Indapamide MB Stade (Indapamide MV Stada)

If you are taking any other drugs, you should consult your doctor before starting treatment.

Unrecommended combinations

When used simultaneously with lithium preparations it is possible to increase the concentration of lithium ions in the blood plasma due to a decrease in excretion of it from the body by the kidneys, accompanied by the appearance of signs of overdose (nephrotoxic action), as well as when observing a salt-free diet (decrease in excretion of lithium ions by the kidneys). In the case of simultaneous reception with lithium preparations, careful monitoring of the concentration of lithium in blood plasma and correction of dosage are necessary.

Combinations that require special attention

Preparations, with simultaneous use with which the probability of occurrence of arrhythmias by the type of "pirouette" ("torsades de pointes"): antiarrhythmics IA class (quinidine, hydroquinidine, disopyramide), antiarrhythmic drugs of III class (amiodarone, dofetilide, ibutilide, brethil tosylate), sotalol, some neuroleptics: phenothiazines (chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoperazine), benzamides (amisulpride, sulpiride, sultopride, tiapride), butyrophenones (droperidol, haloperidol), other (bepridil, cisapride, difemanyl, erythromycin (intravenous (iv)), halofantrine, misolastine, pentamidine, sparfloxacin, moxifloxacin, wincamine (w / w), astemizole.

Simultaneous use with any of these drugs, especially against hypokalemia, increases the risk of ventricular arrhythmias as pirouettes. Before starting the combination therapy with indapamide and the above drugs, you should monitor the potassium content in the blood plasma and, if necessary, adjust it. It is recommended to monitor the clinical state of the patient, as well as the content of plasma electrolytes and ECG. Patients with hypokalemia should use drugs that do not trigger the development of piruet-type arrhythmias.

With simultaneous appointment nonsteroidal anti-inflammatory drugs (NSAIDs) (with systemic use), including selective inhibitors of cyclooxygenase-2 (COX-2), high doses of salicylic acid (3 g / day or more), possibly reducing the antihypertensive effect of indapamide, the development of acute renal failure in dehydrated patients (due to reduced glomerular rate filtering).At the beginning of therapy with indapamide, it is necessary to restore the water-electrolyte balance and control the function of the kidneys.

Angiotensin converting enzyme (ACE) inhibitors with concomitant use with indapamide in patients with hyponatremia (especially in patients with renal artery stenosis) increase the risk of sudden arterial hypotension and / or acute renal failure. Patients with arterial hypertension and reduced by the intake of diuretics with the content of sodium ions in the blood plasma need to stop taking diuretics 3 days before the start of treatment with ACE inhibitors. In the future, if necessary, taking diuretics resume. Therapy with ACE inhibitors should start with low doses, followed by a gradual increase in dose if necessary. In chronic heart failure treatment should start with low doses of ACE inhibitors, previously lowering the dose of diuretics. In all cases, in the first week of taking ACE inhibitors, kidney function (creatinine content in the blood plasma) should be monitored.

Drugs that increase the risk of hypokalemia: amphotericin B (IV); gluco- and mineralocorticosteroids (for systemic administration), tetracosactide, laxatives, stimulating intestinal motility. With the simultaneous administration of the above drugs with indapamide, the risk of developing hypokalemia (additive effect) increases. If necessary, monitor and adjust the content of potassium ions in the blood plasma.

Simultaneous therapy from baclofen enhances the antihypertensive effect of indapamide.

Cardiac glycosides: hypokalemia increases the toxic effect of cardiac glycosides (glycoside intoxication). With the simultaneous use of indapamide and cardiac glycosides, the levels of potassium ions in the blood plasma should be monitored, the ECG parameters should be monitored and, if necessary, the therapy should be adjusted.

Combination from potassium-sparing diuretics (amiloride, spironolactone, triamterene) may be effective in some patients, however, the possibility of hypo- or hyperkalemia, especially in patients with diabetes mellitus and renal insufficiency, is not completely excluded. In such cases, it is necessary to monitor the level of potassium in the blood plasma, the parameters of the ECG and, if necessary, adjust the therapy.