Noliprel 2.5 mg instructions for use. Powerful combination medicine for pressure noliprel and the nuances of its use. Indications, appointments and side effects

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

Noliprel (Bi) Forte is a drug with a double dosage of active substances (Perindopril 4 mg + Indapamide 1.25 mg). If 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 the resistance of peripheral arteries, without affecting the level of lipids and blood glucose.

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

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

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 the active form. This value may decrease when consumed with food. The maximum content in the blood is fixed 3-4 hours after ingestion. A small part of perindopril binds to blood proteins. It is excreted from the body with urine.

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

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

Indications for use

Hypertension (arterial hypertension).

Contraindications

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

How to use

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

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

Can I split the pill

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

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

How to treat type 2 diabetes

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

Side effects

Gastrointestinal tract

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

Hematopoietic organs

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

central nervous system

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

From the respiratory system

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

From the urinary system

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

allergies

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

special instructions

Alcohol compatibility

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

Influence on the ability to control mechanisms

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

In violation of liver function

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

With kidney failure

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

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

During pregnancy and lactation

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

In old age

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

Appointment Noliprel children

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

Overdose

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

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

Interaction with other drugs

Carefully

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

Glucocorticosteroids reduce the antihypertensive effect.

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

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

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

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

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

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

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

Analogues

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

Conditions for dispensing from a pharmacy

Released by prescription.

Price for Noliprel

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

Storage conditions of the drug Noliprel

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

High blood pressure is not just a problem for the elderly. Such a diagnosis can be made to the patient at a young age. The disappointing statistics of cardiovascular diseases has many reasons, the main ones are non-compliance with a healthy lifestyle, constant stressful situations, a busy life schedule, malnutrition and, of course, heredity.

It is very difficult to deal with hypertensive surges, many people do not help to normalize blood pressure, simplified for them, use combined strong drugs in therapy. The drug "Noliprel" also belongs to their group. In this article we will consider its main properties.

Since many are interested in a cheap analogue of Noliprel, we will select several replacements for this drug according to its main characteristics. And also consider several analogues thereof.

Appointment of the drug "Noliprel", price

This is a combined remedy that includes the active substance perindopril, erbumine salt and the diuretic indapamide. This combination of substances allows you to expand the arteries, increase and thereby normalize blood pressure and heart function.

In other words, the components contained in the composition effectively affect the vessels, restoring their elasticity property.

Strengthened therapy with this drug is prescribed only when weaker ACE inhibitors do not affect the body properly.

A package of tablets of this medicine costs 350 rubles. Knowing the price of the drug "Noliprel", analogues are cheaper to pick up easily. But first you need to deal with the provisions that are contained in the instructions attached to the medicine.

Indications, appointments and side effects

The instruction for use attached to the drug "Noliprel" does not define the analogue. It only indicates the properties of the drug.

This remedy is prescribed if necessary to minimize the risk of complications such as myocardial infarction and stroke.

Often, the drug is prescribed to people with diseases of the kidneys, heart, with high blood pressure, diabetes mellitus (type 2).

The medicine is taken once a day (one tablet). It is advisable to do this in the morning. During therapy with this medicine, blood levels of creatinine and potassium should be carefully monitored.

In order to prevent cases of overdose with this drug, only a competent doctor should prescribe it.

A fairly strong medication in relation to the normalization of blood pressure has an impressive list of side effects on the body of sick people, the main ones are:

• arrhythmia;
• decrease in potency;
• impaired renal function;
• bronchospasm, cough, runny nose;
• skin itching.

The advantages of this remedy include rapid action and the possibility of prescribing medication for patients with diabetes mellitus. A cheap analogue of Noliprel should also have similar properties, but it is not always possible to find an exact copy of the drug in terms of composition and action.

Contraindications for admission

You can not take the drug "Noliprel" for kidney diseases, since it contains a diuretic, in the presence of allergic reactions to the components contained in the drug, during pregnancy and lactation, with liver diseases, pathologies associated with not absorbing glucose by the body. You can not combine this medicine with antidepressants.

Preparations identical to the combination drug

Very often, people suffering from high blood pressure are wondering which is better - the medicine "Noliprel" or "Noliprel A". These drugs are interchangeable. The only difference between them is that the Noliprel medication contains erbumine salt in the composition, and Noliprel A contains arginine salt. Arginine is identical to erbumine, only it prolongs the shelf life of the medicines it contains. Its presence is indicated by the letter A.

The cost of packing Noliprel A tablets is 550 rubles. It is pointless to search among drugs identical both in composition and in terms of effects on the body for a cheap analogue of Noliprel. Their cost is on a par with the original combined remedy and higher.

These also include the drug "Noliprel A Forte", it costs 670 rubles, the tablets "Noliprel A Bi Forte", their price is 680 rubles per pack, the pills "Ko-Pyreneva", they can be bought for 650 rubles, the drug "Prestarium Arginin Combi”, its price is 600 rubles. Cheaper medicines are Co-Prenessa tablets, they cost 400 rubles, and Prylamid, its price is 300 rubles.

It is necessary to select cheaper analogues for identical drugs "Noliprel", "Noliprel A", "Noliprel A Forte" from a number of combined ACE inhibitors. They should have the same effect on the patient's body as a combination of the components contained in them.

It should be understood that analogues of Noliprel Forte, for example, or an identical drug under a different name, instead of perindopril and indapamide, may include other components.

At present, similarities in the effect on the patient's body of such active elements as perindopril, quinapril, ramipril, elanopril, lisinopril, captopril have been revealed. Therefore, from the group of combined ACE inhibitors, it is possible to select cheap analogues for the drug "Noliprel" that include these substances in their composition. They are listed below.

Combined with quinapril

So, the cheap analogue of "Noliprel" from this group is the medicine "Quinard N", it costs 200 rubles. Produced in tablet form. Contains quinapril and diuretic hydrochlorothiazide. It is prescribed for arterial hypertension. It is taken once a day (one tablet). May cause insomnia, anemia, headaches, intestinal upset, cough, runny nose, skin rashes and itching.

Even for the drug "Noliprel" a cheap analogue from this group of combined ACE inhibitors - tablets "Quinapril Sandoz Comp", they cost 250 rubles. Their composition and effect on the stabilization of blood pressure is identical to the drug "Quinard N".

Combined ACE inhibitors with ramipril

From this group of complex drugs, the following tablets can be attributed to cheap analogues of the Noliprel drug: Ramag N, they cost 250 rubles, and Rami Sandoz Compositum, their price is 300 rubles.

Let us dwell, for example, on the medicine "Ramag N". Its composition includes ramipril and the diuretic hydrochlorothiazide. It is prescribed for arterial hypertension. The medicine is taken once (one tablet) in the morning. It can cause severe persistent cough, anemia, skin rashes and itching, nausea, intestinal disorders and inflammation of the gastrointestinal tract. It is not prescribed for diseases of the kidneys and liver.

Combined ACE inhibitors with elanopril

Tablets "Berlipril Plus" and "Elanozid" - the drug "Noliprel" analogues, reviews of which are mostly positive. In their composition, they contain elanopril and the diuretic hydrochlorothiazide.

They are prescribed for chronic heart failure and arterial hypertension. Taken once a day (one tablet). May cause side effects such as arrhythmia, thirst, nervous tension, insomnia, tinnitus, blurred vision, urticaria, eczema, pruritus.

Berlipril Plus tablets cost 250 rubles, Elanozid is half the price - 100 rubles.

Combined ACE inhibitors with lisinopril

From this group of drugs, cheap analogues of the Noliprel drug include Liprazide tablets, the cost of which is 210 rubles, and Lopril Bosnalek N, you can buy them for 240 rubles.

For example, the drug "Liprazid" contains lisinopril and the diuretic hydrochlorothiazide in its composition. It is prescribed for arterial hypertension. It is taken once a day (one tablet). May cause side effects such as vomiting, abdominal pain, weakness, irritability, loss of appetite, pancreatitis, chest pain, confusion, bronchospasm.

Combined ACE inhibitors with captopril

From this group of drugs, cheap analogues of the drug "Noliprel" include tablets "Capotiazid", their price is 150 rubles, and "Normopress", which can be bought for 200 rubles.

So, for example, the drug "Normopress" includes captopril and the diuretic hydrochlorothiazide. It is prescribed for arterial hypertension. It is taken once a day (half a tablet). May cause hypoglycemia, blurred vision, rhinitis, dry cough, pruritus, impotence, weakness, intestinal irritation, palpitations.

Cheap analogues of the drug "Noliprel" of Russian production

Choosing analogues for the drug "Noliprel" cheaper (Russia), you can focus on such domestic combination drugs as Dalneva tablets (perindopril + amlodipine diuretic), they cost 500 rubles, Egipres pills (ramipril + amlodipine diuretic) - 200 rubles, the medicine "Equator" (lisinopril + diuretic amlodipine) - 250 rubles, the drug "Iruzid" (lisinopril + diuretic hydrochlorothiazide) - 300 rubles.

The drug "Noliprel" is also replaced by such domestic non-combined strong drugs as "Captopril AKOS" and "Enalapril AKOS", they cost 200 rubles.

As you can see, the list of similar drugs that affect the normalization of high blood pressure is very large. This can only be explained by the fact that a certain type of medicine is suitable for each person.

It is possible to choose a remedy for individual treatment of blood pressure only by trial and under the strict supervision of the attending doctor. After all, each combined ACE inhibitor can cause serious side effects that are life-threatening.

Also, the independent use of such drugs can be the cause of an overdose, in which low blood pressure is observed, which is also not normal.

This page contains detailed instructions for use. Noliprel. The available dosage forms of the drug are listed (tablets - A, Forte, Bi-Forte 2.5 mg, 5 mg and 10 mg), as well as its analogues. Information is provided on the side effects that Noliprel can cause, on interactions with other drugs. In addition to information about the diseases for the treatment and prevention of which a drug is prescribed (arterial hypertension - to reduce pressure), the algorithms for admission, possible dosages for adults and children are described in detail, the possibility of use during pregnancy and lactation is specified. Annotation to Noliprel supplemented by reviews of patients and doctors. The composition of the drug.

Instructions for use and dosage

Assign inside, preferably in the morning, before meals, 1 tablet 1 time per day. If, 1 month after the start of therapy, the desired hypotensive effect has not been achieved, the dose of the drug can be increased to a dose of 5 mg (produced by the company under the trade name Noliprel A forte).

Elderly patients therapy should begin with 1 tablet 1 time per day.

Noliprel should not be prescribed to children and adolescents due to the lack of data on efficacy and safety in patients of this age group.

Compound

Perindopril arginine + Indapamide + excipients.

Release form

Tablets 2.5 mg (Noliprel A).

Tablets 5 mg (Noliprel A Forte).

Tablets 10 mg (Noliprel A Bi-Forte).

Noliprel- a combination drug containing perindopril (ACE inhibitor) and indapamide (thiazide-like diuretic). The pharmacological action of the drug is due to a combination of individual properties of each of the components. The combined use of perindopril and indapamide provides a synergistic antihypertensive effect compared to each of the components separately.

The drug has a pronounced dose-dependent antihypertensive effect on both systolic and diastolic blood pressure in the supine and standing positions. The action of the drug lasts 24 hours. A persistent clinical effect occurs less than 1 month after the start of therapy and is not accompanied by tachycardia. Termination of treatment is not accompanied by the development of a withdrawal syndrome.

Noliprel reduces the degree of left ventricular hypertrophy, improves arterial elasticity, reduces peripheral vascular resistance, does not affect lipid metabolism (total cholesterol, HDL-C, LDL-C, triglycerides).

Perindopril is an inhibitor of the enzyme that converts angiotensin 1 to angiotensin 2. Angiotensin-converting enzyme (ACE), or kinase, is an exopeptidase that both converts angiotensin 1 to angiotensin 2, which has a vasoconstrictive effect, and destroys bradykinin, which has a vasodilating effect, to an inactive heptapeptide . As a result, perindopril reduces the secretion of aldosterone, increases the activity of renin in the blood plasma according to the principle of negative feedback, and with prolonged use reduces OPSS, which is mainly due to the effect on the vessels in the muscles and kidneys. These effects are not accompanied by salt and water retention or the development of reflex tachycardia with prolonged use.

Perindopril has an antihypertensive effect in patients with both low and normal plasma renin activity.

Against the background of the use of perindopril, there is a decrease in both systolic and diastolic blood pressure in the supine and standing positions. Cancellation of the drug does not lead to an increase in blood pressure.

Perindopril has a vasodilating effect, helps to restore the elasticity of large arteries and the structure of the vascular wall of small arteries, and also reduces left ventricular hypertrophy.

Perindopril normalizes the work of the heart, reducing preload and afterload.

The combined use of thiazide diuretics enhances the antihypertensive effect. In addition, the combination of an ACE inhibitor and a thiazide diuretic also reduces the risk of hypokalemia while taking diuretics.

In patients with heart failure, perindopril causes a decrease in filling pressure in the right and left ventricles, a decrease in peripheral vascular resistance, an increase in cardiac output and an improvement in the cardiac index, and an increase in regional blood flow in the muscles.

Indapamide is a sulfanilamide derivative, pharmacologically similar to thiazide diuretics. Inhibits the reabsorption of sodium ions in the cortical segment of the loop of Henle, which leads to an increase in urinary excretion of sodium ions, chloride and, to a lesser extent, potassium and magnesium ions, thereby increasing diuresis. The hypotensive effect is manifested in doses that practically do not cause a diuretic effect.

Indapamide reduces vascular hyperreactivity in relation to adrenaline.

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

Indapamide helps to reduce left ventricular hypertrophy.

Pharmacokinetics

The pharmacokinetic parameters of perindopril and indapamide do not change with the combination compared to their separate use.

Perindopril

After oral administration, perindopril is rapidly absorbed. Approximately 20% of the total absorbed perindopril is converted to the active metabolite perindoprilat. When taking the drug during meals, the conversion of perindopril to perindoprilat decreases (this effect has no significant clinical significance). Perindoprilat is excreted from the body in the urine. T1 / 2 of perindoprilat is 3-5 hours. The excretion of perindoprilat slows down in elderly patients, as well as in patients with renal insufficiency and heart failure.

Indapamide

Indapamide is rapidly and completely absorbed from the gastrointestinal tract. Repeated administration of the drug does not lead to its accumulation in the body. It is excreted mainly in the urine (70% of the administered dose) and in the feces (22%) in the form of inactive metabolites.

Indications

• essential arterial hypertension.

Contraindications

• angioedema in history (including against the background of taking other ACE inhibitors);
• hereditary/idiopathic angioedema;
• severe renal insufficiency (KK< 30 мл/мин);
• hypokalemia;
• bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney;
• severe liver failure (including with encephalopathy);
• concomitant use of drugs that prolong the QT interval;
• simultaneous reception of antiarrhythmic drugs that can cause ventricular arrhythmia of the "pirouette" type;
• pregnancy;
• lactation period (breastfeeding);
• hypersensitivity to perindopril and other ACE inhibitors, to indapamide and sulfonamides, as well as to other auxiliary components of the drug.

special instructions

The use of the drug Noliprel is not accompanied by a significant decrease in the frequency of side effects, with the exception of hypokalemia, compared with perindopril and indapamide at the lowest doses allowed for use. At the beginning of therapy with two antihypertensive drugs that the patient has not previously received, an increased risk of idiosyncrasy cannot be ruled out. To minimize this risk, careful monitoring of the patient's condition should be carried out.

kidney failure

In patients with severe renal insufficiency (CK< 30 мл/мин) данная комбинация противопоказана.

In some patients with arterial hypertension without previous impairment of renal function during Noliprel therapy, laboratory signs of functional renal failure may appear. In this case, treatment should be stopped. In the future, you can resume combination therapy using low doses of drugs, or use drugs in monotherapy. Such patients need regular monitoring of the level of potassium and creatinine in the blood serum - 2 weeks after the start of therapy and then every 2 months. Renal failure occurs more often in patients with severe chronic heart failure or initial impaired renal function, incl. with stenosis of the renal artery.

Arterial hypotension and disturbance of water and electrolyte balance

Hyponatremia is associated with the risk of sudden development of arterial hypotension (especially in patients with stenosis of the artery of a single kidney and bilateral stenosis of the renal arteries). Therefore, during dynamic monitoring of patients, attention should be paid to possible symptoms of dehydration and a decrease in the level of electrolytes in the blood plasma, for example, after diarrhea or vomiting. Such patients require regular monitoring of plasma electrolyte levels. With severe arterial hypotension, intravenous administration of 0.9% sodium chloride solution may be required.

Transient arterial hypotension is not a contraindication for continuing therapy. After the restoration of BCC and blood pressure, therapy can be resumed using low doses of drugs, or drugs can be used in monotherapy.

The combination of perindopril and indapamide does not prevent the development of hypokalemia, especially in patients with diabetes mellitus or with renal insufficiency. As with any antihypertensive drug in combination with a diuretic, the treatment with this combination should regularly monitor the content of potassium in the blood plasma.

Excipients

It should be borne in mind that the excipients of the drug include lactose monohydrate. Noliprel should not be prescribed to patients with hereditary galactose intolerance, lactase deficiency and glucose-galactose malabsorption.

Neutropenia/agranulocytosis

The risk of developing neutropenia while taking ACE inhibitors is dose-dependent and depends on the drug taken and the presence of concomitant diseases. Neutropenia rarely occurs in patients without concomitant diseases, but the risk increases in patients with impaired renal function, especially against the background of systemic connective tissue diseases (including systemic lupus erythematosus, scleroderma). After discontinuation of ACE inhibitors, signs of neutropenia disappear on their own. To avoid the development of such reactions, it is recommended to strictly follow the recommended dose. When prescribing ACE inhibitors to this group of patients, the benefit / risk factor should be carefully correlated.

Angioedema (Quincke's edema)

In rare cases, during therapy with ACE inhibitors, angioedema of the face, extremities, mouth, tongue, pharynx and / or larynx develops. In such a situation, you should immediately stop taking perindopril and monitor the patient's condition until the edema disappears completely. If the swelling affects only the face and mouth, then the manifestations usually disappear without special treatment, however, antihistamines can be used to more quickly relieve symptoms.

Angioedema, which is accompanied by swelling of the larynx, can be fatal. Swelling of the tongue, pharynx, or larynx can lead to airway obstruction. In this case, you should immediately enter epinephrine (adrenaline) s / c at a dose of 1:1000 (from 0.3 to 0.5 ml) and take other emergency measures. Patients with a history of angioedema not associated with ACE inhibitors have an increased risk of developing angioedema when taking these drugs.

In rare cases, during therapy with ACE inhibitors, angioedema of the intestine develops.

Anaphylactic reactions during desensitization

There are separate reports of the development of life-threatening anaphylactic reactions in patients receiving ACE inhibitors during desensitizing therapy with hymenoptera venom (including bee, aspen). ACE inhibitors should be used with caution in patients prone to allergic reactions and undergoing desensitization procedures. Prescribing the drug to patients receiving immunotherapy with hymenoptera venom should be avoided. However, anaphylactic reactions can be avoided by temporarily discontinuing the drug at least 24 hours before the start of a course of desensitizing therapy.

Cough

During therapy with an ACE inhibitor, a dry cough may occur. Cough persists for a long time while taking drugs of this group and disappears after their cancellation. When a patient develops a dry cough, one should be aware of the possible iatrogenic nature of this symptom. If the attending physician considers that ACE inhibitor therapy is necessary for the patient, the drug may be continued.

Risk of arterial hypotension and / or renal failure (including in case of heart failure, water and electrolyte deficiency)

In some pathological conditions, there may be a significant activation of the renin-angiotensin-aldosterone system, especially with severe hypovolemia and a decrease in the level of electrolytes in the blood plasma (due to a salt-free diet or long-term use of diuretics), in patients with initially low blood pressure, with bilateral renal artery stenosis, or with stenosis of the artery of a single kidney, chronic heart failure or cirrhosis of the liver with edema and ascites. The use of an ACE inhibitor causes a blockade of this system and therefore may be accompanied by a sharp decrease in blood pressure and / or an increase in the level of creatinine in the blood plasma, indicating the development of functional renal failure. These phenomena are more often observed when taking the first dose of the drug or during the first two weeks of therapy. Sometimes these conditions develop acutely and at other times of therapy. In such cases, when resuming therapy, it is recommended to use the drug at a lower dose and then gradually increase the dose.

Elderly patients

Before you start taking the drug, it is necessary to evaluate the functional activity of the kidneys and the concentration of potassium in the blood plasma. At the beginning of therapy, the dose of the drug is selected, taking into account the degree of reduction in blood pressure, especially in the case of dehydration and loss of electrolytes. Such measures help to avoid a sharp decrease in blood pressure.

Patients with established atherosclerosis

The risk of arterial hypotension exists in all patients, but the drug should be used with extreme caution in patients with coronary artery disease or cerebrovascular insufficiency. In such cases, treatment should be started at a low dose.

Renovascular hypertension

Revascularization is the treatment for renovascular hypertension. Nevertheless, the use of ACE inhibitors has a beneficial effect in this category of patients, both awaiting surgery and in the case when surgery is not possible. Treatment with Noliprel in patients with diagnosed or suspected bilateral renal artery stenosis or stenosis of the artery of a single kidney should be started with a low dose of the drug in a hospital setting, monitoring kidney function and plasma potassium concentration. Some patients may develop functional renal failure, which disappears when the drug is discontinued.

Other risk groups

In patients with severe heart failure (stage IV) and patients with insulin-dependent diabetes mellitus (danger of a spontaneous increase in potassium levels), treatment with the drug should be started at low doses and carried out under constant medical supervision.

In patients with arterial hypertension and heart failure, beta-blockers should not be canceled: ACE inhibitors should be used together with beta-blockers.

Anemia

Anemia can develop in patients who have undergone a kidney transplant or in patients on hemodialysis. The higher the initial level of hemoglobin, the more pronounced its decrease. This effect does not appear to be dose dependent, but may be related to the mechanism of action of ACE inhibitors. The decrease in hemoglobin content is insignificant, it occurs during the first 1-6 months of treatment, and then stabilizes. With the abolition of treatment, the hemoglobin level is completely restored. Treatment can be continued under the control of the peripheral blood picture.

Surgery/General Anesthesia

The use of ACE inhibitors in patients undergoing surgery using general anesthesia can lead to a pronounced decrease in blood pressure, especially when using general anesthesia agents that have a hypotensive effect. It is recommended to stop taking long-acting ACE inhibitors, incl. perindopril, one day before surgery. It is necessary to warn the anesthesiologist that the patient is taking ACE inhibitors.

Aortic Stenosis/Hypertrophic Cardiomyopathy

ACE inhibitors should be used with caution in patients with left ventricular outflow tract obstruction.

Liver failure

In rare cases, against the background of taking ACE inhibitors, cholestatic jaundice occurs. With the progression of this syndrome, the rapid development of liver necrosis, sometimes with a fatal outcome, is possible. The mechanism by which this syndrome develops is unclear. If jaundice occurs or a significant increase in the activity of liver enzymes while taking ACE inhibitors, the patient should stop taking the drug and consult a doctor.

Indapamide

In the presence of impaired liver function, taking thiazide and thiazide-like diuretics can lead to the development of hepatic encephalopathy. In this case, you should immediately stop taking the drug.

Violations of water and electrolyte balance

Before starting treatment, it is necessary to determine the content of sodium ions in the blood plasma. Against the background of taking the drug, this indicator should be regularly monitored. All diuretic drugs can cause hyponatremia, which sometimes leads to serious complications. Hyponatremia at the initial stage may not be accompanied by clinical symptoms, so regular laboratory monitoring is necessary. More frequent monitoring of the content of sodium ions is indicated for patients with cirrhosis of the liver and the elderly.

Therapy with thiazide and thiazide-like diuretics is associated with the risk of developing hypokalemia. It is necessary to avoid hypokalemia (less than 3.4 mmol / l) in the following categories of patients from the high-risk group: the elderly, malnourished patients or receiving combined drug therapy, patients with liver cirrhosis, peripheral edema or ascites, coronary artery disease, heart failure. Hypokalemia in these patients enhances the toxic effect of cardiac glycosides and increases the risk of arrhythmias. Patients with an increased QT interval are also at increased risk, regardless of whether this increase is caused by congenital causes or by the action of drugs.

Hypokalemia, like bradycardia, contributes to the development of severe cardiac arrhythmias, especially torsades de pointes, which can be fatal. In all the cases described above, more regular monitoring of the content of potassium ions in the blood plasma is necessary. The first measurement of the concentration of potassium ions must be carried out within the first week from the start of therapy.

If hypokalemia is detected, appropriate treatment should be prescribed.

Thiazide and thiazide-like diuretics reduce the excretion of calcium ions by the kidneys, leading to a slight and temporary increase in the concentration of calcium in the blood plasma. Severe hypercalcemia may be due to previously undiagnosed hyperparathyroidism. Before examining the function of the parathyroid gland, you should stop taking diuretics.

It is necessary to control the level of glucose in the blood in patients with diabetes mellitus, especially in the presence of hypokalemia.

Uric acid

In patients with a high content of uric acid in the blood during therapy with Noliprel, the risk of developing gout increases.

Renal function and diuretics

Thiazide and thiazide-like diuretics are fully effective only in patients with normal or slightly impaired renal function (plasma creatinine in adults is below 2.5 mg / dl or 220 μmol / l). At the beginning of treatment with a diuretic in patients due to hypovolemia and hyponatremia, a temporary decrease in the glomerular filtration rate and an increase in the concentration of urea and creatinine in the blood plasma may be observed. This transient functional renal failure is not dangerous in patients with unchanged renal function, but in patients with renal insufficiency, its severity may increase.

photosensitivity

Against the background of taking thiazide and thiazide-like diuretics, cases of photosensitivity reactions have been reported. If photosensitivity reactions develop while taking the drug, treatment should be discontinued. If it is necessary to continue diuretic therapy, it is recommended to protect the skin from exposure to sunlight or artificial ultraviolet rays.

Athletes

Indapamide may give a positive reaction during doping control.

Influence on the ability to drive vehicles and control mechanisms

The action of the substances that make up the drug Noliprel does not lead to a violation of psychomotor reactions. However, in some people, in response to a decrease in blood pressure, various individual reactions may develop, especially at the beginning of therapy or when other antihypertensive drugs are added to ongoing therapy. In this case, the ability to drive a car or other mechanisms may be reduced.

Side effect

• dry mouth;
• nausea;
• loss of appetite;
• abdominal pain;
• taste disorders;
• constipation;
• dry cough, which persists for a long time while taking drugs of this group and disappears after their withdrawal;
• orthostatic hypotension;
• hemorrhagic rash;
• skin rashes;
• exacerbation of systemic lupus erythematosus;
• angioedema (Quincke's edema);
• photosensitivity reactions;
• paresthesia;
• headache;
• asthenia;
• sleep disturbance;
• mood lability;
• dizziness;
• muscle spasms;
• thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia, hemolytic anemia;
• hypokalemia (especially significant for patients at risk), hyponatremia, hypovolemia leading to dehydration and orthostatic hypotension, hypercalcemia.

drug interaction

Noliprel

With the simultaneous use of lithium preparations and ACE inhibitors, a reversible increase in the concentration of lithium in the blood plasma and associated toxic effects may occur. The additional appointment of thiazide diuretics may further increase the concentration of lithium and increase the risk of toxicity. The simultaneous use of a combination of perindopril and indapamide with lithium preparations is not recommended. If it is necessary to carry out such therapy, the content of lithium in the blood plasma should be constantly monitored.

Baclofen enhances the hypotensive effect of Noliprel. With simultaneous use, blood pressure and kidney function should be carefully monitored and the need to adjust the dose of Noliprel.

With simultaneous use with non-steroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid in high doses (more than 3 g per day), a decrease in the diuretic, natriuretic and hypotensive effect is possible. With a significant loss of fluid, acute renal failure may develop (due to a decrease in glomerular filtration). Before starting treatment with the drug, it is necessary to replenish the loss of fluid and carefully monitor renal function at the beginning of treatment.

With the simultaneous use of Noliprel and tricyclic antidepressants, antipsychotics, it is possible to increase the hypotensive effect and increase the risk of developing orthostatic hypotension (additive effect).

Glucocorticosteroids (GCS), tetracosactide reduce the hypotensive effect of Noliprel (water and electrolyte retention as a result of the action of GCS).

Other antihypertensive drugs enhance the effect of Noliprel.

Perindopril

ACE inhibitors reduce the excretion of potassium by the kidneys caused by the diuretic. Potassium-sparing diuretics (eg, spironolactone, triamterene, amiloride), potassium preparations, and potassium-containing table salt substitutes can lead to a significant increase in serum potassium concentration, up to death. If the combined use of an ACE inhibitor and the above drugs (in the case of confirmed hypokalemia) is necessary, care should be taken and regular monitoring of the concentration of potassium in the blood plasma and ECG parameters should be carried out.

Combinations requiring special care

When using ACE inhibitors (captopril, enalapril) in patients with diabetes, it is possible to increase the hypoglycemic effect of insulin and sulfonylurea derivatives. Conditions of hypoglycemia are extremely rare (due to increased glucose tolerance and reduced insulin requirements).

Combinations requiring caution

Against the background of taking ACE inhibitors, allopurinol, cytostatic or immunosuppressive agents, systemic corticosteroids or procainamide increase the risk of developing leukopenia.

ACE inhibitors may increase the hypotensive effect of general anesthetics.

Prior treatment with diuretics (thiazide and "loop") in high doses can cause a decrease in BCC and arterial hypotension when prescribing perindopril.

Indapamide

Combinations requiring special care

Due to the risk of hypokalemia, caution should be exercised when indapamide is co-administered with drugs that can cause torsades de pointes, such as antiarrhythmic drugs (quinidine, sotalol, hydroquinidine), certain antipsychotics (pimozide, thioridazine), other drugs such as cisapride . The development of hypokalemia should be avoided and, if necessary, its correction should be carried out. The QT interval should be monitored.

Amphotericin B (IV), gluco- and mineralocorticosteroids (with systemic administration), tetracosactide, laxatives that stimulate intestinal motility increase the risk of hypokalemia (additive effect). It is necessary to control the level of potassium in the blood plasma, if necessary - its correction. Particular attention should be paid to patients simultaneously receiving cardiac glycosides. Laxatives that do not stimulate intestinal motility should be used.

Hypokalemia enhances the toxic effect of cardiac glycosides. With the simultaneous use of indapamide and cardiac glycosides, the level of potassium in the blood plasma and ECG parameters should be monitored and, if necessary, therapy should be adjusted.

Combinations requiring caution

Diuretics (including indapamide) can cause functional renal failure, which increases the risk of developing lactic acidosis while taking metformin. Metformin should not be given if serum creatinine is greater than 1.5 mg/dl (135 µmol/l) in men and 1.2 mg/dl (110 µmol/l) in women.

With significant dehydration of the body, which is caused by the intake of diuretic drugs, the risk of developing renal failure increases against the background of the use of iodine-containing contrast agents in high doses. Before using iodine-containing contrast agents, it is necessary to rehydrate.

With simultaneous use with calcium salts, hypercalcemia may develop as a result of a decrease in its excretion in the urine.

When using indapamide against the background of constant use of cyclosporine, the level of creatinine in plasma increases even in the normal state of water and electrolyte balance.

Analogues of the drug Noliprel

Structural analogues for the active substance:

• Ko Perineva;
• Noliprel A;
• Noliprel A Bi-forte;
• Noliprel A forte;
• Noliprel forte;
• Perindide;
• Perindopril Indapamide Richter.

Use during pregnancy and lactation

The drug should not be used in the 1st trimester of pregnancy.

When planning pregnancy or when it occurs while taking the drug Noliprel, you should immediately stop taking the drug and prescribe another antihypertensive therapy.

Appropriate controlled studies of ACE inhibitors in pregnant women have not been conducted. The limited data available on the effects of the drug in the 1st trimester of pregnancy indicate that the use of the drug did not lead to malformations associated with fetotoxicity.

Noliprel is contraindicated in the 2nd and 3rd trimesters of pregnancy.

It is known that long-term exposure to ACE inhibitors on the fetus in the 2nd and 3rd trimesters of pregnancy can lead to a violation of its development (decrease in kidney function, oligohydramnios, slowing down the formation of bone substance of the skull) and the development of complications in the newborn (renal failure, arterial hypotension, hyperkalemia).

Long-term use of thiazide diuretics in the 3rd trimester of pregnancy can cause hypovolemia in the mother and a decrease in uteroplacental blood flow, which leads to fetoplacental ischemia and fetal growth retardation. In rare cases, while taking diuretics shortly before delivery, newborns develop hypoglycemia and thrombocytopenia.

If the patient received the drug Noliprel in the 2nd or 3rd trimester of pregnancy, it is recommended to conduct an ultrasound examination of the fetus to assess the condition of the skull and kidney function.

Noliprel is contraindicated during lactation.

Noliprel tablets are a combined antihypertensive agent consisting of two active substances: perindopril, an ACE inhibitor, and indapamide, a sulfonamide diuretic.

Thanks to the combination of perindopril and indapamide, the effect of each of them is enhanced. The maximum antihypertensive effect of Noliprel develops within 1 month and persists for a long time without the occurrence of tachyphylaxis.

When you stop taking Noliprel, there is no withdrawal effect. It should be noted that the therapeutic effect of Noliprel is dose-dependent. The maximum concentration of perindoprilat in plasma is reached 3-4 hours after administration. The phase of equilibrium concentration is reached after 4 days of periodic use at regular intervals.

One of the active ingredients of the drug - Perindopril reduces the work of the heart by:

- vasodilatory effect on the veins (possibly due to changes in the metabolism of prostaglandins) - a decrease in preload;
– reduction of OPSS – reduction of afterload on the heart.

In numerous clinical studies of patients with heart failure, it has been proven that the use of perindopril leads to:
decrease in filling pressure of the left and right ventricles;

– decrease in OPSS;
– increased cardiac output and improved cardiac index;
- increased regional blood flow in the muscles.

It has been proven that Noliprel tablets help to reduce left ventricular hypertrophy.

Indapamide synergistically with perindopril reduces hypertension, reduces the risk of hypokalemia. According to the mechanism of action, indapamide is closer to thiazide diuretics and is excreted mainly in the urine (70% of the dose) and feces (22%) as inactive metabolites. In patients with renal insufficiency, pharmacokinetic parameters do not change.

Indications for use Noliprel

The use of Noliprel and Noliprel Forte 2.5 \ 5 is indicated for conditions and pathologies:

1. Essential hypertension
2. Secondary hypertension

Important - Noliprel reduces arterial diastolic and systolic pressure. In this case, the medication is not accompanied by an increase in heart rate.

At therapeutic doses of Noliprel in patients with chronic heart failure, a decrease in both preload and afterload is clinically noted. As a result, the heart works more efficiently (property of a cardioprotector) - cardiac output increases, blood supply to the myocardium improves.

Noliprel - instructions for use, dosage

Before meals or after taking Noliprel? Since food slows down the conversion of perindopril to perindoprilat, Noliprel should be taken once a day in the morning before breakfast.

How to take Noliprel, dosage?

The maximum daily dose is 2 tablets once a day Noliprel A 2.5 mg.
The maximum daily dose is 1 tablet of Noliprel Forte 5 mg.

Peculiarities:

Elderly patients. Treatment should begin with the usual dose - 1 tablet of Noliprel 1.25 per day.

In severe renal failure (creatinine clearance<30 мл/мин) лечение препаратом противопоказано. При почечной недостаточности умеренной степени (клиренс креатинина 30–60 мл/мин) максимальная доза - 1 таблетка препарата Нолипрел А в сутки.
In patients with creatinine clearance ≥60 ml / min, there is no need to change the dosage of Noliprel.

Doesn't help, what should I do?

With an increase in the dosage of Noliprel, the antihypertensive effect does not increase, while the incidence of side effects increases. If their effectiveness is insufficient, the recommended dose should not be exceeded. Contact your doctor to correct the course of treatment.

Contraindications Noliprel

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

Due to the lack of sufficient clinical experience, Noliprel A / Noliprel Forte should not be prescribed to patients on hemodialysis, as well as in heart failure in the decompensation phase.

Plasma sodium levels should be monitored prior to initiation and regularly during treatment. Therapy with noliprel can cause hyponatremia, sometimes with serious consequences. Be careful not to violate the dosage indicated in the instructions for use.

With the development of arrhythmia of the "pirouette" type, antiarrhythmic drugs should not be used (it is necessary to use an artificial pacemaker).

If an episode of unstable angina (of any severity) occurs during the first month of treatment with perindopril, the risk/benefit ratio must be carefully weighed before deciding whether to continue treatment. You may need to change the drug.

Overdose Noliprel

The effect of an overdose of Noliprel is most often manifested by arterial hypotension (an excessive drop in pressure), which can sometimes be accompanied by nausea, vomiting, convulsions and dizziness. Perhaps a state of drowsiness and confusion.

Treatment is carried out in a hospital.

During pregnancy:

Noliprel is contraindicated during pregnancy and lactation due to the negative impact on the child (increased neonatal mortality, anomalies in the development of the musculoskeletal system, renal failure in newborns, severe oligohydramnios, patent ductus arteriosus, intrauterine fetal death).

If a woman took noliprel before the fact of pregnancy, the reception should be stopped immediately. There is no need for abortion however, the woman must be aware of the possible consequences.

Interactions

There are dangerous interactions with other drugs. When taking it at the same time, it is necessary to warn or consult your doctor.

Analogues Noliprel, list of drugs

The drug Noliprel A is the closest analogue of Noliprel forte. Please note that the instructions for the use of noliprel, the price and reviews are not suitable for the analogue, the dosage and indications must be adjusted by the attending physician.

Noliprel And another analogue, earlier this remedy was known simply as Noliprel. The name was changed after the change in the form of release of one of the active substances - perindopril began to be produced in the form of arginine, and not tert-butylamine salt. Pay attention to the dosage of the active substance.

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

Dosage form

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

Description and composition

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

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

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

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

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

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

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

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

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

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

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

Pharmacological group

Combined antihypertensive agent.

Indications for use

for adults

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

for kids

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

for pregnant women and during lactation

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

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

Contraindications

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

1. Hypersensitivity to ACE inhibitors and sulfanilamide diuretics.
2. Renal failure.
3. Pregnancy and.
4. or disorders of lactose metabolism.
5. Hypokalemia.
6. The likelihood of developing angioedema.
7. Renal stenosis.
8. Childhood.

Applications and doses

for adults

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

Side effects

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

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

Interaction with other drugs

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

special instructions

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

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

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

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

Overdose

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

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

Storage conditions

Noliprel is stored under normal temperature conditions.

Analogues

Analogues of the drug for active substances are:

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

Price

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