How to take Noliprel before meals or after. Noliprel - instructions for use, analogues, use, indications, contraindications, action, side effects, dosage, composition. If the allowable dose is exceeded, it may occur

One of the most powerful antihypertensive drugs. Helps in severe cases of hypertension and is sold in almost every pharmacy. The price of the drug is higher than most other antihypertensive drugs, but its effectiveness justifies the high cost.

Dosage form

The drug is available in the form of oral tablets. Depending on the dosage of the active substances, pharmacies present Noliprel varieties - Noliprel A, and Noliprel A Bi-forte. Patients can buy packages with different amounts of the drug, but the most popular is the jar of Noliprel, which contains 30 tablets.

Description and composition

The drug contains two active ingredients - arginine and. They can be used to reduce pressure on their own, but in combination they significantly increase the overall effectiveness of the treatment.

It belongs to the group of ACE inhibitors. Its action is manifested due to the ability to inhibit the chain of enzyme transformation, which leads to an increase in pressure. After taking it is observed:

Decreased production of aldosterone.
Higher renin activity.
Decrease in vascular resistance.

The above effects are exerted by the metabolite perindoprilat, since it is itself a prodrug. Its effectiveness is not affected by the concentration of renin. The hypotensive effect will be achieved even with a low content of this substance.

It has a positive effect on the work of the heart. It reduces preload due to its vasodilating effect on the veins, and also reduces afterload due to a decrease in vascular resistance. This leads to the following positive effects:

The pressure during filling of the ventricles decreases, which reduces the workload on the heart.
Decreased peripheral vascular resistance.
The amount of cardiac output increases.
The regional blood flow in the muscles is activated.
Vasodilating action.
Restoration of elasticity of large arteries.
Decreased left ventricular hypertrophy.

- no less important component for achieving a hypotensive effect than. The substance belongs to the group of diuretics. It accelerates the excretion of sodium and chloride ions, reduces the volume of circulating fluid and enhances the effect on high blood pressure. Together with the probability of development of a hypokalemia decreases.

In the drug Noliprel, two active ingredients are presented in different quantitative ratios. The concentration and in them, respectively, is:

Noliprel A - 2.5 and 0.625 mg.
- 5 and 1.25 mg.
Noliprel A Bi-forte - 10 and 2.5.

The effect of pressure reduction is dose-dependent, so the specific type of Noliprel is selected individually for each patient. The drug reduces both systolic and diastolic pressure, while the result can be achieved in patients of any age. Efficiency does not change from the position of the patient, so Noliprel can be taken both lying down and standing up.

The maximum severity of the effect is observed approximately 4 hours after taking the tablet. A positive result persists for a day. The big advantage of Noliprel is the absence of a withdrawal syndrome.

Pharmacological group

Combined antihypertensive agent.

Indications for use

for adults

Noliprel is prescribed only for the treatment of arterial hypertension. However, it is equally effective in mild and severe disease. It is important to choose the right dose of the drug, since a large amount of diuretic does not increase its effectiveness, but increases the likelihood of adverse reactions.

for kids

Data on the safety of the drug in patients under 18 years of age is not enough, so Noliprel is not used to treat children and adolescents.

for pregnant women and during lactation

The active metabolite of Noliprel crosses the placental barrier, so the drug is not used in the treatment of pregnant women. The results of some studies have shown that there is no fetotoxic effect of Noliprel in the first 3 months of pregnancy, but at the moment it cannot be completely excluded. In the late stages of fetal formation, taking Noliprel led to developmental pathologies and complications.

If it is necessary to take Noliprel by a nursing woman, lactation must be stopped, and then treatment should be started. If the child managed to get the drug through breast milk, it is necessary to monitor his condition and be prepared for the manifestation of arterial hypotension.

Contraindications

Noliprel can not be used in the presence of the following conditions:

Hypersensitivity to ACE inhibitors and sulfanilamide diuretics.
Renal failure.
Pregnancy and.
or disorders of lactose metabolism.
Hypokalemia.
The likelihood of developing angioedema.
Renal stenosis.
Childhood.

Applications and doses

for adults

Eating negatively affects the process of converting the ACE inhibitor to perindoprilat, which leads to a weakening of the effectiveness of Noliprel. To obtain maximum effectiveness, it is recommended to take the medicine in the morning before breakfast once in a daily dose that the doctor has selected for the patient.

Side effects

Against the background of treatment with Noliprel, side effects may develop, which sometimes require discontinuation of the drug. Their severity depends on the individual characteristics of the patient. Undesirable reactions that provoke Noliprel.

Changes in blood counts, in particular anemia.
Dizziness, weakness, paresthesia, sleep disturbance.
A strong decrease in pressure, orthostatic hypotension, heart rhythm disturbances.
Dry cough, bronchospasm.
Dry mouth, abdominal pain, diarrhea, inflammatory diseases of the digestive system.
Skin rashes, itching, photosensitivity.
Swelling of the tongue, allergic reactions.
Changing ECG data.

Interaction with other drugs

(sharp pressure drop)
Non-steroidal anti-inflammatory drugs (weakening of the main effect, an increase in the likelihood of adverse reactions).
Antipsychotics (potentiation of the effect of Noliprel and a high probability of orthostatic hypotension).
Corticosteroid hormones (contribute to fluid retention and worsen the results of treatment with Noliprel).
Hypoglycemic agents (increased decrease in blood glucose concentration).
Vasodilators (increased antihypertensive effect of Noliprel).

special instructions

Renal dysfunction and heart failure require dose adjustment of the drug, as the excretion of the active metabolite slows down. The same can be observed in elderly patients.

Lactose is used as an auxiliary component, which should be remembered by patients with intolerance to this substance.

During treatment, regular monitoring of the level of potassium and other electrolytes in the blood is necessary.

The drug can cause dizziness, so drivers should stop driving for the duration of treatment.

Overdose

With a significant excess of the permitted dose, the patient has a pronounced decrease in blood pressure. It can be combined with dizziness, convulsions, confusion.

In case of overdose, it is necessary to accelerate the elimination of Noliprel from the body, for which gastric lavage, sorbents and oral rehydration agents are used. The patient is recommended to be placed on a bed with raised legs to provide access to blood to the brain.

Storage conditions

Noliprel is stored under normal temperature conditions.

Analogues

Analogues of the drug for active substances are:

Co Prenessa. The buyer has access to several dosages of the drug and packaging with a different number of tablets, which makes it possible to accurately select the drug, in accordance with the prescribed treatment regimen. A quality drug produced by the Slovenian pharmaceutical company KRKA.
/ . The drug company TEVA, the package of which contains 30 tablets. It is produced in two dosages: 2.5 mg of an ACE inhibitor and 0.625 mg of a diuretic, as well as 5 / 1.25 mg.
. A high-quality French drug, which is presented in dosages of 2.5, 5 and 10 mg.
Prilamide. Combined antihypertensive drug. Available in dosages of 2 / 0.625 mg and 4 / 1.25 mg. A prescription drug manufactured by Sandoz. In pharmacies there are large packages of en 60 tablets, which are more profitable to buy for a long course of treatment.

Price

The cost of Noliprel is an average of 647 rubles. Prices range from 466 to 1030 rubles.

Noliprel: instructions for use and reviews

Noliprel is a combined antihypertensive agent.

Release form and composition

Dosage form - tablets: oblong, white, with a dividing line on both sides (14 or 30 pieces in blisters packed in a sachet, in a carton pack 1 sachet).

Perindopril erbumine (perindopril tertbutylamine) - 2 mg, which is equivalent to 1.669 mg of perindopril base;
Indapamide - 0.625 mg.

Auxiliary components: microcrystalline cellulose, anhydrous colloidal silicon dioxide, magnesium stearate, lactose monohydrate.

Pharmacological properties

Noliprel is a combined drug, which includes indapamide (a diuretic belonging to the group of sulfonamide derivatives) and perindopril (an angiotensin-converting enzyme inhibitor). Its pharmacological properties are a combination of the individual properties of each of the components. The combination of indapamide and perindopril provides an enhancement of the action of each of them.

Pharmacodynamics

Noliprel has a dose-dependent hypotensive effect, affecting both systolic and diastolic blood pressure in the supine or standing position. The antihypertensive effect of the drug is prolonged and persists for 1 day. The therapeutic effect is observed less than 1 month after the start of treatment and is not accompanied by tachycardia. Cancellation of Noliprel does not provoke the development of withdrawal syndrome. Indapamide and perindopril are characterized by a synergistic hypotensive effect compared with monotherapy with these drugs.

The drug reduces the degree of left ventricular hypertrophy, increases the elasticity of arteries, helps to reduce total peripheral vascular resistance and does not affect lipid metabolism (low-density lipoprotein cholesterol (LDL) and high density lipoprotein (HDL), total cholesterol, triglycerides).

The effect of Noliprel on cardiovascular morbidity and mortality is not well understood.

Perindopril

Perindopril is an inhibitor of the enzyme responsible for the conversion of angiotensin I to angiotensin II (ACE inhibitor). Kinase (angiotensin-converting enzyme) is an exopeptidase that carries out both the conversion of angiotensin I to the vasoconstrictor compound angiotensin II and the destruction of bradykinin, which is characterized by a vasodilating effect, with the formation of an inactive heptapeptide.

As a result, perindopril reduces the production of aldosterone, in accordance with the principle of negative feedback, increases the activity of renin in the blood plasma and, with long-term therapy, lowers the total peripheral vascular resistance, which is caused mainly by the effect on the vessels localized in the kidneys and muscles.

These effects are not accompanied by the occurrence of reflex tachycardia or salt and fluid retention.

Perindopril normalizes the functioning of the myocardium, reducing preload and afterload.

Studies of hemodynamic parameters in patients with chronic heart failure revealed that this substance increases muscle peripheral blood flow, increases cardiac output and increases cardiac index, reduces filling pressure in both ventricles of the heart and reduces total peripheral vascular resistance.

Perindopril is effective in the treatment of arterial hypertension of varying severity. The antihypertensive effect of the drug reaches a peak 4-6 hours after a single dose and lasts 24 hours. 1 day after the use of Noliprel, a pronounced (about 80%) inhibition of ACE of a residual nature is noted.

Perindopril has an antihypertensive effect in patients with both reduced and normal plasma renin activity. The compound is characterized by a vasodilating effect, provides regeneration of the structure of the vascular wall of small arteries and restoration of elasticity of large arteries, and also minimizes left ventricular hypertrophy.

The combination of Noliprel with thiazide diuretics makes the antihypertensive effect more pronounced. Also, the simultaneous use of a thiazide diuretic and an ACE inhibitor reduces the risk of hypokalemia during the appointment of diuretics.

Indapamide

Indapamide is a member of the sulfonamide group and is similar in its pharmacological characteristics to thiazide diuretics. The substance slows down the reabsorption of sodium ions in the cortical element of the loop of Henle, which leads to a more intense excretion through the kidneys of chloride, sodium ions and, to a lesser extent, magnesium and potassium ions. This contributes to increased diuresis and lower blood pressure.

Indapamide as a monotherapy drug has an antihypertensive effect lasting 24 hours. It becomes noticeable when taking the drug in doses that have a minimal diuretic effect. The compound improves the elastic properties of large arteries, reduces total peripheral vascular resistance and reduces left ventricular hypertrophy.

At a certain dose of indapamide, thiazide and thiazide-like diuretics reach a plateau of therapeutic effect, while the frequency of side effects continues to increase with a further increase in the dose of the drug. Therefore, an increase in the dose of indapamide is not justified if there is no therapeutic effect when taking the recommended dose.

Indapamide does not change the concentration of lipids (triglycerides, LDL, HDL, cholesterol) and carbohydrate metabolism (including in patients with concomitant diabetes mellitus).

Pharmacokinetics

With the combined use of indapamide and perindopril, their pharmacokinetic parameters do not change compared with the separate intake of these drugs.

Perindopril

When taken orally, perindopril is absorbed at a significant rate. Its maximum content in blood plasma is recorded 1 hour after ingestion. The half-life of the substance from the blood plasma is 1 hour. Pharmacological activity is not typical for perindopril. Approximately 27% of the ingested dose enters the bloodstream after conversion to the active metabolite perindoprilat. In addition to perindoprilat, 5 more metabolites are formed that do not show pharmacological activity. The maximum content of perindoprilat in plasma is observed 3-4 hours after oral administration. Food intake inhibits the transition of perindopril to perindoprilat, affecting its bioavailability. Therefore, the drug should be taken once a day, in the morning and on an empty stomach.

A linear dependence of the content of perindopril in blood plasma on its dose was revealed. The volume of distribution of unbound perindoprilat is about 0.2 l/kg. Perindoprilat binds to plasma proteins, mainly to ACE, and the degree of binding is determined by the level of perindopril in the blood and is approximately 20%.

Perindoprilat is excreted from the body in the urine. The effective half-life is approximately 17 hours, so steady-state concentrations are reached within 4 days.

Removal of perindoprilat slows down in elderly patients, as well as in patients with renal and heart failure. The dialysis clearance of perindoprilat is 70 ml/min. The pharmacokinetics of perindopril changes in patients with cirrhosis of the liver: the hepatic clearance of the compound is reduced by 2 times. However, the amount of perindoprilat formed does not tend to decrease, so dose adjustment is not necessary.

Indapamide

Indapamide is rapidly and completely absorbed from the gastrointestinal tract. The maximum level of the compound in blood plasma is recorded 1 hour after oral administration.

Indapamide binds to plasma proteins by 79%. The half-life is 14-24 hours (mean -18 hours). Repeated administration of the drug does not cause its accumulation in the tissues of the body. Indapamide is excreted mainly through the kidneys (70% of the dose) and through the intestines (22% of the dose) as inactive metabolites. Renal insufficiency does not affect the pharmacokinetics of the compound.

Indications for use

The use of Noliprel is indicated for the treatment of essential arterial hypertension.

Contraindications

Chronic heart failure in the stage of decompensation in untreated patients;
hypokalemia;
Increased content of potassium in the blood plasma;
Angioedema (Quincke's edema) in history;
Idiopathic or hereditary angioedema;
Severe renal (creatinine clearance (CC) less than 30 ml / min) and / or hepatic (including encephalopathy) insufficiency;
Syndrome of glucose-galactose malabsorption, lactase deficiency, galactosemia;
Simultaneous use of potassium-sparing diuretics, potassium and lithium preparations, antiarrhythmic drugs (risk of developing pirouette-type arrhythmia), drugs that prolong the QT interval;
The period of pregnancy and breastfeeding;
Age up to 18 years;
Hypersensitivity to angiotensin-converting enzyme (ACE) inhibitors and sulfonamides;
Hypersensitivity to the components of the drug.

Noliprel is also contraindicated in patients on hemodialysis.

With caution, the drug should be prescribed for systemic diseases of the connective tissue (including systemic lupus erythematosus, scleroderma), inhibition of bone marrow hematopoiesis, treatment with immunosuppressants (due to the risk of developing agranulocytosis, neutropenia), reduced volume of circulating blood (against the background of taking diuretics, salt-free diet, vomiting , diarrhea), cerebrovascular diseases, renovascular hypertension, diabetes mellitus, angina pectoris, aortic valve stenosis, hypertrophic cardiomyopathy, chronic heart failure of functional class IV (NYHA classification), hyperuricemia (especially accompanied by urate nephrolithiasis and gout), hemodialysis using high-flow membranes , lability of blood pressure (BP); in the period after kidney transplantation; elderly patients.

Instructions for use Noliprel: method and dosage

Noliprel is taken orally, preferably before breakfast.

The appointment of the drug in elderly patients should be made on the basis of data on the level of potassium concentration in the blood plasma and the functional activity of the kidneys. Treatment should begin with individual dose selection, taking into account the degree of reduction in blood pressure, especially in patients with dehydration and loss of electrolytes. Treatment should begin with 1 tablet 1 time per day.

In patients with moderate renal insufficiency (CC 30-60 ml / min), the daily dose should not exceed 1 tablet, with CC 60 ml / min and above, dose adjustment is not required. Treatment must be accompanied by monitoring the level of potassium and creatinine in the blood plasma (after two weeks of therapy and then 1 time in 2 months).

If laboratory signs of functional renal failure appear during the use of Noliprel, the drug should be discontinued. Combination treatment should be resumed only with the use of low doses of the drug or in monotherapy. Patients with underlying renal impairment, including renal artery stenosis and severe heart failure, are at risk of developing renal failure.

Dose adjustment is not required in patients with moderate hepatic impairment.

Side effects

General disorders: often - asthenia; infrequently - sweating;
Cardiovascular system: infrequently - a strong decrease in blood pressure, including orthostatic hypotension; very rarely - bradycardia, atrial fibrillation, ventricular tachycardia, angina pectoris, myocardial infarction and other cardiac arrhythmias;
Lymphatic and circulatory systems: very rarely - leukopenia or neutropenia, thrombocytopenia, agranulocytosis, hemolytic anemia, aplastic anemia; in patients after kidney transplantation who are on hemodialysis, anemia may develop;
Digestive system: often - dry mouth, constipation, diarrhea, nausea, abdominal pain, vomiting, epigastric pain, loss of appetite, impaired taste perception, dyspepsia; rarely - cholestatic jaundice, angioedema of the intestine; very rarely - pancreatitis; possibly - hepatic encephalopathy (in patients with liver failure);
Organ of vision: often - visual impairment;
Organ of hearing: often - tinnitus;
Nervous system: often - headache, paresthesia, asthenia, dizziness; infrequently - mood lability, sleep disturbance; very rarely - confusion;
Respiratory system: often - transient dry cough, shortness of breath; infrequently - bronchospasm; very rarely - rhinitis, eosinophilic pneumonia;
Musculoskeletal system and connective tissues: often - muscle spasms;
Reproductive system: infrequently - impotence;
Urinary system: infrequently - renal failure; very rarely - acute renal failure;
Dermatological and allergic reactions: often - skin rash, itching, maculopapular rash; infrequently - urticaria, angioedema of the larynx and / or glottis, mucous membranes of the tongue, lips, face, limbs, hypersensitivity reactions (often skin, in predisposed patients), hemorrhagic vasculitis; exacerbation of disseminated lupus erythematosus; very rarely - toxic epidermal necrolysis, erythema multiforme, Steven-Jones syndrome, photosensitivity reactions;
Laboratory indicators: hypovolemia and hyponatremia, hypokalemia, transient increase in blood glucose and uric acid levels, transient hyperkalemia, a slight increase in plasma creatinine and urea levels (more often with renal artery stenosis, renal failure, against the background of arterial hypertension therapy with diuretics); rarely - hypercalcemia.

Overdose

When taking high doses of Noliprel, the most common symptom of an overdose is a pronounced decrease in blood pressure, sometimes combined with drowsiness, dizziness, clouded consciousness, convulsions, nausea, vomiting and oliguria, which can turn into anuria (due to hypovolemia). Also, electrolyte disorders often develop: hypokalemia or hyponatremia.

Emergency care consists in removing Noliprel from the body by gastric lavage and / or the appointment of activated charcoal, accompanied by the subsequent normalization of water and electrolyte balance. With a significant decrease in blood pressure, the patient is placed in a supine position, lifting his legs. If necessary, hypovolemia is corrected (for example, by intravenous infusion of 0.9% sodium chloride solution). Perindoprilat, the active metabolite of perindopril, is effectively removed from the body by dialysis.

special instructions

At the beginning of therapy, careful monitoring of patients who have not previously taken two antihypertensive drugs (perindopril, indapamide) at the same time is required, since the risk of idiosyncrasy increases.

Since hyponatremia can cause sudden development of arterial hypotension, regular monitoring of the level of electrolyte concentration in the blood plasma is required, especially in patients with renal artery stenosis after vomiting or diarrhea. To restore the water and electrolyte balance, intravenous administration of a 0.9% sodium chloride solution is recommended. Therapy can be continued after normalization of blood pressure and blood volume, using a low dose of the drug or switching to monotherapy.

Treatment should be accompanied by regular monitoring of the level of potassium in the blood plasma.

The risk of developing neutropenia during the use of the drug increases in patients with a functional disorder of the kidneys, more often with scleroderma, systemic lupus erythematosus. Symptoms of neutropenia are dose-dependent.

With concomitant therapy with immunosuppressive agents in patients with diffuse connective tissue pathologies, the level of leukocytes in the blood should be monitored. If symptoms of sore throat, fever and other infectious diseases appear, you should consult a doctor.

If there are signs of hypersensitivity to the drug in the form of angioedema, the drug should be immediately canceled and the patient should be prescribed appropriate therapy. In case of swelling of the tongue, larynx or glottis, it is recommended to secure the airway and immediately inject epinephrine (adrenaline) subcutaneously.

When conducting a differential diagnosis in patients with pain in the abdomen, the possibility of developing angioedema of the intestine should be considered.

Simultaneous administration with immunotherapy with hymenoptera venom is not recommended (in order to prevent the development of an anaphylactoid reaction, Noliprel should be temporarily stopped 24 hours before the start of the desensitization procedure).

There is a risk of anaphylactoid reactions during low-density lipoprotein (LDL) apheresis using dextran sulfate, and the drug must be stopped before each apheresis procedure.

Taking pills can cause a dry cough in a patient.

To avoid a sharp drop in blood pressure, treatment should be started with low doses of the drug and then gradually increased, taking into account tolerability and laboratory parameters of plasma creatinine levels.

Treatment of patients with coronary heart disease and cerebrovascular insufficiency should begin with low doses.

With renovascular hypertension, the use of the drug should be started only in a hospital with low doses with regular monitoring of kidney function and potassium content in the blood plasma.

In arterial hypertension and coronary heart disease, the drug should be used together with beta-blockers.

Treatment of patients with diabetes mellitus who are on insulin or oral hypoglycemic agents during the first month should be accompanied by regular monitoring of blood glucose levels, especially with hypokalemia.

With a planned surgical intervention, the drug is stopped 12 hours before the start of general anesthesia.

In case of a significant increase in the activity of liver enzymes or the appearance of jaundice, the use of Noliprel should be discontinued.

Anemia may develop in patients on hemodialysis or after kidney transplantation.

With the development of hepatic encephalopathy, the use of diuretics should be discontinued.

Avoid exposure to direct sunlight and ultraviolet radiation. With the development of photosensitivity reactions during treatment with the drug, it should be discontinued.

Before starting the use of the drug and during the period of treatment, it is necessary to regularly determine the level of concentration of sodium ions in the blood plasma, especially in elderly patients and patients with cirrhosis of the liver.

The risk of developing hypokalemia during the use of Noliprel is most susceptible to elderly patients, malnourished patients who are on concomitant drug treatment, patients with liver cirrhosis, peripheral edema or ascites, with an extended QT interval, heart failure, coronary heart disease. In this category of patients, hypokalemia contributes to the appearance of severe cardiac arrhythmias, so they need to ensure regular monitoring of the level of potassium ions in the blood plasma from the first week of treatment.

An increase in the level of uric acid in the blood plasma increases the risk of gout attacks.

Before conducting a study of the function of the parathyroid gland, it is necessary to stop taking diuretics.

When conducting a doping control, Noliprel may give a positive reaction.

During the period of use of the drug, patients should be careful when driving vehicles and mechanisms.

Use during pregnancy and lactation

According to the instructions, Noliprel is not recommended during pregnancy. Its reception in the first trimester is strictly prohibited. Planning for pregnancy or its occurrence during drug therapy is a direct indication for discontinuation of the drug and the selection of another antihypertensive therapy regimen. Appropriate controlled studies of ACE inhibitors in pregnant women have not been conducted. There are limited data on the effects of Noliprel in the first trimester of pregnancy, indicating that treatment with it did not increase the risk of malformations due to fetotoxicity.

The effect of the drug on the fetus for a long period of time in the II and III trimesters of pregnancy can cause developmental disorders (delayed ossification of the skull bones, oligohydramnios, decreased renal function) and provoke complications in the newborn (hyperkalemia, arterial hypotension, renal failure).

Prolonged use of thiazide diuretics in the third trimester of pregnancy can cause hypovolemia in the mother, as well as deterioration of uteroplacental blood flow, which causes fetoplacental ischemia and fetal growth retardation. Occasionally, during treatment with diuretics, shortly before the onset of labor, newborns experience thrombocytopenia and hypoglycemia.

If a woman took Noliprel during the II or III trimester of pregnancy, it is necessary to conduct an ultrasound examination of the fetus to assess kidney function and the condition of the bones of the skull.

The period of lactation is a contraindication to the appointment of the drug. Information about the possible penetration of perindopril into breast milk is not considered reliable. Indapamide passes into breast milk. Taking thiazide diuretics can lead to suppression of lactation or a decrease in breast milk production. At the same time, the child sometimes develops increased sensitivity to sulfonamide derivatives, nuclear jaundice and hypokalemia.

Since the appointment of Noliprel during lactation can cause severe complications in an infant, it is recommended to carefully weigh the significance of therapy for the mother and decide whether to stop breastfeeding or discontinue the drug.

drug interaction

The safety of the simultaneous appointment of Noliprel with other drugs can only be determined by the attending physician, taking into account the patient's condition and comorbidities.

Analogues

The analogues of Noliprel are: Co-prenesa, Prestarium, Ko-perineva, Perindopril-Indapamid Richter, Noliprel A Bi-forte.

Terms and conditions of storage

Keep out of the reach of children at room temperature.

Shelf life - 3 years, after opening the sachet - 2 months.

"Noliprel" is a combination of a thiazide-like diuretic with an angiotensin-converting enzyme inhibitor. One tablet contains 2 mg of perindopril and 0.625 mg of indapamide. The drug lowers blood pressure. Has three directions of action.

The mechanism of action of "Noliprel"

The drug acts immediately in three directions:

Inhibition of an enzyme that promotes the transformation of angiotensin-1 into angiotensin-2. The latter is a powerful vasoconstrictor - it constricts blood vessels, and the pressure rises.
Indapamide changes the state of the muscle fibers of the choroid, due to which they relax. Peripheral vascular resistance decreases and pressure drops.
Indapamide is also a mild diuretic. It affects the proximal and distal tubules of the loop of Henle. The reabsorption of primary urine decreases and the excretion of secondary urine increases.

Due to this interaction, a long-term and reliable pressure reduction is achieved.

Noliprel - a potent medicine against high blood pressure

The action of perindopril

Perindopril affects the renin-angiotensin-aldosterone system. This is the predominant system that increases blood pressure in the human body. The kidneys synthesize renin, a hormone that starts the entire system. Renin stimulates the conversion of angiotensinogen (synthesized in the liver) to angiotensin I. Further, under the control of ACE, angiotensin I is converted to angiotensin II. The latter is the most powerful vasoconstrictor mediator. Arterial receptors, under the influence of angiotensin II in the bloodstream, provoke vasoconstriction, as a result, pressure rises. Under the influence of angiotensin II, aldosterone is released - a substance that retains sodium in the body, and sodium retains water. As a result, the volume of circulating blood is increased by water. Perindopril lowers blood pressure by inhibiting angiotensin-converting enzyme through a hypovolemic effect.

Action of indapamide

Indapamide inhibits the exchange of ions, as a result of which the level of catecholamines in the blood increases. This leads to a decrease in the contraction of the muscle fibers of the middle membrane of the arteries. As vascular tone decreases, blood pressure also decreases. In addition to a pronounced hypotensive effect, this substance also has a diuretic effect. The drug changes the state of the proximal and distal tubules of the loop of Henle (reabsorption of water, proteins, glucose, sodium, potassium, chlorine and much more occurs in it), which inhibits the reabsorption of sodium, chlorine and water. Thus, more secondary urine is obtained from primary urine.

The degree of change in the tubules is directly proportional to the dosage of the drug, that is, the more you take it, the greater the diuretic effect will be. The drug does not penetrate the blood-brain barrier, due to which there is no central effect and fewer side effects. Indapamide can be taken by patients with renal insufficiency, because it does not affect the condition of the glomeruli of the kidneys and does not increase the load on them.

This drug is available in several varieties.

Combination action

Perindopril and indapamide work very well together and complement each other. During a hypertensive crisis or simply excessively high blood pressure, a single dose of other drugs is not enough. In such cases, people sometimes increase the dose of medication for treatment on their own. Such actions often lead to overdose or side effects.

The combination of an ACE inhibitor and a thiazide-like diuretic in Noliprel makes it possible to avoid high doses of each of them and achieve a sufficient and stable hypotonic effect.

Pharmacokinetics

After taking "Noliprel" inside, the maximum amount of perindopril in the blood occurs after 1 hour, perindoprilat - the active metabolite - after 3-4 hours. The half-life of perindopril is 1 hour, the free fraction of perindoprilat is 3-5 hours, the protein-bound perindoprilat is 25 hours. If the drug is taken by patients with cirrhosis of the liver, the renal clearance of perindopril is reduced by 2 times, but the amount of perindoprilat does not change, so the medication is not needed.

The maximum concentration of indapamide is set 2 hours after taking Noliprel. The half-life is 18 hours. The maximum effect is observed after 12 hours. The drug is evenly distributed throughout the body except the brain. About 70% of indapamide is excreted by the kidneys as a metabolite, 20% through the gastrointestinal tract and 10% unchanged. A stable therapeutic effect is observed after 8 weeks of systematic use.

Types of "Noliprel"

"Noliprel" is produced with different proportions of active ingredients for different groups of patients:

"Noliprel" - 2 mg of perindopril and 0.625 mg of indapamide;
"Noliprel" Forte - 4 mg of perindopril and 1.25 mg of indapamide;
"Noliprel" A - 2.5 mg of perindopril and 0.625 mg of indapamide;
"Noliprel" A Forte - 5 mg of perindopril and 1.25 mg of indapamide;
"Noliprel" A Bi-Forte - 10 mg of perindopril and 2.5 mg of indapamide.

The most effective and pressure-lowering drug is Noliprel A Bi-forte

Indications and methods of application

Any kind of drug is taken 1 time per day in the morning. Since it is available only in the form of tablets, it is only taken orally. If you need to increase the effect, do not increase the number of tablets, but change the form of "Noliprel" with the desired ratio of components. And if you notice that after taking 1 Noliprel tablet, the pressure drops sharply, you need to reduce the dose and consult a doctor.

Reasons for taking Noliprel:

essential hypertension,
hypertonic disease,
renal hypertension.

Contraindications

Before buying pills for pressure, carefully read the instructions. Familiarize yourself with all the subtleties, find out when you can take this remedy, and when it is strictly forbidden. Get tested, make sure that the medicine for hypertension is right for you, and only then go to the pharmacy.

allergic reactions,
combination with antiarrhythmic drugs,
hypokalemia,
galactosemia,
under the age of 18.

Noliprel should not be taken if the patient has hypersensitivity to the drug

special instructions

Do not combine "Noliprel" with potassium preparations and potassium-sparing diuretics. With increased attention, the drug is prescribed for mental disorders, angina pectoris, renovascular hypertension and cerebrovascular pain. Treatment with Noliprel can be combined with beta-blockers. Taking "Noliprel" will give a positive result when testing for doping. If the patient suffers from coronary heart disease, you need to take the drug in small doses.

Use during pregnancy and lactation

"Noliprel" should not be taken by pregnant and lactating women. If used during pregnancy, the risk of fetal abnormalities increases. If a pregnant woman took pills for hypertension before pregnancy, you need to stop it and prescribe another drug that will not harm the fetus. If you take "Noliprel" in the 2nd and 3rd trimester, the child may experience hypotension, so you need to actively monitor his condition both in utero and after childbirth.

The active substance is excreted in breast milk, so you need to either refrain from feeding for the duration of treatment, or replace the drug with another.

Adverse reactions

There is no drug for the treatment of hypertension without side effects, but not every patient has adverse reactions.

In the treatment of Noliprel, various adverse reactions of the body may develop.

You need to stop taking Noliprel if you notice such disorders in your body:

cardiovascular system - the appearance of arterial hypotension, collapse, cardiac ischemia;
genitourinary system - nephritis, renal failure, impotence;
CNS and PNS - fatigue, dizziness, impaired sense organs, convulsions;
gastrointestinal tract - intestinal upset, gastralgia, inflammation of the pancreas;
blood - hemolytic anemia, agranulocytosis;
immunity - urticaria, rash.

Overdose

If the allowable dose is exceeded, the following may occur:

hypotension,
nausea,
vomit,
mental disorders,
imbalance of water and electrolyte balance.

First aid

If the patient has symptoms of an overdose of "Noliprel", it is necessary to immediately take measures to remove the metabolites of the drug from the body:

infusion therapy,
gastric lavage,
enterosorbents,
dialysis.

Accompanied by vomiting, abdominal pain

Combination with other medicinal products

When prescribing the drug, it is necessary to take into account its interaction with various medicines:

The drug should not be taken together with lithium-containing drugs. If the combination cannot be avoided, the level of lithium in the blood must be actively monitored. Lithium toxicity may occur.
The appointment of potassium-sparing diuretics can lead to the development of hyperkalemia.
Use with insulin may cause hypoglycemia.
Non-steroidal anti-inflammatory drugs reduce the effect of Noliprel.
Combination with neuroleptics causes orthostatic collapse.
Cardiac glycosides cause hypokalemia.
"Metformin" in combination with "Noliprel" causes lactic acidosis.
X-ray contrast and iodine-based drugs can reduce fluid levels in the body.
"Cyclosporine" increases the level of creatinine in the blood.

The drug should not be taken together with alcohol, under its influence the side effects will only increase.

Release form

"Noliprel" is available only in the form of tablets. Tablets are white, oblong in shape, with risks on both sides. Packs of 14 and 30 pieces.

Analogues

Analogues are drugs with a different name, but identical composition. These include:

"Co Prenessa"
"Prestarium"
"Noliprel Forte"
"Noliprel A",
"Noliprel A Forte",
"Noliprel A Bi-Forte".

What is Noliprel A and in what cases is it used

Noliprel A is a combination of two active ingredients, 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 had 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 impaired kidney function and are taking blood pressure medicines 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 section "Pregnancy and lactation");
- if you are breastfeeding;
- if you are taking the combination sacubitril/valsartan, a drug used to treat heart failure (see "Other drugs and Noliprel A").

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 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 had a serious allergic reaction with swelling of the face, lips, mouth, tongue and throat, which 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 to treat diarrhea),
- 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 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 breast-feeding").
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 agent (substance that makes it possible to examine 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 glaucoma or increased 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 a 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 (a medicine to treat hypertension), unless you have diabetes or kidney problems,
- 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 healthcare provider 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 used to treat infections),
- methadone (used to treat drug addiction),
- procainamide (to treat irregular heart rhythms),
- allopurinol (used to treat gout)
mizolastine, terfenadine and astemizole (antihistamines used to treat hay fever or allergies),
- corticosteroids, which are used to treat a variety of conditions, including severe asthma and rheumatoid arthritis,
- immunosuppressive drugs that are used to treat autoimmune disorders or after transplant surgery to prevent rejection (eg cyclosporine, tacrolimus),
- drugs used to treat cancer
- erythromycin intravenously (antibiotic),
- halofantrine (used to treat certain types of malaria),
pentamidine (used to treat pneumonia),
- gold injections (used to treat rheumatoid arthritis),
- vincamine (used to treat clinically significant cognitive impairment in older patients, including memory loss),
- bepridil (used to treat angina),
- 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 illnesses such as depression, anxiety, schizophrenia, etc. (for example, tricyclic antidepressants, neuroleptics (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 should not be taken if more than 3 months pregnant, as taking it if more than 3 months pregnant 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, mouth, tongue or throat, difficulty breathing (angioneurotic edema) (see section "Special instructions and precautions") (infrequent) (occur in up to 1 patient in 100),
- severe skin reactions, including erythema multiforme (skin rash, often beginning with red, itchy patches on the face, arms and legs) or intense skin rashes, hives, reddening of the skin over the entire 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 exercise), 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 limbs, visual disturbances, ringing in the ears (feeling of ringing in the ears), cough, shortness of breath (shortness of breath), disorders of the digestive system (nausea, vomiting, abdominal pain, change in taste, dyspepsia or indigestion, diarrhea, constipation), allergic reactions (such as skin rashes, itching), convulsions, 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 levels, falling 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 type 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 decreased 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.

Noliprel is a combined antihypertensive agent used in the treatment of essential arterial hypertension. The active ingredients are perindopril and indapamide.

As an ACE inhibitor, it prevents the formation of angiotensin II. As a result, vasodilation occurs, sodium and water retention decreases - blood pressure decreases. The condition of patients with signs of chronic heart failure (CHF) is improving. The class effect is nephroprotection.

Refers to diuretics from the group of sulfonamides. The main effects are associated with the removal of excess sodium and water from the body. A decrease in the volume of blood circulating in the vascular bed leads to a drop in pressure.

The combination of active substances enhances the action of each other and leads to a persistent decrease in blood pressure in patients with arterial hypertension (hypertension).

The drug is produced only in the form of white film-coated tablets. The shape is oblong, there are risks on both sides. The composition of Noliprel contains perindopril arginine - 2.5 mg, as well as indapamide - 0.625 mg.

Auxiliary components are: silicon dioxide, lactose, magnesium stearate, sodium carboxymethyl starch, maltodextrin. The shell contains macrogol, magnesium stearate, glycerol, titanium dioxide.

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

Indications for use

What helps Noliprel? The drug is prescribed in the following cases:

for the treatment of essential arterial hypertension.

Instructions for use Noliprel, dosage

Tablets are intended for oral administration, preferably in the morning. Adult patients, including the elderly, are prescribed 1 Noliprel tablet once a day.

Patients with renal insufficiency with creatinine clearance ≥30 ml / min do not require dose adjustment.

During treatment, it is necessary to systematically monitor plasma concentrations of creatinine and potassium, the appearance of clinical signs of salt loss and dehydration, and regularly measure the concentration of electrolytes in plasma.

Side effects

According to the instructions for use, the appointment of Noliprel may be accompanied by the following side effects:

orthostatic hypotension, excessive lowering of blood pressure;
fatigue, headache, dizziness, asthenia, mood lability, tinnitus, blurred vision, convulsions, sleep disturbance, taste disturbance, anorexia, paresthesia;
constipation, diarrhea, nausea, vomiting, abdominal pain; rarely - dryness of the oral mucosa;
dry cough;
anemia (in patients after hemodialysis or kidney transplantation);
skin itching and rashes;
decreased potency, increased sweating.

More rarely, other side effects from taking the drug may occur.

Contraindications

Noliprel is contraindicated in the following cases:

severe renal failure;
severe liver failure (including with encephalopathy);
hypokalemia;
angioedema in history (including against the background of taking angiotensin-converting enzyme (ACE) inhibitors);
simultaneous use of drugs that prolong the qt interval;
the period of pregnancy and breastfeeding;
children and adolescents under 18 years of age (since the safety and efficacy of the drug have not been established);
hypersensitivity to perindopril and / or other ACE inhibitors, indapamide and sulfonamides.

Overdose

The most common symptom of an overdose is a pronounced decrease in blood pressure, sometimes combined with drowsiness, dizziness, clouded consciousness, convulsions, nausea, vomiting and oliguria, which can turn into anuria (due to hypovolemia). Electrolyte disorders also develop: hypokalemia or hyponatremia.

With a significant decrease in blood pressure, the patient is placed in a supine position, lifting his legs. If necessary, hypovolemia is corrected (for example, by intravenous infusion of 0.9% sodium chloride solution). Perindoprilat, the active metabolite of perindopril, is effectively removed from the body by dialysis.

Analogues Noliprel, price in pharmacies

If necessary, you can replace Noliprel with an analogue of the active substance - these are drugs:

Ko-prenesa
Perindopril-Indapamide Richter,

When choosing analogues, it is important to understand that the instructions for use of Noliprel, the price and reviews of drugs of similar action do not apply. It is important to consult a doctor and not to make an independent replacement of the drug.

Price in Russian pharmacies: Noliprel tablets 30 pcs. - from 569 rubles to 685 rubles (A forte).

Store in a dry, dark place and out of the reach of children, at a temperature not exceeding +30 °C. Shelf life - 3 years. Leave in pharmacies by prescription.