Unrecommended combinations
With simultaneous application from 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 an overdose (nephrotoxic action), as well as under observation salt-free diet (decrease in excretion of lithium ions by the kidneys).
Combinations that require special attention
1. Preparations that can cause a disturbance of the rhythm of the heart by the type of "pirouette": 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 the beginning of the combination therapy of CP-Indamed and the above drugs should monitor the potassium content in the blood plasma and, if necessary, adjust it. It is recommended: monitoring the clinical condition 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.
2. With simultaneous appointment non-steroidal anti-inflammatory drugs (NSAIDs) (for systemic use), including selective inhibitors of cyclooxygenase-2 (COX-2), high doses of salicylic acid (3 g / day or more) possibly: a reduction in the antihypertensive effect of indapamide, the development of acute renal failure in dehydrated patients (due to a decrease in glomerular filtration rate). At the beginning of therapy with indapamide, it is necessary to restore the water-electrolyte balance and control the function of the kidneys.
3. Angiotensin converting enzyme (ACE) inhibitors in patients with hyponatremia (especially in patients with renal artery stenosis) increase the risk of developing arterial hypotension and / or acute renal failure. Patients with hypertension and possibly with hyponatraemia, due to the intake of diuretics, should:
- stop taking the drug 3 days before the start of therapy with ACE inhibitors and switch to potassium-sparing diuretics;
- or initiate therapy with ACE inhibitors from low doses, followed by a gradual increase in dose if necessary. In the first week of therapy with ACE inhibitors, it is recommended to monitor the concentration of plasma creatinine.
A. Other drugs that can cause hypokalemia:
- amphotericin B (IV),
- gluco- and mineralocorticosteroids (for systemic administration) (see also the information in the section "Combinations of drugs requiring attention"),
- tetrakozaktid (see also the information in the section "Combinations of drugs that require attention"),
- laxatives, stimulating intestinal motility.
With the simultaneous administration of the above drugs with indapamide, the risk of developing hypokalemia increases(additive effect).
If necessary, monitor and adjust the content of potassium ions in the blood plasma.
5. Simultaneous therapy with baclofen enhances the antihypertensive effect of indapamide.
6. Cardiac glycosides: hypokalemia increases the toxic effect of cardiac glycosides (digitalis intoxication). With the simultaneous use of indapamide and cardiac glycosides, it is necessary to monitor the potassium ions in the blood plasma, the ECG parameters, and, if necessary, adjust the therapy.
Combinations of drugs requiring attention
1. Simultaneous application from potassium-sparing diuretics (amiloride, spironolactone, triamterene) is suitable in some patients, but the possibility of hypokalemia is not ruled out. Against the background of diabetes or kidney failure may develop hyperkalemia. It is necessary to control the content of potassium ions in the blood plasma, the parameters of the ECG, and, if necessary, adjust the therapy.
2. Metformin increases the risk of developing lactic acidosis, t. It is possible to develop renal failure with diuretics, especially "loop". Metformin should not be taken at a plasma creatinine concentration of more than 15 mg / L (135 μmol / L) in men and 12 mg / L (110 μmol / L) in women.
3. The simultaneous use of large doses iodine-containing contrast agents against the background of hypovolemia and the use of diuretics increases the risk of acute renal failure. It is recommended to restore the electrolyte balance of blood before applying the drugs.
4. Tricyclic antidepressants (imipramine-like) and antipsychotics increase the antihypertensive effect and the risk of developing orthostatic hypotension (additive effect).
5. Preparations containing calcium salts, increase the risk of hypercalcemia due to a decrease in excretion of calcium ions by the kidneys.
6. Cyclosporin, tacrolimus - The risk of increasing the concentration of creatinine in the blood plasma without changing the concentration of circulating cyclosporine.
7. Glucorticosteroid preparations, tetracosactide (with system assignment) reduce the antihypertensive effect (sodium and liquid ion retention).