Indapamide even in very high doses (up to 40 mg, ie 27 times the therapeutic dose) does not have a toxic effect.
Symptoms: The symptoms of acute poisoning with medication in the first place related to the violation of water-electrolyte balance (hyponatremia, hypokalemia). From the buy primobolan depot clinical symptoms of an overdose may experience nausea, vomiting, decreased blood pressure, cramps, dizziness, drowsiness, confusion, polyuria or oliguria, leading to anuria (due to hypovolaemia).
Treatment: The first aid measures total fitness control to reduce the excretion of the drug from the body: gastric lavage and / or administration of activated charcoal, followed by restoration of water and electrolyte balance.
Interaction with other drugs
Unwanted drug combination
- Lithium preparations: With simultaneous use of indapamide and drugs lithium may increase the concentration of lithium observed in plasma due to the reduction of its excretion is accompanied by the appearance of signs of overdose. If necessary, diuretic drugs can be used in combination with drugs lithium, and should be carefully selected dose drugs, constantly monitoring plasma lithium content.
The combination of drugs that require special attention
Drugs that can cause arrhythmia type “pirouette”:
- antiarrhythmic drugs class IA (quinidine, gidrohinidin, disopyramide);
- Class III antiarrhythmic drugs (amiodarone, sotalol, dofetilide, Ibutilide);
- some antipsychotics: phenothiazines (chlorpromazine, tsiamemazin, Levomepromazine, thioridazine, trifluoperazine), benzamides (amisulpride, sulpiride, sultopride, tiaprid), butyrophenones (droperidol, haloperidol);
- others: bepridil, cisapride, difemanil erythromycin (w / w), halofantrine, mizolastine, pentamidine, sparfloxacin, moxifloxacin, astemizole, vincamine (w / w).
Increased risk of ventricular arrhythmias, especially arrhythmias such as “pirouette” (a risk factor – hypokalemia).
It should determine the potassium content of the blood plasma and adjust health conscious it before indapamide combination therapy if necessary and the above mentioned drugs. Necessary to control the patient’s clinical status, control of blood plasma electrolytes and ECG parameters.
In patients with hypokalemia is necessary to use drugs, do not cause arrhythmia type “pirouette”.
- Nonsteroidal anti-inflammatory drugs (for systemic administration), including selective buy primobolan depot, high dose salicylates (23 g / day):
Perhaps the reduction in the antihypertensive effect of indapamide.
When a significant loss of fluid may develop acute renal failure (due to a decrease in glomerular filtration rate).
Patients need to compensate for fluid loss and the beginning of treatment carefully monitor renal function.
- Angiotensin converting enzyme
Appointment of inhibitors in patients with a reduced concentration of sodium ions in the blood (especially in patients with renal artery stenosis) is accompanied by a risk of sudden hypotension and / or acute renal failure.
Patients with hypertension and possibly reduced due to diuretics, the content of sodium ions in the blood plasma, it is necessary:
- 3 days prior to initiation of treatment with inhibitor stop taking diuretics. Later, if needed, can be resumed diuretics;
- or begin therapy with an inhibitor with a low dose, and then gradually increasing the dose if necessary.
In chronic heart failure treatment inhibitors should be started at low doses with a possible decrease in pre-dose diuretics. In all cases the first week fitness by fronk inhibitor in patients need to monitor renal function (creatinine concentration in blood plasma).
- Other medications that can cause hypokalaemia: amphotericin B (w / w) glucose and mineralokortikosteroidy (at system assignment) tetrakozaktid, laxative, stimulating bowel motility:
Increased risk of hypokalaemia (additive effect).
A regular control of the content of potassium in the blood plasma, is its correction, if necessary. Particular attention should be given to patients while receiving cardiac glycosides. It is recommended to use laxatives, do not stimulate bowel motility.
- Baclofen: marked enhancement of the antihypertensive effect. Patients need to compensate for fluid loss and the beginning of treatment carefully monitor renal function.
- Cardiac glycosides: Hypokalaemia enhances the toxic effects of cardiac glycosides.With simultaneous use of cardiac glycosides and indapamide should control the content of potassium in the blood plasma, buy primobolan depot, and, if necessary, adjust therapy.
The combination of drugs that require attention
- Potassium-sparing diuretics (amiloride, spironolactone, triamterene): Combination indapamide and potassium-sparing diuretic therapy is suitable for some patients, but it does not exclude the possibility of hypokalemia (especially in diabetic patients and in patients with renal failure) or hyperkalemia. It is necessary to control the content of potassium in the blood plasma, ECG, and if necessary, adjust therapy.
- Metformin: A functional renal failure that can occur in the background of diuretics, particularly “loop”, while the appointment of metformin increases the risk of lactic acidosis. Do not use metformin, if the serum creatinine concentration exceeds in women.
- Iodine-containing contrast agents: Functional renal failure, which can occur in the background of diuretics, particularly “loop”, while the appointment of metformin increases the risk of lactic acidosis. Do not use metformin when creatinine concentration exceeds 1in women.
- Iodine-containing contrast agents: . Dehydration in patients receiving diuretics increases the risk of acute renal failure, especially with high doses of contrast media yodsoderzhashih Before applying yodsoderzhashih contrast agents to patients is necessary to compensate the loss of fluids.
- Tricyclic antidepressants, antipsychotic drugs (neuroleptics): Drugs of these classes increase the antihypertensive effect iidapamida and increase the risk of orthostatic hypotension (additive effect).
- Calcium salts: When concomitant administration may develop hypercalcemia due to decreased excretion of calcium by the kidneys.
- Cyclosporine, Tacrolimus: Possible increased kreatinnna plasma concentrations unchanged circulating concentration of cyclosporin even with normal fluid and sodium ions.
- Corticosteroids, tetrakozaktid (at system assignment): Reduced antihypertensive effect (fluid retention and sodium ions by the action of corticosteroids).
Special instructions: Violations of the liver In the appointment of thiazide and thiazide diuretics in patients with impaired hepatic function may develop hepatic encephalopathy, particularly in case of violations of water-electrolyte balance. In this case, the diuretic should be stopped immediately.
Photosensitivity In patients receiving thiazide and thiazide diuretics reported cases of photosensitivity reactions (see. Section “Side effects”). In the case of photosensitivity reactions in the patients receiving the drug should be discontinued treatment. If necessary, continue diuretic therapy, it is recommended to protect the skin from exposure to sunlight or artificial rays.
Water and electrolyte balance:
- The content of sodium ions in plasma: Before the treatment is necessary to define the content of sodium ions in plasma. While taking the drug, the figure should be regularly monitored. All diuretic drugs can cause hyponatraemia, sometimes leading to dire consequences. A regular control of the content of sodium ions, as initially decrease the sodium content in the blood plasma may not be accompanied by the appearance of pathological symptoms. The most careful control of the content of sodium ions is indicated for patients with cirrhosis and in the elderly (see. Forums “Side effects” and “Overdose”).
- The content of potassium ions in the blood plasma: In therapy thiazide and thiazide diuretics main risk lies in the sharp decrease of potassium in the blood plasma and the development of hypokalemia. It is necessary to avoid the risk of hypokalemia (<3.4 mmol / l) in patients: elderly, debilitated or receiving concomitant medication with other antiarrhythmic drugs, and drugs that may increase the QT interval, patients with cirrhosis, peripheral edema or ascites, coronary heart disease, heart failure. Hypokalemia in these patients increases the toxic effects of cardiac glycosides and the risk of arrhythmias. In addition, the high-risk group includes patients with increased interval the buy primobolan depot, while it does not matter the reason for this increase in congenital causes or the action of drugs. Hypokalemia, as well as and bradycardia, a condition contributing to the development of severe arrhythmias and, in particular, arrhythmias such as “pirouette”, which can lead to death. In all the above cases it is necessary to regularly monitor the content of potassium in the blood plasma. The first measurement of potassium in the blood must be held during the first weeks of treatment. When hypokalaemia should be assigned the appropriate treatment.
- The calcium content in the blood plasma, should be borne in mind that thiazide and thiazide diuretics can decrease calcium excretion by the kidneys, resulting in a slight temporary increase in n of calcium in the blood plasma. Marked hypercalcemia may be due to previously undiagnosed hyperparathyroidism. It is necessary to stop taking the diuretic drugs before the test function of the parathyroid glands.
- Concentration of glucose in plasma: It is necessary to monitor the concentration of blood glucose in patients with diabetes, especially in the presence of hypokalemia.
- Uric acid: Patients with gout may increase the incidence of stroke or worsen gout.
- Diuretic drugs, and kidney function: Thiazide and thiazide diuretics are effective in full only in patients with normal or mildly impaired renal function (serum creatinine concentration in the blood plasma of adults below 25 mg / L or 220 mmol / l). Elderly patients normal creatinine concentration in blood plasma is calculated according to the age, weight and sex. Note that at the beginning of treatment, patients may experience a decrease in glomerular filtration rate due to hypovolemia, which in turn is caused by a loss of fluid and ions sodium in patients receiving diuretics. As a result, the plasma can be increased concentration of urea and creatinine. If renal function is not impaired, such temporary functional renal failure usually takes place without consequences, but the patient’s condition may deteriorate when existing renal insufficiency.