-blockers. Anemia Anemia can develop in patients after kidney transplantation or in people on hemodialysis. In this case, the decrease in hemoglobin concentration is greater, the higher its initial value. This effect does not appear to be dose-dependent, but may be related to the mechanism of action of ACE inhibitors. A slight decrease in hemoglobin concentration occurs during the first 6 months, then it remains stable and is completely restored after discontinuation of the drug. In such patients, treatment can be continued, but hematological tests should be performed regularly. Surgery/general anesthesia The use of ACE inhibitors in patients undergoing surgery under general anesthesia can lead to a marked decrease in blood pressure, especially when using general anesthesia agents that have a hypotensive effect. It is recommended to stop taking long-acting ACE inhibitors, incl. perindopril, the day before surgery. It is necessary to warn the anesthesiologist that the patient is taking ACE inhibitors. Aortic stenosis/hypertrophic cardiomyopathy ACE inhibitors should be prescribed with caution to patients with left ventricular outflow tract obstruction. Liver failure In rare cases, cholestatic jaundice occurs while taking ACE inhibitors. As this syndrome progresses, liver necrosis may rapidly develop, sometimes with death. The mechanism of development of this syndrome is unclear. If jaundice appears or a significant increase in the activity of liver enzymes while taking ACE inhibitors, you should stop taking the drug and consult a doctor (see “Side effects”). Indapamide In the presence of liver dysfunction, taking thiazide and thiazide-like diuretics can lead to the development of hepatic encephalopathy. In this case, you should immediately stop taking the drug. Water-electrolyte balance Content of sodium ions in blood plasma. Before starting treatment, it is necessary to determine the content of sodium ions in the blood plasma. While taking the drug, this indicator should be regularly monitored. All diuretics can cause hyponatremia, which sometimes leads to serious complications. Hyponatremia at the initial stage may not be accompanied by clinical symptoms, so regular laboratory monitoring is necessary. More frequent monitoring of sodium ion levels is indicated for patients with liver cirrhosis and the elderly (see “Side effects” and “Overdose”). Content of potassium ions in blood plasma. Therapy with thiazide and thiazide-like diuretics is associated with a risk of hypokalemia. Hypokalemia (less than 3.4 mmol/l) should be avoided in the following categories of high-risk patients: elderly people, debilitated patients or those receiving concomitant drug therapy, patients with liver cirrhosis, peripheral edema or ascites, coronary artery disease, heart failure. Hypokalemia in these patients enhances the toxic effect of cardiac glycosides and increases the risk of developing arrhythmias. The high-risk group also includes patients with an increased QT interval, and it does not matter whether this increase is caused by congenital causes or the effect of drugs. Hypokalemia, like bradycardia, contributes to the development of severe cardiac arrhythmias, especially arrhythmias, which can be fatal. In all the cases described above, more regular monitoring of the content of potassium ions in the blood plasma is necessary. The first measurement of potassium ion concentration should be carried out within the first week from the start of therapy. If hypokalemia is detected, appropriate treatment should be prescribed. Content of calcium ions in blood plasma. Thiazide and thiazide-like diuretics reduce the excretion of calcium ions by the kidneys, leading to a slight and temporary increase in the concentration of calcium in the blood plasma. Severe hypercalcemia may be a consequence of previously undiagnosed hyperparathyroidism. Before studying the function of the parathyroid gland, you should stop taking diuretics. Glucose content in blood plasma. It is necessary to monitor blood glucose levels in patients with diabetes mellitus, especially in the presence of hypokalemia. Uric acid. In patients with elevated levels of uric acid in the blood plasma during therapy, the frequency of gout attacks may increase. Diuretics and kidney function. Thiazide and thiazide-like diuretics are fully effective only in patients with normal or slightly impaired renal function (plasma creatinine in adults below 25 mg/l or 220 µmol/l). At the beginning of diuretic treatment in patients, due to hypovolemia and hyponatremia, a temporary decrease in glomerular filtration rate and an increase in the concentration of urea and creatinine in the blood plasma may be observed. This transient functional renal failure is not dangerous for patients with unchanged renal function, but its severity may increase in patients with renal failure. Photosensitivity While taking thiazide and thiazide-like diuretics, cases of photosensitivity reactions have been reported. If photosensitivity reactions develop while taking the drug, treatment should be discontinued. If it is necessary to continue diuretic therapy, it is recommended to protect the skin from exposure to sunlight or artificial UV rays. Athletes Indapamide may give a positive reaction during doping control. Impact on the ability to drive a car or perform work that requires increased speed of physical and mental reactions. The effect of the substances included in the drug Noliprel® A forte does not lead to disturbances in psychomotor reactions. However, some people may develop different individual reactions in response to lowering blood pressure, especially at the beginning of therapy or when other antihypertensive drugs are added to therapy. In this case, the ability to drive a car or operate other machinery may be reduced.

Noliprel's analogs

Level 4 ATX code matches:
Akkuzid

Enap-N

Iruzid

Co-Diroton

Enalozide

Enap NL

Enapril-N

Capozide

Tritace Plus

Enzix

Liprazid

Co-Renitec

Hartil N

Hartil D

Ko-Perineva

Kaptopres

Analogs of Noliprel, as well as the drugs Noliprel A Bi Forte, Noliprel A Forte, are other drugs that are used to lower blood pressure and contain similar active ingredients, that is, perindopril and indapamide. Such drugs are Co-prenesa , Prestarium , etc. The price of analogues may be lower than the cost of Noliprel and its varieties.

Reviews of Noliprel

Reviews on forums about Noliprel, as well as about the drugs Noliprel A, Noliprel A Forte, Noliprel A Bi Forte, indicate that this drug effectively lowers blood pressure. The medicine maintains normal blood pressure, reducing the likelihood of strokes and myocardial infarction.

Reviews of Noliprel Forte also often contain information that this medicine and its other varieties allow you to get a positive result in cases where other drugs are ineffective. Sometimes patients note the development of some side effects, in particular, dry cough, headache, but they are not very intense.

Doctors also note the positive effect of the drug, but they always note that the drug must be taken strictly according to the instructions and taking into account the recommendations of a specialist. In particular, the drug should be taken regularly, and not only during periods of intense surges in blood pressure.

Noliprel price, where to buy

The price of Noliprel is on average 500 rubles per pack of 30 pcs. The price in Moscow for Noliprel A is from 500 to 550 rubles. The price for Noliprel Forte is from 550 rubles per package. Noliprel A Forte 5 mg can be purchased at a price of 650 rubles. The cost of Noliprel A Bi Forte is from 700 rubles. per pack 30 pcs.

Online pharmacies in RussiaRussia
Online pharmacies in UkraineUkraine
Online pharmacies in KazakhstanKazakhstan

ZdravCity

Noliprel A Forte tablets p.p.o.
5mg+1.25mg 30 pcs. Servier Rus LLC 727 rub. order
Noliprel A tablets p.p.o. 2.5 mg + 0.625 mg 30 pcs. Serdix LLC/SERVIER RUS LLC
625 rub. order
Noliprel A Bi-Forte tablets p.p.o. 10mg+2.5mg 30 pcs. Servier Rus LLC
770 rub. order

Pharmacy Dialogue

Noliprel A forte tablets po 5mg+1.25mg No. 30Servier
RUB 804 order
Noliprel A Bi-forte tablets 10mg+2.5mg No. 30Servier
RUB 747 order
Noliprel A tablets 2.5 mg + 0.625 mg No. 30Servier
RUR 725 order

Pharmacy24

Noliprel Bi Forte 10 mg No. 30 tablets Laboratories Serv'e Industry/Serve'e (Ireland) Industry Ltd., France/Ireland
207 UAH.order
Noliprel Arginine Forte 5 mg N30 tablets Lab.Serve Industries, France/Serve Industries Ltd., Ireland
176 UAH order
Noliprel Arginine 2.5 mg No. 30 tablets Laboratories Serv'e Industry/Serve'e (Ireland) Industries Ltd., France/Ireland
141 UAH order

PaniPharmacy

Noliprel arginine tablets Noliprel Arginine film-coated tablets 2.5 mg No. 30 France, Servier Industrie
164 UAH order
Noliprel arginine tablets Noliprel Arginine tablets No. 30 France, Servier Industrie
155 UAH order
Noliprel Arginine Forte tablets Noliprel Arginine Forte tablets No. 30 France, Servier Industrie
200 UAH order
Noliprel bi-Forte tablets Noliprel BI-Forte tablets No. 30 France, Servier
229 UAH order

During pregnancy and lactation

For pregnant women and mothers while breastfeeding , the use of Noliprel is contraindicated. Systematic treatment with these drugs can lead to the development of abnormalities and diseases in the fetus, as well as lead to fetal death. If a woman finds out she is pregnant during treatment, there is no need to terminate the pregnancy, but the patient should be aware of the possible consequences. If blood pressure increases, other antihypertensive therapy is prescribed. If a woman took this drug in the second and third trimesters, an ultrasound of the fetus should be performed to evaluate the condition of its skull and kidney function.

Newborns whose mothers took the drug may suffer from manifestations of arterial hypotension, so they need to be constantly monitored by specialists.

When feeding with breast milk, the drug is contraindicated, so lactation should be stopped during therapy or another drug should be selected.