A drug Noliprel is offered in several different forms. All variations of the drug include and indapamide ... Combined tablets Noliprel contain 2 mg of perindopril and 0.625 mg of indapamide. The composition of the tool Noliprel Forte includes 4 mg of perindopril and 1.25 mg of indapamide. Noliprel A contains 2.5 mg of perindopril and 0.625 mg of indapamide. In this drug, perindopril is associated with the amino acid arginine, which has a beneficial effect on the state of the cardiovascular system.
In tablets Noliprel A Forte - 5 mg of perindopril and 1.25 mg of indapamide. In the facility Noliprel A Bi-Forte - 10 mg perindopril and 2.5 mg indapamide.
As additional substances in the composition of the drug Noliprel there is magnesium stearate, lactose monohydrate, colloidal hydrophobic silicon dioxide, microcrystalline cellulose.
Release form
The drugs are available in the form of oblong white tablets, on both sides of the risk tablet. Fitted in cardboard boxes of 14 and 30 pcs. in blisters.
pharmachologic effect
Noliprel is a combined drug that contains perindopril (an angiotensin-converting factor inhibitor) and indapamide (a diuretic that is part of the sulfonamide group).
The pharmacological action of a drug is determined by a combination of some of the effects of these components. In this combination, both components mutually enhance the effect. Noliprel is an antihypertensive drug that effectively lowers both diastolic and systolic blood pressure. The severity of the effect depends on the dose. After taking the drug, there is no rapid heartbeat. The clinical effect is observed 1 month after the start of treatment. The antihypertensive effect lasts for one day. After therapy is suspended, the patient does not have a withdrawal syndrome. In the course of treatment, the severity of left ventricular hypertrophy decreases, the degree of general atrial and postcardiac load decreases. Large vessels become more elastic, the walls of small vessels are restored. The drug has no effect on the metabolic processes that occur in the body.
Perindopril reduces the level of aldosterone secretion, as a result of which the activity of renin in the blood increases. decreases in people with different levels of activity ... Under the influence of this component, blood vessels expand.
When taking the drug, the likelihood of hypokalemia ... The mechanism of action of indapamide is similar to thiazide diuretics: urinary excretion and urinary excretion of sodium and chlorine ions will increase.
The hyperreactivity of the vessels decreases with the influence of adrenaline. The amount of lipids in the blood does not change.
Pharmacokinetics and pharmacodynamics
The pharmacokinetics of perindopril and indapamide when used in combination is the same as when used separately. After ingestion, perindopril is rapidly adsorbed. The bioavailability level is 65-70%. About 20% of the total absorbed perindopril is later converted to perindoprilat (an active metabolite). The maximum concentration of perindoprilat in plasma is observed after 3-4 hours. It binds to blood proteins by less than 30%, depending on the concentration in the blood plasma. The half-life is 25 hours. The substance penetrates through the placental barrier. Perindoprilat is excreted from the body through the kidneys. Its half-life is 3-5 hours. There is a slower administration of perindoprilat in the elderly, as well as in patients with heart failure and renal failure.
Before using iodine-containing X-ray contrast agents with Noliprel, adequate hydration of the body must be performed.
The simultaneous use of calcium salts can provoke hypercalcemia.
Noliprel's analogs
Matching ATX level 4:Analogs of Noliprel, as well as drugs Noliprel A Bi Forte, Noliprel A Forte are other drugs that are used to lower blood pressure and contain similar active ingredients, that is, perindopril and indapamide. These drugs are drugs Ko-prenesa , etc. The price of analogs may be lower than the cost of Noliprel and its varieties.
For children
The drug is not prescribed for the treatment of children under 18 years of age, since there is no exact data on the effectiveness and safety of such treatment.
With alcohol
You should not take alcohol during Noliprel therapy.
During pregnancy and lactation
And for mothers during a baby with breast milk, the use of Noliprel is contraindicated. Systematic treatment with these drugs can lead to the development of abnormalities and diseases in the fetus, as well as lead to fetal death. If a woman finds out about pregnancy during the treatment period, there is no need to terminate the pregnancy, but the patient should be aware of the possible consequences. In the event of an increase in blood pressure, another antihypertensive therapy is prescribed. If a woman has taken this drug in the second and third trimesters, an ultrasound scan of the fetus should be performed to assess the condition of its skull and kidney function.
Newborns whose mothers have taken the drug may suffer from manifestations of arterial hypotension, so they need to ensure constant supervision of specialists.
When breastfeeding, the drug is contraindicated, therefore, lactation should be stopped during therapy or another drug should be selected.
The combined composition of the antihypertensive drug is Noliprel. Instructions for use prescribe taking tablets - A, Forte, Bi-Forte 2.5 mg, 5 mg and 10 mg with high blood pressure, arterial hypertension.
Release form and composition
The drug is produced in the following dosage forms:
- Tablets 2.5 mg (Noliprel A).
- Tablets 5 mg (Noliprel A Forte).
- Tablets 10 mg (Noliprel A Bi-Forte). ...
The hyperreactivity of the vessels decreases with the influence of adrenaline. The amount of lipids in the blood does not change.
Indications for use
What does Noliprel help with? Tablets are prescribed for the treatment of essential arterial hypertension.
Instructions for use
Noliprel is administered orally, preferably in the morning, before meals, 1 tablet once a day. If, 1 month after the start of therapy, the desired antihypertensive effect has not been achieved, the dose of the drug can be increased to a dose of 5 mg (manufactured by a company under the trade name Noliprel A forte).
Elderly patients should start therapy with 1 tablet 1 time per day. Noliprel should not be prescribed to children and adolescents due to the lack of data on efficacy and safety in patients of this age group.
pharmachologic effect
Noliprel is a combined drug that contains perindopril (an angiotensin-converting factor inhibitor) and indapamide (a diuretic that is part of the sulfonamide group).
The pharmacological action of a drug is determined by a combination of some of the effects of these components. In this combination, both components mutually enhance the effect. Noliprel is an antihypertensive drug that effectively lowers both diastolic and systolic blood pressure. The severity of the effect depends on the dose. After taking the drug, there is no rapid heartbeat.
The clinical effect is observed 1 month after the start of treatment. The antihypertensive effect lasts for one day. After therapy is suspended, the patient does not have a withdrawal syndrome. In the course of treatment, the severity of left ventricular hypertrophy decreases, the degree of general atrial and postcardiac load decreases.
Large vessels become more elastic, the walls of small vessels are restored. The drug has no effect on the metabolic processes that occur in the body.
Perindopril reduces the level of aldosterone secretion, as a result of which the activity of renin in the blood increases. Blood pressure decreases in people with different levels of renin activity. Under the influence of this component, blood vessels expand.
When taking the drug, the likelihood of hypokalemia decreases. The mechanism of action of indapamide is similar to thiazide diuretics: urinary excretion and urinary excretion of sodium and chlorine ions will increase.
Contraindications
Taking Noliprel tablets is contraindicated in a number of pathological and physiological conditions of the body, which include:
- Angioedema of tissues (including hereditary), which took place in the past.
- Pregnancy at any stage of the course and the period of breastfeeding.
- Hypokalemia is a decrease in the concentration of potassium ions in the blood.
- A pronounced decrease in the functional activity of the liver.
- Severe renal failure.
- Concomitant use of drugs that lengthen the QT interval on the electrocardiogram, as well as some antiarrhythmic drugs.
- Hypersensitivity to perindopril or other representatives of ACE inhibitors, indapamide, as well as to the auxiliary components of the drug.
- Stenosis (narrowing) of the renal arteries of both kidneys or a single kidney.
Before you start taking Noliprel tablets, you should make sure that there are no contraindications.
Side effects
- Musculoskeletal system and connective tissues: often - muscle spasms.
- Lymphatic and circulatory systems: very rarely - leukopenia or neutropenia, thrombocytopenia, agranulocytosis, hemolytic anemia, aplastic anemia.
- Hearing organ: often - tinnitus.
- Urinary system: infrequently - renal failure; very rarely - acute renal failure.
- Organ of vision: often - visual impairment.
- Dermatological and allergic reactions: often - skin rash, itching, maculopapular rash; infrequently - urticaria, angioedema of the larynx and / or glottis, mucous membranes of the tongue, lips, face, extremities, hypersensitivity reactions (more often skin, in predisposed patients), hemorrhagic vasculitis; exacerbation of disseminated lupus erythematosus.
- Digestive system: often - dry mouth, constipation, diarrhea, nausea, abdominal pain, vomiting, epigastric pain, loss of appetite, impaired taste, dyspepsia.
- Respiratory system: often - transient dry cough, shortness of breath; infrequently - bronchospasm; very rarely - rhinitis, eosinophilic pneumonia.
- Nervous system: often - headache, paresthesia, asthenia, dizziness; infrequently - mood lability, sleep disturbance; very rarely - confusion.
- Patients on hemodialysis after kidney transplantation may develop anemia.
- Cardiovascular system: infrequently - a strong decrease in blood pressure, including orthostatic hypotension; very rarely - bradycardia, atrial fibrillation, ventricular tachycardia, angina pectoris, myocardial infarction and other cardiac arrhythmias.
- Reproductive system: infrequently - impotence.
- Laboratory indicators: hypovolemia and hyponatremia, hypokalemia, a transient increase in the level of glucose and uric acid in the blood, transient hyperkalemia, a slight increase in the level of creatinine and urea in the blood plasma (more often with renal artery stenosis, renal failure, during therapy of arterial hypertension with diuretics); rarely, hypercalcemia.
- General disorders: often - asthenia; infrequently - sweating.
Children, during pregnancy and breastfeeding
The use of Noliprel is contraindicated for pregnant women and mothers during breastfeeding. Systematic treatment with these drugs can lead to the development of abnormalities and diseases in the fetus, as well as lead to fetal death. If a woman finds out about pregnancy during the treatment period, there is no need to terminate the pregnancy, but the patient should be aware of the possible consequences. 
In the event of an increase in blood pressure, another antihypertensive therapy is prescribed. If a woman took this drug in the second and third trimesters, an ultrasound scan of the fetus should be performed to assess the condition of his skull and kidney function.
Newborn children whose mothers have taken the drug may suffer from manifestations of arterial hypotension, so they need to ensure constant supervision of specialists.
When breastfeeding, the drug is contraindicated, therefore, lactation should be stopped during therapy or another drug should be selected.
The drug is not prescribed for the treatment of children under 18 years of age, since there is no exact data on the effectiveness and safety of such treatment.
special instructions
Before you start taking Noliprel tablets, you should carefully read the instructions for the drug. It is necessary to pay attention to several special instructions regarding its use, which include:
For elderly patients over 65 years of age, a dosage reduction is required. If it is necessary to conduct a surgical intervention while taking Noliprel A tablets, it is important to warn the anesthesiologist about the use of the drug.
In the presence of concomitant renal failure of moderate severity, dosage adjustment of the drug is required. The drug is used in case of ineffectiveness of single-component antihypertensive drugs.
The active ingredients of the drug can interact with drugs of other pharmacological groups, therefore, the attending physician should be warned about their possible use.
Against the background of the use of the drug, one should refuse to perform work associated with increased concentration of attention and the speed of psychomotor reactions.
The drug is intended for long-term use, which requires periodic monitoring of laboratory parameters of the functional activity of the liver, kidneys, red bone marrow and peripheral blood.
The drug is not intended for use in children under the age of 18, as well as for pregnant and breastfeeding women. To reduce the likelihood of side effects, the drug should be used in the minimum effective therapeutic dose.
Drug interactions
Due to the possibility of hypokalemia, the risk of toxic effects of cardiac glycosides increases. When combined with, lactic acidosis may develop. Before using iodine-containing X-ray contrast agents with Noliprel, adequate hydration of the body must be performed.
Due to the delay in the body of water and electrolytes during the simultaneous treatment with Noliprel and mineralocorticoids, glucocorticosteroids, stimulating laxatives, tetracosactide, amphotericin B, the hypotensive effect decreases and the likelihood of hypokalemia increases.
With simultaneous treatment with potassium-sparing diuretics or drugs with potassium, the concentration of potassium in the blood may increase. This combination is only recommended for hypokalemia.
Orthostatic hypotension may develop during treatment with Noliprel and antipsychotics or tricyclic antidepressants. Sometimes, with simultaneous treatment with Insulin and Noliprel, hypoglycemia may develop.
When combining indapamide with vincamine, bepridil, sultopride, halofantrine, as well as with simultaneous intravenous administration, arrhythmia and bradycardia may occur. The simultaneous use of calcium salts can provoke hypercalcemia.
When taking non-steroidal anti-inflammatory drugs, the hypotensive properties of Noliprel are inhibited. When dehydrated, this combination of drugs can cause kidney failure or kidney failure.
You should not take Noliprel at the same time as lithium preparations. If it is impossible to cancel one of the drugs, the blood lithium content should be closely monitored. Simultaneous treatment with cyclosporine may increase the level of creatinine in the blood.
Analogues of the drug Noliprel
Analogs are determined by structure:
- Ko-Perineva.
- Noliprel A (Bi-forte; A forte; forte).
- Perindide.
- Perindopril-Indapamide Richter.
Vacation conditions and price
The average cost of Noliprel A (tablets 2.5 + 0.625 mg No. 30) in Moscow is 599 rubles. Dispensed by prescription.
The shelf life of the tablets is 3 years. They should be stored in a dark, dry place, out of the reach of children, at an air temperature not exceeding + 25 C.
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In this article, you can read the instructions for using the drug Noliprel... The reviews of site visitors - consumers of this medicine, as well as opinions of doctors of specialists on the use of Noliprel in their practice are presented. A big request to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, which may not have been declared by the manufacturer in the annotation. Analogs of Noliprel in the presence of available structural analogs. Use for the treatment of hypertension and lowering blood pressure in adults, children, as well as during pregnancy and lactation.
Noliprel - a combined preparation containing perindopril (an ACE inhibitor) and indapamide (a thiazide-like diuretic). The pharmacological action of the drug is due to the combination of the individual properties of each of the components. The combined use of perindopril and indapamide provides a synergistic antihypertensive effect in comparison with each of the components separately.
The drug has a pronounced dose-dependent antihypertensive effect on both systolic and diastolic blood pressure in the supine and standing positions. The action of the drug lasts 24 hours. A persistent clinical effect occurs in less than 1 month from the start of therapy and is not accompanied by tachycardia. Discontinuation of treatment is not accompanied by the development of withdrawal syndrome.
Noliprel reduces the degree of left ventricular hypertrophy, improves the elasticity of the arteries, reduces OPSS, does not affect lipid metabolism (total cholesterol, HDL-cholesterol, LDL-C, triglycerides).
Perindopril is an inhibitor of the enzyme that converts angiotensin 1 to angiotensin 2. Angiotensin-converting enzyme (ACE), or kinase, is an exopeptidase that converts angiotensin 1 into angiotensin 2, which has a vasoconstrictor effect, and the destruction of the vasoconstrictor, which does not have an active ... As a result, perindopril reduces the secretion of aldosterone, according to the principle of negative feedback increases the activity of renin in the blood plasma, with prolonged use reduces the systemic vascular resistance, which is mainly due to the effect on the vessels in the muscles and kidneys. These effects are not accompanied by salt and water retention or the development of reflex tachycardia with prolonged use.
Perindopril has an antihypertensive effect in patients with both low and normal renin activity in blood plasma.
Against the background of the use of perindopril, there is a decrease in both systolic and diastolic blood pressure in the supine and standing positions. Cancellation of the drug does not lead to an increase in blood pressure.
Perindopril has a vasodilating effect, helps to restore the elasticity of large arteries and the structure of the vascular wall of small arteries, and also reduces left ventricular hypertrophy.
Perindopril normalizes heart function by reducing preload and afterload.
The combined use of thiazide diuretics enhances the antihypertensive effect. In addition, the combination of an ACE inhibitor and a thiazide diuretic also reduces the risk of hypokalemia while taking diuretics.
In patients with heart failure, perindopril causes a decrease in filling pressure in the right and left ventricles, a decrease in TPR, an increase in cardiac output and an improvement in the cardiac index, an increase in regional blood flow in the muscles.
Indapamide is a sulfanilamide derivative with pharmacological properties similar to thiazide diuretics. Inhibits the reabsorption of sodium ions in the cortical segment of Henle's loop, which leads to an increase in urinary excretion of sodium ions, chlorine and, to a lesser extent, potassium and magnesium ions, thereby increasing diuresis. The hypotensive effect is manifested in doses that practically do not cause a diuretic effect.
Indapamide reduces vascular hyperreactivity in relation to adrenaline.
Indapamide does not affect the content of lipids in the blood plasma (triglycerides, cholesterol, LDL and HDL), carbohydrate metabolism (including in patients with concomitant diabetes mellitus).
Indapamide helps to reduce left ventricular hypertrophy.
Composition
Perindopril arginine + Indapamide + excipients.
Pharmacokinetics
The pharmacokinetic parameters of perindopril and indapamide when combined do not change compared with their separate use.
Perindopril
After oral administration, perindopril is rapidly absorbed. Approximately 20% of the total absorbed perindopril is converted to the active metabolite perindoprilat. When taking the drug with meals, the conversion of perindopril to perindoprilat decreases (this effect has no significant clinical significance). Perindoprilat is excreted in the urine. T1 / 2 of perindoprilat is 3-5 hours. Excretion of perindoprilat slows down in elderly patients, as well as in patients with renal failure and heart failure.
Indapamide
Indapamide is rapidly and completely absorbed from the gastrointestinal tract. Repeated administration of the drug does not lead to its accumulation in the body. It is excreted mainly in the urine (70% of the administered dose) and in the feces (22%) in the form of inactive metabolites.
Indications
- essential arterial hypertension.
Release forms
Tablets 2.5 mg (Noliprel A).
Tablets 5 mg (Noliprel A Forte).
Tablets 10 mg (Noliprel A Bi-Forte).
Instructions for use and dosage
Assign inside, preferably in the morning, before meals, 1 tablet 1 time per day. If, 1 month after the start of therapy, the desired antihypertensive effect has not been achieved, the dose of the drug can be increased to a dose of 5 mg (manufactured by a company under the trade name Noliprel A forte).
Elderly patients should start therapy with 1 tablet 1 time per day.
Noliprel should not be prescribed to children and adolescents due to the lack of data on efficacy and safety in patients of this age group.
Side effect
- dry mouth;
- nausea;
- decreased appetite;
- abdominal pain;
- taste disturbances;
- constipation;
- dry cough that persists for a long time while taking drugs of this group and disappears after they are canceled;
- orthostatic hypotension;
- hemorrhagic rash;
- rashes on the skin;
- exacerbation of systemic lupus erythematosus;
- angioneurotic edema (Quincke's edema);
- photosensitivity reactions;
- paresthesia;
- headache;
- asthenia;
- sleep disturbance;
- lability of mood;
- dizziness;
- muscle spasms;
- thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia, hemolytic anemia;
- hypokalemia (especially significant for patients at risk), hyponatremia, hypovolemia leading to dehydration and orthostatic hypotension, hypercalcemia.
Contraindications
- a history of angioedema (including while taking other ACE inhibitors);
- hereditary / idiopathic angioedema;
- severe renal failure (CC< 30 мл/мин);
- hypokalemia;
- bilateral stenosis of the renal arteries or stenosis of an artery of a solitary kidney;
- severe liver failure (including with encephalopathy);
- simultaneous administration of drugs that prolong the QT interval;
- concomitant use of antiarrhythmic drugs that can cause ventricular arrhythmias of the "pirouette" type;
- pregnancy;
- lactation period (breastfeeding);
- hypersensitivity to perindopril and other ACE inhibitors, to indapamide and sulfonamides, as well as to other auxiliary components of the drug.
Application during pregnancy and lactation
The drug should not be used in the 1st trimester of pregnancy.
When planning a pregnancy or when it occurs while taking the drug Noliprel, you should immediately stop taking the drug and prescribe another antihypertensive therapy.
Appropriate controlled studies of ACE inhibitors in pregnant women have not been conducted. The available limited data on the effect of the drug in the 1st trimester of pregnancy indicate that taking the drug did not lead to malformations associated with fetotoxicity.
Noliprel is contraindicated in the 2nd and 3rd trimesters of pregnancy.
It is known that long-term exposure to ACE inhibitors on the fetus in the 2nd and 3rd trimesters of pregnancy can lead to impaired development (decreased renal function, oligohydramnios, slowing of the formation of bone substance of the skull) and the development of complications in the newborn (renal failure, arterial hypotension, hyperkalemia).
Long-term use of thiazide diuretics in the 3rd trimester of pregnancy can cause hypovolemia in the mother and a decrease in uteroplacental blood flow, which leads to placental ischemia and fetal growth retardation. In rare cases, while taking diuretics shortly before delivery, newborns develop hypoglycemia and thrombocytopenia.
If the patient received the drug Noliprel in the 2nd or 3rd trimesters of pregnancy, it is recommended to conduct an ultrasound examination of the fetus to assess the condition of the skull and kidney function.
Noliprel is contraindicated during lactation.
special instructions
The use of the drug Noliprel is not accompanied by a significant decrease in the frequency of side effects, with the exception of hypokalemia, compared with perindopril and indapamide in the lowest doses allowed for use. At the beginning of therapy with two antihypertensive drugs that the patient has not previously received, an increased risk of idiosyncrasy cannot be excluded. To minimize this risk, careful monitoring of the patient's condition should be carried out.
Renal failure
In patients with severe renal insufficiency (CC< 30 мл/мин) данная комбинация противопоказана.
In some patients with arterial hypertension without previous impairment of renal function during therapy with Noliprel, laboratory signs of functional renal failure may appear. In this case, treatment should be discontinued. In the future, you can resume combination therapy using low doses of drugs, or use drugs in monotherapy. Such patients need regular monitoring of the level of potassium and creatinine in the blood serum - 2 weeks after the start of therapy and then every 2 months. Renal failure occurs more often in patients with severe chronic heart failure or underlying renal impairment, incl. with renal artery stenosis.
Arterial hypotension and imbalance in water and electrolyte balance
Hyponatremia is associated with the risk of sudden development of arterial hypotension (especially in patients with stenosis of the artery of a solitary kidney and bilateral stenosis of the renal arteries). Therefore, during dynamic monitoring of patients, attention should be paid to possible symptoms of dehydration and a decrease in the level of electrolytes in the blood plasma, for example, after diarrhea or vomiting. Such patients need regular monitoring of blood plasma electrolyte levels. With severe arterial hypotension, intravenous administration of 0.9% sodium chloride solution may be required.
Transient arterial hypotension is not a contraindication for continued therapy. After the restoration of BCC and blood pressure, you can resume therapy using low doses of drugs, or use drugs in monotherapy.
The combination of perindopril and indapamide does not prevent the development of hypokalemia, especially in patients with diabetes mellitus or renal failure. As with any antihypertensive drug in combination with a diuretic, plasma potassium should be monitored regularly during treatment with this combination.
Excipients
It should be borne in mind that the composition of the excipients of the drug includes lactose monohydrate. You should not prescribe Noliprel to patients with hereditary galactose intolerance, lactase deficiency and glucose-galactose malabsorption.
Neutropenia / agranulocytosis
The risk of developing neutropenia while taking ACE inhibitors is dose-dependent and depends on the drug taken and the presence of concomitant diseases. Neutropenia rarely occurs in patients without concomitant diseases, but the risk increases in patients with impaired renal function, especially against the background of systemic connective tissue diseases (including systemic lupus erythematosus, scleroderma). After the abolition of ACE inhibitors, the signs of neutropenia disappear on their own. To avoid the development of such reactions, it is recommended to strictly follow the recommended dose. When prescribing ACE inhibitors to this group of patients, the benefit / risk factor should be carefully correlated.
Angioneurotic edema (Quincke's edema)
In rare cases, against the background of therapy with ACE inhibitors, angioedema of the face, limbs, mouth, tongue, pharynx and / or larynx develops. In such a situation, you should immediately stop taking perindopril and ensure monitoring of the patient's condition until the edema disappears completely. If the swelling affects only the face and mouth, then the manifestations usually go away without special treatment, however, antihistamines can be used to more quickly relieve symptoms.
Angioneurotic edema, which is accompanied by laryngeal edema, can be fatal. Swelling of the tongue, pharynx, or larynx can lead to airway obstruction. In this case, you should immediately enter epinephrine (adrenaline) s / c at a dose of 1: 1000 (from 0.3 to 0.5 ml) and take other emergency measures. Patients with a history of Quincke's edema not associated with ACE inhibitors have an increased risk of developing Quincke's edema with these drugs.
In rare cases, angioedema of the intestine develops during therapy with ACE inhibitors.
Anaphylactic reactions during desensitization
There are separate reports on the development of life-threatening anaphylactic reactions in patients receiving ACE inhibitors during desensitizing therapy with hymenoptera venom (including bee and wasp). ACE inhibitors should be used with caution in patients prone to allergic reactions and undergoing desensitization procedures. Avoid prescribing the drug to patients receiving immunotherapy with hymenoptera venom. However, anaphylactic reactions can be avoided by temporarily discontinuing the drug at least 24 hours before the start of the course of desensitizing therapy.
Cough
During therapy with an ACE inhibitor, a dry cough may occur. The cough persists for a long time while taking drugs of this group and disappears after they are canceled. When a dry cough appears in a patient, one should remember about the possible iatrogenic nature of this symptom. If the attending physician believes that therapy with an ACE inhibitor is necessary for the patient, the drug can be continued.
The risk of arterial hypotension and / or renal failure (including in the case of heart failure, water and electrolyte deficiency)
In some pathological conditions, there may be a significant activation of the renin-angiotensin-aldosterone system, especially with severe hypovolemia and a decrease in the level of blood plasma electrolytes (against the background of a salt-free diet or long-term use of diuretics), in patients with initially low blood pressure, with bilateral renal artery stenosis or with stenosis of an artery of a single kidney, chronic heart failure or cirrhosis of the liver with edema and ascites. The use of an ACE inhibitor causes a blockade of this system and, therefore, can be accompanied by a sharp decrease in blood pressure and / or an increase in the level of creatinine in the blood plasma, indicating the development of functional renal failure. These phenomena are more often observed when taking the first dose of the drug or during the first two weeks of therapy. Sometimes these conditions develop sharply at other times of therapy. In such cases, when resuming therapy, it is recommended to use the drug at a lower dose and then gradually increase the dose.
Elderly patients
Before starting to take the drug, it is necessary to assess the functional activity of the kidneys and the concentration of potassium in the blood plasma. At the beginning of therapy, the dose of the drug is selected, taking into account the degree of decrease in blood pressure, especially in the case of dehydration and loss of electrolytes. Such measures allow you to avoid a sharp decrease in blood pressure.
Patients with established atherosclerosis
The risk of arterial hypotension exists in all patients, but the drug should be used with extreme caution in patients with ischemic heart disease or cerebrovascular accident. In such cases, treatment should be started at a low dose.
Renovascular hypertension
Revascularization is a treatment for renovascular hypertension. Nevertheless, the use of ACE inhibitors has a beneficial effect in this category of patients, both awaiting surgery and in the case when surgery is not possible. Treatment with Noliprel in patients with diagnosed or suspected bilateral renal artery stenosis or stenosis of a solitary kidney artery should be started with a low dose of the drug in a hospital setting, monitoring renal function and plasma potassium concentration. Some patients may develop functional renal failure, which disappears when the drug is discontinued.
Other risk groups
In patients with severe heart failure (stage IV) and patients with insulin-dependent diabetes mellitus (risk of spontaneous increase in potassium levels), drug treatment should be started with low doses and carried out under constant medical supervision.
In patients with arterial hypertension and heart failure, beta-blockers should not be canceled: ACE inhibitors should be used together with beta-blockers.
Anemia
Anemia can develop in patients undergoing kidney transplantation or in patients undergoing hemodialysis. The higher the initial hemoglobin level was, the more pronounced its decrease. This effect, apparently, is not dose-dependent, but may be associated with the mechanism of action of ACE inhibitors. The decrease in hemoglobin content is insignificant, it occurs during the first 1-6 months of treatment, and then stabilizes. If the treatment is canceled, the hemoglobin level is completely restored. Treatment can be continued under the control of the peripheral blood picture.
Surgery / General anesthesia
The use of ACE inhibitors in patients undergoing surgery using general anesthesia can lead to a pronounced decrease in blood pressure, especially when using drugs for general anesthesia that have a hypotensive effect. It is recommended to stop taking long-acting ACE inhibitors, incl. perindopril, one day before surgery. It is necessary to warn the anesthesiologist that the patient is taking ACE inhibitors.
Aortic Stenosis / Hypertrophic Cardiomyopathy
ACE inhibitors should be used with caution in patients with obstruction of the left ventricular outflow tract.
Liver failure
In rare cases, cholestatic jaundice occurs while taking ACE inhibitors. With the progression of this syndrome, the rapid development of liver necrosis is possible, sometimes with a fatal outcome. The mechanism for the development of this syndrome is unclear. If jaundice develops or a significant increase in the activity of liver enzymes occurs while taking ACE inhibitors, the patient should stop taking the drug and consult a doctor.
Indapamide
In the presence of liver dysfunction, taking thiazide and thiazide-like diuretics can lead to the development of hepatic encephalopathy. In this case, you should immediately stop taking the drug.
Violations of water and electrolyte balance
Before starting treatment, it is necessary to determine the content of sodium ions in the blood plasma. While taking the drug, this indicator should be regularly monitored. All diuretic drugs can cause hyponatremia, which sometimes leads to serious complications. Hyponatremia at the initial stage may not be accompanied by clinical symptoms, therefore, regular laboratory monitoring is necessary. More frequent monitoring of sodium ions is indicated for patients with liver cirrhosis and for the elderly.
Therapy with thiazide and thiazide-like diuretics is associated with the risk of hypokalemia. It is necessary to avoid hypokalemia (less than 3.4 mmol / l) in the following categories of patients from the high-risk group: the elderly, malnourished patients or receiving combined drug therapy, patients with liver cirrhosis, peripheral edema or ascites, coronary artery disease, heart failure. Hypokalemia in these patients increases the toxic effect of cardiac glycosides and increases the risk of arrhythmias. The high-risk group also includes patients with an increased QT interval, and it does not matter whether this increase is caused by congenital causes or the action of drugs.
Hypokalemia, like bradycardia, contributes to the development of severe cardiac arrhythmias, especially pirouette arrhythmias, which can be fatal. In all the cases described above, more regular monitoring of the content of potassium ions in the blood plasma is necessary. The first measurement of the concentration of potassium ions must be carried out within the first week from the start of therapy.
If hypokalemia is detected, appropriate treatment should be prescribed.
Thiazide and thiazide-like diuretics reduce the excretion of calcium ions by the kidneys, leading to a slight and temporary increase in the concentration of calcium in the blood plasma. Severe hypercalcemia may be due to previously undiagnosed hyperparathyroidism. Before examining the function of the parathyroid gland, diuretics should be discontinued.
It is necessary to monitor blood glucose levels in patients with diabetes mellitus, especially in the presence of hypokalemia.
Uric acid
In patients with a high content of uric acid in the blood during therapy with Noliprel, the risk of developing gout increases.
Kidney function and diuretics
Thiazide and thiazide-like diuretics are fully effective only in patients with normal or slightly impaired renal function (plasma creatinine content in adults is below 2.5 mg / dL or 220 μmol / L). At the beginning of diuretic treatment in patients due to hypovolemia and hyponatremia, there may be a temporary decrease in the glomerular filtration rate and an increase in the concentration of urea and creatinine in the blood plasma. This transient functional renal failure is not dangerous for patients with unaltered renal function, but in patients with renal failure, its severity may increase.
Photosensitivity
While taking thiazide and thiazide-like diuretics, cases of photosensitivity reactions have been reported. If photosensitivity reactions develop while taking the drug, treatment should be discontinued. If it is necessary to continue diuretic therapy, it is recommended to protect the skin from exposure to sunlight or artificial ultraviolet rays.
Athletes
Indapamide can give a positive reaction during doping control.
Influence on the ability to drive vehicles and use mechanisms
The action of the substances that make up the drug Noliprel does not lead to a violation of psychomotor reactions. However, in some people, in response to a decrease in blood pressure, various individual reactions may develop, especially at the beginning of therapy or when other antihypertensive drugs are added to the therapy. In this case, the ability to drive a car or other mechanisms may be reduced.
Drug interactions
Noliprel
With the simultaneous use of lithium preparations and ACE inhibitors, a reversible increase in the concentration of lithium in the blood plasma and associated toxic effects may occur. Additional administration of thiazide diuretics may further increase the concentration of lithium and increase the risk of toxicity. The simultaneous use of a combination of perindopril and indapamide with lithium preparations is not recommended. If necessary, such therapy should constantly monitor the content of lithium in the blood plasma.
Baclofen enhances the hypotensive effect of Noliprel. With simultaneous use, blood pressure and renal function should be carefully monitored and the need to adjust the dose of Noliprel.
With simultaneous use with non-steroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid in high doses (more than 3 g per day), it is possible to reduce the diuretic, natriuretic and hypotensive effect. With significant fluid loss, acute renal failure (due to a decrease in glomerular filtration) can develop. Before starting treatment with the drug, it is necessary to replenish the loss of fluid and carefully monitor renal function at the beginning of treatment.
With the simultaneous use of Noliprel and tricyclic antidepressants, neuroleptics, an increase in the hypotensive effect and an increase in the risk of orthostatic hypotension (additive effect) is possible.
Glucocorticosteroids (GCS), tetracosactide reduce the hypotensive effect of Noliprel (water and electrolyte retention as a result of GCS).
Other antihypertensive drugs enhance the effect of Noliprel.
Perindopril
ACE inhibitors reduce the excretion of potassium by the kidneys caused by a diuretic. Potassium-sparing diuretics (for example, spironolactone, triamterene, amiloride), potassium preparations and potassium-containing substitutes for table salt can lead to a significant increase in the concentration of potassium in the blood serum, up to death. If the combined use of an ACE inhibitor and the above drugs is necessary (in the case of confirmed hypokalemia), care should be taken and regular monitoring of the concentration of potassium in the blood plasma and ECG parameters.
Combinations requiring special care
When using ACE inhibitors (captopril, enalapril) in patients with diabetes mellitus, the hypoglycemic effect of insulin and sulfonylurea derivatives may increase. Hypoglycemic conditions are extremely rare (due to an increase in glucose tolerance and a decrease in insulin requirements).
Combinations requiring caution
While taking ACE inhibitors, allopurinol, cytostatic or immunosuppressive agents, systemic corticosteroids or procainamide increase the risk of developing leukopenia.
ACE inhibitors can enhance the antihypertensive effect of general anesthetics.
Previous treatment with diuretics (thiazide and "loop") in high doses can cause a decrease in the BCC and hypotension when prescribing perindopril.
Indapamide
Combinations requiring special care
Due to the risk of hypokalemia, caution should be exercised when using indapamide together with drugs that can cause pirouette-type arrhythmias, for example, antiarrhythmic drugs (quinidine, sotalol, hydroquinidine), some neuroleptics (pimozide, thioridazine), other drugs such as cisapride ... The development of hypokalemia should be avoided and, if necessary, corrected. The QT interval should be monitored.
Amphotericin B (i.v.), gluco- and mineralocorticosteroids (for systemic administration), tetracosactide, laxatives that stimulate intestinal motility, increase the risk of hypokalemia (additive effect). It is necessary to control the level of potassium in the blood plasma, if necessary, to correct it. Particular attention should be paid to patients who are simultaneously receiving cardiac glycosides. Use laxatives that do not stimulate intestinal motility.
Hypokalemia enhances the toxic effect of cardiac glycosides. With the simultaneous use of indapamide and cardiac glycosides, the level of potassium in the blood plasma and ECG parameters should be monitored and, if necessary, the therapy should be adjusted.
Combinations requiring caution
Diuretics (including indapamide) can cause functional renal failure, which increases the risk of developing lactic acidosis while taking metformin. Metformin should not be prescribed if serum creatinine exceeds 1.5 mg / dL (135 μmol / L) in men and 1.2 mg / dL (110 μmol / L) in women.
With significant dehydration of the body, which is caused by taking diuretic drugs, the risk of developing renal failure increases with the use of iodine-containing contrast agents in high doses. Rehydration is required before using iodine-containing contrast media.
With simultaneous use with calcium salts, hypercalcemia may develop as a result of a decrease in its excretion in the urine.
With the use of indapamide against the background of constant use of cyclosporine, the level of creatinine in plasma increases, even with a normal state of water and electrolyte balance.
Analogs of the drug Noliprel
Structural analogues for the active substance:
- Ko-Perineva;
- Noliprel A;
- Noliprel A Bi-forte;
- Noliprel A forte;
- Noliprel forte;
- Perindide;
- Perindopril-Indapamide Richter.
In the absence of analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and see the available analogues for the therapeutic effect.
Tradename:Noliprel (Noliprel)
International non-proprietary name of the drug:Indapamide + Perindopril
Dosage form: tablets
Active ingredients: perindopril tert-butylamine salt, indapamide
Pharmacotherapeutic group: antihypertensive drug
Pharmacodynamics:
The pharmacological action of noliprel is due to a combination of the individual properties of each of the components. The combination of perindopril and indapamide enhances the effect of each of them. Noliprel has a pronounced dose-dependent hypotensive effect on both systolic and diastolic blood pressure in the supine and standing positions. The action of the drug lasts 24 hours. A persistent clinical effect occurs in less than 1 month from the start of therapy and is not accompanied by tachycardia. Discontinuation of treatment is not accompanied by the development of withdrawal syndrome. Noliprel reduces the degree of left ventricular hypertrophy, improves the elasticity of the arteries, reduces OPSS, does not affect the metabolism of lipids (total cholesterol, HDL, LDL, triglycerides) and does not affect the metabolism of carbohydrates (including in patients with diabetes mellitus). Perindopril is an inhibitor of the enzyme that converts angiotensin I to angiotensin II. ACE or kinase is an exopeptidase that performs both the conversion of angiotensin I into angiotensin II, which has a vasoconstrictor effect, and the destruction of bradykinin, which has a vasodilating effect, to an inactive heptapeptide. As a result, perindopril reduces the secretion of aldosterone, according to the principle of negative feedback increases the activity of renin in the blood plasma, with prolonged use reduces the systemic vascular resistance, which is mainly due to the effect on the vessels in the muscles and kidneys. These effects are not accompanied by salt and water retention or the development of reflex tachycardia. Perindopril has a hypotensive effect in patients with both low and normal renin activity in blood plasma. Against the background of the use of perindopril, there is a decrease in both systolic and diastolic blood pressure in the supine and standing positions. Cancellation of the drug does not lead to the development of a hypertensive reaction. Perindopril has a vasodilating effect, helps to restore the elasticity of large arteries and the structure of the vascular wall of small arteries, and also reduces left ventricular hypertrophy. The concomitant administration of thiazide diuretics enhances the severity of the antihypertensive effect. In addition, the combination of an ACE inhibitor and a thiazide diuretic also reduces the risk of hypokalemia while taking diuretics. Perindopril normalizes heart function by reducing preload and afterload. When studying hemodynamic parameters in patients with chronic heart failure, a decrease in filling pressure in the left and right ventricles of the heart, a decrease in the systemic vascular resistance, an increase in cardiac output and an increase in the cardiac index, and an increase in muscle regional blood flow were revealed. Indapamide is similar in pharmacological properties to thiazide diuretics. Indapamide inhibits the reabsorption of sodium ions in the cortical segment of the loop of Henle, which leads to an increase in urinary excretion of sodium, chlorine and, to a lesser extent, potassium and magnesium ions, thereby increasing diuresis. The hypotensive effect is manifested in doses that practically do not cause a diuretic effect. Indapamide reduces vascular hyperreactivity in relation to adrenaline. Indapamide does not affect the content of lipids in the blood plasma (triglycerides, cholesterol, LDL and HDL), carbohydrate metabolism (including in patients with concomitant diabetes mellitus). Helps reduce left ventricular hypertrophy.
Indications for use:
Essential arterial hypertension.
Contraindications:
A history of angioneurotic edema (including while taking ACE inhibitors); hypokalemia; severe renal failure (CC less than 30 ml / min); severe hepatic impairment (including with encephalopathy); simultaneous administration of drugs that prolong the QT interval; pregnancy; lactation (breastfeeding); hypersensitivity to perindopril and other ACE inhibitors; hypersensitivity to indapamide and sulfonamides.
Method of administration and dosage:
Adults, including elderly patients, are prescribed 1 tablet / day, preferably in the morning. No dose adjustment is required in patients with renal insufficiency with CC ≥30 ml / min.
Side effects:
Effects due to the action of perindopril: excessive decrease in blood pressure, orthostatic hypotension; in some cases - myocardial infarction, angina pectoris, stroke, arrhythmia; decreased renal function, proteinuria (in patients with glomerular nephropathy); in some cases - acute renal failure; a slight increase in the concentration of creatinine in urine and blood plasma (reversible after discontinuation of the drug); possibly (usually temporary) increase in the concentration of potassium in the blood plasma; headache, increased fatigue, asthenia, dizziness, mood lability, visual disturbances, ringing in the ears, sleep disturbances, convulsions, paresthesia, anorexia, impaired taste; in some cases - confusion of consciousness; dry cough; rarely - difficulty breathing, bronchospasm; in some cases - rhinorrhea; abdominal pain, nausea, vomiting, constipation, diarrhea; rarely - dry mouth; in some cases - cholestatic jaundice, pancreatitis, increased activity of hepatic transaminases, hyperbilirubinemia; hypokalemia is possible; anemia (in patients after kidney transplantation, hemodialysis); rarely - hypoglobinemia, thrombocytopenia, decreased hematocrit; in some cases - agranulocytosis, pancytopenia; possible hemolytic anemia (against the background of glucose-6-phosphate dehydrogenase deficiency); skin rashes, itching; rarely - urticaria, angioedema; in some cases - erythema multiforme; increased sweating, decreased potency. Effects due to the action of indapamide: dizziness, headache, asthenia, paresthesia (usually disappear when the dose of the drug is reduced); rarely - nausea, constipation, dry mouth; in some cases - pancreatitis; with hepatic failure, the development of hepatic encephalopathy is possible; hypokalemia is possible (especially in patients at risk), a decrease in sodium levels, accompanied by hypovolemia, dehydration of the body and orthostatic arterial hypotension; an increase in the content of urea and glucose in the blood plasma is possible; in some cases - thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia, hemolytic anemia, bone marrow aplasia; possible skin rashes, hemorrhagic vasculitis, exacerbation of SLE; in predisposed patients, skin manifestations.
Interaction with other medicinal products:
The simultaneous use of noliprel and lithium preparations is not recommended. An increase in lithium concentration can lead to symptoms and signs of lithium overdose (due to decreased renal excretion of lithium). If the combination therapy, including ACE inhibitors and potassium-sparing diuretics, cannot be canceled, the lithium level should be carefully monitored and the dose of the drug adjusted if necessary. The combination of perindopril with potassium-sparing diuretics and potassium preparations can lead to a significant increase in the concentration of potassium in the blood serum (especially against the background of renal failure) and even death. You should not prescribe ACE inhibitors in combination with potassium-sparing diuretics and potassium preparations, except for patients with hypokalemia (with constant monitoring of the concentration of potassium in the blood plasma and ECG parameters). It should be taken into account that the use of indapamide in combination with potassium-sparing diuretics or potassium preparations does not exclude the development of hypokalemia or hyperkalemia (especially in patients with diabetes mellitus and renal failure). With the simultaneous use of erythromycin (for intravenous administration), pentamidine, sultopride, vincamine, halofantrine, bepridil and indapamide, arrhythmias of the "pirouette" type may develop (provoking factors include hypokalemia, bradycardia or prolonged QT interval). When using ACE inhibitors, incl. noliprel, the hypoglycemic effect of insulin and sulfonylurea derivatives may be enhanced. The development of hypoglycemia is extremely rare (an increase in glucose tolerance and a decrease in insulin requirements). With the simultaneous use of noliprel and baclofen, the hypotensive effect is enhanced (it is necessary to control the level of blood pressure and adjust the dose of noliprel). With the simultaneous use of indapamide, which is part of the drug noliprel, and NSAIDs in case of dehydration of the body, acute renal failure may develop (due to a decrease in glomerular filtration). In such cases, before starting treatment, you should ensure sufficient hydration of the body and assess the functional activity of the kidneys. It should also be borne in mind that NSAIDs weaken the hypotensive effect of ACE inhibitors. It has been found that NSAIDs and ACE inhibitors have an additive effect on hyperkalemia, while it is also possible to reduce renal function. With the simultaneous use of noliprel and tricyclic antidepressants, antipsychotics, an increase in the hypotensive effect and an increase in the risk of developing orthostatic hypotension (additive effect) is possible. GCS, tetracosactide reduce the hypotensive effect of noliprel (retention of water and electrolytes as a result of the action of glucocorticoids). With the simultaneous use of indapamide with antiarrhythmic drugs IA (quinidine, hydroquinidine, disopyramide) and class III (amiodarone, bretylium, sotalol), arrhythmias of the "pirouette" type may develop (provoking factors include hypokalemia, bradycardia or prolonged QT interval). When arrhythmias of the "pirouette" type develop, antiarrhythmic drugs should not be used (an artificial pacemaker must be used). With the simultaneous use of indapamide and drugs that reduce the level of potassium (including amphotericin B IV, gluco- and mineralocorticoids with systemic use, tetracosactide, stimulating laxatives), the risk of hypokalemia increases. The potassium concentration should be monitored and adjusted if necessary. If necessary, the appointment of laxatives should be used drugs without stimulating effect on intestinal motility. With the simultaneous use of noliprel with cardiac glycosides, it should be borne in mind that low potassium levels can enhance the toxic effect of cardiac glycosides. The level of potassium and ECG should be monitored, and if necessary, adjust the therapy. Lactic acidosis while taking metformin is apparently associated with functional renal failure, which is caused by the action of indapamide. Do not use metformin if serum creatinine levels exceed 1.5 mg / dL (135 μmol / L) in men and 1.2 mg / dL (110 μmol / L) in women. Noliprel increases the risk of developing renal dysfunction while using high doses of iodine-containing X-ray contrast agents. Rehydration is required before using iodine-containing contrast media. With simultaneous use with calcium salts, it is possible to increase the calcium content in the blood plasma as a result of a decrease in its excretion in the urine. With simultaneous use with cyclosporine, the risk of hypercreatininemia increases.
Shelf life:3 years
Terms of dispensing from pharmacies: on prescription
Manufacturer:Servier Laboratories, France.
Laboratories Servier Industry Serdix, LLCCountry of origin
Russia FranceProduct group
Cardiovascular drugsCombined antihypertensive agent. (angiotensin-converting enzyme (ACE) inhibitor + diuretic).
Release forms
- Film-coated tablets 10mg + 2.5mg - 30 tablets per pack.
Description of the dosage form
- Round white biconvex film-coated tablets.
pharmachologic effect
Noliprel® A Bi-forte is a combined preparation containing perindopril arginine and indapamide. Pharmacological properties of Noliprel® A Bi-forte combine the individual properties of each of the components. The combination of perindopril arginine and indapamide enhances the effect of each of them. Perindopril is an inhibitor of the enzyme that converts angiotensin I to angiotensin II (ACE inhibitor). ACE, or kininase II, is an exopeptidase that both converts angiotensin I to the vasoconstrictor angiotensin II and degrades bradykinin, which has a vasodilating effect, to an inactive heptapeptide. As a result, perindopril reduces the secretion of aldosterone, according to the principle of negative feedback increases the activity of renin in the blood plasma, with prolonged use reduces the systemic vascular resistance, which is mainly due to the effect on the vessels in the muscles and kidneys. These effects are not accompanied by salt and water retention or the development of reflex tachycardia. Perindopril normalizes myocardial function by reducing preload and afterload. When studying hemodynamic parameters in patients with chronic heart failure, it was revealed: a decrease in filling pressure in the left and right ventricles of the heart; decrease in OPSS; increased cardiac output and increased cardiac index; increased muscle peripheral blood flow. Indapamide belongs to the group of sulfonamides, with pharmacological properties close to thiazide diuretics. Indapamide inhibits the reabsorption of sodium ions in the cortical segment of Henle's loop, which leads to an increase in the excretion of sodium ions, chlorine and, to a lesser extent, potassium and magnesium ions by the kidneys, thereby increasing diuresis and reducing blood pressure. Antihypertensive effect of Noliprel®A Bi-forte Noliprel® A Bi-forte has a dose-dependent hypotensive effect on both diastolic and systolic blood pressure in the standing and lying position. The antihypertensive effect of the drug persists for 24 hours. A stable therapeutic effect occurs in less than 1 month from the start of therapy and is not accompanied by tachycardia. Discontinuation of treatment does not cause withdrawal. Noliprel® A Bi-Forte reduces the degree of left ventricular hypertrophy, improves the elasticity of the arteries, reduces the systemic vascular resistance, does not affect lipid metabolism (total cholesterol, HDL cholesterol and LDL cholesterol, triglycerides). The effect of the drug on indicators of cardiovascular morbidity and mortality has not been studied. The effect of the combination of perindopril and indapamide on left ventricular hypertrophy (LVH) has been proven compared with enalapril. In patients with arterial hypertension and LVH receiving therapy with perindopril terbutylamine 2 mg (equivalent to 2.5 mg perindopril arginine) / indapamide 0.625 mg or enalapril at a dose of 10 mg 1 time /, and with an increase in the dose of perindopril to 8 mg (equivalent to 10 mg perindopril arginine) and indapamide up to 2.5 mg, or enalapril up to 40 mg 1 time / there was a more significant decrease in the left ventricular mass index (LVMI) in the perindopril / indapamide group (-10.1 g / m2) compared with the indapamide group (-1.1 g / m2). The difference in the degree of decrease in this indicator between the groups was -8.3 g / m2 (95% CI (-11.5, -5.0), pSpecial conditions
Noliprel®A Bi-Forte Impaired renal function Therapy with Noliprel® A Bi-Forte is contraindicated in patients with moderate to severe renal failure (CC less than 60 ml / min). In some patients with arterial hypertension, without prior obvious impairment of renal function during therapy, laboratory signs of functional renal failure may appear. In this case, treatment with Noliprel® A Bi-forte should be discontinued. In the future, you can resume combination therapy using low doses of a combination of perindopril and indapamide, or use drugs in monotherapy. Such patients need regular monitoring of the content of potassium and creatinine ions in the blood serum - 2 weeks after the start of therapy and then every 2 months. Renal failure is more common in patients with severe chronic heart failure or underlying renal impairment, including renal artery stenosis. Noliprel® A Bi-forte is not recommended for patients with bilateral renal artery stenosis or arterial stenosis of a single functioning kidney. Arterial hypotension and imbalance in water and electrolyte balance Hyponatremia is associated with the risk of sudden development of arterial hypotension (especially in patients with renal artery stenosis, including bilateral). Therefore, when monitoring patients, attention should be paid to possible symptoms of dehydration and a decrease in the content of electrolytes in the blood plasma, for example, after diarrhea or vomiting. Such patients need regular monitoring of blood plasma electrolytes. With severe arterial hypotension, intravenous administration of 0.9% sodium chloride solution may be required. Transient arterial hypotension is not a contraindication for continued therapy. After the restoration of BCC and blood pressure, therapy can be resumed using low doses of a combination of perindopril and indapamide, or drugs can be used as monotherapy. Potassium content The combined use of perindopril and indapamide does not prevent the development of hypokalemia, especially in patients with diabetes mellitus or renal failure. As in the case of the use of other antihypertensive drugs in combination with a diuretic, regular monitoring of the content of potassium ions in the blood plasma is necessary. Excipients It should be borne in mind that the composition of the excipients of the drug includes lactose monohydrate. The drug should not be prescribed to patients with hereditary galactose intolerance, lactase deficiency and glucose-galactose malabsorption. Perindopril Neutropenia / agranulocytosis The risk of developing neutropenia while taking ACE inhibitors is dose-dependent and depends on the drug taken and the presence of concomitant diseases. Neutropenia rarely occurs in patients without underlying medical conditions, but the risk increases in patients with impaired renal function,Composition
- perindopril arginine 10 mg, which corresponds to 6.79 mg of perindopril and indapamide 2.5 mg. Excipients: lactose monohydrate 142.66 mg, magnesium stearate 0.90 mg, maltodextrin 18.00 mg, anhydrous colloidal silicon dioxide 0.54 mg, sodium carboxymethyl starch (type A) 5.40 mg. The composition of the film shell: macrogol 6000 0.27828 mg, magnesium stearate 0.26220 mg, titanium dioxide (E171) 0.83902 mg, glycerol 0.26220 mg, hypromellose 4.3583 mg. perindopril arginine 10 mg, which corresponds to the content of perindopril 6.79 mg indapamide 2.5 mg Excipients: lactose monohydrate, magnesium stearate, maltodextrin, colloidal anhydrous silicon dioxide, sodium carboxymethyl starch (type A). The composition of the film shell: macrogol 6000, magnesium stearate, titanium dioxide (E171), glycerol, hypromellose.
Noliprel A Bi-forte indications for use
- Essential hypertension (for patients who require therapy with perindopril 10 mg and indapamide 2.5 mg).
Noliprel A Bi-forte contraindications
- - a history of angioedema (Quincke's edema) associated with taking an ACE inhibitor; - hereditary / idiopathic angioedema; - bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney; - severe renal failure (CC less than 60 ml / min); - severe hepatic failure (including with encephalopathy); - hypokalemia; - presence of lactase deficiency, galactosemia or glucose-galactose malabsorption syndrome, lactose intolerance; - simultaneous administration with potassium-sparing diuretics, potassium and lithium preparations, and in patients with an increased content of potassium ions in the blood plasma; - simultaneous use with drugs that can cause arrhythmias of the "pirouette" type; - Simultaneous administration of drugs that lengthen the QT interval; - pregnancy; - the period of breastfeeding; - age up to 18 years (efficacy and safety have not been established);
Noliprel A Bi-forte dosage
- 10 mg + 2.5 mg
Noliprel A Bi-forte side effects
- From the hematopoietic system: very rarely - thrombocytopenia, leukopenia / neutropenia, agranulocytosis, aplastic anemia, hemolytic anemia. In certain clinical situations (patients after kidney transplantation, patients on hemodialysis) ACE inhibitors can cause anemia.
Drug interactions
Noliprel® A Bi-forte Undesirable combination of drugs With the simultaneous use of lithium preparations and ACE inhibitors, a reversible increase in the lithium content in the blood plasma and associated toxic effects may occur. Additional use of thiazide diuretics may further increase lithium levels and increase the risk of toxicity. The simultaneous use of a combination of perindopril and indapamide with lithium preparations is not recommended. In the case of such therapy, regular monitoring of the concentration of lithium in the blood plasma is necessary. A combination of drugs requiring special attention When used simultaneously with baclofen, an increase in the hypotensive effect is possible. Blood pressure and renal function should be monitored, if necessary, dose adjustment of antihypertensive drugs is required. With simultaneous use with NSAIDs, including high doses of acetylsalicylic acid (more than 3 g /), a decrease in diureticOverdose
the most likely symptom of an overdose is a marked decrease in blood pressure, sometimes in combination with nausea, vomiting, seizures, dizziness, drowsiness, confusion, and oliguria, which can turn into anuria (as a result of hypovolemia)Storage conditions
- keep away from children
