Powerful combined medicine from pressure noliprel and nuances of its use. Naliprell a forte and its analogues: what is more effective? Noliprell and forte what does
Essential arterial hypertension. Patients S. arterial hypertension and diabetes 2 types to reduce the risk of developing microvascular complications (by kidney side) and macrovascular complications from cardiovascular diseases.
Contraindications Nolyiprel A Forte Tablets 1.25mg + 5mg
Increased sensitivity to perindopril and other ACE inhibitors, to Indapamide and Sulfonamidam, as well as to other auxiliary components of the drug, which is part of the drug; angioedema edema in history (including against the background of the reception of other ACE inhibitors); hereditary / idiopathic angioedema swelling; hypokalemia; renal failure of severe (QC less than 30 ml / min); stenosis of the arteries of the only kidney; bilateral stenosis of renal arteries; pronounced hepatic insufficiency (including with encephalopathy); simultaneous reception of drugs lengthening the Qt interval; Simultaneous reception antiarrhythmic agentswhich can cause ventricular arrhythmia like "Pirouette"; pregnancy; lactation period (breastfeeding); Simultaneous reception of the drug with potassium-saving diuretics, potassium and lithium preparations and hypercalemia are not recommended. Due to the lack of sufficient clinical experience, the drug should not be used in patients with untreated decompensated heart failure and in patients on hemodialysis.
Method of application and dosage Naliprell A Forte Tablets 1.25mg + 5mg
Inside, preferably in the morning, before taking food. Essential hypertension. Assign 1 tablets 1 time per day. If possible, the preparation is starting with the selection of doses of single-component drugs. In the case of clinical need, you can consider the possibility of appointing combined therapy by the drug immediately after monotherapy. In patients with arterial hypertension and type 2 diabetes mellitus to reduce the risk of developing microvascular complications by kidney and macrovascular complications of cardiovascular diseases. It is recommended to start therapy with a combination of perindopril / indapamide at a dose of 2.5 mg / 0.625 mg 1 time per day. After 3 months of therapy, provided good tolerability, a dose increases - 1 tablets 1 times a day. Elderly patients should be prescribed treatment after controlling the kidney function and blood pressure. Drug is contraindicated in patients with renal failure Heavy degree (QC 60 ml / min, dose correction is not required. Against therapy, regular monitoring of creatinine and potassium concentration is needed. Hepatic insufficiency. The drug is contraindicated with patients with severe hepatic insufficiency. With moderately pronounced liver failure Dose correction is not required. Children and teenagers. The drug should not be prescribed to children and adolescents under 18 due to lack of data on the efficiency and safety of the drug in patients of this age group.
in a blister 14 or 30 pcs.; In a box 1 blister.
Description of the dosage form
Pills white color, oblong form.
pharmachologic effect
pharmachologic effect - Antihypertensive.Pharmacodynamics
Combined preparation containing perindopril (ACE inhibitor) and indapamide (diuretik from the group of derivatives of sulfonamide). The pharmacological effect of Noliprela ® Forte is due to the combination of individual properties of each of the components. The combination of perindopril and indapamide enhances each of them.
Noliprel ® has a pronounced dose-dependent hypotensive effect both on the garden and for DDA in the "lying" position and standing. The effect of the drug lasts 24 hours. The steady clinical effect occurs in less than 1 months from the start of therapy and is not accompanied by tachycardia. Termination of treatment is not accompanied by the development of cancellation syndrome.
Nolyiprel ® Forte reduces the degree of hyperrophy of the left ventricle, improves the elasticity of the arteries, reduces the OPS, does not affect the metabolism of lipids (total cholesterol, HDL, LDL, triglycerides) and carbohydrates (including patients with diabetes mellitus).
Perindopril - an enzyme inhibitor converting angiotensin I to angiotensin II. APE (or kinase) is an exopeptidase, which carries out the conversion of angiotensin I in angiotensin II, which has a vasoconductive effect, and the destruction of bradykinin, which has a vasodilatory action, to an inactive heptapeptide. As a result, perindopril reduces the secretion of aldosterone, according to the principle of negative feedback increases the activity of renin in the blood plasma, long use Reduces the OPS, which is due, mainly by the action on the vessels in the muscles and kidneys. These effects are not accompanied by delaying salts and water or the development of reflex tachycardia.
Perindopril has hypotensive effect in patients with both low and with the normal activity of renin in the blood plasma.
Against the background of the use of perindopril, there is a decline of both the garden and DDA in the position "lying" and "standing". Cancellation of the drug does not lead to the development of a hypertensive reaction.
Perindopril has a vasodilatory effect, helps to restore the elasticity of large arteries and the structure of the vascular wall of small arteries, and also reduces the left ventricular hypertrophy.
The concomitant appointment of thiazide diuretics enhances the severity of antihypertensive action. In addition, combination inf inhibitor and thiazide diuretics also leads to a decrease in risk of hypokalemia against the background of receiving diuretics. Perindopril normalizes the work of the heart, reducing the preload and postload.
When studying hemodynamic indicators in patients with chronic heart failure, a decrease in filling pressure in the left and right ventricles of the heart was revealed, the decline in the OPS, an increase heart Emission and an increase in the heart index, an increase in muscle regional blood flow.
Indapamide by pharmacological properties Close to thiazide diuretics. Indapamide inhibits the reabsorption of sodium ions in the cortical segment of the loop of Genela, which leads to an increase in the selection of sodium ions, chlorine and to a lesser degree of potassium and magnesium ions, intensifying the diuresis.
The hypotensive effect is manifested in doses of practically non-diuretic effect.
Indapamide reduces the hyperreactivity of the vessels in relation to adrenaline, does not affect the content of lipids in the blood plasma (triglycerides, cholesterol, LDL and HDL), carbohydrate metabolism (including patients with accompanying diabetes mellitus).
It helps to reduce the hypertrophy of the left ventricle of the heart.
Pharmacokinetics
Pharmacokinetic parameters of perindopril and indapamide during combinations do not change compared to their separate use.
Perindopril
Suction and metabolism
After receiving inside, the perindopril is quickly absorbed. Bioavailability - 65-70%. Approximately 20% of the total amount of absorbed perindopoid turns into a perindoid - active metabolite. Reception of the drug during meals is accompanied by a decrease in the transformation of perindopril into the perindospota ( this effect It does not have a significant clinical value).
C max Perindoprote in blood plasma is achieved after 3-4 hours after receiving perindopril inside.
Distribution
The binding of perindoprote with plasma proteins is usually less than 30% and depends on its concentration in the blood.
The dissociation of perindoprote associated with the ACE is slowed down. As a result, effective T 1/2 is 25 hours. The reappointment of perindopril does not lead to its cumulation, and T 1/2 perindoprote with re-admission corresponds to the period of its activity, thus, C SS is achieved on average after 4 days.
Perindopril penetrates a placental barrier.
Election
Perindoid is excreted from the body with urine. T 1/2 - 3-5 h.
The removal of perindophers is slowed down in old age, as well as in patients with cardiac and renal failure.
CL Perindoprote with dialysis - 70 ml / min.
Pharmacokinetics perindopril varies in patients with cirrhosis of the liver: hepatic clearance of perindopoid decreases by 2 times. However, the concentration of the formed perindoprote does not change, and, therefore, there is no need to change the dose of the drug.
Indapamide
Suction
Indapamide is quickly and completely absorbed from the gastrointestinal tract. C Max in the blood plasma is achieved after 1 hour after oral administration.
Distribution
Bonding with blood plasma proteins - 79%.
Repeating preparation does not lead to its cumulation in the body.
Election
T 1/2 - 14-24 h (on average 19 h). It is excreted mainly with urine (70% of the administered dose) and with a fee (22%) in the form of inactive metabolites.
Pharmacokinetics in special clinical cases
Pharmacokinetics Indapamide does not change in patients with renal failure.
Indications of the drug Noliprel ® Forte
Essential arterial hypertension.
Contraindications
increased sensitivity to indapamide and sulfonamide; to perindopril and other ACE inhibitors;
angioemical edema in history (including on the background of receiving ACE inhibitors);
hypokalemia;
renal insufficiency of severe (CL creatinine<30 мл/мин);
pronounced hepatic insufficiency (including with encephalopathy);
simultaneous reception of drugs lengthening the Qt interval;
pregnancy;
lactation (breastfeeding).
Application in pregnancy and breastfeeding
Naliprel ® is contraindicated to use during pregnancy and in breastfeeding period.
Additional and controlled studies on the use of Noliprela ® during pregnancy in people were not carried out. ACE inhibitors can penetrate the placental barrier and lead to an increase in morbidity and mortality of the fetus and a newborn. The effects of ACE inhibitors on the fetus in the II and III of trimesters of pregnancy can lead to development in newborn arterial hypotension, renal failure, deformation of the bones of the skull and face and even to death.
There are reports of the development of an olighydramnion (pronounced decrease in the volume of the octoped fluid), due to the disorder of the kidney function in the fetus. Oligohydramnion may be accompanied by the appearance of contractures of the upper and lower limbs in the fetus, deformations of the bones of the skull and face, the hypoplastic development of the lungs and the slowdown in the intrauterine development. Babies undergoing an ACE inhibitor intrauterine must be a thorough examination to eliminate arterial hypotension, oliguria and hypercalemia. Oliguria treatment should be combined with the maintenance of adequate level of blood pressure and renal perfusion.
There are reports of a slowdown in the intrauterine development, premature births, the unexproaction of arterial (Botallov) duct, as well as the death of the fetus against the background of taking ACE inhibitors during pregnancy. However, to accurately determine to what extent in these situations the designation of the drug played the importance of the drug, and in what - the background disease of the mother is not possible.
Currently, there are no data on the effect of the ACE inhibitor appointed in the first trimester of pregnancy.
If pregnancy has come against the background of the admission of an ACF inhibitor, then it is not necessary to interrupt it, but should immediately stop taking the drug and conduct an ultrasound of the fetus skull. Women, whose pregnancy has come during the reception of the ACE inhibitor, should be informed about the potential hazard for the health of the fetus.
Receiving diuretics, including indapamide, can cause the development of placental insufficiency and the delay in the intrauterine development of the fetus.
Both Perindopril and Indapamide can penetrate into breast milk. If it is necessary to appoint Noliprela ® during lactation, breastfeeding should be discontinued.
Side effects
Effects caused by Perindopril
From the side of the cardiovascular system: excessive decrease in blood pressure, orthostatic hypotension; In some cases - myocardial infarction, angina, stroke, arrhythmia.
From the urinary system: rarely - reducing the kidney function, proteinuria (in patients with glomerular nephropathy); In some cases - acute renal failure. A minor increase in the concentration of creatinine in the urine and blood plasma (reversible after the abolition of the drug) is most likely with the stenosis of renal arteries, the treatment of arterial hypertension using diuretic drugs, renal failure. Perhaps (usually temporary) increase in the concentration of potassium in the blood plasma.
headache, increased fatigue, asthenia, dizziness, mood lability, vision violation, ripping in ears, sleep disorder, convulsions, couplesia, anorexia, violation of taste perception; In some cases, the confusion of consciousness.
From the respiratory system: dry cough; rarely - breathing difficulty, bronchospasm; In some cases, Rinorea.
pain in the abdomen, nausea, vomiting, constipation, diarrhea; rarely dry mouth; In some cases, cholestatic jaundice, pancreatitis, increasing activity of hepatic transaminases, hyperbilirubinemia.
Increases the concentration of potassium by inhibiting the renin-angiotensin-aldosterone system, leads to a decrease in potassium loss caused by Indapamide. It has been shown that against the background of taking the noliprela ® Forte, the decrease in potassium concentration was less than 3.4 mmol / l after 12 weeks of therapy in 2% of patients. Basically, a decrease in potassium concentration after 12 weeks of therapy was 0.1 mmol / l.
anemia (in patients after kidney transplantation, hemodialysis); rarely - hypochemoglobinemia, thrombocytopenia, reduced hematocrit; In some cases, agranulocytosis, pancytopenia; Hemolytic anemia is possible (against the background of the deficiency of glucose-6-phosphate dehydrogenases).
Allergic reactions: Skin rash, itching; rarely - urticaria, angioedema edema; In some cases - Multiform Erythema.
Others: Rarely - an increase in sweating, a reduction in potency.
Effects caused by Indapamide
From the CNS and the peripheral nervous system: Rarely - dizziness, headache, asthenia, paresthesia (usually disappear while reduced dose of the drug).
From the digestive system: rarely - nausea, constipation, dry mouth; In some cases - pancreatitis; With hepatic insufficiency, hepatic encephalopathy is possible.
From the water and electrolyte balance: Hypologiamia is possible (especially in patients belonging to the risk group), a decrease in sodium levels, accompanied by hypovolemia, dehydration of the body and orthostatic arterial hypotension. The simultaneous loss of chlorine ions can lead to compensatory metabolic alkalosis (the frequency of alkalosis and its severity is small). In some cases, an increase in calcium levels.
From the metabolism: It is possible to increase the content of urea and glucose in blood plasma.
From the hematopopitation system: In some cases, thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia, hemolytic anemia, bone marrow aplasia.
Dermatological reactions: Skin rashes are possible, hemorrhagic vasculitis, exacerbation of the systemic red lupus.
Allergic reactions: In predisposed patients - skin manifestations.
Interaction
The simultaneous use of Noliprela ® Forte and Lithium Preparations is not recommended. An increase in lithium concentration can lead to symptoms and signs of overdose of lithium (due to reducing the excretion of lithium kidneys). If combined therapy, including ACE inhibitors and potassium-saving diuretics, cannot be canceled, it is necessary to carefully monitor the level of lithium and, if necessary, adjust the dose of the drug.
The combination of perindopril with potassium-saving diuretics and potassium preparations can lead to a significant increase in serum concentration in serum (especially on the background of renal failure) up to death. ACE inhibitors should not be prescribed in combination with potassium-saving diuretics and potassium drugs; The exception is patients with hypokalemia (with constant control of potassium concentration in the blood plasma and ECG parameters).
It should be taken into account that Indapamide in combination with potassium-saving diuretics or potassium drugs does not exclude the development of hypokalemia or hypercalemia (especially in patients with diabetes mellitus and renal failure).
With the simultaneous use of erythromycin (for in / in administration), pentamidine, sultopher, Vincamine, Galofantrin, Buredil and Indapamide, the development of the type "Pirouette" is possible (provoking factors include hypocalemia, bradycardia or the elongated Qt interval).
When using ACE inhibitors, an increase in the hypoglycemic effect of insulin and sulfonylurea derivatives is possible. The development of hypoglycemia is extremely rare (an increase in glucose tolerance and a decrease in insulin need).
With the simultaneous use of NOLiprel ® Forte and Baclofen, a hypotensive action is gained (it is necessary to control the level of blood pressure and adjust the dose of Noliprela ® Forte).
With the simultaneous use of indapamide and the NSAID in the event of dehydration of the body, the development of acute renal failure is possible (due to the decrease in glomerular filtration). In such cases, before the beginning of treatment, sufficient hydration of the body should ensure and evaluate the functional activity of the kidneys. It is also necessary to take into account that the NSAIDs weaken the hypotensive effect of ACE inhibitors. It has been established that the NSAIDs and the ACE inhibitors have an additive effect on hypercalemia, it is also possible to reduce the kidney function.
With the simultaneous use of Noliprela ® Forte and tricyclic antidepressants, neuroleptics are increased hypotensive action and an increase in the risk of orthostatic hypotension (additive effect).
GCS, tetracoactide reduces the hypotensive effect of NOLiprel ® Forte (water delay and electrolytes as a result of glucocorticoids).
With the simultaneous use of indapamide with antiarrhythmic drugs Ia (County, hydrochinididin, dyspeyramide) and class III (amiodarone, Bretily, Satolol), the development of type "Piroet" is possible (provoking factors include hypokalemia, bradycardia or the elongated Qt interval). When the development of type "Pirouette", antiarrhythmic drugs should not be applied (it is necessary to use an artificial rhythm driver).
With the simultaneous use of indapamide and drugs that reduce potassium levels (including amphotericin B with in / in administration, gluco- and mineralocorticoids with systemic use, tetracoactide, stimulating the laxatives) increases the risk of hypokalemia (potassium concentration should be monitored and, If necessary, adjust it). If necessary, the appointment of laxatives should use drugs without stimulating actions on the intestinal motorcycle.
With the simultaneous use of noliprela ® Forte with cardiac glycosides, it should be borne in mind that a low level of potassium can enhance the toxic effect of cardiac glycosides. The level of potassium and ECG should be monitored and, if necessary, adjust the therapy.
Local acidosis against the background of metformin intake is associated, apparently with functional renal failure, which is due to the action of Indapamide. Metformin should not be used if the level of serum creatinine exceeds 1.5 mg / dl (135 μmol / l) in men and 1.2 mg / dl (110 μmol / l) in women.
NOLIPROL ® Forte increases the risk of developing violations of the kidney function against the background of the use of iodine-containing radiocontrase substances in high doses. Before using iodine-containing contrast agents, it is necessary to rehydrate.
With simultaneous use with calcium salts, it is possible to increase the calcium content in the blood plasma as a result of reducing its excretion with urine.
With simultaneous use with the cyclosporin, the risk of hypercreatyinemia increases.
Method of application and dose
Inside Preferably in the morning.
Adults - 1 table. 1 time per day.
Older patients and patients with renal insufficiency of medium severity (CL creatinine ≥30 ml / min, but<60 мл/мин) терапию следует начинать с 1 табл. препарата Нолипрел ® 1 раз в сутки предпочтительно утром.
Patients with renal failure of light severity (CL creatinine\u003e 60 ml / min) dose correction is not required (1 table. Naliprell ® Forte 1 time per day with constant control of creatinine and potassium content).
Overdose
Symptoms: A pronounced decline in blood pressure, nausea, vomiting, convulsions, dizziness, insomnia, a decrease in mood, polyuria or oliguria, which can go to Anuria (as a result of hypovolemia), bradycardia, electrolyte disorders.
Treatment: Washing the stomach, appointment of adsorbents, correction of the water and electrolyte balance. With a significant decrease in blood pressure, the patient should be transferred to a horizontal position with raised legs.
Perjdospota can be removed from the body using dialysis.
special instructions
The use of the drug NOLiprel ® Forte can cause a sharp decrease in blood pressure, especially when the preparation is first taking and during the first 2 weeks of therapy. The risk of excessive decrease in blood pressure is elevated in patients with reduced BCC (as a result of compliance with strict residue diet, hemodialysis, vomiting and diarrhea), severe heart failure (both in the presence of concomitant renal failure and in its absence), with initially low blood pressure, stenosis Renal arteries or stenosis of the artery of the only functioning kidney, cirrhosis of the liver, accompanied by edema and ascites.
It is necessary to systematically monitor the appearance of clinical signs of dehydration and loss of salts, regularly measure the concentration of electrolytes in the blood plasma.
A pronounced decline in blood pressure at the first reception is not an obstacle for further purpose. After the restoration of the BCC and blood pressure, treatment can be continued using a smaller dose of the drug or monotherapy with one of its components.
The blocking of the renin angiotensin-aldosterone system inhibitors of the ACE can lead along with a sharp drop of blood pressure to increase the content of creatinine in the blood plasma, indicating the functional deficiency of the kidneys, sometimes acute. These status arise rarely. Nevertheless, in all such cases, treatment should be started carefully and gradually.
In the treatment of Nolipraly ® Forte needs to systematically monitor the concentration of creatinine in the blood plasma.
Against the background of taking the noliprela ® Forte, it is necessary to regularly monitor the concentration of potassium in the blood plasma. In elderly or weakened patients, it is necessary to take into account the risk of reduced potassium concentration below the permissible level (<3,4 ммоль/л). К этой же группе следует отнести пациентов, принимающих несколько различных лекарственных препаратов, больных с циррозом печени, который сопровождается появлением отеков или асцита, больных с ИБС или сердечной недостаточностью. Снижение уровня калия усиливает токсичность сердечных гликозидов и увеличивает риск развития аритмий. Низкий уровень калия, брадикардия, а также увеличение интервала QT являются факторами риска для развития аритмии типа «пируэт», которая может привести к летальному исходу.
Before receiving the drug in elderly patients, it is necessary to estimate the functional activity of the kidneys and the concentration of potassium in the blood plasma. The initial dose of the drug is established on the basis of the degree of reduction of blood pressure, given the possible dehydration and loss of electrolytes. Such measures allow you to avoid a sharp decline in blood pressure.
It should be borne in mind that the auxiliary substances of the drug NOLiprel ® Forte includes lactose monohydrate. As a result, this drug is not recommended to be prescribed to persons with lactase insufficiency, galactosemia or glucose / galactose maleabsorption syndrome.
Precautions when applying perindopril
The risk of neutropenia on the background of the admission of ACE inhibitors is dose-dependent in nature and depends on the received drug and the presence of concomitant diseases (violation of the kidney function, especially against the background of the systemic diseases of the connective tissue (system red lupus, sclerodermia).
When taking ACE inhibitors, incl. Both perindopoid, sometimes there is a development of angioedema edema of the lower part of the face, lips, language, pharynx and / or larynx. When these symptoms appear, the reception of perindopril should be discontinued immediately, and the patient's condition should be monitored until the signs of the edema disappear completely. If the edema affects only the face and lips, then its manifestations usually pass on their own, although antihistamines can be used to faster the symptoms.
An angioedema edema, accompanied by swelling of the larynx, can lead to a fatal outcome. Swells of language, pharynx or larynx can cause the respiratory tract. When such symptoms appear, it is necessary to immediately enter the p / k adrenaline in the dilution of 1/1000 (0.3 or 0.5 ml) and assign appropriate treatment. In patients, in the history of which there was a swelling of quinqu, not related to the admission of ACE inhibitors, the development of angioedema swelling at the reception of these drugs is much more likely.
In hemodialysis using high-permeable membranes (polyacrylonitrile), the development of anaphylactic reactions in patients receiving ACE inhibitors (tongue and lip swelling, accompanied by shortness of breath and decreased blood pressure), is possible. The combination of hemodialysis should be avoided using polyacryl membranes and treatment of ACE inhibitors.
When using ACE inhibitors, it is possible to develop a dry non-extensive cough. Cache attacks are persistent, but quickly disappear after the discharge of the drug. If necessary, treatment can be continued.
In patients with IHD or insufficiency of cerebral circulation, treatment should be started using low doses of the drug.
The use of ACE inhibitors has a favorable effect in patients with vasorenal arterial hypertension, both pending operational intervention, and if the operation is impossible. Treatment should be started with low doses of the drug, estimating both the functional activity of the kidneys and the level of potassium in the blood plasma. In some patients, the functional deficiency of the kidneys can develop, which quickly disappears when canceling the drug.
In patients with severe heart failure (IV stage) and patients with type 2 diabetes (the danger of spontaneous increase in potassium level) treatment should begin with low doses and carried out under the permanent control of the doctor.
Patients with arterial hypertension and heart failure should not stop receiving beta adrenoblastors: ACE inhibitors should be applied together with beta-adrenoblays.
Anemia can be observed in patients after kidney transplantation or in hemodialysis persons. At the same time, the reduction in hemoglobin levels, the greater, the higher its initial level was. This effect, apparently, is not dose-dependent, but may be associated with the mechanism of action of ACE inhibitors.
A slight decrease in hemoglobin levels occurs during the first 6 months, then the hemoglobin content remains stable and completely restored after the discharge of the drug. In such patients, treatment can be continued, but hematological analyzes should be carried out regularly.
The action of ACE inhibitors may be accompanied by a pronounced decrease in blood pressure during general anesthesia, especially if anesthetic has a hypotensive effect. It is recommended to stop the reception of ACE inhibitors, incl. Perindopril, 12 hours before a surgical operation.
Precautions when using Indpamide
In patients with impaired liver function, the intapamide can lead to the development of hepatic encephalopathy. In this case, the drug should be discontinued immediately.
Before and during treatment, it is necessary to control sodium concentration in blood plasma. The reception of any diuretic drugs can lead to a decrease in sodium content in the blood plasma, in some cases asymptomatic, which, in turn, contributes to the development of a number of serious complications. The most common control of sodium concentration in the blood plasma should be carried out in persons included in risk groups (for example, in elderly patients or under the cirrhosis).
Indapamide, like thiazide diuretics, is able to reduce the removal of calcium with urine, which leads to a temporary and insignificant increase in the concentration of calcium in the blood. A significant increase in calcium can be associated with undiagnosed hyperparathyroidism. In this case, treatment should be discontinued until the function of the parachitoid glands is investigated.
In patients with diabetes, it is necessary to constantly monitor the level of glucose in the blood, especially against the background of hypokalemia.
In patients with a high uric acid content in plasma, the risk of gout development increases.
At the beginning of treatment, against the background of diuretic drugs, the patients may have a decrease in glomerular filtration due to hypovolemia, which, in turn, is caused by the loss of water and sodium ions. As a result, the concentration of urea and creatinine may increase in blood plasma. If the kidney function is not broken, then it is usually normalized, but with already existing renal failure, the patient's condition may worse.
Athletes should keep in mind that Indapamide can give a positive reaction during doping control.
Use in pediatrics
The efficiency and safety of the use of Noliprela ® Forte in children are not installed. It is not recommended to use the drug in children and adolescents under the age of 18.
Impact on the ability to driving vehicles and control mechanisms
During the reception period of Noliprela ® Forte (especially at the beginning of the therapy), caution should be taken when driving a car and performing work that requires increased attention and high velocity of psychomotor reactions.
Conditions for the storage of the drug Nolyiprel ® Forte
At a temperature not higher than 30 ° C.Keep out of the reach of children.
The shelf life of the drug Noliprel ® Forte
2 years.Do not apply after the expiration date indicated on the package.
Synonyms of nosological groups
| Rubric ICB-10 | Synonyms for diseases of the ICD-10 |
|---|---|
| I10 essential (primary) hypertension | Arterial hypertension |
| Arterial hypertension | |
| Arterial hypertension | |
| Sudden increase in hell | |
| Hypertensive state | |
| Hypertensive crisis | |
| Hypertension | |
| Hypertension arterial | |
| Hypertenia malignant | |
| Essential hypertension | |
| Hypertonic disease | |
| Hypertensive crisis | |
| Hypertensive crisis | |
| Hypertension | |
| Malignant hypertension | |
| Malignant hypertension | |
| Isolated systolic hypertension | |
| Crisis hypertensive | |
| Primary arterial hypertension | |
| Essential arterial hypertension | |
| Essential arterial hypertension | |
| Essential hypertension | |
| Essential hypertension | |
| I15 Secondary hypertension | Arterial hypertension |
| Arterial hypertension | |
| Arterial hypertension of critical flow | |
| Arterial hypertension complicated by diabetes | |
| Arterial hypertension | |
| Vasorenal hypertension | |
| Sudden increase in hell | |
| Hypertensive circulatory disorder | |
| Hypertensive state | |
| Hypertensive crisis | |
| Hypertension | |
| Hypertension arterial | |
| Hypertenia malignant | |
| Hypertension is symptomatic | |
| Hypertensive crisis | |
| Hypertensive crisis | |
| Hypertension | |
| Malignant hypertension | |
| Malignant hypertension | |
| Crisis hypertensive | |
| Exacerbation of hypertension | |
| Renal hypertension | |
| Renovascular arterial hypertension | |
| Renovascular hypertension | |
| Symptomatic arterial hypertension | |
| Transient arterial hypertension |
Price in the Internet pharmacy Site: from 753
Statistics and facts
The drug is noliprell a forte - a modern means with an antihypertensive effect of proven effectiveness. The French pharmaceutical company of the Laboratory of Servier Industries, which has a representative office and in Russia is produced. The manufacturer specializes in drugs for the treatment of cardiac and rheumatic pathologies. The main disease in which the noliprell hypotensive means is prescribed is primary arterial hypertension, therapeutic pathology, which ignoring which can lead to serious complications from not only cardiovascular, but also urinary and respiratory systems.
According to the statistics of the World Health Organization, various cardiovascular diseases have become world leaders among diseases, every year more and more lives. The prevalence of arterial hypertension is extremely high, a third of the adult population suffers from it, and to old age - more than half. To some extent it is due to the fact that high pressure is not difficult to diagnose, and in many families there are home tonometers, allowing this pathology in time. But in greater - with the wrong lifestyle of people, more than half affecting the occurrence of cardiological diseases. There are several terms for the designation of a hypertensive disease, in other countries it is often called essential arterial hypertension. "Essential" means that the disease arose idiopathically, without any external cause. When the reason exists and is known, we are talking about symptomatic arterial hypertension (AG). With h systolic pressure necessarily above or equal to 140 millimeters of a mercury pillar, and diastolic - 90 and higher, if the patient does not drink any tablets designed to reduce pressure. AG can even be revealed to those who suffered from hypotension all her life. Hypertensive disease is dangerous both by itself and the risk of hypertensive crisis and other formidable complications, therefore requires a lifelong adjustment. Patients reluctantly agree with the terms of life admission, but it is necessary for the organoprotective effect, extension of life and improving its quality. Noliprell A Forte is a two-component effective means to combat hypertension, consistent with standards and recommendations for the treatment of AG.
Pharmacological group
Refers to antihypertensive means affecting survival. Inhibits the effect of angiotensin glossy enzyme + inhibits the reverse absorption of water and salts in the kidney channels and increases their selection with urine. It is used in therapy both on the outpatient and in the stationary stage of treatment.
Release form and component composition
The drug is available in the most convenient for use in any situation in any situation - in the form of tablets coated with film shell, in packs of two species, characterized by the number of tablets: 30 or 90 pieces. Tablets are inside a special convenient bottle, with which you can control the first autopsy and reception of each new tablet. In a medicine box - instructions with all the necessary recommendations.
Nolyiprel - two-component, contains two active pharmaceutical substances related to different classes. The composition includes: - a substance that inhibits an angiotensipreshing enzyme, by interacting with its zinc cation - Perindoprilum 3.395 milligrams in each tablet. It is contained in the medicine in the form of arginine in a slightly larger amount, which contributes to the release of the desired perindopril concentration during the metabolism. - A component close to pharmacological properties to thiazide diuretics due to the inverse absorption of sodium cations in the kidneys - Indapamidum 1.25 milligram. - Additional substances necessary to impart drug tablet forms and enhancing the action of active pharmaceutical substances, as well as the components of the film shell.
Pharmacological action and pharmacokinetic hypotensive parameters
Nolyiprel A Forte contains two main components relating to different pharmacological classes, which ensures the regulation of blood pressure by implementing two control mechanisms. Perindoprilum affects one of the blood pressure regulation systems - Renin-angiotensin-aldosterone. Inhibits the effect of an angiotensin glossy enzyme, the main value of which is the realization of the reaction of the conversion of one hormone to another, which, in turn, is a vasoconductive effect. To reduce blood pressure by reducing the total peripheral resistance of the vessels, the vessels are necessary, on the contrary, to expand what happens when the perindopril is exposed to ACE. When receiving PER OS is absorbed slightly. Blood proteins are associated inactive and in a small amount. The amount of substance reducing to the place of action, target organs - 70%. The maximum concentration is achieved in an hour. The time required for the loss of half of the pharmacological properties is about an hour. There is an accumulation of the concentration of the active ingredient, which causes the effectiveness of the drug not immediately after the first reception, but after a while (about four days). Indapamidum is close by properties to the class of thiazide diuretics that violate the reverse absorption of sodium cation. Promotes enhanced selection with urine sodium, magnesium, calcium, chlorine and water anions. At the same time, the volume of urinations in patients does not change significantly. After receiving Per OS is absorbed quickly, it is distributed intensively, associated with red blood cells and plasma proteins. The maximum concentration is achieved in two hours. The time required for the loss of half of the pharmacological properties is approximately 14 hours.
Spectrum of indications for use, ICD-10
Nolyiprel A Forte is effective for essential hypertension (code I10 in the international classification of diseases of the tenth revision) of the second and third degree. This, accordingly, moderate hypertension with pressure numbers 160-179 / 100-109 millimeters of mercury pillar and heavy - with numbers 180 and more / 110 and more. In addition, the drug is shown to use in patients with endocrine disease - diabetes and some other pathologies, necessarily accompanied by the lesion of the kidney glomerular, with a violation of glomerular filtration velocity or the appearance of a significant amount of protein in the urine.
Spectrum of contraindications for use for treatment
Increased individual sensitivity to the main components, additional substances necessary to impart the dosage form and enhance the action of the active substance, the components of the film shell. - Sweet quinque in history, as well as hereditary. - liver pathologies, having a class in the Child-Pugh scale, since the main metabolism of the drug takes place in the liver and entails a larger load on it. - Pathology of the kidneys with the speed of glomerular filtration in the standard of Rarbarga less than 30 milliliters per minute, as the two main components directly affect the kidney function and change its biochemical and physiological processes.
Reduced potassium level, blood sodium, elevated level of calcium, uric acid in the blood. - narrowing the diameter of the renal arteries or their branches. - Reducing the mass circulating in the body of the blood. - Violation of the equilibrium of anions and cations, as well as water in the body. - Insufficiency of the enzyme, which splits lactose. - Heriatricly determined disruption of metabolism when transforming galactose in glucose. - Malabsorption glucose-galactose. Be careful in applying patients with pathologies and states as: - Libman-Saks disease; - autoimmune disease - systemic sclerodermia; - treatment with the help of the "Artificial Kidney" apparatus; - severe cardiac pathologies; - stenosis of the mouth of the aorta; - Endocrine disease - diabetes; - Unstable blood pressure.
Naliprell: Side Effect
Dizziness and positional dizziness; - violation of vision and hearing; - heart swelling, most often in the field of stop, increasing at the end of the day;
Headaches of varying degrees of severity and localization; - violation of the digestion of a functional nature; - allergic reactions in the form of redness of the skin, rashes, accompanied by or without it, swelling of quinque; - excessive pressure decrease, orthostatic hypotension; - Weakness, Breakage, Sleep Disruption: Insomney; - reduction in the level of potassium, sodium in the blood, an increase in calcium concentration, lipids; - impaired appetite, up to anorexia; - perversion of taste; - dysna; - frequent liquid chair; - involuntary muscle tension; - pain in the muscles, joints;
Feeling of intense heartbeat; - Pathological loss of hair.
Application of tablets Noliprel: Method, Features, Dose
Tablets take one time each time, preferably in the morning, drinking the necessary amount of water before taking food.
special instructions
Naliprell A Forte in pediatrics is not used, the effects on the children's body are not fully studied. For elderly patients, no dosage reduction is required, but regular control of the speed of glomerular filtration and blood pressure is necessary. If the kidney functions are violated with the preservation of glomerular filtering speed of more than 30 milliliters per minute, the dose correction is not required. In the pathologies of the liver of class and the child-drink scale, the adjustment is not needed. Regular laboratory diagnostics of liver functions are needed, assessing the level of hepatic enzymes, flushing filtration rates. In the case of indicators, expressed from the norm - cancel the reception. Blood pressure should be regularly measured and to keep a diary, in order to avoid excessive reduction in its level and even orthostatic hypotension.
During pregnancy and before the cessation of breastfeeding
Noliprel is not prescribed, the reception is contraindicated.
Overdose
There is no information about the cases of reception of doses more recommended. Manifestations are possible, similar to the symptoms from the side effect point. Treatment is symptomatic. The medicinal means of a specific action that stops or weakening the effect of adopted large dosages is not developed. High risk of orthostatic hypotension, which requires urgent therapy - increase blood pressure, maintaining the activities of the heart, lungs and kidneys. It is possible to use hemodialysis to remove a substance from the body.
Simultaneous use with other medicines and compatibility with alcohol drinking drinks
With a joint reception with lithium preparations, it is possible to strengthen the effect of the latter, and the increase in lithium content in the blood, which is dangerous toxic effect on the body. The Miorlaxant of the central action of Baclophenum enhances the antihypertensive effect of the noliprela, which can lead to an excessive decrease in blood pressure. Reducing the pharmacological effect is observed while using non-steroidal anti-inflammatory agents. It is not recommended to use together with other drugs that inhibit angiotensin glossy enzyme, as well as potassium preparations and potassium-saving diuretics. A complete list of funds prohibited to jointly with Nolipraly is presented in instructions for use. Alcohol during the course of treatment is prohibited.
Storage conditions
Noliprell requires optimal storage conditions, including such items as: compliance with the dry temperature regime to 25 degrees, use until the expiration date of 3 years, inaccessibility for children.
Vacation from pharmacies
Officially, the acquisition of this medicinal product is possible in the pharmacy network with the provision of a prescription.
Analogs
Antihypertensive agents with similar composition, spectrum of action, purpose or pharmacology: perindopril-indapamide Richter, Indapamide / Perjamid-Teva, Co-Parotel, Ko-Perineva, Perindapam, Perindide, Perindopril + Indapamide Sandoz and others.
The tool "Naliprel Forte" is a combined drug that affects several systems of the human body immediately. It has a diuretic, hypotensive and vasodilant impact. In modern medicine, this medicine is used quite often. That is why many patients are interested in issues on the composition and properties of the medication.
Preparation "Naliprel Forte": composition and form of release
The medicine is produced in the form of tablets covered with a protective film. This drug includes several active substances at once, which ensure its combined effect. In particular, each tablet contains 10 mg of arginine perindopril (this amount corresponds to 6.79 mg perindopril) and 2.5 ml of indapamine.
In the production of drugs, substances such as magnesium stearate, colloidal wilderness dioxide, lactose monohydrate, maltodextrin, hypirompas, macrogol 6000, glyccerin and some others are also used as auxiliary means.
Pharmacological properties of medicine
Of course, the properties of the drug "Naliprel Forte" are bound primarily with the impact on the body of its individual components. But for a start, it is worth noting that the drug has a pronounced hypotensive effect, and affects both systolic and diastolic pressure. The degree of severity of the effect in this case depends on the dose. Resistant results appear no earlier than a month after the start of treatment.
In addition, this drug increases the elasticity of the walls of the vessels and reduces the degree of hypertrophy of the left ventricle, without affecting the exchange of carbohydrates and lipids.
Perindopril is one of the main components of the medicine. This substance is an inhibitor of a certain variety of enzymes. It expands the vessels and restores the structure of their walls. Numerous studies have proven that perindropril reduces pressure, and the abolition of the drug does not lead to a sharp jump. Another active substance is Indapamide - according to its properties, it looks like thiazide diuretics. This component inhibits the suction of potassium ions in nephron, which leads to a strengthening of diuresis and excretion along with the urine chlorine and sodium ions.
Perindopril is excreted from the body with urine. Its maximum concentration is observed 3-4 hours after reception. As for Indapamide, he begins to actively act an hour, but is excreted together with the urine and cartoons.
Indications for use
It is worth noting immediately noting that only the attending physician after complete diagnosis and diagnosis can assign a medication "Noliprel Forte". An indication of its use is arterial hypertension, which arises for various reasons.
Instructions for using medication
Naturally, the dosage in this case should be individual, as it depends on the age and state of the patient, as well as disease diagnosed with him. Nevertheless, there are general recommended doses and useful rules. Tablets "Noliprel" best to take in the morning hours - so the effect to manifest itself faster and will stay longer, and the increased pressure will not interfere with the usual flow of the day.
Preparation "Naliprell Forte": Contraindications
Of course, not every patient can undergo similar therapy. First of all, the contraindication is increased sensitivity to any of the drug components. This agent can also be taken to pregnant women, as well as mothers during lactation. In the early period of pregnancy, the drug is able to provoke its interruption, and at later stages - to disrupt the process of fetal development, cause the deformation of the skeleton, hypotension, renal failure.
In addition, contraindications also include pronounced hepatic insufficiency and hypokalemia. Patients with severe kidney diseases Taking the drug is also prohibited. And, of course, the medicine is not recommended to give children under 18. And since the lactose monohydrate is located as part of the fund, it is not prescribed to people suffering from lactose insufficiency and some other diseases associated with violation of carbohydrate exchange processes.
That is why one should not forget that this drug can prescribe an exclusively attending physician after receiving all the results of analyzes and research. In the presence of contraindications, the effects of therapy may be dangerous to health and even life.
Possible adverse reactions
Note that in some cases, such therapy is associated with a risk for health - in the end, the side effects are almost every medical drug. In this case, the reception of the tablets can lead to the appearance of headaches, asthenia, constant fatigue and drowsiness. Some patients also complain about ringing in ears, violations of taste perception and vision, mood lability, confusion.
Occasionally, drugs leads to a violation by the respiratory system - a dry cough, bronchospasm, Rinorea can manifest itself. In rare cases, the use of the drug can lead to angina, arrhythmia, stroke, heart attack, acute renal failure.
Sometimes there is nausea, vomiting, stool disorders, dry mouth. Extremely rare treatment leads to the development of pancreatitis or jaundice.
Additional Information
It is worth noting that the first reception of the medication can provoke a sharp decrease in blood pressure - no need to be frightened, it is normal, especially in the first few days. But such a patient should be under constant supervision of medical staff.
In addition, during therapy, it is necessary to take tests from time to time - it helps to monitor the level of creatinine and potassium in the blood, since deviations from the norm are possible under the influence of medication.
Doctors are also not recommended during therapy to get behind the wheel, work with various mechanisms that require maximum concentration and rapid reaction. Before starting treatment, be sure to inform the doctor about the medicines that you take, as the drug "Noliprel Forte" in combination with other means can be dangerous.
What is noliprell and forte and in what cases it is applied
Nolyiprel A Forte is a combination of two active ingredients, perindopril and indapamide. This is an antihypertensive drug, it is used to treat elevated blood pressure (hypertension) in adults.
Perjdopor belongs to the class of drugs, which are called ACE inhibitors. They act, providing an expanding effect on blood vessels, which facilitates blood injection. Indapamide is a diuretic. Diuretics increase urine volume, which is produced by the kidneys. However, Indapamide differs from other diuretics, as it is only slightly increasing the volume of urine produced. Each of the active ingredients reduces blood pressure, and they together control your blood pressure.
Do not take the drug
If you have allergies to perindopril, any other ACE inhibitor, indapamide, any other sulfonamide or any other component of the drug (listed in the section "Composition");
- if earlier when receiving other APE inhibitors or under other circumstances, you or someone from your relatives showed such symptoms such as whistling breath, swelling of a person or language, intense itching or abundant skin rash (angio-moved);
- if you have diabetes or a violation of the kidney function and you are taking medicines that reduce blood pressure containing alianis;
- if you have severe liver disease or hepatic encephalopathy (degenerative brain disease);
- if you have a seriously broken kidney function, accompanied by a decrease in the blood supply to the kidneys (stenosis of the renal artery);
- If you pass dialysis or any other type of blood filtering. Depending on the equipment used, the noliprel and forte may not be suitable for you by the drug;
- If you have too low potassium levels in blood;
- If you have suspicion of the untreated decompensated heart failure (serious fluid delay, difficulty breathing);
- if your pregnancy period exceeds 3 months (it is also better to avoid the use of noliprela and forte in early pregnancy - see the section "Pregnancy and breastfeeding");
- if you feed the breast;
- If you adopt a combination of Sakubitril / Valsartan, a drug used in the treatment of heart failure (see "Other drugs and noliprell and forte").
Special instructions and precautions
Meet your doctor or pharmacist before taking Noliprell and Forte:
- if you suffer by stenosis of aorta (narrowing the main blood vessel coming from the heart), hypertrophic cardiomyopathy (heart muscle disease) or renal artery stenosis (narrowing the artery in the blood of the kidney), if you suffer heart failure or other heart disease,
- if you suffer from kidney disease or pass dialysis,
- If you have an abnormally elevated levels of aldosterone hormone in the blood (primary aldosteroneism),
- If you suffer impaired liver function,
- If you suffer collagenomy (skin disease) such as systemic red lupus or sclerodermia,
- if you suffer atherosclerosis (solidification of the walls of the arteries),
- if you suffer hyperparathyroidism (parachite gland hyperfunction), if you suffer gout,
- If you suffer diabetes,
- If you keep a diet with a reduced salt content or take substitutes for potassium salts,
- If you are taking lithium, potassium-saving drugs (spironolactone, triamteren) or potassium preparations, since it should not be taken simultaneously with the nolipralya and forte (see "Other drugs and noliprell and forte"),
- If you are in old age,
- if you have experienced photosensitivity reactions,
- If you have experienced serious allergic reactions with edema, lips, mouth, language and throat, which can cause difficulties in swallowing or breathing (angioedema edema). This may occur at any time during treatment. If you have developed such symptoms, you must stop treating and immediately consult a doctor.
- If you take any of the following medicines used in the treatment of arterial hypertension:
- Angiotensin II receptor blockers (s) (also known as sardans, for example, Valsartan, Telmisartan, Irbesartan), especially if you have diabetes problems with kidneys,
- Alisian.
Your doctor can check the kidney function, blood pressure and the amount of electrolytes (for example, potassium) in the blood at regular intervals.
See also information under the heading "Do not take the drug."
- If you belong to the Negroid race, as you can be subject to higher risk of angioedema edema, as well as this drug may be less effective in reducing blood pressure in comparison with patients with different racial affiliation,
- If you pass dialysis with high-pixed membranes,
- If you take any of the following drugs, the risk of angioedema edema can increase:
- Racekadotril (used to treat diarrhea),
- Sirolimus, Everolimus, Temsyrolymus and other drugs belonging to the class of so-called MTO inhibitors (used to prevent rehabilitation of transplanted organs),
- Sakubitril (affordable in a fixed combination with valsartan) for the treatment of chronic heart failure.
Angioedema swelling
Cases of angioedema edema (a serious allergic reaction with accompanying swelling of the person, lips, language or throat, difficult to swallowing or breathing) were noted in patients who took ACE inhibitors, including the noliprell and Forte. These reactions may occur at any time during therapy. If you have these symptoms, you must immediately stop taking the noliprela and forte and consult a doctor. See also the section "Possible side effects".
You must tell your doctor if you think that pregnant (or you can get pregnant). Noliprella and Forte is not recommended to be taken in early pregnancy and should not be taken in pregnancy more than 3 months, as this may cause serious harm to the child (see "Pregnancy and breastfeeding").
When you are taking the noliprell a forte, you should also inform your attending physician or medical personnel about the following:
- If you have anesthesia or a serious surgical operation,
- If you have recently observed diarrhea, or vomiting, or dehydration,
- if you pass through dialysis or apferez LDL (hardware of blood cholesterol),
- if you pass desensitization, which should reduce allergic reactions to bees or OS bites,
- If you pass a medical examination for which the introduction of the iodine-containing X-ray-repeat substance (substance that makes it possible to examine internal organs, such as kidney or stomach, using X-ray rays).
- If you have changed a change in view or pain in one or both eyes when applying noliprela and forte. This may be a sign of the development of glaucoma or high pressure in the eye (s). You must stop taking the noliprela and forte and consult a doctor.
The athletes should know that the noliprel A Fort contains an active substance (indapamide), which can give a positive reaction during doping control.
Children and teenagers
It should not be given noliprell and forte children and adolescents.
Naliprell and forte contains lactose monohydrate.
If the doctor told you that you have the intolerance of some types of sugars, then consult your doctor before starting the reception of this drug.
Other drugs and noliprell a forte
Tell your doctor or pharmacist if you accept, recently accepted or you can start taking any other drugs.
Avoid simultaneous intake of noliprela and forte with the following drugs:
- Lithium (used to treat mania and depression),
- Alisian (preparation for the treatment of hypertension), if you do not suffer from diabetes or impaired kidney function,
- potassium-saving diuretics (for example, triamtenenes, amylorride), potassium salts, as well as other drugs that can increase potassium level in your body (for example, heparin and catrimoxazole, also known as the combination of trimethoprium / sulfamethoxazole),
- etramstine (used in the treatment of cancer),
- other drugs against increased blood pressure: angiotensin-transformative enzyme inhibitors and angiotensin receptor blockers.
For treatment with nolipralya, Forte may affect the reception of other drugs.
Your doctor may, if necessary, change the dose and / or take other precautions.
Be sure to inform your attending physician if you take the following drugs, since when they are taken, it should be especially careful:
- other drugs that are used in the treatment of arterial hypertension, including angiotensin II receptor blockers (sconce), alianis (see also directions under the headlines "Do not take the noliprell and forte" and "be especially careful when taking") or diuretics (preparations, Increasing the volume of urine isolated by the kidneys),
- Potassium drugs used in the treatment of heart failure: Eplerenone and Spironolactone in doses from 12.5 to 50 mg / day,
- drugs that are most commonly used to treat diarrhea (rketchadotril) or for the prevention of transplanted rejection (Sirolimus, Everolimus, Temsyrolymus and other drugs belonging to the class of so-called MTOR inhibitors). See section "Special instructions and precautions",
- a combination of Sakubitril / Valsartan used to treat chronic heart failure (see "Do not take the drug" and "Special instructions and precautions"),
- anesthetic drugs,
- iodine-containing radiocontrase substances,
- Moxifloxacin, Sparfloxacin (antibiotics that are used to treat infections),
- Methadon (used to treat drug addiction),
- Prosanamide (for the treatment of irregular heart rhythm),
- Allopurinol (for the treatment of gout),
- Mizolastine, Terfenadine and asthymizol (antihistamines for the treatment of hay fever or allergies),
- corticosteroids that are used to treat various diseases, including heavy asthma and rheumatoid arthritis,
- immunosuppressive drugs that are used to treat autoimmune violations or after transplant operations to prevent rejection (for example, cyclosporine, tacrolimus),
- erythromycin intravenous (antibiotic),
- Galophantrin (used to treat some types of malaria),
- Pentamidine (used to treat pneumonia),
- Injection of gold (used to treat rheumatoid polyarthritis)
- Vinkin (used to treat clinically pronounced cognitive violations in elderly patients, including memory loss),
- bipridyl (used for the treatment of angina),
- drugs appointed in the treatment of heart rate disorders (for example, quinidine, hydrochinidin, dyspeyramide, amiodaron, sotalol),
- cisaprid, diphemal (used to treat gastrointestinal disorders),
- Digoxin and other heart glycosides (for the treatment of heart disease),
- Baclofen (for the treatment of muscle rigidity, which occurs in certain diseases, for example, with multiple sclerosis),
- drugs for treating diabetes, such as insulin, metformin and glipetins,
- calcium, including calcium additives,
- stimulating laxatives (for example, Senna),
- non-steroidal anti-inflammatory drugs (for example, ibuprofen) or high doses of salicylates (for example, aspirin),
- amphotericin in intravenous (for the treatment of serious fungal diseases),
- preparations for the treatment of mental illnesses, such as depression, anxiety, schizophrenia, etc. (for example, tricyclic antidepressants, neuroleptics (amisulpride, sulpiride, sulctrid, thiaprid, haloperidol, droperidol)),
- tetracoactide (for the treatment of Crohn's disease),
- trimethoprim (for the treatment of infections),
- vasodilating drugs, including nitrates (drugs causing the expansion of blood vessels),
- Preparations that are used to treat reduced blood pressure, shock or asthma (for example, ephedrine, norepinephrine or adrenaline).
Reception Naliprela and Forte with food and drink
Preferably, taking the noliprell a fort before eating.
Pregnancy and breastfeeding
If you are pregnant or breastfeed, you intend or plan a pregnancy, consult your doctor or pharmacist, before starting receiving this drug.
Pregnancy
You must tell a doctor if you think that pregnant, (or you can get pregnant).
Your doctor will advise you to stop taking the noliprela and fort before the onset of pregnancy or immediately, as soon as you learn what are pregnant; The doctor will advise you to take another drug instead of noliprela and forte. Noliprella and Forte is not recommended in early pregnancy, as well as it should not be accepted at a pregnancy period for more than 3 months, as its reception with a period of pregnancy for more than 3 months can cause serious harm to the child.
Lactation
You should not take the noliprell and Forte, if you breastfeed.
Immediately inform the doctor that you feed or are going to start breastfeeding.
Immediately consult with your doctor.
Driving vehicles and mechanisms management
Nolyiprel A Fort usually does not affect the reaction rate, but some patients due to reduced blood pressure can occur different reactions, such as dizziness or weakness. As a result, the ability to control the car or other mechanisms can be broken.
How to take the drug
When receiving the drug, always strictly follow the instructions of the doctor or pharmacist. If you doubt the correctness of the drug, you must consult with a doctor or pharmacist. Recommended dose - 1 tablet per day. Your doctor can decide to change the reception mode if your kidney function is broken. Preferably take tablets in the morning, before meals. Swallow the tablet by drinking it with a glass of water.
If you have taken more noliprela and forte than you recommended
If you accepted too much tablets, contact the nearest point of ambulance or immediately inform your doctor. The most likely effect in the event of an overdose is to reduce blood pressure. If you have fallen pressure (it is accompanied by nausea, vomiting, convulsions, dizziness, drowsiness, confusion of consciousness and change in the volume of urine produced by the kidneys), lie and lift the legs, it can facilitate your condition.
If you forgot to take the noliprell and forte
It is important to take the drug every day, since the regularity of the reception makes treatment more efficient. However, if you forgot to take the dose of noliprela and forte, take the next dose at normal time. Do not double the subsequent dose.
If you stop taking noliprela and forte
Since the treatment of arterial hypertension usually lasts a lifetime, you must consult with your doctor before stopping the preparation.
If you have additional questions about the drug, consult your doctor or pharmacist.
Possible side effect
Like all other medications, Noliprell A Forte, although not every patient, can cause side effects.
If you have one of the following side effects that may be serious, immediately stop taking the drug and contact your doctor immediately:
- severe dizziness or loss of consciousness caused by low arterial pressure (frequent - no more than in 1 patient out of 10),
- bronchospasm (feeling of compression in the chest, whistling breath and shortness of breath) (infrequent) (no more than 1 patient out of 100),
- swelling of the face, lips, oral cavity, language or throat, difficulty breathing (angioedemaid swelling) (see section "Special instructions and precautions") (infrequent) (no more than 1 patient out of 100),
- heavy skin reactions that include multiform erythema (skin rash, often starting with the appearance of red items on the face, hands and legs) or intense skin rashes, urticule, redness of the skin on the entire body surface, heavy itching, bubbles, peeling and skin swelling , inflammation of mucous membranes (Stevens-Johnson syndrome) or other allergic reactions (very rare) (no more than 1 patient out of 10,000),
- cardiovascular disorders (irregular heartbeat, angina (chest pain, jaw and back, caused by physical exertion), heart attack) (very rare) (no more than 1 patient out of 10,000),
- weakness in hands or legs, problems with speech, which may be a sign of stroke (very rare) (no more than 1 patient out of 10,000),
- inflammation of the pancreas, which can cause severe abdominal pain and back, accompanied by poor well-being (very rare) (no more than 1 patient out of 10,000),
- yellowing of the skin or eye proteins (jaundice), which may be a sign of hepatitis (very rare) (no more than 1 patient out of 10,000),
- Arrhythmia's life threatening (frequency unknown),
- a disease of the brain caused by a violation of the liver function (hepatic encephalopathy) (frequency of unknown).
In descending order by frequency, side effects may be as follows:
- Frequent (no more than 1 patient out of 10): Skin reactions in people with predisposition to allergic and asthmatic reactions, headache, sensation of dizziness, dizziness, tingling in limbs, vision disorder, ringing in the ears (sensation of noise in the ears) , cough, shortness of breath (shortness of breathing), disorders from the digestive system (nausea, vomiting, stomach pain, change in taste, dyspepsia or disorder, diarrhea, constipation), allergic reactions (such as skin rashes, itching), convulsions fatigue.
- infrequent (no more than 1 patient out of 100):
- Drops of mood, sleep disorders, urticaria, purpura (red dots on the skin), focal blisters on the skin, disruption of the kidneys, impotence, sweating, increased content of eosinophils (species of white blood cells), change of laboratory indicators: high level potassium in blood, Reduced after discontinuation of therapy, low sodium level, drowsiness, loss of consciousness, heartbeat (sensation of own heartbeat), tachycardia (rapid heartbeat), hypoglycemia (very low blood sugar) in patients with diabetes, vasculitis (inflammation of blood vessels), Dry mouth, photosensitivity reactions (increased skin sensitivity to the Sun), arthralgia (pain in the joints), Malgia (pain in the muscles), chest pain, malaise, peripheral edema, fever, increased urea content and creatinine in the blood, fall.
- Rare (no more than 1 patient out of 1000): deterioration of the flow of psoriasis, changes in laboratory indicators: improving the activity of liver enzymes, high level of bilirubin, fatigue.
- Very rare (no more than 1 patient out of 10,000): confusion of consciousness, eosinophilic pneumonia (rare type of pneumonia), rhinitis (nasal congestion or runny nose), severe disorders of the kidney, blood violations, such as a decrease in the number of leukocytes and Erythrocytes, decrease in hemoglobin content, reducing the number of platelets, high level of calcium in the blood, violation of the liver function.
- The frequency is unknown (the frequency cannot be determined on the basis of the available data): deviations in the work of the heart on the ECG, change of laboratory indicators: low sodium level, high level of uric acid and blood sugar, myopia (myopia), vision of vision, violations. If you suffer from a systemic red lupus (collagenosis), it is possible to exacerbate the disease.
There may also be disorders in the blood, kidneys, liver or pancreas and deviations in laboratory parameters (blood tests). Your doctor may assign blood research to monitor your condition.
There may be disorders from blood, kidneys, liver and pancreas, as well as changes in laboratory indicators (in blood tests). To control your condition, the doctor may assign blood test.
Such symptoms as a reduced urine release (darling of urine color), nausea or vomiting, muscle cramps, confusion and seizures can be caused by the inadequate secretion of ADG (antidiuretic hormone). If you have these symptoms, contact your doctor as soon as possible.
Side Effects Report
If you have any side effects, consult a doctor or pharmacist. It also concerns the emergence of any possible side effects not listed in this liner. You can also report side effects directly through the state system of messages. Reporting on side effects, you help to collect more information about the safety of the drug.