Unsuitable combination of medicinal substances
Lithium preparations:
With simultaneous use of indapamide and lithium preparations, an increase in the concentration of lithium in blood plasma can be observed due to a decrease in its excretion, accompanied by the appearance of signs of an overdose. If necessary, diuretic drugs can be used in combination with lithium preparations, while carefully selecting the dose of drugs, constantly monitoring the lithium content in blood plasma.
COMPOSITION OF PREPARATIONS THAT REQUIRE SPECIAL ATTENTION
Preparations that can cause arrhythmia of the "pirouette" type:
- antiarrhythmic drugs IA class (quinidine, hydroquinidine, disopyramide);
- antiarrhythmic drugs of III class (amiodarone, sotalol, dofetilide, ibutilide);
- some neuroleptics: phenothiazines (chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoroperazine), benzamides (amisulpride, sulpiride, sultopride, tiapride), butyrophenones (droperidol, haloperidol);
- other: bepridil, cisapride, difemanyl, erythromycin (iv), halofantrine, misolastine, pentamidine, sparfloxacin, moxifloxacin, astemizole, wincamine (w / w).
Increased risk of ventricular arrhythmias, especially arrhythmias such as pirouettes (risk factor - hypokalemia).
It is necessary to determine the level of potassium in the blood plasma and, if necessary, adjust it before starting the combination therapy with indapamide and the above drugs. It is necessary to monitor the clinical state of the patient, control the level of electrolytes of blood plasma, ECG parameters.
Patients with hypokalemia should use drugs that do not cause piruet-type arrhythmia.
- Non-steroidal anti-inflammatory drugs (for systemic administration), including selective inhibitors of COX-2, high doses of salicylates (≥ 3 g / day):
It is possible to reduce the antihypertensive effect of indapamide.
With a significant loss of fluid, acute renal failure may develop (due to a decrease in glomerular filtration). Patients need to compensate for fluid loss and at the beginning of treatment carefully monitor kidney function.
- Angiotensin-converting enzyme (ACE) inhibitors:
The administration of 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, due to the intake of diuretics, the content of sodium ions in the blood plasma is necessary:
- 3 days before the start of treatment with an ACE inhibitor, stop taking diuretics. In the future, if necessary, the reception of diuretics can be resumed;
- or initiate therapy with an ACE inhibitor from low doses, followed by a gradual increase in dose if necessary.
When chronic heart failure treatment with ACE inhibitors should be started with low doses with a possible preliminary reduction in the dose of diuretics.
In all cases in the first week of taking ACE inhibitors in patients, it is necessary to monitor the kidney function (creatinine content in the blood plasma).
- Other drugs that can cause hypokalemia: amphotericin B (IV), gluco- and mineralocorticosteroids (for systemic administration), tetracosactide, laxatives, stimulating bowel motility:
Increased risk of hypokalemia (additive effect).
It is necessary to constantly monitor the level of potassium in the blood plasma, if necessary - its correction. Particular attention should be given to patients who simultaneously receive cardiac glycosides. It is recommended to use laxatives that do not stimulate intestinal motility.
- 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.
- Cardiac glycosides:
Hypokalemia increases the toxic effect of cardiac glycosides.
With the simultaneous use of indapamide and cardiac glycosides, it is necessary to monitor the level of potassium in the blood plasma, the parameters of the ECG, and, if necessary, adjust the therapy.
COMPOSITION OF THE PREPARATIONS REQUIRING ATTENTION
- Potassium-sparing diuretics (amiloride, spironolactone, triamterene):
Combination therapy with indapamide and potassium-sparing diuretics is suitable in some patients, but the possibility of hypokalemia (especially in patients with diabetes mellitus and patients with renal insufficiency) or hyperkalemia is not ruled out.
It is necessary to monitor the level of potassium in the blood plasma, the parameters of the ECG and, if necessary, adjust the therapy.
- Metformin:
Functional renal failure, which can occur against the background of diuretics, especially loop, with the simultaneous appointment of metformin increases the risk of lactic acidosis.
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.
- Iodine-containing contrast agents:
Dehydration of the body against the background of taking diuretic drugs increases the risk of acute renal failure, especially when using high doses of iodine-containing contrast agents.
Before using iodine-containing contrast agents, patients should compensate for fluid loss.
- Tricyclic antidepressants, antipsychotics (antipsychotics):
Preparations of these classes increase the antihypertensive effect of indapamide and increase the risk of orthostatic hypotension (additive effect).
- Salts of calcium:
With simultaneous administration, it is possible to develop hypercalcemia due to a decrease in excretion of calcium ions by the kidneys.
- Cyclosporin, tacrolimus:
It is possible to increase the creatinine content in the blood plasma without changing the concentration of circulating cyclosporine, even with normal liquid and sodium ions.
- Corticosteroids, tetracosactide (with system assignment):
Reduction of hypotensive effect (fluid retention and sodium ions as a result of corticosteroids).