Indapamide Canon
Indapamide Canon: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Use in the elderly
- 14. Drug interactions
- 15. Analogs
- 16. Terms and conditions of storage
- 17. Terms of dispensing from pharmacies
- 18. Reviews
- 19. Price in pharmacies
Latin name: Indapamide Canon
ATX code: C03BA11
Active ingredient: indapamide (Indapamide)
Producer: CJSC "Kanonfarma production" (Russia)
Description and photo update: 2020-23-07
Indapamide Canon is a diuretic.
Release form and composition
The drug is produced in the form of tablets, film-coated, biconvex, round, with a white or almost white film shell, the color on the cross-section is white (in blister packs made of polyvinyl chloride film and aluminum varnished printing foil, 10 or 30 pcs., In cardboard a pack of instructions for the use of Indapamide Canon and 1-4 packs of 10 tablets or 1-3 packs of 30 tablets).
Composition of one tablet:
- active ingredient: indapamide - 2.5 mg;
- additional ingredients: MCC (microcrystalline cellulose), potato starch, lactose monohydrate, povidone K-30, crospovidone, magnesium stearate, colloidal silicon dioxide;
- film shell: ready-mixed Vivacoat or White Opadrai [hydroxypropyl cellulose (hyprolose), hydroxypropyl methylcellulose (hypromellose), titanium dioxide, talc].
Pharmacological properties
Pharmacodynamics
Indapamide is a sulfonamide derivative with pharmacological properties similar to thiazide diuretics.
Shows a moderate saluretic and diuretic effect due to inhibition in the cortical segment of the distal tubule of the nephron, and in the proximal renal tubules of the reabsorption of chloride ions, sodium, to a lesser extent magnesium and potassium ions.
Under the influence of indapamide, the tone of the smooth muscles of the arteries decreases, the vessels dilate, the OPSS (total peripheral vascular resistance) decreases. These phenomena are due to inhibition of calcium flow in vascular smooth muscle cells, a decrease in the reactivity of the vascular wall to angiotensin II and norepinephrine, an increase in the synthesis of prostaglandin E2, which exhibits vasodilating activity.
Drug therapy helps to reduce left ventricular hypertrophy of the heart. Indapamide, taken in doses that do not have a pronounced diuretic effect, has an antihypertensive effect. Therapeutic doses of the substance have no effect on carbohydrate and lipid metabolism (including in patients with concomitant diabetes mellitus).
A pronounced clinical effect with the systematic administration of the drug is observed after 7-14 days from the start of treatment, reaches a maximum after 2-3 months and lasts for another 2 months. After taking a single dose of indapamide, the maximum effect is noted after a day.
Pharmacokinetics
After taking Indapamide Canon inside, indapamide is rapidly and almost completely absorbed in the digestive tract. Its bioavailability is 93%. Taking tablets simultaneously with food slightly slows down the rate of absorption of indapamide, but does not affect the completeness of absorption. T Cmax (time to reach the maximum concentration in the blood) varies within 1–2 hours.
Binding of indapamide to plasma proteins at the level of 71–79%. Also, the substance binds to elastin of smooth muscles of the vascular wall. V d (volume of distribution) is high. Indapamide crosses histohematogenous barriers (including placental).
The metabolism of indapamide occurs in the liver with the formation of inactive metabolites.
T 1/2 (half-life) - on average 16 hours. Excretion from the body occurs through the intestines (20-23% of the dose) and kidneys (60-80% - in the form of metabolites, about 5-7% - unchanged).
It does not accumulate in the body.
There are no changes in the pharmacokinetic parameters of indapamide in patients with renal failure.
Indications for use
Indapamide Canon is used to treat arterial hypertension.
Contraindications
Absolute:
- glucose-galactose malabsorption, lactase deficiency or lactose intolerance;
- hypokalemia;
- hepatic encephalopathy, severe hepatic failure;
- renal failure of severe degree [with CC (creatinine clearance) <30 ml / min];
- children and adolescents under 18 years of age (due to the lack of information on the effectiveness and safety of the use of Indapamide Canon in pediatrics);
- gestation period;
- lactation (breastfeeding);
- hypersensitivity to indapamide, other sulfonamide derivatives or other substances included in the tablets.
Relative (Indapamide Canon should be taken with caution):
- hepatic dysfunction;
- impaired renal function (with CC> 30 ml / min);
- violations of water and electrolyte balance;
- hyperparathyroidism;
- hyperuricemia (especially accompanied by urate nephrolithiasis and gout);
- diabetes;
- elderly age;
- lengthening the QT interval on the ECG (electrocardiogram);
- carrying out therapy, which may result in prolongation of the QT interval: class IA antiarrhythmic drugs (for example, disopyramide and quinidine) and class III (for example, bretylium tosylate and amiodarone), erythromycin (intravenous), vincamine, astemizole, pentamidine, sultopride, terfenadine.
Indapamide Canon, instructions for use: method and dosage
Indapamide Canon tablets are taken orally, regardless of the meal, preferably in the morning. They are swallowed whole, without chewing, and washed down with a sufficient amount of liquid.
For arterial hypertension, the recommended dose of indapamide is 2.5 mg (1 tablet) once a day. In the case of an increase in the dose of the drug, an increase in the antihypertensive effect is not observed.
In the absence of the desired result after 1–2 months of treatment, it is not recommended to increase the dose of Indapamide Canon, as this may increase the risk of side effects without increasing the antihypertensive effect. An alternative solution is to include in the therapeutic regimen another antihypertensive agent that is not a diuretic. When the patient is taking two antihypertensive drugs at the same time, the dose of Indapamide Canon remains equal to 2.5 mg (1 tablet) once in the morning.
For elderly patients, Indapamide Canon is prescribed only in the absence of deterioration in the functioning of the kidneys, or in the presence of minor impairments of renal function.
Side effects
- CNS (central nervous system): often (≥ 1/100 to <1/10) - muscle spasms, irritability, anxiety, hyperexcitability, sleep disturbances, malaise, increased fatigue, headache, dizziness, tension, paresthesia, asthenia, depression;
- cardiovascular system: extremely rare (<1/10 000, including individual messages) - ECG changes characteristic of hypokalemia, palpitations, arrhythmia, orthostatic hypotension;
- respiratory system: often - sinusitis, pharyngitis, cough; extremely rare - rhinitis;
- genitourinary system: extremely rare - renal failure;
- hematopoietic organs: extremely rarely - bone marrow aplasia, leukopenia, hemolytic anemia, thrombocytopenia, agranulocytosis;
- digestive tract: infrequently (from ≥ 1/1000 to <1/100) - vomiting; rarely (≥ 1/10 000 to <1/1000) - nausea, dry mouth, decreased appetite, constipation / diarrhea, abdominal pain; extremely rare - pancreatitis; with hepatic failure, the development of hepatic encephalopathy is possible;
- skin and subcutaneous fat: hypersensitivity reactions (mainly of a dermatological nature) in patients with a predisposition to asthmatic and allergic pathologies: often - maculopapular rash, itching; infrequently - hemorrhagic vasculitis; extremely rare - Stevens-Johnson syndrome, Lyell's syndrome (toxic epidermal necrolysis), angioedema and / or urticaria; with an unknown frequency (it was not possible to determine the frequency of development of reactions based on the available data) - worsening of the course of systemic lupus erythematosus in patients with an acute form of this disease; in some cases - photosensitivity reactions;
- laboratory parameters: extremely rarely - hyperuricemia, hypercalcemia; with an unknown frequency - glucosuria, increased concentration of blood urea nitrogen, hypercreatininemia, hypokalemia, hyperglycemia, hyponatremia, hypochloremia.
Overdose
Symptoms of an overdose of Indapamide Canon are associated with a violation of water and electrolyte balance. So when taking an excessive dose of indapamide, dizziness, drowsiness, a marked decrease in blood pressure (blood pressure), nausea / vomiting, confusion, convulsions, oliguria / polyuria, leading to anuria (due to hypovolemia) are possible.
Treatment consists in gastric lavage, intake of activated carbon, and subsequent restoration of water and electrolyte balance. If necessary, symptomatic therapy is prescribed. No specific antidote has been identified for indapamide.
special instructions
In patients undergoing therapy with Indapamide Canon, it is necessary to regularly monitor the concentration in the blood of sodium, magnesium ions (due to the possible development of electrolyte disturbances), residual nitrogen and uric acid, glucose and blood pH.
In elderly patients and patients with hyperaldosteronism, as well as when taking cardiac glycosides and laxatives during drug therapy, the concentration of creatinine and potassium ions in the blood should be carefully monitored. An initial measurement of blood potassium ions should be performed within the first seven days of treatment.
Closer control is indicated for patients with liver cirrhosis, especially those with ascites or edema (due to an increased risk of metabolic alkalosis, which can worsen the course of hepatic encephalopathy), for patients with CHF (chronic heart failure) and coronary artery disease (coronary artery disease), elderly patients … The high-risk group also includes patients with prolongation of the QT interval on the ECG (developed against the background of any pathological process, or congenital).
The appearance of hypercalcemia during therapy with Indapamide Canon may be a consequence of previously undiagnosed hyperparathyroidism.
In some patients, greater efficacy was observed when taking indapamide in combination with potassium-sparing diuretics, but it should be borne in mind that in this case, hyper- or hypokalemia may occur, especially in patients with renal failure / diabetes mellitus.
In the presence of diabetes mellitus, it is necessary to control the concentration of glucose in the blood, especially with concomitant hypokalemia.
Significant dehydration during drug therapy can cause the development of acute renal failure due to a decrease in GFR (glomerular filtration rate). The BCC (volume of circulating blood) should be compensated for at the beginning of treatment and renal function should be closely monitored.
Derivatives of sulfonamides can cause exacerbation of SLE (systemic lupus erythematosus), which is important to take into account before prescribing Indapamide Canon.
While taking indapamide, positive results are possible during doping control.
The efficacy and safety of Indapamide Canon in patients under the age of 18 have not been established.
There are reports of cases of development of photosensitivity reactions while taking thiazide and thiazide-like diuretics. If such side effects appear, it is necessary to interrupt therapy with indapamide. If there is a need to continue taking diuretics, you should protect the skin from exposure to both sunlight and artificial sources of ultraviolet radiation.
Influence on the ability to drive vehicles and complex mechanisms
Patients who begin taking Indapamide Canon, due to the possible development of dizziness, should refrain from driving and any other vehicles, as well as from engaging in potentially hazardous activities that require quick psychomotor reactions and increased concentration of attention.
Application during pregnancy and lactation
For women carrying a child, taking Indapamide Canon tablets is contraindicated, since this can provoke the development of placental ischemia with the risk of slowing down the development of the fetus.
During lactation, drug therapy is not recommended. If it is necessary to use indapamide during this period, breastfeeding should be suspended.
Pediatric use
Due to the lack of information on the efficacy and safety of the drug in pediatrics, Indapamide Canon is not prescribed to children and adolescents under 18 years of age.
With impaired renal function
Renal failure of severe degree (with CC <30 ml / min) is an absolute contraindication to the use of Indapamide Canon.
In case of impaired renal function (with CC> 30 ml / min) Indapamide Canon should be taken with caution.
For violations of liver function
Hepatic encephalopathy and severe hepatic failure are absolute contraindications to taking the drug.
In case of impaired hepatic function, Indapamide Canon should be taken with caution.
Use in the elderly
Elderly patients should use Indapamide Canon with caution, only in the absence of impaired renal function, or in the presence of minor impairments of renal function.
In elderly patients, the threshold value of the concentration of creatinine in blood plasma may vary depending on body weight, age and gender.
Drug interactions
- NSAIDs (non-steroidal anti-inflammatory drugs), adrenostimulants, glucocorticosteroids, tetracosactide: reduce the hypotensive effect of indapamide;
- iodine-containing contrast agents (in high doses): when combined with Indapamide Canon, the risk of developing renal dysfunction increases (due to a decrease in the BCC); BCC should be corrected before using iodine-containing contrast agents;
- indirect anticoagulants (derivatives of indandione or coumarin): under the influence of indapamide, their effectiveness decreases due to an increase in the concentration of FSK (blood coagulation factors) as a result of a decrease in the BCC;
- non-depolarizing muscle relaxants: Indapamide Canon enhances their effect;
- angiotensin-converting enzyme inhibitors: combined use with the drug increases the risk of acute renal failure (especially in the presence of renal artery stenosis) and / or orthostatic hypotension;
- antipsychotics (antipsychotics), tricyclic (imipramine) antidepressants: increase the hypotensive effect of indapamide and increase the likelihood of orthostatic hypotension;
- class IA antiarrhythmic drugs (eg, disopyramide, quinidine) and class III (eg, bretylium tosylate, amiodarone), erythromycin (intravenous), sultopride, astemizole, vincamine, terfenadine, pentamidine: due to prolongation of the QT interval, an increased risk of developing arrhythmias of the type "pirouette";
- laxatives, amphotericin B (intravenously), tetracosactide, mineralocorticoids, glucocorticosteroids, cardiac glycosides, diuretics (loop, thiazide): when used simultaneously with indapamide, the risk of hypokalemia increases; combined intake with cardiac glycosides also increases the likelihood of developing digitalis intoxication;
- calcium supplements: the likelihood of developing hypercalcemia increases;
- lithium preparations: with simultaneous use with indapamide, the concentration of lithium ions in the blood plasma increases (due to a decrease in its excretion by the kidneys);
- metformin: the risk of developing lactic acidosis increases;
- cyclosporine: coadministration with indapamide increases the risk of developing hypercreatininemia;
- baclofen: enhances the hypotensive effect of Indapamide Canon.
Analogs
Analogs of Indapamide Canon are Acripamide, Acripamide retard, Akuter-Sanovel, Arifon, Arifon retard, Indap, Vero-Indapamide, Indapamide Alkaloid, Indapamide Velpharm, Indapamide retard, Indapamide Sandoz, Indapamide Stada, Indapamid-Treson Retapres, SR-Indamed, etc.
Terms and conditions of storage
Store in a place inaccessible to children, protected from light and moisture, at a temperature not exceeding 25 ° C.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Indapamide Canon
Patients leave positive reviews about Indapamide Canon. They characterize the drug as inexpensive, effective and capable of showing results after the first use.
In some cases, they indicate the development of side effects, especially from the gastrointestinal tract. In addition, the disadvantages are the need for long-term intake of tablets to achieve a therapeutic effect and the presence of a large list of contraindications.
Price for Indapamide Canon in pharmacies
In pharmacy chains, the price of Indapamide Canon, film-coated tablets, 2.5 mg, per pack containing 30 pcs. is 26–36 rubles.
Maria Kulkes Medical journalist About the author
Education: First Moscow State Medical University named after I. M. Sechenov, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
