Действующее вещество: Индапамид (Indapamide)Концентрация действующего вещества (мг): 2,5
Фармакологические свойства
Антигипертензивный (диуретический) препарат, производное сульфонамида, содержащее индольное кольцо. По фармакологическим свойствам индапамид близок к тиазидным диуретикам, действие которых связано с ингибированием обратной абсорбции ионов натрия в кортикальном сегменте петли нефрона. Индапамид увеличивает выделение с мочой ионов натрия, хлора и, в меньшей степени, ионов калия и магния, что сопровождается усилением диуреза и вызывает антигипертензивный эффект. В клинических исследованиях II и III фаз при использовании индапамида в режиме монотерапии в дозах, не оказывающих выраженного диуретического эффекта, был продемонстрирован гипотензивный эффект, сохраняющийся в течение 24 ч. Антигипертензивное действие индапамида связано с улучшением эластичности крупных артерий, уменьшением сопротивления артериальных сосудов и ОПСС. Препарат способствует уменьшению гипертрофии левого желудочка сердца. Тиазидные и тиазидоподобные диуретики при определенной дозе достигают плато терапевтического эффекта, в то время как частота побочных эффектов продолжает увеличиваться при дальнейшем повышении дозы препарата. Поэтому не следует увеличивать дозу препарата, если при приеме рекомендованной дозы не достигнут терапевтический эффект. В коротких, средней длительности и долгосрочных исследованиях с участием больных с артериальной гипертензией было показано, что индапамид не влияет на показатели липидного обмена (в т.ч. на уровень триглицеридов, холестерина, ЛПНП и ЛПВП) и на показатели обмена углеводов (в т.ч. у больных сахарным диабетом).
Показания к применению
Эссенциальная артериальная гипертензия.
Противопоказания
Тяжелая почечная недостаточность; печеночная энцефалопатия; гипокалиемия; повышенная чувствительность к производным сульфонамидов. Следует избегать одновременного приема Арифона и препаратов, удлиняющих интервал QT
Применение при беременности и в период грудного вскармливания
Как правило, при беременности не следует назначать диуретические препараты. Не следует использовать эти препараты для лечения физиологических отеков при беременности. Диуретические препараты могут вызывать фетоплацентарную ишемию и приводить к нарушению развития плода. В связи с тем, что индапамид выделяется с грудным молоком, не рекомендуется назначение препарата в период грудного вскармливания.
Способ применения и дозы
Внутрь, желательно утром, 1 таблетка в сутки. При лечении больных артериальной гипертензией доза препарата не должна превышать 2,5 мг/сут(увеличение риска побочного действия без усиления антигипертензивного эффекта).
Побочное действие
Со стороны системы крови и лимфатической системыОчень редко - тромбоцитопения, лейкопения, агранулоцитоз, апластическая анемия, гемолитическая анемия. неврологические расстройстваРедко - головокружение (вертиго), утомляемость, головная боль, парестезии; частота неизвестна - обморок. кардиальные нарушенияОчень редко - аритмия, артериальная гипотензиячастота неизвестна - пароксизмальная желудочковая тахикардия типа «пируэт» ( torsades de pointes ), что может привести к летальному исходу. Желудочно-кишечные расстройстваНечасто - рвотаредко - тошнота, запор, сухость во ртуочень редко - панкреатит. Со стороны мочевыделительной системыОчень редко - почечная недостаточность. Со стороны пищеварительной системыОчень редко - нарушение функции печеничастота неизвестна - при печеночной недостаточности возможно возникновение печеночной энцефалопатии, гепатит. Со стороны кожи и подкожной клетчаткиРеакции гиперчувствительности, главным образом со стороны кожи, у пациентов, имеющих склонность к аллергическим и астматическим реакциям: часто - макулопапулезная сыпь; нечасто - пурпураочень редко - ангионевротический отек и / или крапивница, токсический эпидермальный некролиз, синдром Стивенса-Джонсоначастота неизвестна - возможно обострение существующего острого системной красной волчанки; сообщалось о случаях реакций фоточувствительности.
Передозировка
Индапамид даже в очень высоких концентрациях (до 40 мг, т.е. в 27 раз больше терапевтической дозы) не оказывает токсического действия. Симптомы острого отравления препаратом в первую очередь связаны с нарушением водно-электролитного баланса (гипонатриемия, гипокалиемия). Также могут отмечаться тошнота, рвота, снижение АД, судороги, головокружение, сонливость, спутанность сознания, полиурия или олигурия, приводящая к анурии (вследствие гиповолемии). Лечение: неотложные меры, направленные на удаление препарата из организма: промывание желудка и/или назначение активированного угля с последующим восстановлением нормального водно-электролитного баланса.
Особые указания
Нарушения функции печениПри назначении тиазидных и тиазидоподобных диуретиков у больных с нарушениями функции печени возможно развитие печеночной энцефалопатии, особенно в случае нарушения электролитного баланса. В этом случае прием диуретиков следует немедленно прекратить. ФоточувствительностьНа фоне приема тиазидных и тиазидоподобных диуретиков сообщалось о случаях развития реакций фоточувствительности. В случае развития реакций фоточувствительности на фоне приема препарата следует прекратить лечение. При необходимости продолжения терапии диуретиками, рекомендуется защищать кожные покровы от воздействия солнечных лучей или искусственных ультрафиолетовых лучей. Содержание ионов натрия в плазме кровиДо начала лечения необходимо определить содержание ионов натрия в плазме крови. На фоне приема препарата следует регулярно контролировать этот показатель. Все диуретические препараты могут вызывать гипонатриемию, приводящую иногда к крайне тяжелым последствиям. Необходим постоянный контроль содержания ионов натрия, т.к. первоначально снижение концентрации натрия в плазме крови может и не сопровождаться появлением патологических симптомов. Наиболее тщательный контроль содержания ионов натрия показан больным с циррозом печени и лицам пожилого возраста. Содержание ионов калия в плазме кровиПри терапии тиазидными и тиазидоподобными диуретиками основной риск заключается в резком снижении уровня калия в плазме крови и развитии гипокалиемии. Необходимо избегать риска развития гипокалиемии (< 3.4 ммоль/л) у больных следующих категорий: пожилого возраста, ослабленных или получающих сочетанную медикаментозную терапию с другими антиаритмическими препаратами и препаратами, которые могут увеличить интервал QT, больных с циррозом печени, периферическими отеками или асцитом, ИБС, сердечной недостаточностью. Гипокалиемия у этих больных усиливает токсическое действие сердечных гликозидов и повышает риск развития аритмий. Кроме того, к группе повышенного риска относятся больные с увеличенным интервалом QT, при этом не имеет значения, вызвано это увеличение врожденными причинами или действием лекарственных средств. Гипокалиемия, также как и брадикардия, является состоянием, способствующим развитию тяжелых аритмий и, особенно, желудочковой аритмии типа пируэт, которые могут приводить к летальному исходу. Во всех описанных выше случаях необходимо регулярно контролировать содержание калия в плазме крови. Первое измерение концентрации ионов калия в крови необходимо провести в течение первой недели от начала лечения. При появлении гипокалиемии должно быть назначено соответствующее лечение. Содержание кальция в плазме кровиСледует иметь в виду, что тиазидные и тиазидоподобные диуретики могут уменьшать выведение ионов кальция почками, приводя к незначительному и временному повышению концентрации кальция в плазме крови. Выраженная гиперкальциемия может быть следствием ранее не диагностированного гиперпаратиреоза. Следует отменить прием диуретических препаратов перед исследованием функции паращитовидных желез. Содержание глюкозы в плазме кровиНеобходимо контролировать уровень глюкозы в крови у пациентов с сахарным диабетом, особенно при наличии гипокалиемии. Мочевая кислотаУ больных подагрой может увеличиваться частота возникновения приступов или обостряться течение подагры. Диуретические препараты и функция почекТиазидные и тиазидоподобные диуретики эффективны в полной мере только у больных с нормальной или незначительно нарушенной функцией почек (содержание креатинина в плазме крови у взрослых лиц ниже 25 мг/л или 220 мкмоль/л). У пациентов пожилого возраста нормальный уровень креатинина в плазме крови рассчитывают с учетом возраста, массы тела и пола. Следует учитывать, что в начале лечения у больных может наблюдаться снижение скорости клубочковой фильтрации, обусловленное гиповолемией, которая, в свою очередь, вызвана потерей жидкости и ионов натрия на фоне приема диуретических препаратов. Как следствие, в плазме крови может увеличиваться концентрация мочевины и креатинина. Если функция почек не нарушена, такая временная функциональная почечная недостаточность, как правило, проходит без последствий, однако при уже имеющейся почечной недостаточности состояние больного может ухудшиться. СпортсменыИндапамид может давать положительный результат при проведении допинг-контроля у спортсменов. Влияние на способность к вождению автотранспорта и управлению механизмамиДействие веществ, входящих в состав препарата Арифон ретард, не приводит к нарушению психомоторных реакций. Однако у некоторых людей в ответ на снижение АД могут развиться различные индивидуальные реакции, особенно в начале терапии или при добавлении к проводимой терапии других гипотензивных средств. В этом случае способность управлять автомобилем или другими механизмами может быть снижена.
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По фармакологическим свойствам индапамид близок к тиазидным диуретикам, действие которых связано с ингибированием обратной абсорбции ионов натрия в кортикальном сегменте петли нефрона. Индапамид увеличивает выделение с мочой ионов натрия, хлора и, в меньшей степени, ионов калия и магния, что сопровождается усилением диуреза и вызывает антигипертензивный эффект. В клинических исследованиях II и III фаз при использовании индапамида в режиме монотерапии в дозах, не оказывающих выраженного диуретического эффекта, был продемонстрирован гипотензивный эффект, сохраняющийся в течение 24 ч. Антигипертензивное действие индапамида связано с улучшением эластичности крупных артерий, уменьшением сопротивления артериальных сосудов и ОПСС. Препарат способствует уменьшению гипертрофии левого желудочка сердца. Тиазидные и тиазидоподобные диуретики при определенной дозе достигают плато терапевтического эффекта, в то время как частота побочных эффектов продолжает увеличиваться при дальнейшем повышении дозы препарата. Поэтому не следует увеличивать дозу препарата, если при приеме рекомендованной дозы не достигнут терапевтический эффект. В коротких, средней длительности и долгосрочных исследованиях с участием больных с артериальной гипертензией было показано, что индапамид не влияет на показатели липидного обмена (в т.ч. на уровень триглицеридов, холестерина, ЛПНП и ЛПВП) и на показатели обмена углеводов (в т.ч. у больных сахарным диабетом)."}}]},{"id":3,"name":"Показания к применению","slug":"indications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Эссенциальная артериальная гипертензия."}}]},{"id":4,"name":"Противопоказания","slug":"contraindications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Тяжелая почечная недостаточность; печеночная энцефалопатия; гипокалиемия; повышенная чувствительность к производным сульфонамидов. Следует избегать одновременного приема Арифона и препаратов, удлиняющих интервал QT"}}]},{"id":5,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Как правило, при беременности не следует назначать диуретические препараты. Не следует использовать эти препараты для лечения физиологических отеков при беременности. Диуретические препараты могут вызывать фетоплацентарную ишемию и приводить к нарушению развития плода. В связи с тем, что индапамид выделяется с грудным молоком, не рекомендуется назначение препарата в период грудного вскармливания."}}]},{"id":6,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Внутрь, желательно утром, 1 таблетка в сутки. При лечении больных артериальной гипертензией доза препарата не должна превышать 2,5 мг/сут(увеличение риска побочного действия без усиления антигипертензивного эффекта)."}}]},{"id":7,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Со стороны системы крови и лимфатической системыОчень редко - тромбоцитопения, лейкопения, агранулоцитоз, апластическая анемия, гемолитическая анемия. неврологические расстройстваРедко - головокружение (вертиго), утомляемость, головная боль, парестезии; частота неизвестна - обморок. кардиальные нарушенияОчень редко - аритмия, артериальная гипотензиячастота неизвестна - пароксизмальная желудочковая тахикардия типа «пируэт» ( torsades de pointes ), что может привести к летальному исходу. Желудочно-кишечные расстройстваНечасто - рвотаредко - тошнота, запор, сухость во ртуочень редко - панкреатит. Со стороны мочевыделительной системыОчень редко - почечная недостаточность. Со стороны пищеварительной системыОчень редко - нарушение функции печеничастота неизвестна - при печеночной недостаточности возможно возникновение печеночной энцефалопатии, гепатит. Со стороны кожи и подкожной клетчаткиРеакции гиперчувствительности, главным образом со стороны кожи, у пациентов, имеющих склонность к аллергическим и астматическим реакциям: часто - макулопапулезная сыпь; нечасто - пурпураочень редко - ангионевротический отек и / или крапивница, токсический эпидермальный некролиз, синдром Стивенса-Джонсоначастота неизвестна - возможно обострение существующего острого системной красной волчанки; сообщалось о случаях реакций фоточувствительности."}}]},{"id":8,"name":"Передозировка","slug":"overdose","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Индапамид даже в очень высоких концентрациях (до 40 мг, т.е. в 27 раз больше терапевтической дозы) не оказывает токсического действия. Симптомы острого отравления препаратом в первую очередь связаны с нарушением водно-электролитного баланса (гипонатриемия, гипокалиемия). Также могут отмечаться тошнота, рвота, снижение АД, судороги, головокружение, сонливость, спутанность сознания, полиурия или олигурия, приводящая к анурии (вследствие гиповолемии). Лечение: неотложные меры, направленные на удаление препарата из организма: промывание желудка и/или назначение активированного угля с последующим восстановлением нормального водно-электролитного баланса."}}]},{"id":9,"name":"Особые указания","slug":"cautions","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Нарушения функции печениПри назначении тиазидных и тиазидоподобных диуретиков у больных с нарушениями функции печени возможно развитие печеночной энцефалопатии, особенно в случае нарушения электролитного баланса. В этом случае прием диуретиков следует немедленно прекратить. ФоточувствительностьНа фоне приема тиазидных и тиазидоподобных диуретиков сообщалось о случаях развития реакций фоточувствительности. В случае развития реакций фоточувствительности на фоне приема препарата следует прекратить лечение. При необходимости продолжения терапии диуретиками, рекомендуется защищать кожные покровы от воздействия солнечных лучей или искусственных ультрафиолетовых лучей. Содержание ионов натрия в плазме кровиДо начала лечения необходимо определить содержание ионов натрия в плазме крови. На фоне приема препарата следует регулярно контролировать этот показатель. Все диуретические препараты могут вызывать гипонатриемию, приводящую иногда к крайне тяжелым последствиям. Необходим постоянный контроль содержания ионов натрия, т.к. первоначально снижение концентрации натрия в плазме крови может и не сопровождаться появлением патологических симптомов. Наиболее тщательный контроль содержания ионов натрия показан больным с циррозом печени и лицам пожилого возраста. Содержание ионов калия в плазме кровиПри терапии тиазидными и тиазидоподобными диуретиками основной риск заключается в резком снижении уровня калия в плазме крови и развитии гипокалиемии. Необходимо избегать риска развития гипокалиемии (\u003c 3.4 ммоль/л) у больных следующих категорий: пожилого возраста, ослабленных или получающих сочетанную медикаментозную терапию с другими антиаритмическими препаратами и препаратами, которые могут увеличить интервал QT, больных с циррозом печени, периферическими отеками или асцитом, ИБС, сердечной недостаточностью. Гипокалиемия у этих больных усиливает токсическое действие сердечных гликозидов и повышает риск развития аритмий. Кроме того, к группе повышенного риска относятся больные с увеличенным интервалом QT, при этом не имеет значения, вызвано это увеличение врожденными причинами или действием лекарственных средств. Гипокалиемия, также как и брадикардия, является состоянием, способствующим развитию тяжелых аритмий и, особенно, желудочковой аритмии типа пируэт, которые могут приводить к летальному исходу. Во всех описанных выше случаях необходимо регулярно контролировать содержание калия в плазме крови. Первое измерение концентрации ионов калия в крови необходимо провести в течение первой недели от начала лечения. При появлении гипокалиемии должно быть назначено соответствующее лечение. Содержание кальция в плазме кровиСледует иметь в виду, что тиазидные и тиазидоподобные диуретики могут уменьшать выведение ионов кальция почками, приводя к незначительному и временному повышению концентрации кальция в плазме крови. Выраженная гиперкальциемия может быть следствием ранее не диагностированного гиперпаратиреоза. Следует отменить прием диуретических препаратов перед исследованием функции паращитовидных желез. Содержание глюкозы в плазме кровиНеобходимо контролировать уровень глюкозы в крови у пациентов с сахарным диабетом, особенно при наличии гипокалиемии. Мочевая кислотаУ больных подагрой может увеличиваться частота возникновения приступов или обостряться течение подагры. Диуретические препараты и функция почекТиазидные и тиазидоподобные диуретики эффективны в полной мере только у больных с нормальной или незначительно нарушенной функцией почек (содержание креатинина в плазме крови у взрослых лиц ниже 25 мг/л или 220 мкмоль/л). У пациентов пожилого возраста нормальный уровень креатинина в плазме крови рассчитывают с учетом возраста, массы тела и пола. Следует учитывать, что в начале лечения у больных может наблюдаться снижение скорости клубочковой фильтрации, обусловленное гиповолемией, которая, в свою очередь, вызвана потерей жидкости и ионов натрия на фоне приема диуретических препаратов. Как следствие, в плазме крови может увеличиваться концентрация мочевины и креатинина. Если функция почек не нарушена, такая временная функциональная почечная недостаточность, как правило, проходит без последствий, однако при уже имеющейся почечной недостаточности состояние больного может ухудшиться. СпортсменыИндапамид может давать положительный результат при проведении допинг-контроля у спортсменов. Влияние на способность к вождению автотранспорта и управлению механизмамиДействие веществ, входящих в состав препарата Арифон ретард, не приводит к нарушению психомоторных реакций. Однако у некоторых людей в ответ на снижение АД могут развиться различные индивидуальные реакции, особенно в начале терапии или при добавлении к проводимой терапии других гипотензивных средств. В этом случае способность управлять автомобилем или другими механизмами может быть снижена."}}]}],"source":{"title":"36.6","url":"https://366.ru"}},"description_toggle":false,"short_description":"Антигипертензивный (диуретический) препарат, производное сульфонамида, содержащее индольное кольцо. По фармакологическим свойствам индапамид близок к тиазидным диуретикам, действие которых связано с ингибированием обратной абсорбции ионов натрия в кортикальном сегменте петли нефрона. Индапамид увеличивает выделение с мочой ионов натрия, хлора и, в меньшей степени, ионов калия и магния, что сопровождается усилением диуреза и вызывает антигипертензивный эффект. В клинических исследованиях II и III фаз при использовании индапамида в режиме монотерапии в дозах, не оказывающих выраженного диуретического эффекта, был продемонстрирован гипотензивный эффект, сохраняющийся в течение 24 ч. Антигипертензивное действие индапамида связано с улучшением эластичности крупных артерий, уменьшением сопротивления артериальных сосудов и ОПСС. Препарат способствует уменьшению гипертрофии левого желудочка сердца. Тиазидные и тиазидоподобные диуретики при определенной дозе достигают плато терапевтического эффекта, в то время как частота побочных эффектов продолжает увеличиваться при дальнейшем повышении дозы препарата. Поэтому не следует увеличивать дозу препарата, если при приеме рекомендованной дозы не достигнут терапевтический эффект. В коротких, средней длительности и долгосрочных исследованиях с участием больных с артериальной гипертензией было показано, что индапамид не влияет на показатели липидного обмена (в т.ч. на уровень триглицеридов, холестерина, ЛПНП и ЛПВП) и на показатели обмена углеводов (в т.ч. у больных сахарным диабетом).","substance":[{"id":21,"title":"Индапамид","title_latin":"Indapamidum","slug":"indapamid_21"}],"branding":null,"valid_for_quick_buy":true,"is_available_to_delivery":false,"comments":null,"image_alt":"Арифон - фото упаковки","image_share":{"isTouch":{"default":"https://vseapteki.ru/cropping/thumbnails/101/5949/share_default/"},"isFromTablet":{"default":"https://vseapteki.ru/cropping/thumbnails/101/5949/share_default/"}},"diseases":[{"id":"717","title":"Эссенциальная [первичная] гипертензия","slug":"717-essentsialnaya_pervichnaya_gipertenziya"},{"id":"750","title":"Застойная сердечная 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