Noliprel A tablets p/o 2.5mg/0.625mg №30

Name Noliprel A tab. p / pl.ob. 2.5mg/0.625mg per col. No. 30 in the pack. No. 1 The main active ingredient Indapamide + Perindopril Release form tablets Dosage 2.5 mg / 0.625 mg Special instructions People who have been prescribed Noliprel treatment need adequate dehydration of the body to prevent a sharp decrease in pressure. People with heart failure may be treated with beta-blockers at the same time. In the treatment of Noliprel, a positive reaction is noted during a doping test. In the first weeks of treatment, it is important to carefully drive vehicles or work with precise mechanisms during the treatment with Noliprel. If during treatment there is a strong decrease in pressure, it may be necessary to administer 0.9% sodium chloride intravenously. Treatment of patients with circulatory failure in the brain or with coronary heart disease should begin with low doses of Noliprel. In people who have a very high level of uric acid in the blood, when treated with varieties of the drug Noliprel, the risk of developing gout increases. Pharmacological action Noliprel is a combination drug that contains perindopril (an angiotensin-converting factor inhibitor) and indapamide (a diuretic that is part of the sulfonamide group). The pharmacological action of the drug is determined by a combination of some of the effects of these components. In this combination, both components mutually increase the effect. Noliprel is an antihypertensive drug that effectively lowers both diastolic and systolic blood pressure. The severity of the effect depends on the dose. After taking the drug, there is no palpitations. The clinical effect is noted 1 month after the treatment was started. The antihypertensive effect persists for one day. After therapy is suspended, the patient does not have a withdrawal syndrome. In the process of treatment, the severity of left ventricular hypertrophy decreases, the degree of total precardiac and postcardiac load decreases. Large vessels become more elastic, the walls of small vessels are restored. The drug does not affect the metabolic processes that occur in the body. Perindopril reduces the level of aldosterone secretion, as a result of which the activity of renin in the blood increases. Blood pressure decreases in people with different levels of renin activity. Under the influence of this component, the vessels expand. When taking the drug, the likelihood of hypokalemia decreases. The mechanism of action of indapamide is similar to thiazide diuretics: urination and urinary excretion of sodium and chlorine ions will increase. Hyperreactivity of vessels under the influence of adrenaline is reduced. The amount of lipids in the blood does not change. Pharmacodynamics and Pharmacokinetics The pharmacokinetics of perindopril and indapamide when used in combination is the same as when they are used separately. After ingestion, perindopril is rapidly absorbed. The level of bioavailability is 65-70%. About 20% of the total absorbed perindopril is later converted to perindoprilat (active metabolite). The maximum concentration of perindoprilat in plasma is observed after 3-4 hours. Less than 30% binds to blood proteins, depending on plasma concentration. The half-life is 25 hours. The substance penetrates through the placental barrier. Perindoprilat is excreted from the body through the kidneys. Its half-life is 3-5 hours. There is a slower introduction of perindoprilat in the elderly, as well as in patients with heart failure and renal failure. Indapamide is completely and relatively rapidly absorbed from the gastrointestinal tract. The maximum concentration of the substance in plasma is observed one hour after oral administration. The substance binds to plasma proteins by 79%. The half-life is 19 hours. The substance is excreted in the form of inactive metabolites by the kidneys (about 70%) and intestines (about 22%). In people with renal insufficiency, changes in the pharmacokinetics of the substance are not observed. Indications for use There are such indications for the use of the drug: essential hypertension; the need to reduce the risk of microvascular complications in people with diseases of the kidneys, blood vessels and heart, who at the same time suffer from arterial hypertension, as well as type 2 diabetes mellitus. Dosage and administration Noliprel tablets should preferably be taken in the morning. The medicine is prescribed one tablet per day. The instruction on Noliprel Forte provides for a similar treatment regimen. Noliprel A and Noliprel A Bi Forte are prescribed to patients 1 tablet per day. If patients have creatinine clearance equal to or greater than 30 ml / min, then there is no need to reduce the dose. If the clearance equals or exceeds 60 ml per day, then the level of potassium and creatinine in the blood should be carefully monitored during treatment. If necessary, after a few months of treatment, the doctor may increase the dose by prescribing Noliprel A Forte instead of Noliprel or another version of this drug. Use during pregnancy and lactation 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 about pregnancy during the treatment period, there is no need to terminate the pregnancy, but the patient should be aware of the possible consequences. In the event of an increase in blood pressure, another 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 assess the condition of his skull and kidney function. Newborns whose mothers took the drug may suffer from manifestations of arterial hypotension, so they need to ensure the constant supervision of specialists. When breastfeeding, the drug is contraindicated, so lactation for the duration of therapy should be stopped or another drug should be selected. Interaction with other drugs Noliprel should not be taken at the same time as lithium preparations. If it is impossible to cancel one of the drugs, the content of lithium in the blood should be clearly monitored. With simultaneous treatment with potassium-sparing diuretics or drugs with potassium, the concentration of potassium in the blood may increase. This combination is recommended only for hypokalemia. When combining indapamide with vincamine, bepridil, sultopride, halofantrine, as well as with simultaneous intravenous administration of erythromycin, arrhythmia and bradycardia may occur. Sometimes, with simultaneous treatment with insulin and Noliprel, hypoglycemia may develop. When taking non-steroidal anti-inflammatory drugs, the hypotensive properties of Noliprel are inhibited. When dehydrated, this combination of drugs can cause kidney damage or kidney failure. In the treatment of Noliprel and neuroleptics or tricyclic antidepressants, orthostatic hypotension may develop. Due to the delay in the body of water and electrolytes, with simultaneous treatment with Noliprel and mineralocorticoids, glucocorticosteroids, stimulant laxatives, tetracosactide, amphotericin B, the hypotensive effect decreases and the likelihood of hypokalemia increases. In view of the possibility of developing hypokalemia, the risk of toxic effects of cardiac glycosides increases. When combined with Metformin, lactic acidosis may develop. Before using iodine-containing radiopaque preparations with Noliprel, adequate hydration of the body must be carried out. The simultaneous use of calcium salts can provoke hypercalcemia. Simultaneous treatment with cyclosporine may increase the level of creatinine in the blood. Contraindications Contraindications to the use of all varieties of the drug Noliprel are such diseases and conditions: high sensitivity to the components of the drug or the presence of allergic reactions to its components; renal failure, in which creatinine clearance is less than 30 ml / min; liver failure, in which there is a tendency to encephalopathy; combination with drugs that prolong the QT interval, as well as antiarrhythmic drugs; hypokalemia; stenosis of the renal arteries; lactase deficiency, glucose-galactose malabsorption syndrome, galactosemia; angioedema in history; pregnancy, lactation; under the age of eighteen. Also, you should not take the drug at the same time as potassium preparations, potassium-sparing diuretics, if the patient has hyperkalemia. Due to the lack of sufficient information, it is not recommended to use tablets for the treatment of people who are on hemodialysis, as well as patients with decompensated heart failure. It is carefully prescribed to people with systemic connective tissue diseases, those who take antidepressants, with oppression of bone marrow hematopoiesis. Also, patients with angina pectoris, renovascular hypertension, cerebrovascular diseases, hyperuricemia, and blood pressure lability are treated with caution. Composition 5 mg of perindopril and 1.25 mg of indapamide Overdose In case of an overdose of the drug, there is a strong decrease in pressure, nausea, vomiting, dizziness, mood instability, symptoms of kidney failure, electrolyte imbalance. In this case, it is necessary to immediately bring the water-electrolyte balance back to normal, wash the stomach, and take enterosorbents. Noliprel metabolites can be removed by dialysis. If necessary, intravenous saline is administered. Side effects In the functions of the cardiovascular system: severe hypotension, orthostatic collapse, in rare cases: arrhythmia, stroke, myocardial infarction. In the functions of the genitourinary system: deterioration of kidney function, proteinuria in people with glomerular nephropathy, in rare cases, acute renal failure. There may be a decrease in potency. In the functions of the central and peripheral NS: severe fatigue, dizziness, headache, asthenia, unstable mood, impaired hearing, vision, loss of appetite, convulsions, in some cases – stupor. In the functions of the respiratory system: cough, difficulty breathing, bronchospasm, nasal discharge. In the functions of the gastrointestinal tract: dyspepsia, abdominal pain, pancreatitis, cholestasis, increased activity of transaminases, hyperbilirubinemia. In the functions of the blood system: against the background of hemodialysis or after a kidney transplant, patients may develop anemia, in rare cases – thrombocytopenia, pancytopenia, agranulocytosis, hemolytic anemia. Allergic manifestations: skin itching, rash, swelling, urticaria. Patients with hepatic insufficiency may develop hepatic encephalopathy. In people with impaired water and electrolyte balance, hyponatremia, hypovolemia, hypokalemia, and dehydration may occur. Storage conditions Should be stored at a temperature not exceeding 30 ° C, you need to protect the medicine from children’s access. Buy Noliprel A tablets p / o 2.5 mg / 0.625 mg No. 30 Instructions for use for Noliprel A tablets p/o 2.5mg/0.625mg No. 30