Unwanted combination of drugs
Lithium preparations. With the simultaneous use of indapamide and lithium preparations, as well as when observing a salt-free diet, an increase in the concentration of lithium in the 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.
Combination of drugs, requiring special attention
Preparations, Able to 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).
The risk of developing ventricular arrhythmias is increased, especially arrhythmias such as "pirouettes" (a risk factor is hypokalemia).
It is necessary to determine the concentration of potassium in the blood plasma and, if necessary, to adjust it before the initiation of combined 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 acetylsalicylic acid (> 3 g / day). It is possible to reduce the antihypertensive effect of indapamide. There is a risk of developing acute kidney failure due to reduced 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 appointment of ACE inhibitors to patients with an initially 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 at the lowest dose with a possible preliminary reduction in the dose of diuretics. In all cases in the first weeks 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 (with systemic application), tetracosactide, laxatives, stimulating intestinal motility. Increased risk of hypokalemia (additive effect). Continuous monitoring of potassium concentration is required in 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. With simultaneous use with 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.
Combination of drugs, 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 or hyperkalemia (especially in patients with renal insufficiency or in patients with diabetes mellitus) 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. In the case of dehydration of the body against the background of taking diuretics, the risk of acute renal failure increases, especially when using high doses of iodine-containing contrast agents. Before using iodine-containing contrast agents, patients must compensate for fluid loss.
Tricyclic antidepressants. antipsychotic drugs (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.
Cyclosporine, 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).