Yak lіkuvatisya drug NOLIPREL - lecture іnstruktsіyі іstosuvannya аnd special recommendations. NOLIPREL: Instructions from storage NOLIPREL Instructions from storage

hypotensive drug combinations (іngіbіtor APF i diuretic)

diyuchі speeches

Form vipusku, warehouse and packaging

Tablets, including a plastic sheath, white color, Dovgasti, at risk on both sides.

Additional words: lactose monohydrate - 74.455 mg, magnesium stearate - 0.45 mg, maltodextrin - 9 mg, silicon dioxide coloidal anhydrous - 0.27 mg, sodium carboxymethylcrochmal (type A) - 2.7 mg.

Warehouse for ply casing: macrogol 6000 - 0.087 mg, premix for soft shell of white colora SEPIFILM 37781 RBC (glucerin - 4.5%, hypromelose - 74.8%, macrogol 6000 - 1.8%, magnesium stearate - 4.5%, titanium dioxide (E171) - 14.4%) - 2.913 mg ...

14 pcs. - bottles of polypropylene with a dispenser and a cork, to cover the moisture-absorbing gel (1) - packs of cardboard with the control of the first opening.
29 pcs. - bottles of polypropylene with a dispenser and a cork, to cover the moisture-absorbing gel (1) - packs of cardboard with the control of the first opening.
30 pcs. - bottles of polypropylene with a dispenser and a cork, to cover the moisture-absorbing gel (1) - packs of cardboard with the control of the first opening.

Packages for stationary:
30 pcs. - bottles of polypropylene with a dispenser and a cork, to cover the moisture-absorbing gel (3); - packs of cardboard with the control of the first opening.

Pharmacological diya

Likarsky drug NOLIPREL A - a combination of a drug to take revenge on perindopril arginin and indapamide. Pharmacological authorities lykarsky drug NOLIPREL And feel the power of the skin components.

Mechanism of Diya

NOLIPREL A

Combination of perindopril and indapamide according to the strength of the antihypertensive dermal effect from them.

perindopril

Perindopril is an enzyme inhibitor that converts angiotensin I into angiotensin II (angiotensin ACE). ACE, aka kinase II, ekzopeptidazi, as a result of converting angiotensin I into the angiotensin II, as well as reducing bradykinin, which is not active, is not active until recently. As a result, perindopril reduces the secretion of aldosterone; the principle of a negative ringing sound increases the activity of the renin in the blood plasma; with a trivial zasosuvannі change OPSS, scho amoused, in the main, dієu on the judge in the meat and nirkah. The goal is not to be supervised by the catch of sodium and line, but rather by the development of reflex tachycardia.

Perindopril normalizes the myocardium to the robot, reducing the anterior and postnavant.

With the introduction of indicators of hemodynamics in patients with chronic heart failure (CHF), a decrease in the pressure on the left and right side of the heart, a decrease in OPSS, hemorrhagic heart failure, peripheral heart failure

indapamid

Indapamid is assigned to a group of sulfonamides, according to pharmacological authorities close to thiazide diuretics. Indapamid induces reabsorption of ions in sodium in the cortical segment of the loop of Henle, so that it can be used to increase the absorption of ions in sodium, chlorine and in the minor world

antihypertensive action

NOLIPREL A

Lykarsky drug NOLIPREL A nadaє dose-dependent antihypertensive activity, both for diastolic, and for systolic AT, when standing, and lying down. The antihypertensive effect will last for 24 years. A stable therapeutic effect develops less after 1 month from the ear of therapy and does not supervise tachyphilaxis. Predinennya lіkuvannya not wiklikє syndrome vіdmini.

Lykarsky drug NOLIPREL A changes the steps of the hypertrophy of the lactic acid (HLS), reduces the elasticity of the arteries, reduces the OPSS, does not infuse on the metabolism of lipids (zagalny cholesterol, LDL cholesterol).

The injection of the combination of perindopril and indapamid was brought in to the SFS in the same way with enalapril. At the children arterial hypertensionі HLS, if they took therapy with perindopril erbumin 2 mg (equivalent to 2.5 mg perindopril arginin) / indapamid 0.625 mg or enalapril at a dose of 10 mg 1 time / day; up to 2.5 mg, or up to 40 mg of enalapril 1 time / day, it is indicated that there is a greater decrease in the index of oil slurry (LVMI) in the group of perindopril / indapamid in the group of enalapril. At the same time, a significant infusion on LVMI is indicated when perindopril erbumin is consumed 8 mg / indapamid 2.5 mg.

It is also indicated that the antihypertensive effect is more pronounced in the combination therapy with perindopril and indapamid in patients with enalapril.

At the children for diabet Type 2 (average indicators - vik 66 rocks, IMT 28 kg / m 2, glucosylation hemoglobin (HbA 1c) 7.5%, AT 145/81 mm Hg. Art.) in addition to standard glucemic control therapy, as well as the strategy of intensive glucemic control (IGC) (whole HbA 1c<6.5%).

83% of patients had arterial hypertension, 32% and 10% had macro- and microvascular acceleration, and 27% had microalbuminuria. The majority of patients at the time of inclusion in the pre-admission period were treated for hypoglycemic therapy, 90% of patients were for hypoglycemic therapy (47% of patients with dual therapy - in monotherapy) 1% of patients have eliminated insulinotherapy, 9% are deprived of therapy. Survivors took 72% of the patients, Metformin - 61%. In supplemental therapy, 75% of patients were treated for hypotensive disorders, 35% of patients were hypotensive (head rank, Ingibitoria HMG-CoA reductase (statin) - 28%)

After 6 months of the introductory period, before the hour of each patient, they received 120 mg of perindopril / indapamid, the stench was added to the group of standard glucose control, or to the group of IGC (diabetes mellitus for more or less supplementation).

In the IGC group (average triviality with a caution 4.8 rockets, average HbA 1c 6.5%) in the group of standard control (average HbA 1c 7.3%), a significant decrease by 10% in the combined frequency of macro- and low-low

The overhaul was reached for a significant decrease in the tolerable risk: the main micro-vane acceleration by 14%, the increase in nephropathy by 21%, the microalbuminuria by 9%, the macroalbuminuria by 30% and the development of the side by 11%.

Perevagi of hypotensive therapy did not lie down as perevag, reaching the end of the IGC.

perindopril

Perindopril is effective in the therapy of arterial hypertension of any degree of severity.

The antihypertensive action of the drug reaches a maximum in 4-6 years, after a one-time reception in the middle and last for 24 years. After 24 years, the intake of the drug is prevented from developing (close to 80%) over-ingestion of ACE.

Perindopril also appears to be antihypertensive in patients with low and normal renin activity in blood plasma.

One-hour sign of thiazide diuretics in the course of antihypertensive action. In addition, combining the ACE Ingibitor and hydrochlorothiazide can also reduce the risk of hypochondriasis against the background of the intake of diuretics.

Subway blockade of RAAS

Є Data of clinical studies of combined therapy from the intake of an ACE inhibitor with ARA II (antagonist of angiotensin II receptors).

Wire klіnіchnі doslіdzhennya for participation patsієntіv scho mayutsya in anamnezі Sertsevy-sudinne abo tserebrovaskulyarnі zahvoryuvannya, tsukrovy dіabet ABO 2 type scho suprovodzhuєtsya pіdtverdzhenim urazhennyam organ mіshenі and takozh doslіdzhennya for participation of patsієntіv tsukrovim dіabetom 2 dіabetichnoyu nefropatієyu type i.

Danі doslіdzhennya not viyavili in patsієntіv, SSMSC otrimuvali kombіnovanu terapіyu, significant positive vplivu on viniknennya nirkovih i / abo kardіovaskulyarnih podіy i on pokazniki smertnostі, in one hour yak rizik rozvitku gіperkalієmії, gostroї nirkovoї nedostatnostі i / abo gіpotenzії zbіlshuvavsya in porіvnyannі of patsієntami, SSMSC monotherapy was eliminated.

To respect similar internal groups, pharmacodynamic powers of the Ingibitoriv APF and ARA II, these results can be obtained for the interaction of any kind of drugs, representatives of the classes of Ingibitoriv APF II.

This was contraindicated at once for the ingestion of ACE and ARA II in patients with diabetic nephropathy.

Є Tribute to the clinical experience of positive development from the introduction of the aliskiren to the standard therapy by the ACE engineer and ARA II in children with type 2 diabetics and chronic obsession with heart disease in court Before the end of the day, the bulo was pinned up to the end of the day at the link with the grown-up rider. Heart-and-death death and stroke were more common in the group of patients, who are eligible for aliskiren, in the case of the placebo group. Likewise, non-essential and serious non-essential phenomena of particular interest (hypercalculation, arterial hypotension and impaired function of nirok) were refurbished often in the Aliskiren group, not in the placebo group.

indapamid

Antihypertensive action manifests itself when the drug is consumed in doses that produce the least diuretic action.

The antihypertensive action of the indapamid is tied to the polypsy of the elastic powers of the great arteries, the changes of the OPSS.

Indapamid changes HLS, not pouring into the concentration of lipids in the blood plasma: triglycerides, zalny cholesterol, LPNSH, LPVSH; carbohydrate metabolism (including for children with diabetics).

Pharmacokinetics

The combination of perindopril and indapamide does not change the pharmacokinetic characteristics in relation to the separate intake of the drug.

perindopril

Wetness and metabolism

When I was taken in the middle of perindopril, I got wet. Bioavailability to become 65-70%. Approximately 20% of the intrinsic amount of absorbed perindopril is converted into the active metabolite of perindoprilat. C max of perindoprilat in blood plasma is reached in 3-4 hours. When the drug is taken, the conversion of perindopril into perindoprilat will change (this is not an effective clinical value).

Rozpodil i vivedennya

The concentration of blood plasmas is less than 30% and the concentration of perindopril in the blood plasma is deposited. Dissociation of perindoprilat, associated with ACE, is spovilnena. In addition, the "effective" T 1/2 to become 25 hours. Repeated perindopril should not be re-assigned to its cumulative rate, and T 1/2 perindoprilat during repeated intake of perindopril during the period of its activity, in such a rank, is equally important to reach after 4.

Perindoprilat vivoditsya s organism nirkami. T 1/2 perindoprilat become 3-5 years.

Vivedennya perindoprilatu is reduced in patients of a kidnapped person, as well as in patients with a nirk deficiency and a heart failure.

Clirens perindoprilat with dialis becomes 70 ml / min.

Pharmacokinetics of perindopril changes in patients with liver cirrhosis: perindopril liver disease changes 2 times. However, the number of approved perindoprilat does not change, so a dose correction is not required for the drug.

Perindopril penetrates through the placental bar.

indapamid

soaktuvannya

Indapamid quickly and is absorbed from the intestinal tract. C max in blood plasma can be reached in 1 year after being received in the middle.

rospodil

Linkage with blood plasma blood - 79%.

Repeated use of the drug does not lead to cumulation in the body.

vivedennya

T 1/2 becomes 14-24 years old (in the middle of 19 years). Vivoditsya mainly nirkami (70% of the administered dose) through the intestine (22%) in the form of inactive metabolites.

Pharmacokinetics in special clinical forms

Pharmacokinetics of indapamide does not change in ailments with nirkovy deficiency.

showing

- essential hypertension;

- in patients with arterial hypertension and type 2 diabetics, to reduce the risk of development of micro-outbound slows (from the side of nirok) and macro-outcrops from heart-fanged diseases.

Prototype

perindopril

- increased sensitivity to perindopril and other ACE ingibitors;

- Angioneurotic nabryak (nabryak Kvinke) in the anamnesis for the first time at the reception of the first angibitors of the APF (div. Rozdil "Osoblivosti zasosuvannya");

- drooping / idiopathic angioedema;

- availability;

- One-hour consumption of aliskiren and drug preparations, to replace aliskiren, in patients with diabetic diabetics and / or for some serious impairment of the function of niroc (the menopause of the glomerular filter of the 1.60 ml) Rozdili "Pharmacological Diya" and "Likarska Vzaєmodiya");

- overnight stagnation with antagonists of receptors to angiotensin II (ARA II) in patients with diabetic nephropathy (div. Rozdil "Singularities of stasis");

indapamid

- sensitivity has been adjusted up to indapamid and other sulfonamides;

- severe nirkova lack (CC less than 30 ml / hv);

- pechinkova encephalopathy;

- hypocalypse;

- severe pechinkova lack;

- overnight stagnation with non-antiarrhythmic lykarskiye zasob, zdatnymi viclikati polymorphic lingering tachycardia of the "feast" type;

- period of chest vigodovuvannya;

- up to 18 rockets (efficiency and safety has not been established).

NOLIPREL A

- sensitivity has been adjusted to the additional words, so that the preparation should be included in the warehouse;

- through the availability of sufficient clinical information, the drug NOLIPREL And not a trail of stasis in patients who are on hemodialysis, as well as in patients with a lack of untreated unstable heart;

- up to 18 rockets (efficiency and safety is not established);

- the manifestation of lactase deficiency, galactosemia or glucose-galactose malabsorption syndrome (a drug to avenge lactose).

With protection (div. Rozdili "Osoblivosti zasosuvannya" and "Likarska vzaєmodiya"): systemic zhvoryuvannya spoluchnoї fabrics (including systemic chervonia vovchak, scleroderma); therapy with immunosuppressants (development of neutropenia, agranulocytosis); therapy with drugs lithium; preparations of gold, non-steroidal antiapaline preparations, baclofen, corticosteroids; drugs, which can reduce the QT interval, drugs, which can polymorphic tachycardia type "fever", except for antiarrhythmic drug problems (div. imputation of cystic carcinoma hematopoiesis; lowering of the BCC (intake of diuretics, without salt, bloating, diarrhea, hemodialis); angina pectoris; cerebrovascular disease; renovascular hypertension; Diabetes mellitus; chronic heart failure (IV FC for NYHA classification); pechinkova lack; hyperuricemia (especially supportive of gout and urate nephrolithiasis); lability of AT; abduction of vіk; carrying out hemodialysis from the stasis of high-flow membranes, or desensitization, before the procedure of apheresis of lipoproteins of low level; mill for transplantation of nirka; anesthesia; aortic valve stenosis / hypertrophic obstructive cardiomyopathy; atherosclerosis; among representatives of the negro race (mensh of turns are effective in terms of storing); in athletes (a positive reaction is possible during doping control); bilateral stenosis of the nircoval arteries or the manifestation of only one function of the nerve, the therapy with high blood pressure diuretics, drugs, or in patients with an increase in the volume of the stool.

sundown

I mean everything in the middle, whatever the lie, before the reception of the їzhі.

essential hypertension

1 tablet preparation Noliprel A 1 time / day.

If possible, with the use of the drug, fix a selection of doses of single-component drugs. Whenever there is a clinical need, it is possible to see the possibility of a combination therapy with NOLIPREL and as a monotherapy.

Patients with arterial hypertension and type 2 diabetes mellitus for reducing the risk of development of microvascular acceleration (from the side of the nyrok) and macrovascular delay in the heart-and-vascular disease

1 tablet NOLIPREL A 1 time / day. After 3 months of therapy, for improved tolerance, you can increase the dose up to 2 tablets NOLIPREL A 1 time / day (or 1 tablet 1 time / day).

Patients of the kidnapped vik

Slide the sign of the drug administration to control the function of nirok and arterial vise.

Nirkova lack

severe nirk deficiency (KK<30 мл/мин). For patients pomirnaya nirkova deficiency (CC 30-60 ml / min) it is recommended to repair therapy with the necessary doses of drugs (in the case of monotherapy), before entering the warehouse of NOLIPREL A. Patients with QC≥60 ml / min Dose change is not required. During the course of therapy, regular monitoring of the concentration of creatine and calories in blood plasma is required.

pechinkova lack

Drug contraindications for patients with grave pechinka deficiency... at amid pechin deficiency Dose change is not required.

Children and children

NOLIPREL And not to acknowledge through the information about the effectiveness and safety of the drug intake in patients of the group.

Pobichna diya

Headline data about the safety profile

Perindopril іngіbuє RAAS і changes іnіvіdnіa іonіv kalіy nirkami on tlі received іndapamіda. Gіpokalієmіya (vmіst kalіyu<3.4 ммоль/л) развивается у 2% пациентов на фоне применения лекарственного препарата Нолипрел А.

Some of the most common side effects of the boule:

For perindopril: zamorochennya, headache, paresthesia, dysgeusia (twisting relish), ruined zoru, vertigo, dzvin in vuhah, hypotonia, cough, dizzy, abdominal pain, constipation, dyspepsia, swelling, boredom, nudity , spasms of myaziv and asthenia;

For indapamide: hypersensitivity reactions, mainly in children, in patients who are sick to allergic and asthmatic reactions, and maculopapular visip.

List of side effects

The frequency of side reactions, which was spontaneous for every hour of clinical events, and / or in case of post-marketing caution, is induced in the following gradation: even often (≥1 / 10), often (≥1 / 100,<1/10), нечасто (≥1/1000, <1/100), редко (≥1/10 000, <1/1000), очень редко (<1/10 000), неуточненной частоты (частота не может быть подсчитана по доступным данным).

* Estimation of the frequency of undesirable reactions, occurring after spontaneous events, was carried out at the presentation of the given results in clinical reports

Overdose

symptoms: the most important symptom - a decrease in the arterial clutch, sometimes in the absence of boredom, blues, sudomy, dullness, drowsiness, wobbling of svidomosty, oliguria, yaria (the result can go into an anxiety) Also, there is a possibility of electrolysis damage (hyponatrієmiya, hіpokalієmiya).

lykuvannya: come in unadulterated additional help to be made before the preparation has been introduced to the body - the preparation of the slurry and / or the sign of the active increase in the upcoming changes in the water-electrolyte balance. With a significant decrease in the arterial grip, it is necessary to transfer the sick person to the "lying" position with raised legs. If necessary, carry out correction of hypovolemia (for example, intravenous infusion of 0.9% retail). Perindoprilat, an active metabolite of perindopril, can be seen in the body behind additional dialysis.

likarska vzaєmodiya

Preparations for lithium: in case of a one-hour consumption of drugs in the lithium and ingibitoriv ACE, it may be possible to increase the concentration of lithiasis in the blood plasma and induce toxic effects. It is not recommended to immediately consume the combination of perindopril and indapamide with lithium preparations. If necessary, such therapy should be regularly monitored instead of lithium in the blood plasma (div. Rozdil "Osoblivosti zasosuvannya").

Lykarsky preparations, given the need for special respect and care

baclofen: making the antihypertensive action more powerful. Slid control arterial vise and, if necessary, coriguvati doses of hypotensive drugs.

Oil refinery products, including high doses of acetylsalicylic acid (≥ 3 g / add): overnight stagnation of ingibitorіv ACE from NPZP (acetylsalicylic acid in a dose, which is needed for antiapaline dіyu, іngіbіtory COX-2 and nonselective NPZP), can lead to a decrease in antihypertensive diy. One hour, the consumption of the APF and the oil refinery can lead to an increase in the risk of diminishing the function of nirok, including the development of a hospitable disadvantage, and an increase in the amount of blood, especially in the amount of blood After taking care of the prescribed combination of drugs and NSAIDs, especially in patients with a kidney disease: patients are guilty of taking adequate amount of birth, it is recommended to control the pertinent function of the process as well as

Tricyclic antidepressants, antipsychotic drugs (antipsychotics): preparations of these classes provide antihypertensive effect and increase the risk of orthostatic hypotension (additive effect).

perindopril

Danі klіnіchnih doslіdzhen pokazuyut scho podvіyna blockade of the RAAS in rezultatі odnochasnogo priyah іngіbіtorіv ACE ARA II abo alіskіren generally produces up zbіlshennya frequency now viniknennya such nebazhanih yavisch yak arterіalna gіpotenzіya, gіperkalієmіya i torn down funktsії nirok (vklyuchayuchi GOSTR nirkovu nedostatnіst) in porіvnyannі of situatsіyami, if Only one drug is stored, which is poured into the RAAS (div. distributions "Pharmacological diya", "Prototypes" and "Specialties of storage").

Lykarskі drugs, scho viklikayut hyperkalієmiyu: deyakі lіkarskі preparations abo Klas preparatіv mozhut zbіlshuvati frequency rozvitku gіperkalієmії: alіskіren, solі kalіyu, kalіyzberіgayuchі dіuretiki, іngіbіtori ACE ARA II, nesteroїdnі protizapalnі zasobi, heparin іmunodepresanti (takі yak cyclosporin abo takrolіmus) lіkarskі preparations scho mіstyat trimethoprim in that the number of fixed combination of trimethoprim and sulfomethoxazole. Combination of cich drug preparations for the development of hypercalculation.

Overnight zasosuvannya protested

Aliskiren and drug preparations, for revealing aliskiren: overnight consumption of ACE ingibitors with drugs to avenge aliskiren, is suggested in patients with diabetic diabetics and / or for severely impaired function of nirok (GFR<60 мл/мин/1.73 м 2 площади поверхности тела) (см. раздел "Противопоказания"). Возрастает риск развития гиперкалиемии, ухудшения функции почек, сердечно-сосудистой заболеваемости и смертности.

aliskiren: in patients who do not have a diabetic or impaired function of nirok (GFR<60 мл/мин/1.73 м 2 площади поверхности тела), возможно повышение риска гиперкалиемии, ухудшения функции почек и повышения частоты сердечно-сосудистой заболеваемости и смертности (см. раздел "Особые указания").

Additional therapy with ACE and ARA II Ingibitors: for nayavnimi lіteraturnimi danimi, y patsієntіv Zi vstanovlenoyu aterosklerotichnoї hvoroboyu, Sertsevy nedostatnіstyu abo tsukrovim dіabetom of urazhennyam organіv-mіsheney odnochasny priyah іngіbіtorіv ACE i ARA II generally produces up zbіlshennya frequency now rozvitku arterіalnoї gіpotenzії, nepritomnostі, gіperkalієmії i torn down funktsії nirok (vklyuchayuchi GOSTR nirkovu nedostatnіst) , in some situations, if only one drug is consumed, it is poured into the RAAS. The stagnation of the sub-blockade of the RAAS (for example, at the time of the one-hour reception of the APF and ARA II) can be surrounded by single drops due to the strict control of the function of a wide range, instead of the calories in the plasma of the blood and the arteries.

estramustine: overnight stagnation can lead to the development of the risk of side effects, such as an ankyoneurotic quagmire.

Calcium-containing diuretics (for example, triamterene, amyloride) and calcium salts: hypercalculation (with a potentially fatal result), especially with impaired function of nirok (additional effects, tying with hypercalcium).

It is not recommended to recommend perindopril with vitamins and medications (Div. Rozdil "Osoblivosti zasosuvannya"). Yakshcho, prote, it is immediately shown that it’s stagnant, it’s followed by foreign visits and regularly monitored instead of calories in the blood.

Particularities of spironolactone intake in chronic heart deficiencies are described in the pediatric patients "Advantageous preparations, which are especially respectful".

Hypoglikemichnizasobi for the reception in the middle and insulin: epіdemіologіchnі doslіdzhennya showed scho spіlne zastosuvannya іngіbіtorіv ACE i gіpoglіkemіchnih zasobіv (іnsulіni, gіpoglіkemіchnіzasobi for Priya vseredine) Mauger posilyuvati gіpoglіkemіchny efekt іnsulіnu that gіpoglіkemіchnih zasobіv for Priya vseredine right up rozvitku gіpoglіkemії. The Danish effect can be promoted by stretching the first tendencies of one-hour therapy, as well as for patients with impaired functions.

Caline-saving diuretics: y patsієntіv, SSMSC otrimuyut dіuretiki, Especially in patsієntіv іz solovim she / abo znizhenoyu kontsentratsієyu salts for cob terapії perindopril Mauger sposterіgatisya nadmіrne znizhennya arterіalnogo vise rizik rozvitku yakogo mozhna zmenshiti Shlyakhov skasuvannya dіuretichny zasіb, zapovnennyam vtrati rіdini abo salts before cob terapії perindopril, as well as the signs of perindopril in the smallest dose with the further steps to be taken.

With arterial hypertension y patsієntіv of gіpovolemієyu abo znizhenoyu kontsentratsієyu salts in tlі terapії dіuretikami, dіuretiki povinnі Buti abo Canceled to cob zastosuvannya іngіbіtoru ACE (at tsomu kalіynesberegayuschіy dіuretik Mauger Buti pіznіshe znovu priznacheny) abo іngіbіtor ACE responsible Buti priznacheny in menshіy dozі s away postupovim її zbіlshennyam ...

In case of stagnation of diuretics in cases of chronic heart failure The ACE Ingibitor is guilty of the same low dose, possibly by changing the dose of a one-hour, high-quality diuretic.

In all cases, the function of nirok (concentration of creatine) is responsible for the control over the persistence of ingibitoris ACE.

Calaisberic diuretics (eplerenone, spironolactone): in case of stasis of eplerenone or spironolactone in doses from 12.5 mg to 50 mg for additional and low doses of ACE inhibitors in therapy of chronic heart failure II-IV functional class for the class of high NYHA patients< 40% и ранее применявшимися ингибиторами АПФ и "петлевыми" диуретиками, существует риск гиперкалиемии (с возможным летальным исходом), особенно в случае несоблюдения рекомендаций относительно этой комбинации препаратов. Перед применением данной комбинации лекарственных препаратов, необходимо убедиться в отсутствии гиперкалиемии и нарушений функции почек. Рекомендуется регулярно контролировать концентрацию креатинина и калия в крови: еженедельно в первый месяц лечения и ежемесячно в последующем.

for patients who immediately receive therapy with mTOR Ingibitors, they can develop the development of an angioeurotic embryo (div. razdil "Particularities of stasis").

Racecadotril: I have experienced the development of an aneurotic swelling on the thyroid gland of the angiotensin ACE (such as perindopril). Rizik the development of an angio-neurotic nabrya can grow older with a one-hour stagnation of racecadotrila (ingibitor enkephalinazi, stasis for the treatment of the state of affairs).

Submission of preparations, scho vimagak uvagi

Hypotensive and vasodilators: Immediately antihypertensive drug intake can be given to perindopril. With a one-hour sign of nitroglycerin, other nitrates, or other vasodilators, a decrease in the arterial grip is possible.

Alopurinol, cytostatic and immunosuppressive drugs, corticosteroids (for systemic drug use) and procainamides: overnight storing with ACE Ingibitors can be supervised by advancing leukopenia (div. razdil "Particulars storing").

Provide for anesthesia: Angibitorium ACE can enhance the hypotensive effect in a number of ways for anesthetic anesthesia (Div.

Gliptin (linagliptin, saxagliptin, citagliptin, vildagliptin): in case of a spinal stagnation with ACE ingibitors, an increase in the risk of an aneurotic blockage is caused by a suppressed activity of dipeptidylpeptidase-4 (DPP-IV) with gliptin.

sympathomimetics There may be a lax antihypertensive effect of the ACE inhibitors.

Gold preparations: in case of stasis ingibitoriv ACE, incl. perindopril, in patients who receive an i / v gold preparation (sodium aurothomalate), there are described negative reactions, which are manifested in a hyperactive manner of exposure, nudity, bloating, hypertension.

indapamid

Submission of preparations, which is especially respectful

Preparations for the formation of a polymorphic tachycardia type "fever": through rizik rozvitku gіpokalієmії slіd dotrimuvatisya oberezhnostі at odnochasnomu zastosuvannі іndapamіdu of drugs zdatnimi viklikati polіmorfnu shlunochkovu tahіkardіyu type "pіruet" napriklad, antiaritmіchnimi zasobami Klas IA (hіnіdin, gіdrohіnіdin, dizopіramіd) i Klas III (amіodaron, dofetilіd, іbutilіd, bretylium , sotalol); antipsychotics (chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoperazine); benzamide (amisulpride, sulpiride, sultopride, tiapride); butyrophenones (droperidol, haloperidol); other neuroleptics (pimozide); Other drugs such as yak bepridil, cisapride, diphemanyl methyl sulfate, erythromicin i / v, halofantrine, mizolastin, moxifloxacin, pentamidine, sparfloxacin, vinkamin i / v, methadone, asteminizole. Slid control instead of calories in blood plasma and, if necessary, carry out a correction; control of the QT interval.

Preparations for the treatment of hypokalies:(I / v), gluco- and minerlocorticoid (with systemic congestion), tetracosactide, penetrated, stimulating intestinal motility: improving the development of hypocalmus (additive effect). Necessary control of feces in blood plasma, if necessary - yogo correction. I pay special respect to the people who come to the children, to immediately get the hearts of the glucosides. Slide zastosovuvati carried, but does not stimulate intestinal motility.

Heart glucoside: hypocalypse to the degree of toxicity of heart glucosides. With a one-hour consumption of indapamide and heart glycosides in the blood plasma instead of blood plasma and EKG indicators and, if necessary, coriguvati therapy.

Submission of preparations, scho vimagak uvagi

Calaisberic diuretics (amiloride, spironolactone, triamterene): it is also primed by children. At the same time, there is a possibility of hypocalypse and hypercalcemia (especially in patients with a nircovy lack of diabetes). If it is necessary to immediately conserve indapamides and significant diseases of the blood plasma, then monitor the blood plasma and parameters of the EKG. If necessary, the scheme of treatment can be changed.

metformin: functional deficiency, as it can be recognized for aphids of diuretics, especially "loop" ones, with a one-hour sign of metformin leads to the development of lactic acidosis. Metformin was not consumed because the concentration of creatine in blood plasma was 15 mg / l (135 μmol / l) in choloviks and 12 mg / l (110 μmol / l) in females.

Calcium salt: with an one-hour sign of high growth rates of hypercalcification, there is a decrease in the rate of reduction in calcification by nirkami.

cyclosporine: It is possible to adjust the concentration of creatine in the blood plasma without changing the concentration of cyclosporine in the blood plasma, in case of normal water intake and sodium ions.

Corticosteroids, tetracosactide (for systemic intake): reduction of antihypertensive effect (intake of salt and water on aphids of corticosteroid intake).

special requests

Headquarters for perindopril and indapamid

Stagnation of the drug NOLIPREL A, so that a low dose of indapamide and perindopril arginin should be taken away from the dose of indapamide and perindopril arginin, not superfluous to the extreme decrease in the frequency of secondary On the cob of therapy with two hypotensive drugs, since the patient has not been removed earlier, it is impossible to turn on the increased risk of idiosyncrasy. A loyal look at the patient will allow you to bring the rizik to the minimum.

Damaged function of nirok

Therapy is contraindicated in patients with severe nirc disability (CC<30 мл/мин). У некоторых пациентов с артериальной гипертензией без предшествующего очевидного нарушения функции почек на фоне терапии могут появиться лабораторные признаки функциональной почечной недостаточности. В этом случае лечение следует прекратить. В дальнейшем можно возобновить комбинированную терапию, применяя низкие дозы препаратов, либо применять только один из препаратов. Таким пациентам необходим регулярный контроль содержания калия и концентрации креатинина в сыворотке крови - через 2 недели после начала терапии и в дальнейшем каждые 2 мес. Почечная недостаточность чаще возникает у пациентов с тяжелой хронической сердечной недостаточностью или исходным нарушением функции почек, в т.ч. при стенозе почечной артерии. Лекарственный препарат Нолипрел А не рекомендуется применять в случае двустороннего стеноза почечных артерий или стеноза артерии единственной функционирующей почки

Arterial hypotension and damage to the water-electrolyte balance

In the development of arterial hyponatremia, especially in patients with stenosis of the nyrkovo artery. In addition, with the dynamical care of the patients, I will respect for the possible symptoms of anger and decrease in the amount of electrolytes in the blood plasma, for example, when there is diarrhea or vomiting. Such patients need regular monitoring instead of blood plasma electrolytes. In case of arterial hypotension, intravenous injection of 0.9% sodium chloride can be used.

Transient hypotension is not contraindicated for continued therapy. For the renewal of BCC and AT, it is possible to update the therapy, using a low dose of drugs, or using only one drug.

Combination of storing perindopril and indapamid does not develop hypocalypse, especially in patients with diabetic diabetic or because of their deficiency. As soon as there is any hypotensive drug and diuretics, regular monitoring of the blood plasma is required.

lithium preparations

It is not recommended to immediately consume the combination of perindopril and indapamide with drugs (Div. Rozdil "Lykarska vzaєmodiya").

Additional speeches

Slid vrahovuvati, before the warehouse of additional speeches, the preparation includes lactose. Do not sign the drug NOLIPREL, but also є spadkovo intolerance to galactose, lactase deficiency and glucose-galactose malabsorption.

Vikoristannya in pediatrics

Do not sign NOLIPREL A for children and adolescents up to 18 years old Through the information about the efficiency and safety of perindopril and indapamide, as well as socially for the patients of the group.

perindopril

Subway blockade of RAAS

Є Data about the improvement of the risk of arterial hypotensiveness, hypercalculation and deterioration of the functions of nirok (including the state standard deficiency) in case of an one-hour stagnation of the hypertension of the APF from the ARA II It is not recommended to use the blockade of the RAAS for the additional help of the APF engineer from the ARA II (div. Rozdili "Likarska vzaєmodiya" and "Pharmacological activity"). If a sub-blockade is necessary, then it is worthwhile to check the control of the function with regular control of the function of the blood, instead of the calories in the blood plasma and arterial grip. Stagnation of ACE in patients with APA II has been proven in patients with diabetic nephropathy and is not recommended for young patients (div. Rozdil "Prototype).

Kaliyzberigayuchі diuretics, preparations of kaliyu, potassium-containing substitutes for gruel salt and gruel supplements

It is not recommended to immediately recognize perindopril and kaliyzberigayuchihdiuretikiv, as well as preparations of kaliyu, kaliyvmіsnyh alternates of salt and grub supplements (div. Rozdil "Likarska vzaєmodiya").

Neutropenia / agranulocytosis / thrombocytopenia / anemia

Є Due to the development of neutropenia / agranulocytosis, thrombocytopenia and anemia in the presence of ACE angiomyocytes. Patients with normal functioning have no supportive factors in the development of neutropenia. Due to the extreme protection of perindopril on the last of the systemic diseases of the tissue (including the systemic chervonia, scleroderma), as well as on the other side of immunosuppressants, alopurinol and the anti-inflammatory factors of cysts ...

The children from the cycle of the patients were diagnosed with important infections, in a number of vipads, the stipulations to intensive antibiotic therapy. When perindopril is recognized, such patients are recommended to periodically monitor the number of leukocytes in the blood. The patients are guilty of seeing the doctor about any signs of infectious diseases (for example, a throat-throat, a feverish woman) (div. Rozdil "Likarska vzaєmodiya" and "Pobichna dya").

anemia

Anemia can develop in patients who have undergone Nirka transplantation, or in patients who are undergoing hemodialysis. With a large amount of growth, a decrease in hemoglobin is increased. Daniy is effective, mabut, not doze-up, but it can be tied with the mechanism of the ingibitoriv ACE mechanism. An insignificant decrease in hemoglobin occurs during the first 6 months of treatment, instead of hemoglobin, it stabilizes and is updated when the drug is taken. Such patients may have continued treatment, however, hematological analyzes of the guilt are carried out regularly.

Sensitiveness / angioedema

When receiving ingibitoriv ACE, incl. and perindopril, in rare cases, it is possible to promote the development of an anioneurotic swelling, lips, tongue, vocal folds and / or larynx (div. distributed "Pobichna dya"). It can happen in any period of therapy. When symptoms appear in taking the drug, it is inaccurate to pinch and prevent control of the patient's body until the patient recovers. As soon as you get overwhelmed only by exposure and lips, then you should be willing to go through on your own, if you want to use antihistamines in the form of symptomatic therapy.

Angioneurotic larynx, which can lead to fatal results. Nabreak language, vocal folds or the larynx can lead to the obstruction of the dickheads. If such symptoms appear, then it is inaccurate to carry out a separate therapy, for example, to inject adrenaline (adrenaline) s / c at a dose of 1: 1000 (from 0.3 to 0.5 ml), or else to prevent the passage of dyshlichnyh slugs.

I have seen the development of an aneurotic nodule in children of a negro race.

Patients with an anamnesis of some kind of Kvinke have not been tied with ACE ingibitoriv, ​​they can change the risk of developing Kvinke with the use of drugs of the group of a group.

Angioeurotic intestinal obstruction develops in children with ACE in the background of therapy with ACE angibitors.

At the same time, the patients had a beating in the abdomen as a symptom, or in some cases, with a tediousness and blues, in some cases without an anterior angioedema in the presence of a normal C1-estera. Diagnosis has arisen behind the aid of CT scan of a black empty, ultrasound scan, or at the time of surgical intervention. Symptoms were resolved when receiving ACE ingibitors. In addition, in patients with pain in the abdominal region, who recognize the angiotensin angiotensin-converting enzyme (ACE), during the differential diagnosis, it is necessary to develop the ability to develop an angioedema in the intestine.

Іngіbіtory mTOR (missions to rapamіtsinu ssavtsіv) (for example, sirolimus, everolimus, temsіrolimus): for patients who can immediately find therapy with mTOR (for example, sirolimus, everolimus, temsirolimus) ").

Anaphylactic reactions during desensitization

Є About the occasion of the development of trivial, how to clutter up the life of anaphylactic reactions in patients, as they recognize the ACF for an hour of desensitization of the axes, Angibitoria ACE is necessary for the protection of stasis in patients who are sick to allergic reactions and undergo desensitization procedures. It is a unique sign of the drug's recognition for patients who receive immunotherapy from abrupt overreturn of frequent coma. Protest, anaphylactic reactions can be unique with a team-hour message to the ACE engineer at least 24 years before the ear of the procedure.

Anaphylactoid reactions during apheresis of LPNS

In small children in patients who recognize the ACE angiitis, during the apheresis of the lipoproteins of low aphilia with the presence of sulphate dextran, they developed hazardous for the life of the anaphylactic To prevent anaphylactoid reaction, take an hourly therapy with an ACE inhibitor before the skin apheresis procedure.

hemodialis

In patients who recognize the ACE angiogenesis, during the hemodialysis of high-flow membranes (for example, AN69), anaphylactoid reactions were indicated. That is why it is necessary to fix a membrane of the іnsh type, or zastosovuvati a hypotensive as a pharmacotherapeutic group.

cough

During the therapy with an ACE inhibitor, a dry cough may occur, which is not a sign of taking the drug. When a patient has a dry cough, there is a memory of a possible iatrogenic characteristic symptom. Since the drug is injected, the therapy with an ACE inhibitor is necessary for patients who can be continued with the drug.

Risk of hypotensive and / or nirkova deficiency (including in patients with heart deficiency, impaired water-electrolyte balance)

When deyakih patologіchnih mills Mauger vіdznachatisya-valued aktivatsіya RAAS Especially when virazhenіy gіpovolemії i znizhennі vmіstu elektrolіtіv plasma krovі (on fonі dієti without solі abo trivalogo priyah dіuretikіv) at patsієntіv of Pochatkova nizkim arterіalnim vise Zi stenosis nirkovih arterіy, hronіchnoyu Sertsevy nedostatnіstyu abo tsiroz liver with swelling and ascites. Stagnation of the ACE inhibitor to the blockade of the systemic system and that can supervise the sharp decrease in the arterial pressure and / or the increase in the concentration of creatine in the blood plasma, in order to indicate the developmental deficiencies. Quite often, it is spontaneous when taking the first dose of the drug, or after the first 2 types of therapy. In children of small origin, there is a state-of-the-art and in the context of therapy. In such cases, with newer therapy, it is recommended to take the drug in a smaller dose and then step by step increase the dose.

Patients of the kidnapped vik

Before the ear, the received perindopril needs to assess the functional activity of the blood plasma. On the cob of therapy, the dose of the drug is taken, in the way of lowering the arterial vise, especially in times of heat and consumption of electrolytes. Please come in to allow uniknuti the sharp decrease in the arterial grip.

atherosclerosis

Rizik hypotensiveness in all patients, even with special protection, the drug should be used in patients with ischemic ailments of the heart or lack of cerebral blood circulation. In such patients, treatment should be taken from low doses.

renovascular hypertension

Method of treatment of renovascular hypertension є revascularization. On the other hand, the stasis of the ACE ings can give a positive effect in the category of patients, as to clear up the operative engagement, and in that case, if it is not a matter of the surgical procedure to be carried out manually.

Treatment with the drug NOLIPREL A is not indicated in patients with diagnosed or transmissible stenosis of the nirkovo artery, since K.

Sertseva lack / importance heart failure

Patients with severe heart failure (IV FC for NYHA classification) and patients with type 1 diabetes

Patients with arterial hypertension from the IXC are not guilty of taking beta-blockers: ACE inhibitors are guilty of being stuck with beta-blockers at once.

Diabetes mellitus

Patients with type 1 diabetes mellitus (who do not have spontaneous increase in the place of their calories) have been guilty of taking a low dose of the drug and undergoing medical control.

In the first month of therapy with ACE inhibitors, it was possible to control the glucose concentration in the blood plasma of patients with diabetic diabetic patients, who will be able to take hypochlorite medications for admission "in the middle of the day."

Surgery / general anesthesia

Carrying out of anesthesia on the background of stagnation of angibitoris of the ACE can lead to a pronounced decrease in the arterial vise, especially when stagnant for anesthesia, as well as a hypotensive effect.

It is recommended, if possible, to fix the reception of the ingibitoriv APF trivalo diy, incl. perindopril, for add to the surgical operation. It is necessary to tell the doctor-anesthesiologist about those who are receiving the ACE in the patient.

Aortic or mitral stenosis / hypertrophic obstructive cardiomyopathy

Angіbіtori APF went on to protect the patients with obstruction of the vyhіdny tract of the lіvnі sluchnok.

pechinkova lack

In childbirths on the background of the reception of ACE ingibitors, the diagnosis is cholestatic. In case of progressive syndrome of mossy development of fulminant liver necrosis, in some cases with a lethal result. Mechanism of development of the syndrome of ambiguity. In the event of a significant increase in the activity of liver enzymes on the ingestion of the ACE, the patient should be treated with the drug and turned to the drug (div. Rozdil "Pobichna diya")

hyperkalієmіya

For an hour, lіkuvannya іngіbіtorov APF, incl. perindopril, a powerful development of hyperkali. Factors riziku gіperkalієmії Je nirkova nedostatnіst, pogіrshennya funktsії nirok, vіk over 70 rokіv, tsukrovy dіabet, deyakі will suputnі (degіdratatsіya, GOSTR dekompensatsіya sertsevoї dіyalnostі, metabolіchny acidosis) odnochasny priyah kalіyzberіgayuchih dіuretikіv (including spironolactone i Yogo pohіdne eplerenon, triamterene, amiloride), a preparation in calories, but also in calories by substitutes for salts, as well as in the intake of other preparations, in order to take away calories in the blood plasma (for example, heparin, an inhibitor of acetaminophen, іngіbіtory COX-2 і non-selective refineries, immunodepressants, such as cyclosporine or tacrolimus, trimethoprim). The stagnation of drugs in calories, high-calorie diuretics, which are high-calorie substitutes, can lead to a significant increase in calories in the blood, especially in patients with a decrease in function. Hyperkalієmiya can cause serious, sometimes fatal damage to the heart rhythm. It’s a necessary one-hour reception of significant drugs, it is guilty that it is guiltyly carried out with the safety of the regular control of the calories in the blood (div. Rozdil "Likarska vzaєmodia").

etn_chnі vіdminnostі

Perindopril, as і інші іngіbіtory ACE, clearly has a lesser degree of antihypertensive effect in patients of the Negro race among the representatives of the other races. It is possible, at the price of the brain, that in patients with arterial hypertension of the negro race, the low activity of the renin is often indicated.

indapamid

pechinkova encephalopathy

With the manifestation of a deterioration in the functions of the liver with the use of thiazide and thiazide-like diuretics, it can lead to the development of hepatic encephalopathy. In such situations, it is inaccurate to pin down the use of diuretics.

Water-electrolyte balance

Zmіst ionіv sodium in blood plasma. It is necessary to start drinking sodium in the blood plasma before the ear of the drug, and then regularly monitor the drug. Hyponatremia on the cob may not be superimposed on clinical symptoms, which requires regular laboratory monitoring. More frequent control in place of some of the testimonies to patients with liver cirrhosis and to patients with a kidney disease (div. Rozdili "Pobichna dia" and "Overdoing"). Whether you are using diuretics, you can get sick with hyponatriyemia, sometimes with even more serious inheritances. Hyponatremia can lead to hyponatremia and orthostatic hypotension. An overnight decrease in chlorine instead of ions can lead to the development of a secondary compensatory metabolic alkalosis: the frequency of the decrease and the degree of variation is insignificant.

Zmіst іonіv cali in blood plasma. Therapy with thiazide and thiazide-like diuretics is associated with the development of hypocalis. It is necessary to have a unique hypocalm (mensch 3.4 mmol / l) in the onset of patients with a high risk group: patients of a kidnapped person, when a patient is diagnosed (as therapist, so I don’t take medication) , heart failure. Hypocalypse in cych patients is due to the toxicity of heart glucosides and increases the development of arrhythmias. Before the group of the raised risik, it is also possible to lay down the patients with the increase in the QT interval, as in the case of the growth, as well as the viciousness of the likars' wages.

Hypokaliyemia, like bradycardia, the development of severe damage to the heart rhythm, especially arrhythmias of the "fever" type, which can be fatal. In all the diseases described above, it is necessary to have more regular monitoring in place of the calories in the blood plasma. The first wimp for the change of heart must be carried out with a stretch of the first work out of the cob of therapy.

In case of detected hypokalias, an additional correction is carried out.

Zmіst ionіv calcium in blood plasma. Thiazide and spore diuretics can change the amount of calcium in the blood, bringing to an insignificant and hourly increase in the concentration of calcium in the blood plasma. Hyperparathyroidism is often affected by hyperparathyroidism, which has not been diagnosed before. Before the preliminaries of the function of the parathyroid gland, there was a decline in the development of diuretic diseases.

Concentration of glucose in blood plasma

It is necessary to control the concentration of glucose in the blood of patients with diabetes, especially when hypocalypse is present.

Secic acid

With an increase in the concentration of sech acid in the blood plasma during the therapy, the incidence of gout attacks may increase.

Diuretic and function of nirok

Thiazid and spore diuretics are effective in the majority of the world only in patients with normal or slightly impaired function (the concentration of creatine in the blood plasma in adults is less than 25 mg / l or 220 μm).

In patients with a kidney disease, the normative indicator of the concentration of creatine in the blood plasma is guilty of but corrections for urahuvannya viku, vagi and statis, according to Cockcroft's formula:

for the choloviks of the kidnapped veterinarian:

K = (140 - vіk) x wag / 0.814 x concentration of creatine in plasma,

de vіk in rocks, wag in kg, concentration of creatine in plasma in µmol / l

for women of the kidnapped vik:

otrimaniyu result slid multiplied by efficiency 0.85.

On the ear of being a diuretic in patients due to hypoemia (in the case of water and ionizing sodium), a decrease in GFR can be promoted during a period of time and an increase in the blood concentration of the serum. Tsya transient functional nirkova lack of safety for patients with cob normal function nirok, however, patients with nircovy lack of rotation can do it.

photosensitivity

At the same time, the development of photosensitivity reactions (div. Rozdil "Pobichna dya") was observed in the development of thiazide and thiazide-like diuretics. The development of photosensitivity reactions to the ingesting drug should be corrected. If there is a need for further therapy with diuretics, it is recommended to seize a small number of sleepy exchanges or one-off ultraviolet exchanges.

Gostra myopia and vtorinna zakrytokutova glaucoma

Sulfonamides and іхідні can change the development of Іdіosіncratic reactions, which can lead to a time-based (fast-moving) myopia and state of the art. Without proper therapy, zakrytokutovaya glaucoma can lead to loss. In the first place, it is necessary to pinch it with a lykarsky drug. At once the internal grip of the prodovzhu will become high, it may be necessary to carry out a secret therapeutic or surgical treatment. To the factors of risk, which can lead to the development of severe glaucoma, it is possible to bring an allergy to sulfonamide or penicilin

athlete

Indapamid can give a positive reaction during doping control.

Inflow to the building of keruvati by transport means and mechanisms

Diya rechovin, before entering the warehouse for the drug NOLIPREL A, does not lead to the destruction of psychomotor reactions. However, in some people, in the case of a decrease in the arterial clutch, there can be development of individual reactions, especially to the cob of therapy, even if given before therapy, other antihypertensive drugs can be carried out. In general, the performance of a carousel by car or other mechanisms can be reduced.

Vigor and lactation

Preparation of contraindications for vaginosti (div. Rozdil "Prototype indications").

Lykarsky drug NOLIPREL A contraindications in the period of breast cancer. It is necessary to assess the significance of the therapy for the mother and to take the decision about the treatment of breast cancer, or about the treatment of the drug taken.

availability

perindopril

There was no recent monitoring of ACE ingibitors in vaginal patients. At the present moment, there are no overwhelming epidemiological data about teratogenic rises in patients with ACE in the first trimester of vaginosity, protects against the development of rhizik, the development of the fetus is not possible. In case of planned vaginosity, the drug becomes active and signs of hypotensive disorders, permitted for persistence in case of vaginosity. If vaginosity is detected, it is inappropriate to initiate therapy with ACE inhibitors and, if necessary, indicate this therapy.

At the same time, infusion of the ACE in the period of the second and third trimesters of the pregnancy may lead to the deterioration of its development (lowering the function of the nerves, oligogram, improving the efficiency of the growth of the scalp)

As soon as the patient is able to correct the ACE in the second or third trimester, it is recommended to carry out an ultrasound scan of the fetus to assess the cranium and function of the fetus.

In newborns, mothers who have been discouraged from therapy with ACE ingibitors, arterial hypotension can be promoted, in connection with the new born women who are guilty of being overwhelmed by medical control (div. Development "Protype").

indapamid

Dani about storing indapamid among women who are traveling on a daily basis (less than 300 wines). Trivial stagnation of thiazide diuretics in the III trimester of vaginosis can lead to hypovolemia in the mother and decreased uterine-placental blood flow, which can lead to fetoplacental ischemia and fetal development.

Preslidzhennya on creatures did not show direct or indirect toxic infusion on reproductive function.

Period of breastfeeding

Lykarsky drug NOLIPREL A contraindications in the period of breast cancer.

perindopril

At the moment, it has not been established that perindopril can be seen in breast milk. It is sensitive to the availability of information, but there is a need to consume perindopril during the period of breastfeeding, if not recommended, it is more important that other drugs are consumed with a more advanced health-care profile, especially for a new year.

indapamid

At the moment, there is no reliable information about the vision of indapamide or its metabolites in breast milk.

A newborn can develop a sensitivity to old sulphonamides and hypocalyses.

Rizik for new people / nemovlyat is not possible to become vicious.

Indapamid is close in structure to thiazide diuretics, taking any changes in the amount of breast milk or stifling lactation.

Indapamid contraindications in the period of breast vigoduvannya.

fertility

Zagalna for perindopril and indapamid

The increase in reproductive toxicity has shown the rate of change in fertility in both cases. Imovirno infusion on fertility in people on the day.

Stuck in a childish vіtsі

Stagnation in children and children in children up to 18 years is not shown.

In case of deterioration of the functions of nirok

at nirkovaya lack of severe stage (CC less than 30 ml / min) zasosuvannya drug is contraindicated. at nirkovy deficiency of the middle stage of severity (CC 30-60 ml / min) the maximum dose of Noliprel A is 1 tab. / day at CC ≥ 60 ml / hv

Mind that term zberigannya

The drug should be taken at a temperature of 30 ° C. Term of affinity - 3 rocks.

Do not fix the message for the end of the term of accessibility indicated on the package.

Country of promenade

Group of goods

Hypotensive combinations for (Ingibitor of angiotensin converting enzyme (ACE) + diuretic).

formy vipusku

• 14 - bottles of polypropylene with a dispenser (1) - packs of cardboard with control of the first opening. 30 - bottles of polypropylene with a dispenser (1) - packs of cardboard with control of the first opening. 30 - bottles of polypropylene with a dispenser (1) - packs of cardboard with control of the first opening. Tablets, vkritі plіvkovyu envelope 10mg + 2.5 mg - 30 tablets per pack.

Description of licarsky form

• Round two-shaped tablets of a white color, including a plush shell. Tablets, including a plaster shell of a tablet, a plunge shell of a white color, a dovgaste tablet, a plate of a plush shell of a white color, dovgasti, with a risk on both sides. Tablets, in a plavkovoy shell of a white color, dovgasti.

Pharmacological diya

Pharmacokinetics

Special mind

warehouse

• perindopril arginine 10 mg, but formulated 6.79 mg perindopril and indapamid 2.5 mg. Additional words: lactose monohydrate 142.66 mg, magnesium stearate 0.90 mg, maltodextrin 18.00 mg, coloidal anhydrous silicon dioxide 0.54 mg, sodium carboxymethyl crochmal (type A) 5.40 mg. Warehouse of plavkovo shell: macrogol 6000 0.27828 mg, magnesium stearate 0.26220 mg, titanium dioxide (E171) 0.83902 mg, glycerin 0.26220 mg, hypromelose 4.3583 mg. perindopril arginin 2.5 mg additional words: sodium carboxymethylcrochmal (type A), coloide anhydrous silica, lactose, magnesium stearate, maltodextrin. Warehouse of plush shell: macrogol 6000, SEPIFILM 37781 RBC (glucerin, hypromelose, macrogol-6000, magnesium stearate, titanium dioxide (E171)). perindopril arginin 5 mg, for the formulation of perindopril 3.395 mg; additional words: sodium carboxymethylcrochmal (type A), coloide anhydrous silica, lactose, magnesium stearate, maltodextrin. Warehouse of plavkovoy shell: macrogol 6000, SEPIFILM 37781 RBC (glucerin, hypromelose, macrogol 6000, magnesium stearate, titanium dioxide (E171)). perindopril arginin 5 mg, for the formulation of perindopril 3.395 mg; additional words: sodium carboxymethylcrochmal (type A), coloide anhydrous silica, lactose, magnesium stearate, maltodextrin. Warehouse of plavkovo casing: macrogol 6000, SEPIFILM 37781 RBC (glucerin, hypromelose, macrogol 6000, magnesium stearate, titanium dioxide (E171)). perindopril arginine 10 mg additional words: lactose, magnesium stearate, maltodextrin, silicon dioxide coloidal anhydrous, sodium carboxymethyl starch (type A). Warehouse of plavkovoi shell: macrogol 6000, magnesium stearate, titanium dioxide (E171), glucerin, hypromelose.

likarska vzaєmodiya

Overdose

Umovi zberigannya

• take care of children

Naming:

NOLIPREL (Noliprel)

Pharmacological
diya:

NOLIPREL - combination of perindopril(Іngіbіtor angіotensin-converting factor) і indapamide(Diuretic sulfonamide group).
Mechanism of pharmacological development of a drug of accumulation with a combination of effects and components.
Perindopril-indapamide has a potential pharmacological effect for cutaneous preparations.
NOLIPREL is referred to hypotensive lykarskiy zasobіv.
I lower yak arterial dyastolic, so and systolic vice.
Effective Nolіprela lay down in the first dose.

Taking the drug does not lead to frequent sercebittia.
Adequate clinical effect develops in 1 ms. send a cob to Noliprel's reception. The triviality of antihypertensive action - 1 add.
Pislya pripinennya vzhivannya Noliprel do not develop vidmini syndrome.
Decrease in the turn of the hypertrophy of the lynx, the posterior atrial and postcardiac nasal pressure (for the rakhunok of the sudin mucosa and nirok).
NOLIPREL does not infuse into metabolic processes (exchange of lipids and carbohydrates).
Increase the elasticity of the Sudin(Great arterial stovburiv), the structure of the wall of small caliber vessels is introduced.
Perindopril changes the secretion of aldosterone, due to the mechanism of the negative vocal sound, the activity of renin in the blood.

Influenced on the lowering of the arterial grip of yak in individuals with a low level, and in particular with a normal activity of the renin in the blood.
Macadinosilicate effect.
Indapamid synergistically with perindopril reduces hypertension, reduces the risk of hypertension.
According to the mechanism of the mechanism, the indapamide is closer to the thiazide diuretics: the ingibitor of the reabsorption of ions in the sodium of the cortical formation of the Gentlo loop.
already, to be able to grow more efficiently and efficiently with chlorine ions, Sodium (in a small amount - in calories, magnesium).
I lower the arterial grip in a dose, which is practically not infused into the secular vision. Change in hyperreactivity of sudin when infused with adrenaline.
There is no change in the number of lipids in the blood (lipoproteins of NP and VP, triglycerides, cholesterol). Chi does not contribute to carbohydrate metabolism.

showing before
sucking:

Hypertension is arterial essential.

Ways of storing:

NOLIPREL
We are sick with creatinine clearance ≥ 30 ml / h. The dose change is not required.
NOLIPREL - Forte- 1 tablet per dob, bazhano per year.
We are sick with creatine 30-60 ml / hc. The dose change is not required.
When cleansing is ≥ 60 ml / day, the control is carried out to control the level of blood and creatine in the blood.

Pobichna diya:

Diy, enriched by Noliprel
Water-electrolyte rivovagi: perindopril increased the concentration of calories by the way of attracting the renin-angiotensin-aldosterone system.
The power of change is to waste calories for rakhunok dii іndapamіdu.
Change instead of calories when taking Noliprela to become< 3,4 ммоль/л через 3 месяца лечения у 2% пациентов.
In the middle of the concentration of calories after 3 months of liquidation, it dropped 0.1 mmol / l.

Pobichni efekti perindopril
Heart-vascular system: hypotension is even greater, orthostatic collapse, even worse is myocardial infarction, arrhythmia, insult.
Models of people and state system: in ailments with glomerular nephropathy, there is a possibility of proteinuria, degradation of the function of nirok (little), in some cases of restructuring of the state of nirkova deficiency. With nircovian deficiencies, stenosis of nircoval arteries, stagnation of other diuretics, there may be little increase in the amount of creatine in the blood and slaughter (when the drug is taken into account). Potential reduction is more possible.
Central and peripheral nervous system: malaise, headache, impairment, asthenia, impaired hearing and hearing (zenkit in wuhah), labile mood, impaired sleep, decreased appetite, paresthesia, judgment in okremih vipadkas - stupor.

Dichal system: rarely - difficulty in dysfunction, dry cough, bronchial spasm, vision from the nose.
Shlunkovo-intestinal tract: dyspepsia (diarrhea or constipation), bloody or nausea, pain in the abdomen, dryness in the mouth (small), increased activity of transaminases, cholestasis, pancreatitis, hyperbilirubinemia.
Blood system: in ailments on aphids hemodialysis or transplantation of nirka - anemia; Ridko - thrombocytopenia, change in hematocrit number, pancytopenia, agranulocytosis; hemolytic anemia.
Allergic reactions: visip, sverbіzh, angioedema, kropivyanka.

Indapamide side effects
Shlunkovo-intestinal tract: dyspepsia (diarrhea or constipation), bloating or nudity, dryness in mouth (small), pancreatitis (near vipadi), in case of subtypous liver failure - pechinka encephalopathy.
Central and peripheral nervous system: show an impulse to pass the message (headache, congestion, asthenic syndrome, paresthesia).
Water-electrolyte rivovagi: patients in a group develop hypocalypse, hyponatriyemia, hypovolemia, dehydration. Yak naslidok - orthostatic collapse. Metabolic alkalosis to end up with rare (dressings with overwhelming excretion of chlorine). Hyperkaltsієmiya - in the surroundings.

Blood system: leuko-, thrombocytopenia, agranulocytosis, hemolytic or aplastic anemia.
The biochemical picture of the blood supply: hyperglycemia, the increase in the concentration of the seed.
Shkiri system: visip, aggravated syndrome of systemic chervony vovchak, hemorrhagic vasculitis.
Allergic reactions: visip, kropivyanka.

Prototype indications:

Hypersensitivity or allergy to the components of the preparation of any of the other subassemblies (sulfonamides and / or ingibitoriv ACE);
- creatine clearance less than 30 ml / hv (nirkova lack);
- pechinkova lack of mental strength to encephalopathy;
- hypocalypse;
- add a line to match the QT interval;
- up to 18 rockets;
- lactase deficiency, galactosemia, syndrome of glucose or galactose malabsorption (to avenge lactose).

When taking Noliprela it is required adequate dehydration to the body, so as a powerful development of the growing hypotension.
The administration of the drug is carried out under the control of electrolytes, creatine and arterial vise.
With suppurative heart failure, it is possible to combine it with beta-blockers.
Acceptance of Nolіprela gave a positive reaction during laboratory tests for doping.
slid just take care of when driving or driving high-precision mechanisms, especially in the first time.

Vzaєmodiya z
інshim medicinal
cats:

NOLIPREL is not recommended to be taken at once with drugs lithium (ekskretsiya lithiyu decrease and may develop yogo overdose). It’s not a matter of death - it’s just a matter of keeping control of the blood flowing.
Spilnyy reception with kaliyzberigayuchimidiuretics or, for revenge kaliy, can lead to an increase in the concentration of calories in the blood(Navigate to a fatal result).
Alcohol intake of Noliprel with high-calorie diuretics and calcium preparations is recommended only in times of high blood pressure (in case of caution for a sufficient amount of calories in the blood and EKG).
Patients with diabetic diabetes and lack of diabetes are not diagnosed with either hypo- or hypercaloric deficiency.

The combination of indapamide with the internal form of erithromycin, vincamin, sultopride, bepridil, halofantrine, antiarrhythmic drugs (IA and III classes) provokes arrhythmia for forgiving the option, especially stimulates
Ridko mossy development of hypoglycemia on the background of stasis of insulinu, scho vimagaє korektsii dozi ostnogo. Non-steroidal anti-burners to bring the power of Noliprela to reduce the arterial grip. At the time of dehydration to the body, the combination I can wicklikati nirkova lack of for the deterioration of the function of nirok.
The combination of NOLIPREL-baclofen is synergistic (it is necessary to adjust the dose of NOLIPREL). Antipsychotics and tricyclic antidepressants for aphids Noliprela suffer orthostatic hypotension.

Replenishment of water and electrolytes in case of total intake of Noliprel with glucocorticosteroids, minerocorticoids, stimulants, amphotericin In and tetracosactide, to reduce the hypotensive effect of the drug.
Toxic infusion of heart glucosides can occur on aphids of Noliprela through the development of hypocalis (control of the EKG and change in blood calories).
Combination with metformin wiklica lactic acidosis Especially when the creatine content in the blood is more than 135 μmol / l in choloviks and 110 μmol / l in females.
Before the vikorystannyam of iodine x-ray contrast speeches on aphids, Noliprela needs adequate hydration to the body (risik development of nirk deficiency).
One-hour intake of calcium salts wiklikag hypercalcism. With the combination of NOLIPREL-cyclosporine, it is possible to increase the creatine in syrovatz blood instead of creatine.

availability:

contraindications reception of Nolіprela with vaginosity and in women who are yearning (increased mortality in new women, anomalies in the development of the musculoskeletal apparatus, nirkov deficiency in new women, lack of water deficiency, incomplete artery disease)
Yaksho vagіtna took NOLIPREL before the fact of the establishment of vagіtnosti - when you get it, it’s innocently pinned.
The need to carry out a change in the vaginosity of the disease, the protector is guilty but is informed about the possible inheritance.

Overdose:

symptoms: Hypotensiveness, blues, nudity, spoiled, sleep disturbance, mood lability, signs of nirkovo deficiency, electrolyte imbalance.
lykuvannya: Slurry cleaning, intake of intersorbents, normalization of water-electrolyte ryvnovagi. Metabolism Nolіprela elimіnuyutsya dіalіzom.

- additional speeches: MCC; lactozymonohydrate; magnesium stearate; silicon dioxide coloidal hydrophobic.

Cardiologists priznachayut yogo for lowering blood yak lower, so і upper vise. Diya Nolіprela vvazhaєnim dozazalezhnym. Win minimizu in such a way that you do not spoil the flow of food into the vision.

I still do not pour into the exchange processes that are tied to the wet tsukru. NOLIPREL, the instruction before the stasis of the vicladen in the tsy statty, also does not change the fat in the blood.

Yogo priznachayut in arterial hypertension. There are indications before the test in case of damage in the robotic endocrine system.

warehouse

The active words are the tert-butylamine silt perindopril in a dose of 2 mg and indapamide - 1.26 mg. Additional words: lactose monohydrate, magnesium stearate, microcrystalline cellulose, coloidal hydrophobic silica.

Form vipusku i packaging

NOLIPREL is dispensed only in tablets of a white form.

The drug NOLIPREL Forte

The stench is divided into three categories according to vase, depending on the type of drug:

• NOLIPREL - 2 mg;
• NOLIPREL Forte - 6 mg;
• NOLIPREL Bi-Forte - 10 mg.

One plate in itself is equal to 7 or 10 tablets. All in packs can be 14 or 30.

Pharmacological diya

Dana diya u Noliprel antihypertensive.

Yogo way not to supervise, but to the normal functioning of all internal organs.

The good effect is reached in about 30 days after taking the first Noliprel tablet.

The triviality of yogo day becomes 24 years. When the drug is finished, the drug is considered to be the syndrome of vidmini. In this case, the manifestation of symptoms of hypertrophy of the louse, as well as atrial and postcardiac nascence (through the blood vessels of the muscles and organs of the visual system), is minimized.

It is important to note that the lykarsky zasib NOLIPREL does not spoil significant influx into the exchange processes that flow into the body of people (sprinkle, carbohydrate and fat).

Pharmacokinetics and pharmacodynamics

The speech was given for a tense hypotensive effect on the camp of ailments as it is low, as well as the permissible activity of the renin in syrovattsi blood.

Mind the sale

The drug is available in pharmacies only for the prescription of a drug.

Umovi zberigannya

It is necessary to take it at a temperature of 29 ° C in a place inaccessible to children.

Term of attachment

The term of accessibility Noliprela is to become 3 times from the date of delivery, indicated on the packaging.

Price and de buy

You can buy yogo only in pharmacies. The average rate of leads to become 600 rubles.

One of the straining antihypertensive disorders. Additional help in important types of hypertension and is sold practically in a skin pharmacy. The price of the drug is great for hypotensive drugs, and it is highly effective.

Lykarska form

The drug is dispensed in the form of oral tablets. There is a long list of daily speeches, in pharmacies the performances of Noliprela - NOLIPREL A, і NOLIPREL A Bi-forte. Patients can buy packs with a small amount of the drug, or the most requested bottle of Noliprel, which contains 30 tablets.

Description and warehouse

The drug to take revenge on two different words - arginin I. The stench can vikoristovuvatisya for lowering the vice independently, but in combination it is significant to increase the efficiency of the treatment.

Become a member of the ACE Ingibitor group. Yogo way to manifest itself in the building of galmuvati lantsyuzhok of re-fermenting of enzymes, yak to produce a vice. For the reception to be promoted:

1. Change of virobite aldosterone.
2. Greater activity of the renin.
3. Zmenshennya judiciary support.

The nutritional description of the effect is based on the metabolite of perindoprilate, as it is itself є by means. The efficiency does not infuse the concentration of the renin. The hypotensive effect will be reached with a low rate of speech.

I will give a positive heart to the robot. Vіn lowering the front of the vantage point of the vessel-widening effect on the vein, as well as the post-vantage of the vessel - through the change of the vessel support. Tse to produce before the onset of positive effects:

1. The vice when napovnennі shlunochkіv go down, so dіnu navantazhennya on the heart.
2. The peripheral opir of sudin changes.
3. The number of the heart wikid is growing.
4. To activate the regional blood flow in the meat.
5. Sudinorosilicidal action.
6. Renovation of the elasticity of the great arteries.
7. Changing the hypertrophy of the lilac duck.

- not less important component for reaching hypotensive effect, niz. Rechevina to lay down to a group of diuretics. Winning the introduction of sodium and chlorine, reducing the amount of circulating life and the effect of increasing pressure. At the same time, the development of the hypocalypse will change.

In the drug NOLIPREL, two different types of speech are presented in the small children. Concentration and in them according to the warehouse:

1. NOLIPREL A - 2.5 and 0.625 mg.
2. - 5 і 1.25 mg.
3. NOLIPREL A Bi-forte - 10 and 2.5.

The effect of lowering the vice is to lay down in the first dose, that is, the specific type of Noliprela is selected individually for the skin patient. Likki lower as systolic, so it is a diastolic grip, with the result that the result will be reached by the patients of any kind. Efficiency does not change due to the position of the patient, so NOLIPREL can accept both recumbent and standing.

The maximum incidence of the effect starts to develop in about 4 years after taking the pill. A positive result is obtained by reaching out to finish. The great experience of Nolіprela є the visibility of the vidmini syndrome.

pharmacological group

Combined hypotensive susceptibility.

Shown to sucking

for grown-ups

NOLIPREL is designated only for the treatment of arterial hypertension. At the same time, it is equally effective at an easy and important stage of becoming ill. It is important to correctly take the dose of the drug, since the number of diuretics is not large enough to be effective, but it does not change the development of side reactions.

for children

Given that the drug is safe for children younger than 18 years, it is not enough for NOLIPREL not to be vicious for the liking of children and children.

for women in the period of lactation

The active metabolite of Noliprela penetrates through the placental bar, which is why it does not get involved in vaginal therapy. The results of these events showed that the fetotoxic effect of Nolіprela in the first 3 months of vaginosis during the day, however, at the present moment, it is not possible to wake up. On different terms, the formation of the fetus with the use of Noliprela, leading to pathological development and acceleration.

If necessary, the reception of Nolіprela woman, yak yearє, lactation needs to be pinned, and then you can start drinking. Yaksho ditina took the drug through breast milk, it is necessary to control the stance and prepare it until the hypotension is shown.

Prototype

NOLIPREL can not be stashed in the presence of advancing stances:

1. Sensitivity to drugs in ACE and sulfanilamide diuretics has been adjusted.
2. Nirkov's lack.
3. Viability i.
4. or disruption of lactose metabolism.
5. Hіpokalієmіya.
6. Іmovіrnіst development of an anioneurotic embryo.
7. Nirok stenosis.
8. Childish vіk.

Gagging ta dozi

for grown-ups

The reception of the negatively infused into the process of converting the ACE into the perindoprilate, which leads to the weakening of the efficiency of Noliprel. To reject the maximum efficiency of the drug, it is recommended to take a one-time dose of the drug before the drink in an additional dose, as for the patient the drug is taken.

Pobichna diya

In the course of treatment with Noliprel, there may be development of side effects, such as in some form of administration to the drug. Їх turn-by-turn of the patient's individual features. Negative reactions, which provoke NOLIPREL.

1. Serpents of blood indications, sprouts, anemia.
2. Loss, weakness, paresthesia, loss of sleep.
3. Stronger vise reduction, orthostatic hypotension, breakdown of the heart rhythm.
4. Dry cough, bronchospasm.
5. Dryness of the mouth emptying, beating in the stomach, diarrhea, igniting poisoning of organs of etching.
6. Shkirnі visipannya, sverbіzh, photosensitivity.
7. Nabryak language, allergic reactions.
8. Zmіna danih cardiograms.

Vzaєmodia with іnshy lіkarskiy zasob

1. (Rizke lower grip)
2. Non-steroidal anti-pyretic drugs (weakening of the main effect, improvement of negative side reactions).
3. Antipsychotic drugs (the potential for the effect of Noliprela and the temporality of orthostatic hypotension).
4. Corticosteroids hormones (use Noliprel)
5. Hypoklikemichny with a dose (due to the decrease in the concentration of glucose in the blood).
6. Vasodilators (improving the hypotensive effect of Noliprel).

special requests

Damage to the robotics and heart failure to correct the dose of the drug, so as to allow the active metabolism to develop. Those same can be spared from the children of the kidnapped vik.

In the capacity of an additional component, lactose is victorious, just for the memory of patients with intolerance of this speech.

It is necessary to regularly monitor the level of blood and other electrolytes in the blood for every hour.

The drug can be damaged because of this, because it should be taken out of the car for an hour of driving.

Overdose

With a significant transposition of the permissible dose, the patient is prevented from turning around a decrease in the arterial grip. Vono can come from zamorochennyam, by sundom, intertwined with evidence.

In case of an overdose, it is necessary to speed up the treatment of Noliprel to the body, for which the vikorist production of the slunk is necessary, with the use of sorbents and methods for oral rehydration. It is recommended that the patient should rest on his feet with raised legs, so as to prevent blood access to the brain.

Umovi zberigannya

NOLIPREL zberіgaєtsya with extraordinary temperature minds.

analogs

Analogs of the drug for diyuchy speech є:

1. Co-Prenessa. Buyer є a few doses of the drug and packaging with a small number of tablets, so that you can accurately select the drug, depending on the prescribed drug regimen. Qualitatively a drug, like viroblyaє pharmaceutical company of Slovenia - KRKA.
2. /. The preparation of the TEVA company, packing of 30 tablets. Vibrate in two doses: 2.5 mg ACE Ingibitor and 0.625 mg diuretic, as well as 5 / 1.25 mg.
3. ... Yakisny French preparation, which representations in doses of 2.5, 5 and 10 mg.
4. Prilamid. Combinations of antihypertensive drug. It is dispensed in doses of 2 / 0.625 mg and 4 / 1.25 mg. Prescription drug from the Sandoz company. In pharmacies there are є large packs of 60 tablets, as well as vigidnish cupuvati for a trivial course of treatment.

Price

The part of Nolіprela to become in the middle 647 rubles. Prices range from 466 to 1030 rubles.