Pamid (coated tablets 2,5 mg)
Pamid
International unlicensed name
Indapamide.
Pharmacotherapy group
Diuretics.
Composition
1 tablet contains 2,5 mg of indapamide.
Pharmacological action
Pharmacodynamics
Indapamide is oral antihypertensive/diuretic agent.
The medicine has a diuretic, vasodilatation, hypertensive effect. It inhibits reverse absorption of sodions in the cortical segment of Henle’s loop, increases urine excretion of ions of sodium, chlorine, calcium and magnesium. It reduces the vascular wall sensitivity to noradrenaline and angiotensin II, stimulates dinoprostonesynthesis, depresses calcium ion current into the smooth muscle cells of the vascular wall, thus reducing peripheral resistance. It reduces generation of free and stable oxygen radicals.
Pharmacokinetics
The medication is absorbed rapidly and completely on ingestion. Max.concentration in the blood plasma is accumulated in 2 hours after administration. The medicine is bound with proteins at 71—79% and can be sorbed by erythrocytes. The half-period is about 14 hours. It passes placental and other histohematogenous barriers, penetrates into the breast milk. 70% of the administered dose is excreted by the kidney, 23% with faeces. Indapamid is excreted mainly unaltered, only 7% of the substance is excreted as metabolites.
Application
Arterial hypertension. Chronic heart failure.
Route and dosage
In vase of hypertension the initial dose of indapamid in adults shall be 1,25 mg, and the medicine shall be taken in the morning. In the absence of reaction to the dose of 1,25 mg in 4 weeks the daily dose can be increased up to 2,5 mg, administration — once per day. In the absence of reaction to the medicine dose of 2,5 mg in 4 weeks the daily dose can be increased up to 5 mg (once per day). Another diuretic shall be considered to be taken jointly in this case. In case of combined therapy the normal dose of the other medicine shall be reduced twice.
To eliminate oedema on congestive heart failure: the initial dose in adults is 2,5 mg administered once a day in the morning. In the absence of reaction to the medicine dose of 2,5 mg in a week, increasing of the dose up to 5 mg is inappropriate, as it does not have a therapeutic effect but related to increased risk of hypokaliemia.
Use in pediatrics: no practice of indapamid administration in children.
Special indications
It is not recommended to prescribe indapamid simultaneously with lithium, vincamine, potassium-excreting diuretics.
Side effects
The majority of side effects are slight and of short duration. The most frequent cases are as follows: headache, fatigability, asthenia, flabbiness, breakdown, lethargy, indisposition, muscle spasms, extremities numbness, nervousness, tension, anxiety, irritability. Sometimes (less than in 5% of cases) insomnia, drowsing, depression, vision blurring, hypertension, constipation, nausea, vomiting, diarrhea, pain in the stomach, lost of appetite, gastric discomfort, orthostatic hypotension, ventricle extrasystole, arrhythmic heart beats, palpitation, polyuria, rapid urination, nocturia, polyuria, rash, urticaria fever, itching, vasculitis, angitis necroticans, hyperuricemy, hypokaliemia, hyponatremia, hypochloremia, glycosuria, extremities tingling, weight loss, dry mouth.
Contraindications
Anuria, high sensitivity to the medicine or other sulfonamides derivatives.
Precautions
On prolong use of indapamid electrolytic disturbances may develop such as hyponatremia, hypokaliemia and hypochloremic alkalosis. Electrolytic disturbances are more frequently observed in patients with heart failure, kidney diseases, cirrhosis and patients suffering from vomiting and diarrhea, as well as in patients keeping a low-salt diet. Simultaneous administration of indapamid and digitalis preparations and corticosteroids increases the risk of hypokaliemia. Thiazides may increase urine excretion of magnesium, what can lead to hypomagnesemia. Reduction in lithic acid ecretion from the organism and podagra exacerbation may be registered on indapamid administration. Tiazides may stimulate hyperglycemia and exacerbation of insular diabetes.
Indapamid shall be prescribed with care in patients with severe kidney diseases as the medicine can cause azotemia. In the course of treatment monitoring of electrolytic blood assay and arterial pressure shall be carried out and renal function shall be monitored at regular intervals, as well as glucose concentration and lithic acid in blood serum.
Indapamid, as well as other tiazides, may cause excerbation of systemic lupus erythematosus.
Interaction with other medications
The medicine intensifies the action of hypotensive preparations, increases the risk of hypokaliemia against the administration of potassium excreting diuretics.
Overdosing
Symptoms: weakness, water-electrolytic balance disturbances, respiratory deppression, hypotonia.
Treatment: gastric lavage, vomiting induction (not later than 1 hour after administration), water-electrolytic balance correction.
Product form
2,5 mg tablets.
