Unwanted combination of drugs
- 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.
A combination of drugs that requires 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);
- others: beprideil, cisapride, difemannil, 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 content 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 condition of the patient, control of plasma electrolytes, ECG parameters.
Patients with hypokalemia should use drugs that do not cause arrhythmia such as "pirouette".
- 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 rate).
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 hypertension and possibly reduced, due to the use of diuretics, the content of sodium ions in blood plasma should:
- 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.
In chronic heart failure, treatment with ACE inhibitors should begin with low doses with the possible preliminary reduction of doses of diuretics.
In all cases, in the first week of taking ACE inhibitors in patients, it is necessary to monitor renal function (creatinine concentration in the blood plasma).
- Other drugs that can cause hypokalemia: amphotericin B (IV), gluco- and mineralocorticosteroids (for systemic administration), tetracosactide, laxatives, stimulating intestinal motility:
Increased risk of hypokalemia (additive effect).
Regular monitoring of the potassium content in the blood plasma is necessary; 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 antihypertensive 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 simultaneous use of indapamide and cardiac glycosides, it is necessary to monitor the potassium content in the blood plasma, the ECG parameters and, if necessary, adjust the therapy.
A combination of drugs that requires 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 potassium content 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 creatinine concentration 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 diuretics increases the risk of acute renal failure, especially when using high doses of iodine-containing contrast agents.
Before using iodine-containing contrast agents, patients needcompensate 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 concentration of creatinine in the blood plasma without changing the concentration of circulating cyclosporine, even with a normal content of liquid and sodium ions.
- Corticosteroids, tetracosactide (with system assignment):
Reduction of antihypertensive action (fluid retention and sodium ions due to the action of corticosteroids).