Unwanted combination of drugs
Lithium preparations: with the simultaneous use of indapamide with lithium preparations, an increase in the concentration of lithium in blood plasma is possible. If necessary, diuretic drugs can be used in combination with lithium preparations, but you should carefully select the dose of drugs, constantly monitoring the lithium content in blood plasma.
Preparations that do not belong to the class of antiarrhythmic drugs, causing arrhythmia of the type "pirouette" (astemizole, beprideil, erythromycin (with intravenous administration), halofantrine, pentamidine, sultopride, terfenadine, wincamine): with simultaneous use with indapamide increases the likelihood of heart rhythm disorders by type torsades de pointes (ventricular tachycardia of the "pirouette" type).
A combination of drugs that requires special attention
Nonsteroidal anti-inflammatory drugs (for systemic administration): with a significant loss of fluid may develop acute renal failure (due to reduced glomerular filtration). Patients need to compensate for fluid loss and at the beginning of treatment carefully monitor kidney function.
Other drugs that can cause hypokalemia: amphotericin B (with in / in the introduction), gluco- and mineralocorticosteroids (for systemic administration), tetracosactide, agents that stimulate intestinal motility: increased risk of hypokalemia (additive effect). It is necessary to constantly monitor the level of potassium in the blood plasma, if necessary, patients are prescribed appropriate treatment.
Baclofen: there is an increase in the hypotensive effect.Patients need to compensate for fluid loss and at the beginning of treatment carefully monitor kidney function.
Drugs of digitalis: the probability of development of digitalis intoxication increases. With the simultaneous use of thiazide diuretics and cardiac glycosides, the level of potassium in the blood plasma and ECG parameters should be carefully monitored.
Saluretics (looped, thiazide): increase the risk of hypokalemia.
Potassium-sparing diuretics (amiloride, spironolactone, triamterene): this combination of drugs is effective in some patients, but the possibility of developing hypokalemia, especially in patients with diabetes mellitus or kidney failure, is not completely excluded. It is necessary to monitor the level of potassium in the blood plasma, the parameters of the ECG and, if necessary, change the course of treatment.
Angiotensin-converting enzyme (ACE) inhibitors: a reduced plasma concentration of sodium in patients receiving ACE inhibitors increases the risk of sudden arterial hypotension and / or acute renal failure during the first week (especially with existing renal artery stenosis).In the first week of taking ACE inhibitors in patients, it is necessary to monitor the function of the kidneys (containing creatinine in the blood plasma).
Antiarrhythmic drugs that can cause arrhythmia of the "pirouette" type: drug IA (quinidine, disopyramide) and III class (amiodarone, brethil tosylate, sotalol): arrhythmia of the "pirouette" type (risk factors: hypokalemia, bradycardia and initially elongated interval QT). Care should be taken to monitor potassium levels in the blood plasma and the interval QT, changing the course of treatment if necessary.
Metformin: lactic acidosis, arising on the background of taking metformin, is often a consequence of functional renal failure caused by the action of diuretics and especially loop diuretics. Do not use metformin, if the level of creatinine exceeds 15 mg / L (135 μmol / L) in men and 12 mg / L (110 μmol / L) in women.
Contrasting iodine-containing products: in high doses increase the risk of kidney dysfunction (dehydration). Before using contrasting iodine-containing substances, patients need to restore fluid loss.
Tricyclic antidepressants and antipsychotics: increase the hypotensive effect of indapamide and increase the risk of developing orthostatic hypotension.
Salts of calcium: with the simultaneous administration of an increase in the concentration of calcium ions in the blood plasma due to a decrease in their excretion in the urine.
Cyclosporin: while simultaneous use with indapamide increases the risk of hypercreatininaemia.
Glucose and mineralocorticosteroids (for systemic administration), tetracosactide: decreased hypotensive effect (fluid retention and sodium ions as a result of the action of corticosteroids).
Indirect anticoagulants: reduction in the effect of coumarin or indanedione derivatives due to increased liver production (dose adjustment may be required).
Non-depolarizing muscle relaxants: strengthening the blockade of neuromuscular transmission.
Adrenostimulators: decreased hypotensive effect.