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 choosing the dose of drugs, regularly monitoring the lithium content in blood plasma.
A combination of drugs that requires special attention
Drugs that can cause arrhythmia such as "pirouette":
- antiarrhythmic drugs IA class (hydroquinidine (quinidine), disopyramide), antiarrhythmic drugs of III class (amiodarone, dofetilide, ibutilide), sotalol;
- 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 ventricular arrhythmia risk, especially arrhythmias such as "pirouette" (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 blood plasma electrolytes, electrocardiogram (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 (cyclooxygenase-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 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 start therapy with an ACE inhibitor from low doses, with subsequent a gradual increase in the 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 that stimulate bowel 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 anti-hypertensive 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 cccontrols the content of potassium in the blood plasma, the parameters of the ECG, and, if necessary, adjust the therapy.
A combination of drugs that requires attention
Potassium-sparing diuretics (amiloride, spironolactone, triamterene, eplerenone (a derivative of spironolactone))
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 administration of metformin increases the risk of developed lactic acidosis.
No should be applied 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 must compensate for fluid loss.
Trand cyclic 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.
Corticosteroid preparations, tetracosactide (for systemic administration)
Reduction of antihypertensive action (fluid retention and sodium ions due to the action of corticosteroids).