Noliprel: instructions for use and what it is for, price, reviews, analogues. How to be treated with Noliprel - detailed instructions for use and special recommendations Noliprel instructions for use

What is Noliprel A and in what cases is it used

Noliprel A is a combination of two active components, perindopril and indapamide. It is an antihypertensive drug used to treat high blood pressure(hypertension) in adults.
Perindopril belongs to a class of drugs called ACE inhibitors. They act by dilating the blood vessels, making it easier for the blood to pump. Indapamide is a diuretic. Diuretics increase the volume of urine produced by the kidneys. However, indapamide differs from other diuretics in that it only slightly increases the volume of urine produced. Each of the active ingredients lowers blood pressure, and together they control your blood pressure.

Do not take the drug

If you are allergic to perindopril, any other ACE inhibitor, indapamide, one of the sulfonamides, or any of the other ingredients of this medicine (listed in the Composition section);
- if you or your relatives have experienced symptoms such as wheezing, swelling of the face or tongue, intense itching or a profuse skin rash (angioedema) while taking other ACE inhibitors or under other circumstances;
- if you have diabetes or a disorder kidney function and you accept medications to lower blood pressure, containing aliskiren;
- if you have severe liver disease or hepatic encephalopathy (a degenerative disease of the brain);
- if you have severely impaired kidney function, accompanied by a decrease in the blood supply to the kidneys (renal artery stenosis);
- if you are undergoing dialysis or any other type of blood filtration. Depending on the equipment you use, Noliprel A may not be the right drug for you;
- if you have too low a level of potassium in your blood;
- if you suspect untreated decompensated heart failure (severe water retention, difficulty breathing);
- if your pregnancy is more than 3 months (it is also better to avoid the use of Noliprel A in the early stages of pregnancy - see the section "Pregnancy and lactation");
- if you are breastfeeding;
- if you are taking the combination sacubitril/valsartan, a medicine used to treat heart failure (see "Other drugs and Noliprel A").

precautionary measures"type="checkbox">

Special instructions and precautions

Talk to your doctor or pharmacist before taking Noliprel A:
- if you suffer from aortic stenosis (narrowing of the main blood vessel coming from the heart), hypertrophic cardiomyopathy(heart muscle disease) or renal artery stenosis (narrowing of the artery that supplies blood to the kidneys);
- if you suffer from heart failure or other heart disease;
- if you suffer from kidney disease or are undergoing dialysis;
- if you have abnormally high levels of the hormone aldosterone in your blood (primary aldosteronism),
- if you suffer from impaired liver function;
- if you suffer from a collagen disease (skin disease) such as systemic lupus erythematosus or scleroderma;
- if you suffer from atherosclerosis (hardening of the walls of the arteries);
- if you suffer from hyperparathyroidism (hyperfunction of the parathyroid gland);
- if you suffer from gout;
- if you suffer from diabetes;
- if you are on a low-salt diet or are taking salt substitutes containing potassium;
- if you are taking lithium, potassium-sparing diuretics (spironolactone, triamterene) or potassium preparations, as you should not take them at the same time as Noliprel A (see "Other drugs and Noliprel A");
- if you are elderly;
- if you have experienced photosensitivity reactions;
- if you have experienced serious allergic reactions with swelling of the face, lips, mouth, tongue, and throat that may cause difficulty in swallowing or breathing (angioedema). This can happen at any time during treatment. If you develop these symptoms, you should stop treatment and contact your doctor immediately.
- if you are taking any of the following medicines used to treat hypertension:
- angiotensin II receptor blockers (ARBs) (also known as sartans - for example, valsartan, telmisartan, irbesartan), especially if you have diabetes-related kidney problems,
- aliskiren.
Your doctor may check your kidney function, blood pressure, and the amount of electrolytes (such as potassium) in your blood at regular intervals.
See also the information under the heading "Do not take this drug".
- if you are of a Black race, as you may be at a higher risk of angioedema and this drug may be less effective in lowering blood pressure than in patients of other races;
- if you are undergoing dialysis with high-permeability membranes;
- if you are taking any of the following medicines, your risk of angioedema may be increased:
- racecadotril (used for diarrhea treatment),
- sirolimus, everolimus, temsirolimus and other drugs belonging to the class of so-called mTor inhibitors (used to prevent rejection of transplanted organs),
- sacubitril (available in fixed combination with valsartan) for the treatment of chronic heart failure.
Angioedema
Cases of angioedema (a serious allergic reaction with concomitant swelling of the face, lips, tongue or throat, difficulty swallowing or breathing) have been observed in patients taking ACE inhibitors, including Noliprel A. These reactions can occur at any time during therapy. If you develop these symptoms, you should immediately stop taking Noliprel A and consult a doctor. See also the section "Possible side effects».
You should tell your doctor if you think you are (or might become) pregnant. Noliprel A is not recommended for early pregnancy and should not be taken beyond 3 months of pregnancy as it may cause serious harm to the baby (see "Pregnancy and lactation").
When you are taking Noliprel A, you should also inform your doctor or medical staff of the following:
- if you are going to have anesthesia or major surgery,
- if you have recently had diarrhea or vomiting or dehydration,
- if you are undergoing dialysis or LDL apheresis (hardware removal of cholesterol from the blood),
- if you are undergoing desensitization, which should reduce allergic reactions to bee or wasp stings,
- if you are undergoing a medical examination that requires the administration of an iodine-containing radiopaque substance (a substance that makes it possible to internal organs, such as the kidneys or stomach, using x-rays).
- if you experience changes in vision or pain in one or both eyes while taking Noliprel A. This may be a sign of developing glaucoma or high blood pressure in the eye(s). You should stop taking Noliprel A and contact your doctor.
Athletes should be aware that Noliprel A contains an active substance (indapamide), which can give positive reaction during doping control.

Children and teenagers
Noliprel A should not be given to children and adolescents.

Noliprel A contains lactose monohydrate.
If you have been told by your doctor that you have an intolerance to some sugars, talk to your doctor before taking this medicine.

Other drugs and Noliprel A

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.
Avoid concomitant use of Noliprel A with the following drugs:
- lithium (used to treat mania and depression),
- aliskiren (hypertension medicine) if you do not suffer from diabetes or impaired renal function,
- potassium-sparing diuretics (eg, triamterene, amiloride), potassium salts, and other drugs that can increase your body's potassium levels (eg, heparin and cotrimoxazole, also known as the trimethoprim/sulfamethoxazole combination),
- estramustine (used in the treatment of cancer),
- other drugs for high blood pressure: angiotensin-converting enzyme inhibitors and angiotensin receptor blockers.
Treatment with Noliprel A may be affected by other medications.
Your doctor may change the dose and/or take other precautions if necessary. Be sure to tell your doctor if you are taking any of the following medications, as special care should be taken when taking them:
- other drugs that are used in the treatment of hypertension, including angiotensin II receptor blockers (ARBs), aliskiren (see also instructions under the headings "Do not take this drug", "Be especially careful when taking Noliprel A"), or diuretics (drugs that increase the amount of urine excreted by the kidneys)
- potassium-sparing drugs used in the treatment of heart failure: eplerenone and spironolactone at doses of 12.5 to 50 mg / day,
- drugs most commonly used to treat diarrhea (racecadotril) or to prevent rejection of organ transplants (sirolimus, everolimus, temsirolimus and other drugs belonging to the class of so-called mTor inhibitors). See section "Special instructions and precautions",
- a combination of sacubitril / valsartan used to treat chronic heart failure (see "Do not take this drug" and "Special instructions and precautions"),
- anesthetic drugs,
- iodine-containing radiopaque substances,
- moxifloxacin, sparfloxacin (antibiotics that are used to treatment of infections),
- methadone (used to treat drug addiction),
- procainamide (for the treatment of irregular heart rate),
- allopurinol (used to treat gout)
- mizolastine, terfenadine and astemizole ( antihistamines to treat hay fever or allergies),
- corticosteroids, which are used to treat a variety of conditions, including severe asthma and rheumatoid arthritis,
- immunosuppressive drugs used to treat autoimmune disorders or after transplant surgery to prevent rejection (eg cyclosporine, tacrolimus),
- drugs prescribed for cancer treatment,
- erythromycin intravenously (antibiotic),
- halofantrine (used to treat certain types of malaria),
- pentamidine (used for pneumonia treatment),
- gold injections (used to treat rheumatoid arthritis),
- vincamine (used to treat clinically significant cognitive impairment in older patients, including memory loss),
- bepridil (used for treatment of angina pectoris),
- drugs prescribed for the treatment of cardiac arrhythmias (for example, quinidine, hydroquinidine, disopyramide, amiodarone, sotalol),
- cisapride, diphemanil (used to treat gastrointestinal disorders),
- digoxin and other cardiac glycosides (for the treatment of heart disease),
- baclofen (for the treatment of muscle stiffness that occurs with certain diseases, such as multiple sclerosis),
- drugs for the treatment of diabetes, such as insulin, metformin and gliptins,
- calcium, including calcium supplements,
- stimulant laxatives (eg senna)
- non-steroidal anti-inflammatory drugs (eg ibuprofen) or high doses of salicylates (eg aspirin),
- amphotericin B intravenously (for the treatment of serious fungal diseases),
- drugs for the treatment of mental illness such as depression, anxiety, schizophrenia, etc. (for example, tricyclic antidepressants, antipsychotics (such as amisulpride, sulpiride, sultopride, tiapride, haloperidol, droperidol)),
Tetracosactide (used to treat Crohn's disease)
- trimethoprim (to treat infections),
- vasodilators, including nitrates (drugs that cause blood vessels to dilate),
- medicines used to treat low blood pressure, shock or asthma (eg ephedrine, norepinephrine or epinephrine).

Taking Noliprel A with food and drink
It is preferable to take Noliprel A before meals.

Pregnancy and lactation

If you are pregnant or breastfeeding, think or plan to become pregnant, ask your doctor or pharmacist for advice before taking this medicine.
Pregnancy
You should tell your doctor if you think you are (or might become) pregnant. Your doctor will advise you to stop taking Noliprel A before becoming pregnant or as soon as you know you are pregnant; your doctor will advise you to take another drug instead of Noliprel A. Noliprel A is not recommended in early pregnancy, and it should not be taken if the pregnancy is more than 3 months old, as taking it if the pregnancy is more than 3 months old can cause serious harm to the baby.
Lactation
You should not take Noliprel A if you are breastfeeding.
Tell your doctor right away if you are breastfeeding or about to start breastfeeding.
Consult your physician immediately.

Driving vehicles and operating mechanisms

Noliprel A usually does not affect the reaction rate, but in some patients, due to low blood pressure, various reactions may occur, for example, dizziness or weakness. As a result, the ability to drive a car or other mechanisms may be impaired.

How to take the drug

Always follow the instructions of your doctor or pharmacist when taking a medicine. If you are in doubt about the correct use of the drug, you should consult your doctor or pharmacist. The recommended dose is 1 tablet per day. Your doctor may increase your dose to 2 tablets per day or change your regimen if you have impaired kidney function. It is preferable to take the tablets in the morning, before meals. Swallow the tablet with a glass of water.
The score on the tablet does not imply the division of the tablet.
If you take more Noliprel A than recommended
If you have taken too many tablets, contact the nearest emergency room or tell your doctor immediately. The most likely effect in case of an overdose is a decrease in blood pressure. If you have low blood pressure (symptoms such as dizziness or fainting), lie down and elevate your legs, this may help you.
If you forget to take Noliprel A
It is important to take the drug every day, as the regularity of the dose makes the treatment more effective. However, if you forget to take a dose of Noliprel A, take your next dose at the usual time. Do not double the next dose.
If you stop taking Noliprel A
Since antihypertensive treatment usually lasts a lifetime, you should consult your doctor before stopping the drug.
If you have any further questions about taking this medicine, ask your doctor or pharmacist.

Possible side effect

Like all medicines, Noliprel A can cause side effects, although not everybody gets them.
If you experience any of the following side effects, which may be serious, stop taking the drug immediately and contact your doctor immediately:
- severe dizziness or loss of consciousness caused by low blood pressure (common - occurs in no more than 1 patient in 10),
Bronchospasm (chest tightness, wheezing and shortness of breath) (uncommon) (may affect up to 1 in 100 people)
- swelling of the face, lips, oral cavity, tongue or throat, shortness of breath (angioneurotic edema) (see section "Special instructions and precautions") (infrequent) (occurs in up to 1 patient in 100),
- severe skin reactions, including erythema multiforme (skin rash, often beginning with the appearance of red, itchy areas on the face, arms and legs) or intense skin rashes, urticaria, redness of the skin over the entire surface of the body, severe itching, blistering, peeling and swelling of the skin, inflammation of the mucous membranes (Stevens-Johnson syndrome) or other allergic reactions (very rare) (occur in up to 1 in 10,000 people),
- cardiovascular disorders (irregular heartbeat, angina pectoris (chest, jaw and back pain caused by physical activity), heart attack) (very rare) (may affect up to 1 in 10,000 people),
weakness in the arms or legs, trouble speaking, which may be a sign of a stroke (very rare) (may affect up to 1 in 10,000 people)
- inflammation of the pancreas, which can cause severe pain in the abdomen and back, accompanied by poor health (very rare) (occurs in less than 1 patient in 10,000),
- yellowing of the skin or whites of the eyes (jaundice), which may be a sign of hepatitis (very rare) (affects up to 1 in 10,000 people),
- life-threatening arrhythmia (frequency unknown),
- brain disease caused by impaired liver function (hepatic encephalopathy) (frequency unknown).
In descending order of frequency, side effects can be as follows:
- Frequent (occurs in up to 1 in 10 patients):
skin reactions in people with a predisposition to allergic and asthmatic reactions, headache, feeling dizzy, dizziness, tingling in the extremities, visual disturbances, ringing in the ears (feeling of ringing in the ears), cough, shortness of breath (shortness of breath), digestive system disorders (nausea, vomiting, abdominal pain, change in taste, dyspepsia or indigestion, diarrhea, constipation), allergic reactions (such as skin rashes, itching), cramps, feeling tired.
- Uncommon (occurs in up to 1 in 100 patients):
mood swings, sleep disturbances, hives, purpura (red dots on the skin), patchy blisters on the skin, kidney problems, impotence, sweating, increased eosinophils (a type of white blood cell), laboratory changes: high blood potassium, decreasing after stopping therapy, low sodium levels, drowsiness, loss of consciousness, palpitations (feeling your own heart beat), tachycardia (rapid heartbeat), hypoglycemia (very low blood sugar) in diabetic patients, vasculitis (inflammation of the blood vessels), dryness in the mouth, photosensitivity reactions (increased sensitivity of the skin to the sun), arthralgia (joint pain), myalgia (muscle pain), chest pain, malaise, peripheral edema, fever, increased blood urea and creatinine, falling.
- Rare (occurs in up to 1 in 1,000 patients):
deterioration of the course of psoriasis, changes in laboratory parameters: increased activity of liver enzymes, high levels of bilirubin, fatigue.
- Very rare (occurs in up to 1 in 10,000 people):
confusion, eosinophilic pneumonia (a rare form of pneumonia), rhinitis (nasal congestion or runny nose), severe kidney problems, blood disorders such as a decrease in the number of white and red blood cells, a decrease in hemoglobin, a decrease in the number of platelets, high levels of calcium in the blood, liver dysfunction.
- Frequency not known (frequency cannot be determined from the available data):
abnormalities in the work of the heart on the ECG, changes in laboratory parameters: low sodium, high levels of uric acid and blood sugar, myopia (myopia), blurred vision, visual disturbances. If you suffer from systemic lupus erythematosus (collagenosis), the disease may worsen.
There may also be abnormalities in the blood, kidneys, liver or pancreas and abnormalities in laboratory parameters (blood tests). Your doctor may order a blood test to monitor your condition.
Symptoms such as reduced urine output (darkening color of urine), nausea or vomiting, muscle cramps, confusion, and seizures may be caused by inadequate ADH (antidiuretic hormone) secretion. If you experience these symptoms, contact your doctor as soon as possible.
Reporting side effects
If you experience any side effects, contact your doctor or pharmacist. This also applies to the occurrence of any possible side effects not listed in this leaflet. You can also report side effects directly through the public reporting system. By reporting side effects, you help gather more information about the safety of a drug.

Name:

Noliprel (Noliprel)

Pharmacological
action:

Noliprel - perindopril combination(is an angiotensin-converting factor inhibitor) and indapamide(a diuretic of the sulfonamide group).
The mechanism of the pharmacological action of the drug is due to a combination of individual effects of these components.
The combination of perindopril-indapamide potentiates pharmachologic effect each of these drugs.
Noliprel refers to antihypertensive drugs.
Reduces both arterial diastolic and systolic pressure.
The effect of noliprel is dose-dependent.

Taking the drug is not accompanied by increased heart rate.
Adequate clinical effect develops after 1 month. after starting Noliprel. The duration of antihypertensive action is 1 day.
After stopping the use of noliprel withdrawal syndrome does not develop.
The severity of left ventricular hypertrophy, the total precardiac and postcardiac load (due to the vessels of the muscles and kidneys) are reduced.
Noliprel does not affect metabolic processes (metabolism of lipids and carbohydrates).
Improves vascular elasticity(large arterial trunks), the structure of the wall of small-caliber vessels is restored.
Perindopril reduces the secretion of aldosterone, which, by the mechanism of negative feedback enhances the activity of renin in the blood.

It affects the lowering of blood pressure in both individuals with low and in individuals with normal renin activity in the blood.
Has a vasodilating effect.
Indapamide synergistically with perindopril reduces hypertension, reduces the risk of hypokalemia.
According to the mechanism of action, indapamide is closer to thiazide diuretics: it is an inhibitor of the reabsorption of sodium ions of the cortical segment of the loop of Gentle.
Consequently, there is an increase in urination and urinary excretion of chloride ions, sodium (in a small amount - potassium, magnesium ions).
Reduces blood pressure at a dose that has little to no effect on urinary excretion. Reduces vascular hyperreactivity when exposed to adrenaline.
Does not change the amount of lipids in the blood (LP and VP lipoproteins, triglycerides, cholesterol). Does not affect carbohydrate metabolism.

Indications for
application:

Essential arterial hypertension.

Mode of application:

Noliprel
Patients with creatinine clearance ≥ 30 ml / min dose reduction is not required.
Noliprel - Forte- 1 tablet per day, preferably in the morning.
Patients with a creatinine clearance of 30-60 ml / min dose reduction is not required.
With clearance ≥ 60 ml / day, treatment should be carried out under the control of the level of potassium and creatinine in the blood serum.

Side effects:

Actions due to noliprel
Water-electrolyte balance: perindopril increases the concentration of potassium by inhibiting the renin-angiotensin-aldosterone system.
This property reduces the loss of potassium due to the action of indapamide.
The decrease in potassium content when taking noliprel is< 3,4 ммоль/л через 3 месяца лечения у 2% пациентов.
The average concentration of potassium after 3 months of treatment was 0.1 mmol/L.

Side effects of perindopril
Cardiovascular system: too much hypotension, orthostatic collapse, very rarely - myocardial infarction, arrhythmia, stroke.
urinary and reproductive system: in patients with glomerular nephropathy, proteinuria is possible, worsening of kidney function (rarely), acute renal failure has sometimes been recorded. At kidney failure, stenosis of the renal arteries, the use of other diuretics, a slight increase in creatinine in the blood and urine is possible (it disappears after discontinuation of the drug). Possible decrease in potency.
Central and peripheral nervous system: increased fatigue, headaches, dizziness, asthenia, impaired vision and hearing (ringing in the ears), mood lability, sleep disturbance, loss of appetite, paresthesia, convulsions, changes in taste sensations; in some cases - stupor.

Respiratory system: rarely - shortness of breath, dry cough, bronchospasm, nasal discharge.
Gastrointestinal tract: dyspepsia (diarrhea or constipation), vomiting or nausea, abdominal pain, dry mouth (rarely), increased transaminase activity, cholestasis, pancreatitis, hyperbilirubinemia.
Blood system: in patients on the background of hemodialysis or kidney transplant - anemia; rarely - thrombocytopenia, decrease in hematocrit, pancytopenia, agranulocytosis; hemolytic anemia.
Allergic reactions: rash, itching, angioedema, urticaria.

Side effects of indapamide
Gastrointestinal tract: dyspepsia (diarrhea or constipation), vomiting or nausea, dry mouth (rarely), pancreatitis (in isolated cases), with concomitant liver failure - hepatic encephalopathy.
Central and peripheral nervous system: manifestations usually disappear after withdrawal (headaches, dizziness, asthenic syndrome, paresthesia).
Water and electrolyte balance: patients at risk develop hypokalemia, hyponatremia, hypovolemia, dehydration. The result is orthostatic collapse. Metabolic alkalosis is quite rare (associated with excessive excretion of chloride ions). Hypercalcemia - in some cases.

Blood system: leuko-, thrombocytopenia, agranulocytosis, hemolytic or aplastic anemia.
Biochemical picture of blood serum: hyperglycemia, an increase in the concentration of urea.
Skin system: rash, exacerbation of systemic lupus erythematosus syndrome, hemorrhagic vasculitis.
Allergic reactions: rash, urticaria.

Contraindications:

Hypersensitivity or allergy to the components of the drug or other similar agents (sulfonamides and / or ACE inhibitors);
- creatinine clearance less than 30 ml / min (renal failure);
- liver failure with a tendency to encephalopathy;
- hypokalemia;
- combination with drugs that prolong the QT interval;
- age up to 18 years;
- lactase deficiency, galactosemia, glucose or galactose malabsorption syndrome (contains lactose).

When taking Noliprel adequate dehydration of the body is required, as severe hypotension may develop.
The drug is taken under the control of electrolytes, creatinine and blood pressure.
With concomitant heart failure, it can be combined with beta-blockers.
Taking Noliprel gives a positive reaction when conducting laboratory tests for doping.
Should be careful when driving or driving high-precision mechanisms, especially in the first weeks of admission.

Interaction
other medicinal
by other means:

Noliprel is not recommended to be taken together with lithium preparations (lithium excretion is reduced and its overdose may develop). If this is not possible, continue treatment against the background of monitoring the level of lithium in the blood.
Co-administration with potassium-sparing diuretics or medicines containing potassium, can lead to an increase in the concentration of potassium in the blood(even to death).
Co-administration of noliprel with potassium-sparing diuretics and potassium preparations is recommended only in case of hypokalemia (when monitoring the level of potassium in the blood and ECG).
In patients with diabetes mellitus and renal insufficiency, in this case, the occurrence of both hypo- and hyperkalemia is not excluded.

The combination of indapamide with an intravenous form of erythromycin, vincamine, sultopride, bepridil, halofantrine, antiarrhythmic drugs (IA and III classes) provokes arrhythmia according to the "pirouette" variant, especially against the background of prolongation of the QT interval, bradycardia and hypokalemia.
Rarely, the development of hypoglycemia during the use of insulin is possible, which requires dose adjustment of the latter. Non-steroidal anti-inflammatory drugs inhibit the property of noliprel to reduce blood pressure. In case of dehydration of the body, this combination can cause kidney failure or impaired renal function.
The combination of noliprel-baclofen is synergistic (it is necessary to adjust the dose of noliprel). Antipsychotics and tricyclic antidepressants while taking noliprel cause orthostatic hypotension.

Water and electrolyte retention when co-administered with noliprel with glucocorticosteroids, mineralocorticoids, stimulant laxatives, amphotericin B and tetracosactide leads to a decrease in the hypotensive effect of the drug and an increased risk of hypokalemia.
The toxic effect of cardiac glycosides may increase against the background of noliprel due to the development of hypokalemia (control of the ECG and the content of potassium in the blood).
combination with metformin causes lactic acidosis, especially when the content of creatinine in the blood is more than 135 µmol / l in men and 110 µmol / l in women.
Before using iodine-containing radiopaque substances against the background of noliprel, adequate hydration of the body is necessary (risk of developing renal failure).
Simultaneous intake of calcium salts causes hypercalcemia. With the combination of noliprel-cyclosporine, an increase in serum creatinine is possible.

Pregnancy:

Contraindicated taking Noliprel during pregnancy and in lactating women (increased neonatal mortality, anomalies in the development of the musculoskeletal system, renal failure in newborns, severe oligohydramnios, patent ductus arteriosus, intrauterine fetal death).
If a pregnant woman took noliprel before the fact of pregnancy, the reception should be stopped immediately.
There is no need for an abortion, but the woman should be aware of possible consequences.

Overdose:

Symptoms: hypotension, vomiting, nausea, dizziness, sleep disturbances, mood lability, signs of renal failure, electrolyte imbalance.
Treatment: gastric lavage, intake of enterosorbents, normalization of water-electrolyte balance. Noliprel metabolites are eliminated by dialysis.

- Excipients: MCC; lactose monohydrate; magnesium stearate; silicon dioxide colloidal hydrophobic.

A drug Noliprel offered in several different types. The composition of all variations of the drug includes and indapamide . Combination tablets Noliprel contain 2 mg of perindopril and 0.625 mg of indapamide. The composition of the tool Noliprel Forte includes 4 mg of perindopril and 1.25 mg of indapamide. Noliprel A contains 2.5 mg of perindopril and 0.625 mg of indapamide. In this preparation, perindopril is associated with the amino acid arginine, which favorably affects the state of the cardiovascular system.

In tablets Noliprel A Forte - 5 mg of perindopril and 1.25 mg of indapamide. In the facility Noliprel A Bi-forte - 10 mg of perindopril and 2.5 mg of indapamide.

As additional substances in the composition of the drug Noliprel there is magnesium stearate, lactose monohydrate, colloidal hydrophobic silicon dioxide, microcrystalline cellulose.

Release form

The drugs are available in the form of oblong white tablets, on both sides of the risk tablet. Fit in a carton of 14 and 30 pcs. in blisters.

pharmachologic effect

Noliprel is a combination drug that contains perindopril (an angiotensin-converting factor inhibitor) and indapamide (a diuretic that is part of the sulfonamide group).

The pharmacological action of the drug is determined by a combination of some of the effects of these components. In this combination, both components mutually increase the effect. Noliprel is an antihypertensive drug that effectively lowers both diastolic and systolic blood pressure. The severity of the effect depends on the dose. After taking the drug, there is no palpitations. The clinical effect is noted 1 month after the treatment was started. The antihypertensive effect persists for one day. After therapy is suspended, the patient does not have a withdrawal syndrome. In the process of treatment, the severity of left ventricular hypertrophy decreases, the degree of total precardiac and postcardiac load decreases. Large vessels become more elastic, the walls of small vessels are restored. The drug does not affect the metabolic processes that occur in the body.

Perindopril reduces the level of aldosterone secretion, as a result of which the activity of renin in the blood increases. decreases in people with different levels activity . Under the influence of this component, the vessels expand.

When taking the drug, the likelihood is reduced hypokalemia . The mechanism of action of indapamide is similar to thiazide diuretics: urination and urinary excretion of sodium and chlorine ions will increase.

Hyperreactivity of vessels under the influence of adrenaline is reduced. The amount of lipids in the blood does not change.

Pharmacokinetics and pharmacodynamics

The pharmacokinetics of perindopril and indapamide when used in combination is the same as when they are used separately. After ingestion, perindopril is rapidly absorbed. The level of bioavailability is 65-70%. About 20% of the total absorbed perindopril is later converted to perindoprilat (active metabolite). The maximum concentration of perindoprilat in plasma is observed after 3-4 hours. Less than 30% binds to blood proteins, depending on plasma concentration. The half-life is 25 hours. The substance penetrates through the placental barrier. Perindoprilat is excreted from the body through the kidneys. Its half-life is 3-5 hours. There is a slower introduction of perindoprilat in the elderly, as well as in patients with heart failure and renal failure.

Before using iodine-containing radiopaque preparations with Noliprel, adequate hydration of the body must be carried out.

The simultaneous use of calcium salts can provoke hypercalcemia.

Noliprel's analogs

Analogues of Noliprel, as well as drugs Noliprel A Bi Forte, Noliprel A Forte are other drugs that are used to lower blood pressure and contain similar active ingredients, that is, perindopril and indapamide. These medicines are Ko-prenesa , etc. The price of analogues may be lower than the cost of Noliprel and its varieties.

children

The drug is not prescribed for the treatment of children under 18 years of age, since there is no accurate data on the efficacy and safety of such treatment.

With alcohol

You should not take alcohol during the period of Noliprel therapy.

During pregnancy and lactation

And for mothers during a baby with breast milk, the use of Noliprel is contraindicated. Systematic treatment with these drugs can lead to the development of abnormalities and diseases in the fetus, as well as lead to fetal death. If a woman finds out about pregnancy during the treatment period, there is no need to terminate the pregnancy, but the patient should be aware of the possible consequences. In the event of an increase in blood pressure, another antihypertensive therapy is prescribed. If a woman took this drug in the second and third trimesters, an ultrasound of the fetus should be performed to assess the condition of his skull and kidney function.

Newborns whose mothers took the drug may suffer from manifestations of arterial hypotension, so they need to ensure the constant supervision of specialists.

When breastfeeding, the drug is contraindicated, so lactation for the duration of therapy should be stopped or another drug should be selected.

Content

With hypertension, Noliprel A is used as monotherapy, which normalizes the state of the cardiac system and blood vessels, allowing you to do without surgery for a long time. The drug gently lowers blood pressure, can be used for a long time as directed by the doctor. Read the instructions for its use.

Instructions for use Noliprel A

According to the generally accepted medical classification, the drug Noliprel A refers to antihypertensive drugs with a complex active substances. It is formed by the components of perindopril arginine and indapamide. Due to them, the drug has the ability to reduce systolic and diastolic pressure with a gradual accumulation of the effect. After a month of admission, the patient's health stabilizes.

Composition

Three types of the drug are produced, all of them are presented in the form of tablets. The composition and description of funds are indicated in the table:

Pharmacological properties

The drug Noliprel A is considered combined, pharmacological and pharmacokinetic properties depend on two components:

Indications for use

The instructions for use indicate that the drug Noliprel A is used for common (96%) essential hypertension to reduce pressure. Second indication for use medicinal product serves to prevent the development of microvascular complications in the kidneys in patients with arterial hypertension and type 2 diabetes mellitus, as well as macrovascular complications in cardiovascular diseases.

Method of application and dosage

Three forms of release of the drug Noliprel are used in different doses. General rules for taking medications are ingestion before meals, preferably in the morning. The preparations are washed down with clean water. The course, regimen and frequency of use of each type of tablet depend on the individual characteristics of the patient and are prescribed by the attending physician according to indications.

Noliprel A tablets

The medicine for pressure Noliprel A is prescribed in a tablet once a day. It is advisable to take only this drug, but in case of clinical need, it is allowed to combine it with combined agents. complex treatment. To reduce the risk of complications from the cardiovascular system, 1 tab. times/day, after 3 months. the dose can be increased to 2 tab. every day or one tablet of Forte once a day.

Noliprel A Forte

Tablets Forte Noliprel from pressure are taken orally before meals, one tablet once a day. If possible, dose selection begins with a single drug, and after monotherapy, if necessary, a combined treatment is prescribed. To eliminate the risk of complications in the treatment of patients with diabetes mellitus, the dose is a tablet / day, does not change throughout the entire duration of therapy.

Noliprel A Bi-forte

Like the previous forms of preparations, Noliprel A Bi-forte is prescribed as a tablet once / day in the morning before meals. The medicine is prescribed based on the indications of systolic and diastolic blood pressure. Elderly patients dose calculation is based on age, body weight and gender. Dosage adjustment is also needed for impaired renal function.

special instructions

Before using Noliprel A, you need to study the special instructions for taking the drug, which are in the instructions section of the same name:

• the use of the drug can cause hypokalemia, impaired water and electrolyte balance, neutropenia, agranulocytosis, thrombocytopenia, hepatic encephalopathy, anemia, dry cough, jaundice, exacerbations of gout, photosensitivity;
• therapy is contraindicated in severe renal failure;
• when signs of renal failure appear, treatment is stopped;
• lactose is present in the composition, so the remedy cannot be prescribed for hereditary intolerance to lactose and galactose, lactase deficiency and glucose-galactose malabsorption;
• in rare cases, treatment may be accompanied by hypersensitivity, the development of angioedema (if it affects the larynx, there is a risk of death due to suffocation, Epinephrine is required);
• while taking Noliprel against the background of desensitizing therapy, hemodialysis, anaphylactoid reactions may develop;
• the medication is prescribed with caution to elderly patients, with atherosclerosis, renovascular hypertension, heart failure, diabetes mellitus, anemia after kidney transplantation, left ventricular outflow tract obstruction;
• general anesthesia markedly reduces blood pressure;
• indapamide gives a positive reaction in a blood test for doping control in athletes;
• the drug does not affect the ability to drive a car and reduce the speed of psychomotor reactions, but there are several cases with a decrease in concentration while taking the drug.

During pregnancy

Doctors forbid taking Noliprel A to pregnant and lactating mothers. When carrying a child, the drug can have fetotoxicity in relation to the fetus, in the second and third trimesters it can lead to impaired kidney development, ossification of the skull bones (ossification process involving calcium). Indapamide, when used in the 3rd trimester, can cause hypovolemia in a woman and ischemia in the fetus.

When planning pregnancy or its onset during treatment with a drug, therapy is urgently canceled and another, permitted, is prescribed. When using the medicine during breastfeeding the newborn may develop hypokalemia, nuclear jaundice, hypersensitivity to sulfonamide derivatives. Indapamide is able to reduce the amount breast milk or completely suppress lactation.

In childhood

Due to the lack of information on the safety and effectiveness of the drug, it is contraindicated for use in children under the age of 18 years. Children and adolescents should not receive the drug due to the possible development of hypersensitivity and allergic reactions to sulfonamide derivatives. The ban on taking Noliprel is justified by the fact that at a young age there is a small likelihood of developing hypertension.

drug interaction

Taking the drug Noliprel has permitted, permitted with caution and prohibited combinations with medicines:

• lithium preparations increase the concentration of lithium in plasma, lead to toxic effects;
• Baclofen, tricyclic antidepressants, antipsychotics, antihypertensive drugs, vasodilators, general anesthesia enhance the antihypertensive effect;
• non-steroidal anti-inflammatory drugs, including acetylsalicylic acid, corticosteroids, tetracosactide, sympathomimetics reduce the antihypertensive effect;
• double blockade leads to hyperkalemia, hypotensive effect and hyperkalemia;
• potassium-sparing diuretics, potassium preparations lead to an increase in the concentration of potassium in the blood serum, this threatens with death;
• Estramustine, gliptins increase the risk of developing angioedema;
• Noliprel increases the hypoglycemic effect of insulin, oral sulfonylurea derivatives, the toxicity of cardiac glycosides;
• Allopurinol, cytostatics, immunosuppressants, corticosteroids, Procainamide increase the risk of developing leukopenia;
• taking thiazide and loop diuretics leads to hypovolemia;
• gold preparations lead to nitrite-like reactions.

Alcohol compatibility

During treatment with Noliprel A, alcohol intake is prohibited, since ethanol increases the risk of hepatotoxicity and further increases blood pressure. As a result of the combination with alcohol, the load on the liver increases, the risk of drug overdose increases, poisoning occurs with nausea, vomiting, and pain in the stomach. Patients receiving tablets should be warned about the incompatibility of the components with ethanol.

Side effects

Taking pills, the patient sometimes experiences the following side effects from different systems. It can be:

• anemia, paresthesia, pain syndromes, asthenia;
• dizziness, vertigo, sleep disturbance, confusion;
• fainting, visual disturbances, tinnitus, bradycardia;
• the agent can cause arrhythmia, myocardial infarction;
• dry cough, shortness of breath, bronchospasm, pneumonia, rhinitis;
• sometimes the reception is accompanied by tachycardia, angina pectoris,
• dryness of the oral mucosa, nausea, abdominal and epigastric pain;
• vomiting, dyspepsia, constipation, decreased appetite, taste disturbance, diarrhea;
• jaundice, hepatitis, pancreatitis, skin rash;
• itching, purpura, erythema, necrolysis, photosensitivity, allergic reactions;
• muscle spasms, kidney failure, impotence, increased sweating.

Terms of sale and storage

The drug can only be bought with a prescription, it is stored in a dry, dark place without children's access at temperatures up to 25 degrees for three years.

Analogues

On sale there are synonyms and substitutes for Noliprel. The former include funds with the same active ingredients, to the second - with the same antihypertensive effect. Direct and indirect analogues of the drug are:

• Co Prenessa;
• Perindopril;
• Prestarium;
• Prilamide;
• Erupnil;
• Akkuzid;
• Ampril;
• Euroramipril;
• Mipril;
• Prevencor;
• Ramag;
• Ramazid.

Combined preparation consisting of 2 active substances, complementary pharmacological effects, and used for the treatment of arterial hypertension.

Noliprel (Bi) Forte is a drug with a double dosage of active substances (Perindopril 4 mg + Indapamide 1.25 mg). If necessary, use maximum doses in high-risk patients (diabetes mellitus, smoking, hypercholesterolemia), Bi-forte (Perindopril 10 mg + Indapamide 2.5 mg) is prescribed.

ATX

C09BA04 Perindopril and diuretics.

Forms of release and composition

Active substance: Perindopril 2 mg + Indapamide 0.625 mg.

pharmachologic effect

Contributes to the normalization of both systolic and diastolic blood pressure (BP) within 24 hours. Full effects are realized after a month of regular use. Completion of the reception does not lead to the development of withdrawal syndrome

The drug reduces the rate of myocardial remodeling processes, reduces the resistance of peripheral arteries, without affecting the level of lipids and blood glucose.

Perindopril inhibits the activity of the enzyme that converts angiotensin I into the active enzyme angiotensin II, which is a powerful vasoconstrictor. ACE also destroys bradykinin, a biologically active vasodilator. As a result of vasodilation, vascular resistance decreases and blood pressure decreases.

Indapamide is a diuretic from the thiazide group. The diuretic effect and hypotensive properties are realized by reducing the reabsorption of sodium ions in the kidneys. There is an increase in the excretion of sodium in the urine, as a result of which the resistance of the arteries decreases and the volume of blood ejected by the heart increases.

Co-administration of perindopril and indapamide enhances the effectiveness of therapy hypertension, reduces the risk of hypokalemia ( side effect taking diuretics).

Pharmacokinetics

The pharmacokinetics of active substances does not differ when they are used together or separately.

When taken orally, approximately 20% of the total dose of perindopril is metabolized into the active form. This value may decrease when consumed with food. The maximum content in the blood is fixed 3-4 hours after ingestion. A small part of perindopril binds to blood proteins. It is excreted from the body with urine.

Elimination of perindopril may be delayed in renal failure, especially in elderly patients.

Indapamide is absorbed from the gastrointestinal tract, after 60 minutes the maximum content of the active metabolite is recorded in the blood plasma. 80% of the drug is transported with blood albumin. It is excreted by filtration through the kidneys in the urine, 22% is excreted in the feces.

Indications for use

Hypertension (arterial hypertension).

Contraindications

• individual intolerance to thiazide diuretics, ACE inhibitors;
• the level of potassium in the blood is less than 3.5 mmol / l;
• severe renal dysfunction with a decrease in glomerular filtration rate less than 30 ml / min;
• atherosclerotic stenosis of the arteries of both kidneys or stenosis of the artery of the only functioning kidney;
• severe liver dysfunction;
• simultaneous administration of drugs with a proarrhythmic effect;
• pregnancy;
• breastfeeding period.

How to use

Before starting therapy, you should read the instructions for use and consult a specialist.

The drug is taken 1 tablet orally 1 time per day, preferably in the morning on an empty stomach.

Can I split the pill

You can divide, the tablet has a risk on both sides.

Forms of the drug with the prefix "forte" do not have risks and are film-coated. They cannot be divided.

How to treat type 2 diabetes

Does not affect glucose metabolism, metabolically neutral. For patients with diabetes, the use is possible according to the standard scheme.

Side effects

Gastrointestinal tract

Pain in the abdomen, accompanied by nausea and vomiting; stool disorders; dry mouth; the appearance of yellowness of the skin; an increase in laboratory parameters of the liver and pancreas in the blood; with concomitant liver dysfunction, encephalopathy may develop.

Hematopoietic organs

Anemia (in patients with severe concomitant kidney disease); decrease in the amount of hemoglobin, platelets, leukocytes, granulocytes; decrease in hematocrit; hemolytic anemia; aplastic anemia; hypofunction of the bone marrow.

central nervous system

Headaches, dizziness, weakness, fatigue, irritability, tearfulness, emotional instability, disorders of the auditory and visual analyzer, insomnia, increased peripheral sensitivity.

From the respiratory system

Coughing that appears with the start of use, persists throughout the entire time of taking the drug and disappears after its withdrawal; difficulty breathing; spasm respiratory tract; rarely - mucous discharge from the nose.

From the urinary system

Decreased kidney function; the appearance of protein in the urine; in some cases - acute renal injury; changes in the level of electrolytes: a decrease in the content of potassium in the blood plasma, accompanied by hypotension.

allergies

Skin itching, rash like urticaria; angioedema; hemorrhagic vasculitis; rarely - erythema multiforme.

special instructions

Alcohol compatibility

Joint use with ethanol derivatives can contribute to episodes of a sharp drop in blood pressure, vascular collapse. Simultaneous reception is not recommended.

Influence on the ability to control mechanisms

At the beginning of taking the drug, you should be careful when driving vehicles and doing work that requires attention and quick response.

In violation of liver function

May cause the development of cholestatic jaundice with a sharp increase in the activity of liver enzymes. If this condition occurs, it is necessary to stop the drug and consult a doctor.

With kidney failure

In the presence of diseases of the urinary system with a pronounced deterioration in the filtration function, an increase in the content of creatinine, uric acid and urea in plasma, an increase in the content of potassium is possible.

With a decrease in creatinine clearance less than 30 ml / min. the drug should be excluded from the therapeutic regimen.

During pregnancy and lactation

The use is contraindicated due to the lack of studies on the effect of the drug on the fetus. Women in the II and III trimester should be especially careful.

In old age

Before you start taking it is necessary to monitor the indicators of kidney function (creatinine, urea), liver enzymes (AST, ALT), electrolytes. Therapy begins with low doses and is selected individually, taking into account the reduction in blood pressure.

Appointment Noliprel children

Contraindicated for children and adolescents under 18 years of age due to the lack of data on its safety in this group of patients.

Overdose

Signs of overdose: severe hypotension, nausea, vomiting, convulsive syndrome, anuria, slowing of the pulse.

Emergency care: gastric lavage, administration of activated charcoal, correction of blood electrolytes. In case of hypotension, the patient should be placed in a supine position with raised legs.

Interaction with other drugs

Carefully

When combined with antidepressants or antipsychotics, there may be an increase in the effect on blood pressure with the development of hypotension.

Glucocorticosteroids reduce the antihypertensive effect.

Against the background of taking, it is possible to increase the hypoglycemic effect of insulin and sulfonylurea derivatives.

Combinations with cardiac glycosides require careful monitoring of potassium levels and ECG, correction of hypovolemia.

With the planned X-ray contrast study, it is necessary to prevent dehydration.

With the simultaneous use of certain drugs (Erythromycin, Amiodarone, Sotalol, Quinidine), the risk of ventricular arrhythmias increases.

Sharing with lithium preparations is not allowed due to the high risk of lithium overdose.

With reduced renal function, combination with diuretics that promote electrolyte retention and infusions of potassium chloride should be avoided.

With simultaneous ingestion with NSAIDs against the background of dehydration, it can lead to an acute pathology of kidney filtration.

Analogues

Ko-Perineva, Ko-Parnavel, Perindapam, Perindid.

Conditions for dispensing from a pharmacy

Released by prescription.

Price for Noliprel

The cost of one package of the drug (30 tablets), designed for a month of treatment, starts from 470 rubles.

Storage conditions of the drug Noliprel

Keep out of the reach of children. Special storage conditions are not required.