Noliprel a - instructions for use, indications, dosage of tablets, side effects, analogues and price. How to be treated with Noliprel - detailed instructions for use and special recommendations In case of impaired renal function

Cardiologists prescribe it to lower both lower and upper blood pressure. The action of Noliprel is considered dose-dependent. It minimizes manifestations to an extent that does not have a significant effect on urinary excretion.

Another tool does not affect the metabolic processes associated with the absorption of sugar. Noliprel, the instructions for use of which are described in this article, also does not change the amount of fat in the blood.

It is prescribed for arterial essential hypertension. It is also indicated for use in combination with disorders in the endocrine system.

Compound

The active substances are the tert-butylamine salt of perindopril in the amount of 2 mg and indapamide - 1.26 mg. Auxiliary components: lactose monohydrate, magnesium stearate, microcrystalline cellulose, colloidal hydrophobic silicon dioxide.

Release form and packaging

Noliprel is available only in tablets of a snow-white shade of a streamlined shape.

The drug Noliprel Forte

Depending on the type of drug, they are divided into three categories by weight:

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

One plate contains exactly 7 or 10 tablets. In total, there can be 14 or 30 of them in a package.

pharmachologic effect

This action of Noliprel antihypertensive.

Its reception is not accompanied by interfering with the normal functioning of all internal organs.

The desired effect is achieved approximately 30 days after taking the first Noliprel tablet.

Its duration is 24 hours. At the end of treatment with this drug, a withdrawal syndrome is noted. In this case, the manifestation in the form of symptoms of left ventricular hypertrophy, as well as precardiac and postcardiac stress (due to the blood vessels of the muscles and organs of the excretory system) is minimized.

It is important to note that medicine Noliprel does not have a significant effect on the metabolic processes occurring in the human body (in particular, carbohydrate and fat).

Pharmacokinetics and pharmacodynamics

This substance has a powerful hypotensive effect on the condition of patients with both low and acceptable renin activity in the blood serum.

Terms of sale

The drug is dispensed in pharmacies only by prescription.

Storage conditions

It must be stored at a temperature not higher than 29 ° C in a place inaccessible to children.

Best before date

The shelf life of Noliprel is 3 years from the date of manufacture indicated on the package.

Price and where to buy

It can only be bought in pharmacies. The average cost of a medicine is 600 rubles.

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.

Combination active ingredients enhance each other's action and lead to a persistent decrease in blood pressure in patients with arterial hypertension(hypertension).

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.

The drug is produced only in the form of film-coated tablets. white color. 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.

In patients with moderate kidney failure(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).

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

Side effects

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

• orthostatic hypotension, excessive reduction 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;
• period of pregnancy and breastfeeding;
• children's and adolescence up to 18 years (since the safety and efficacy of the drug have not been established);
• hypersensitivity to perindopril and / or other ACE inhibitors, indapamide and sulfonamides.

Overdose

Most common symptom overdose becomes 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.

Emergency care consists in removing Noliprel from the body by gastric lavage and / or prescribing activated carbon, accompanied by subsequent normalization of the water-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.

Noliprel analogs, price in pharmacies

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

1. Ko-prenesa,
2. 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.

Noliprel is a combination of perindopril (an ACE inhibitor) and (a diuretic from sulfonamide derivatives). This interaction is quite effective in the fight against high blood pressure, so Noliprel has a lot of analogues and substitutions.

Is French drug, which is produced in France in the "Laboratory Servier Industry". The presented pharmacological company has its representative office in Russia, where it also manufactures this product.

Noliprel. Composition and form of release

The main components of Noliprel are and indapamide. It is sold in pharmacies in five formats: Noliprel has the lowest dosage active substances, containing 2 mg of perindopril and 0.625 indapamide. Noliprel forte contains exactly twice as much of each of the components.

Noliprel A is also produced, with a content of 2.5 mg of the first component and 0.625 of the second. The next format - Noliprel A Forte, includes a double portion of the previous dosage. Noliprel A Bi-Forte comes in the largest consistency, collecting 10 mg of the first ingredient and 2.5 mg of the second.

The existing letter "A" in some interpretations indicates that in this preparation perindopril is supplemented with the amino acid arginine. Which, in turn, improves the condition of the heart and blood vessels.

Properties

It owes its characteristics to the main ingredients - perindopril and indapamide. The first of the list is known for fast absorption. Once in the body, it helps to lower blood pressure, reducing the load on the heart.

One fifth of the total volume ingested into the body is transformed into the active metabolite perindoprilat. The half-life is on average four hours.

This process can be somewhat delayed with existing renal and heart failure.

Indapamide is also rapidly absorbed from the gastrointestinal tract. Two-thirds of the entire portion comes out with urine, a quarter - with feces. Stimulates the excretion of sodium salts through the urinary system, which results in a decrease in blood pressure.

Purpose

Essential hypertension is the main reason for taking Noliprel.

It is also actively used in patients suffering from high blood pressure, but at the same time having type 2 diabetes mellitus. It is needed to reduce the risk of microvascular complications from the kidneys and the likely macrovascular complications in terms of cardiovascular disease.

Noliprel - instructions for use

You need to take it in the morning, on an empty stomach, before breakfast, one tablet once a day. Depending on the age and condition of the patient, the dosage is selected. If after thirty days the expected result has not been achieved, a single dose should be increased.

In elderly patients, before treatment, it is imperative to analyze the content of potassium in the body and perform complete diagnostics kidney function in order to avoid possible problems in the work of this organ in the future.

The initial dosage should be selected taking into account the work of the kidneys.

With a clearance of 30-60 ml / min. adjustments are not required. With readings of 60 and above, correction is also not required. At lower readings, an individual approach is required.

Overdose

The most common symptom is low blood pressure. In private situations, vomiting, nausea, convulsions may occur. In some cases, drowsiness, confusion were noted.

Gastric lavage is the first action to be taken in case of an overdose. To do this, you need to drink as much warm water as possible and press on the root of the tongue, thereby causing vomiting. After the procedure, you can take activated charcoal.

If there is too much pressure jump down, you should immediately put the patient down, slightly raising his legs, if necessary, you can enter drugs that raise blood pressure.

Side effects

In terms of the gastrointestinal tract, digestive disorders are often noted, accompanied by diarrhea, vomiting, and constipation. There may be disturbances in the perception of tastes, a feeling of thirst in the mouth, and often there is no appetite. Extremely rare, but still likely swelling of the intestine, pancreatitis. Possible manifestation of hepatic encephalopathy.

It is extremely rare, but still there is a decrease in the level of platelets, leukocytes, aplastic anemia, increased destruction of red blood cells. In the case of a kidney transplant, Noliprel can cause anemia.

Quite often there is a headache, dizziness, increased fatigue, mood swings, bad dream, confused mind.

Visual disturbances may occur, tinnitus is noted.

Too much pressure drop, with a sharp rise, dizziness and even fainting are observed, tachycardia, bradycardia, and arrhythmia are extremely rarely noted. On the background reduced pressure in patients at high risk, myocardial infarction may occur.

Prolonged dry cough, shortness of breath, bronchospasm, runny nose, eosinophilic pneumonia - all these side effects disappear immediately after discontinuation of this medication.

It is not excluded the likelihood of a rash on the skin, itching. Occasionally, swelling of the face or its individual parts, limbs of the body, mucous membranes of the mouth is noted. All these symptoms are noted in people with asthma or predisposed to allergic reactions. Erythema multiforme, Lyell's syndrome, a form of toxic epidermal necrolysis, and photosensitivity are extremely rare.

Quite often there are spasms in the muscles, less often, but kidney failure is also likely, its acute form manifestations are extremely rare.

Infrequently, but there are also cases of impotence, excessive sweating, chronic fatigue syndrome is often noted.

During the course of Noliprel, a decrease in the concentration of sodium and potassium ions in the blood is noted, at the same time, an increase in uric acid and glucose, creatinine may occur. All these indicators are aligned immediately after the end of the drug.

Contraindications

Do not prescribe Noliprel in the treatment of potassium-sparing diuretics, as well as with an increase in the blood of this microelement. It is also impossible to conduct a parallel course of treatment with antiarrhythmic drugs.

Pregnancy in any trimester, breastfeeding, and age under 18 are strong contraindications.

With the existing increased susceptibility to the ingredients of Noliprel, it is not worth prescribing it. If Quincke's edema occurs, it should also be excluded from therapy. Renal failure will also be a reason for refusal, especially in situations where the clearance is below 30 ml / min. Encephalopathy is also a good reason to choose a more suitable analogue that does not put such a burden on the liver.

In the presence of chronic heart failure at the time of instability, you should also not take Noliprel. Rheumatic diseases, including diffuse diseases of the connective tissue, for example, Sjögren's disease, dermatomyositis.

Treatment with immunosuppressants in parallel with Noliprel can lead to the appearance of agranulocytosis.

The state of depressed bone marrow hematopoiesis is also an undesirable syndrome for this drug. Treatment with diuretics, a salt-free diet, instability of glucose levels, high levels of uric acid in the blood, unstable blood pressure, arterial valve stenosis, as well as a condition after a kidney transplant - all these conditions are a good reason to choose a drug that is more suitable for indications among analogues.

Interaction

Noliprel has a "complex" character, so not every drug is in good contact with it. So, in combination with lithium, it is able to create its increased presence in the blood, as a result - toxic effects.

Concurrent therapy with thiazide diuretics leads to the same result. If there is a need to prescribe lithium preparations, constant monitoring of its level is required. Without special need, it is better not to prescribe such combinations.

In conjunction with NSAIDs, including Acetylsalicylic acid, there is a risk of a decrease in the diuretic result, and, as a result, a decrease in the effect of treatment. But, at the same time, with a strong loss of fluid, acute renal failure is possible.

Accompanied by the treatment of diuretics in high dosages, it can provoke a significant decrease in the body-centered cubic system and a strong decrease in blood pressure.

Baclofen can enhance the effect of Nolipril treatment, so with this tandem, you need to more carefully monitor the level of pressure, not forgetting to monitor kidney function. If necessary, immediately reduce the dosage.

In combination with tricyclic antidepressants, there is also the possibility of too much reduction in blood pressure, the possibility of dizziness when standing up and even the development of fainting is high.

In the treatment of glucocorticosteroids and tetracosactides, the removal of excess fluid from the body worsens, so the effectiveness of the antihypertensive drug may decline sharply.

ACE inhibitors delay the release of potassium through the kidneys. As a result, death may occur. To prevent such a result, it is necessary to check the content of potassium salts in the blood, it will not be superfluous to regularly conduct an ECG.

To prevent potassium levels from falling below the permissible level, antiarrhythmic drugs should be chosen with utmost care. Separate antipsychotics can also lead to a similar deviation. In such a tandem, constant monitoring of potassium levels is needed.

Laxatives can also lead to hypokalemia, in this case, monitoring of the level of potassium is also required, and if necessary, its correction. If there is a need to take laxatives, one should choose those that do not stimulate the bowels.

Metformin and indapamide in the complex can lead to kidney failure due to the diuretic effect of the second. There is also the possibility of accumulation of lactic acid in the blood.

Analogues

Co-Perineva, Perindide, Perindopril-Indapamide Richter. All of them are complete analogues of Noliprel, having the same ingredients. Therefore, in their characteristics, for the most part, they coincide with it. Available in various dosages, which allows you to more accurately adjust the course of treatment.

Despite the fact that all analogues have the same composition as Noliprel, the cost is different for everyone. On average, it starts from 250 and for some drugs reaches 1200 rubles per pack.

special instructions

If a person has never received treatment with perindopril and indapamide before, then at first, a comprehensive monitoring of his condition should be carried out, first of all, to exclude the appearance of hypokalemia. Also, the risk of idiosyncrasy cannot be ruled out. To minimize the likelihood of these side effects, monitoring is essential.

It must be taken into account that with severe swelling of the larynx, breathing difficulties are likely and even death is possible. With such an outcome, immediate adrenaline therapy is required. Extremely rare, but intestinal edema is also likely.

While taking Noliprel, there is a high probability of developing anaphylactic shock from the sting of a bee or wasp. For the same reasons, a parallel course of ACE inhibitors and immunotherapy based on bee venom should not be carried out.

In order to avoid trouble, taking poisonous drugs should be stopped at least a day before treatment.

Noliprel may cause neutropenia, the risk of this disease higher in patients with renal impairment. Depends solely on the size of a single portion. After the end of the course of treatment, all the symptoms of neutropenia disappear by themselves, without treatment. To reduce the risk of this deviation, you need to carefully monitor the dosage and compare all the pros and cons before treatment.

Often during therapy, a dry cough appears. As soon as the treatment ends, it goes away on its own. Whether or not to continue treatment against the background of such a deviation is decided by the doctor.

With renal insufficiency, CC below 30 ml / min Nolipril is undesirable, for treatment it is better to choose analogues containing one of its main components. If, during the course of treatment, tests revealed renal failure, it also makes sense to switch to an analogue with one of the leading components.

After a while, you can take Noliprel again, but at a lower dosage. At the same time, constant monitoring of the level of potassium and creatinine is necessary. As a rule, such monitoring is carried out for the first time two weeks after the start of administration, in the future, such an analysis should be done at least once every two months.

In patients suffering from stenosis of the arteries of the kidneys, the likelihood of hypotension is high. To avoid such an outcome Special attention should be given to the water content of the body, especially after diarrhea or vomiting. Constant monitoring of electrolytes in the blood in this case is required.

If, however, there was too much decrease in blood pressure, you can enter intravenously 0.9% sodium chloride. A temporary too strong decrease in blood pressure is not a reason to cancel Noliprel. It is possible to switch to a lower dosage or use analogues containing one of the active components.

We must not forget that in addition to the main ingredients in Noliprel there are additional substances, one of which is lactose monohydrate. Therefore, people suffering from intolerance to this component or lactase deficiency should also choose one of the analogues.

In order to avoid anemia in people who have undergone a kidney transplant, monitoring the level of iron in the blood is required. The trend is that the higher its initial indicator, the higher the likelihood that it could fall below the maximum allowable level.

Such a reaction of the body does not depend on the dosage, therefore, in the first six months of the course, careful monitoring is needed, after which the situation stabilizes by itself. After discontinuation of the drug, the hemoglobin level is completely restored.

To avoid the development of hypotension and renal failure, especially in elderly patients and with pre-existing kidney disease, treatment should be started with a small dose, gradually increasing it until the desired result is achieved.

In addition to hypotension, it can also develop. Such a risk exists with bilateral renal stenosis, so it makes sense to start treatment with a low dosage, gradually bringing it up to the desired one, while not forgetting to control the level of potassium in the blood. After discontinuation of the drug, all symptoms disappear.

In the case of severe heart failure, therapy should also be started with minimal portions and at the same time constantly monitor the patient's condition. These recommendations also apply to insulin-dependent patients.

If, in addition to hypertension, the patient also has heart failure, in no case should beta-blockers be withdrawn from the course. They must be taken in combination with ACE inhibitors.

When conducting general anesthesia taking Noliprel is likely to have a too large jump in blood pressure down, especially if the drug used for anesthesia also has a hypotensive property. Therefore, at least a day before taking the ACE inhibitor should be stopped. The anesthesiologist should also be informed about the use of these drugs.

With obstruction of the outflow tract of the left ventricle, therapy should be carried out with extreme caution.

Cholestatic jaundice as a fact may occur during treatment in patients with liver failure. If the processes are fast, liver necrosis may occur. In extreme cases, death is likely. The reasons for the appearance of such a deviation are unclear, therefore, at the first signs of jaundice or malfunctions in the liver, you should stop taking the drug and consult a doctor.

Hyponatremia is another diagnosis that can develop as a result of taking drugs that have a diuretic effect. The difficulty may also lie in the fact that at the beginning of treatment, symptoms may not appear, but occur after some time, therefore, it is necessary to monitor this indicator especially carefully.

If there are liver diseases, for example, cirrhosis, or the elderly, heart failure, then the likelihood of hyponatremia increases several times.

Against such a background, the chance of arrhythmias, including arrhythmias of the "pirouette" type, increases, as a result, in exceptional cases, a fatal outcome is likely.

Often occurring hypokalemia requires immediate treatment, which can be reduced to taking thiazide diuretics, which reduce the amount of excreted potassium from the body. As a result, the situation is stabilizing.

In this case, it is important to ensure that hypercalcemia does not occur, which can also occur against the background of such treatment. This deviation can also occur if a person had hyperparathyroidism, which was not detected in a timely manner.

With existing diabetes, constant monitoring of the patient's blood sugar is required.

The risk of gout occurs when too high levels of uric acid are present in the blood.

If the patient has malfunctions of the kidneys, when hyponatremia and hypovolemia appear during the procedures, there is a chance of a decrease in the glomerular filtration rate, against which a surge in the content of urea and creatinine in the body occurs.

When taken rarely, but photosensitivity situations still occur. With such a deviation, the reception should be stopped, if necessary, later you can start treatment again, but carefully hiding from direct sunlight.

Indapamide present in Noliprel is able to show positive reaction for the presence of doping in the body, for these reasons, athletes are not recommended to take it.

Noliprel can be taken by patients driving a car, but in some situations, if a person has special reactions to pressure reduction: dizziness and other disturbances in psychomotor function, driving should be abandoned.

Noliprel and alcohol, like most of these drugs, are not compatible. Moreover, such a combination can lead to a lot of complications, including death. Given the toxicity of alcoholic beverages, the load on the liver increases, contributing to its destruction.

The metabolism of Noliprel also takes place in the liver, as a result, too much responsibility falls on this organ, which can cause serious changes and cell death, as a result - alcoholic hepatitis or cirrhosis.

In addition to the negative impact on the liver, there is an increased load on the central nervous system. The ethanol contained in alcohol can increase side effects Noliprela on this side of the body.

absorbability ACE inhibitors also decreases due to alcohol intake, which contributes to the reduction therapeutic effect. After that, you will have to start the whole course again. In contrast, ethanol can also increase the effectiveness of the drug, which can lead to too much vasodilation and a significant decrease in blood pressure.

During pregnancy, the drug is contraindicated, so when planning one, you should immediately stop taking it and choose another one that is more suitable in this position. Not refusing to take Noliprel can cause fetal malformations and lead to abnormal development, for example, oligohydramnios, especially in the second and third trimesters. The drug can cause complications in newborn babies. A pregnant woman may develop hypovolemia.

Information that perindopril passes into breast milk is considered unreliable, but indapamide has such an ability. As a result, the baby is likely to increase sensitivity to sulfonamide derivatives, and there is also a possibility of nuclear jaundice, and the manifestation of hypokalemia is not excluded.

For those whose value of this indicator is not too high, sometimes it is worth reducing the dosage of the medication indicated in the instructions for the drug, but in any case, you should not self-medicate, the appointment and dosage should be prescribed by a doctor. All the nuances of taking the medicine, its instructions and reviews about it are given in the article.

This drug is available in several varieties. They differ in the dosage of active substances. It has two of them. The table below shows their exact content.

In preparations, the prefix "A" means that in this type of tablet, the substance perindopril is found together with the amino acid arginine. Acid has an additional beneficial effect on the condition of the heart and blood vessels. The most effective and pressure-lowering drug is Noliprel A Bi-forte, but sometimes its dosage is too strong, and the doctor prescribes less powerful varieties after it, with a lower content of active agents.

Release form

Noliprel is produced in the form of white oblong oval tablets, with a score on both sides, which makes it easier to break the pill when you need to take half a dose. Tablets different types of this means go by weight:

• Noliprel A - 2.5 mg;
• Noliprel A Forte - 5 mg;
• Noliprel A Bi-Forte - 10 mg.

One blister can hold 7 or 10 pills. In total there are 14 or 30 of them in a pack.

Instruction Noliprel

It is a combined medicine, its two active substances are listed above. Each of them has its own set of properties, thanks to their joint activity, the drug is able to:

• Influence the activity of renin in the blood;
• Reduce vascular resistance;
• Normalize the work of the myocardial muscle;
• Decrease aldosterone secretion;
• Reduces the effects of overloading the body;
• Reduces blood pressure;
• Increases cardiac output;
• Prevents an increase in the left ventricle;
• Improves the elasticity of blood vessels.

The drug, despite its strong effect, does not affect the amount of cholesterol and lipids, does not participate in metabolic processes, does not affect the content of salts and fluids in the body. The action continues throughout the day. The desired effect, which remains for a long time, occurs after a month. After stopping its use, there is no addiction syndrome.

Noliprel - indications for use

The drug is most often prescribed for essential hypertension to prevent the risk of microvascular complications in patients who suffer from this disease, as well as from diabetes.

Features of taking the medicine

This combined medication contains active substances that have a high level of impact on the body, so they are taken only once a day. This pill is ideal for older people who may forget how many pills were taken in the allotted time, and got up in the morning, took it, and all day long you don’t have to remember about it.

It is better to take this drug in the morning, take it for 5 weeks at one dosage, then the doctor can adjust the dose of the medicine depending on how the treatment is going. If you need to enhance the effect of the drug, then together they prescribe drugs that act as calcium antagonists.

In cases where the pressure drops sharply, the doctor will reduce the dose.

In the first days of using Noliprel, you should refrain from driving a car and working on high-precision energized mechanisms, then you need to focus on your condition.

Taking medication during pregnancy and lactation

During the period of planning and bearing a child, it is better not to use Noliprel A, and if they were prescribed treatment before, then they should stop drinking it and replace it with another drug.

This medication did not work clinical research effects of ACE inhibitors during pregnancy. But even if the drug was taken in the first trimester, it does not affect the development of the fetus in any way, but its fetotoxic effect has not been studied.

In the II and III trimester, Noliprel A is contraindicated for use. The components of the medicine can affect the development of the baby. Adversely affect the function of the kidneys, the formation of the bones of the skull, and the newborn may have a slowdown in the overgrowth of the "fontanelle", the appearance of arterial hypotension and the development of renal failure.

To exclude the influence of the drug, which was taken at the end of pregnancy, you need to undergo an ultrasound of the kidneys, as well as check the condition of the skull of the newborn.

During breastfeeding, Noliprel is contraindicated, as it reduces the amount breast milk, and inhibits the process of lactation. While taking this medicine, the baby may develop jaundice, hypokalemia and sulfonamide.

If this drug is extremely important for the health of a new mother, then it may be necessary to stop breastfeeding so as not to harm the baby.

Overdose

It causes water and electrolyte abnormalities in the body, which result in hyponatremia and hypokalemia. In addition, it is accompanied by the following symptoms:

• Drowsiness;
• Anuria and polyuria;
• Strong decrease in pressure;
• Nausea leading to vomiting;
• Decreased heart rate;
• Fainting;
• Cold sweat with chilliness;
• convulsions;
• Vertigo.

Contraindications

Noliprel should not be taken if the patient has hypersensitivity to the drug. You should not take the drug for the following diseases:

• Severe form of renal failure;
• Patients undergoing hemodialysis treatment;
• In childhood;
• hepatic encephalopathy;
• Those who have previously noticed the occurrence of angioedema after taking similar drugs;
• Stenosis of the kidneys and their arteries.

Side effects

In the treatment of Noliprel may develop different adverse reactions organism from its different systems:

1. Urogenital. Rarely, but there is a deterioration in kidney function, a decrease in potency. And if you take the drug in conjunction with other diuretics, you will get an excess of creatinine in both urine and blood.
2. Cardiovascular. It can respond to excess with orthostatic collapse, increased hypotension, rarely, but all this turns into arrhythmia, myocardial infarction or stroke.
3. Digestive. Accompanied by vomiting, abdominal pain, cholestasis, drying of the mucous membranes of the throat, sometimes abdominal pain, bloating or constipation.
4. Nervous. There are prolonged headaches accompanied by dizziness, vision deteriorates, and sometimes ringing in the ears is heard, appetite decreases, convulsions appear, slight inhibitions in reasoning and perception of what is happening.
5. Respiratory. Dry cough that does not last long, runny nose, difficulty breathing, spasms in the bronchi.
6. Circulatory. Hyperglycemia, increased amount of urea, pancytopenia, thrombocytopenia, hemolytic anemia and agranulocytosis.
7. Skin covers. A rash appears on them with an overdose, as a result allergic reactions, urticaria, hemorrhagic vasculitis and lupus erythematosus.

Taking Noliprel with other medicines

Let's display the compatibility of the drug with drugs in a tabular form.

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

Noliprel forte - analogues

Among the worthy substitutes for this drug are:

1. Accusid. It is used for patients who are prescribed a complex treatment of a diuretic and quinapril.
2. Iruzid. Treats people with mild to moderate hypertension if they are on stable therapy.
3. Capothiazid. It is used in conjunction with other antihypertensive drugs, treats any form of arterial hypertension.
4. Quinard. It is prescribed for chronic insufficiency and hypertension.
5. Ko-renitek. It is used for patients who undergo complex therapy.
6. Lisinopril/hydrochlorothiazide. The drug is intended for mild treatment and medium degree hypertension.
7. Lysopress. Treats hypertension.
8. Liprazide. Created to cure any form of hypertension, including renovascular.
9. Mipril. Reduces BP.
10. Rami compositum. It is an option for those patients who cannot control their blood pressure with monotherapy.
11. Tritace. Applies to both complex treatment, and can be used in conjunction with other calcium antagonists and diuretics. Helps with congestive heart failure.
12. Phosid. It is prescribed for arterial hypertension.
13. Ena sandoz. It is used for essential hypertension, chronic heart failure, is used to prevent a heart attack.

Reception of Noliprel should occur during normal dehydration of the body in order to avoid severe hypotension. During its use, creatinine, electrolytes and blood pressure are monitored. If the patient suffers from heart failure, then the drug should be combined with beta-blockers. It should be noted that Noliprel gives a positive reaction to doping tests.

Combined preparation consisting of 2 active substances, complementary pharmacological effects, and used to treat hypertension.

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

ATX

C09BA04 Perindopril and diuretics.

Forms of release and composition

Active substance: Perindopril 2 mg + Indapamide 0.625 mg.

pharmachologic effect

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

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

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

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

The joint appointment of perindopril and indapamide enhances the effectiveness of therapy for hypertension, reduces the risk of hypokalemia (a side effect of taking diuretics).

Pharmacokinetics

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

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

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

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

Indications for use

Hypertension (arterial hypertension).

Contraindications

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

How to use

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

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

Can I split the pill

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

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

How to treat type 2 diabetes

Does not affect glucose metabolism, metabolically neutral. For the sick diabetes application is possible according to the standard scheme.

Side effects

Gastrointestinal tract

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

Hematopoietic organs

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

central nervous system

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

From the respiratory system

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

From the urinary system

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

allergies

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

special instructions

Alcohol compatibility

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

Influence on the ability to control mechanisms

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

In violation of liver function

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

With kidney failure

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

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

During pregnancy and lactation

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

In old age

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

Appointment Noliprel children

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

Overdose

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

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

Interaction with other drugs

Carefully

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

Glucocorticosteroids reduce the antihypertensive effect.

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

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

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

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

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

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

When taken orally with NSAIDs against the background of dehydration, it can lead to acute pathology kidney filtration.

Analogues

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

Conditions for dispensing from a pharmacy

Released by prescription.

Price for Noliprel

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

Storage conditions of the drug Noliprel

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