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Максимальная концентрация в плазме крови достигается через 12 часов после приёма внутрь однократной дозы. При повторных приёмах колебания концентрации препарата в плазме крови в промежуток между приёмами препарата сглаживаются."}},{"type":"paragraph","data":{"text":"Наблюдается индивидуальная вариабельность показателей всасывания индапамида."}},{"type":"paragraph","data":{"text":"Распределение"}},{"type":"paragraph","data":{"text":"Около 79% индапамида связывается с белками плазмы крови. Период полувыведения составляет 14-24 часа (в среднем 18 ч)."}},{"type":"paragraph","data":{"text":"Равновесная концентрация достигается через 7 дней приёма препарата. При повторном приёме препарата кумуляции индапамида не наблюдается."}},{"type":"paragraph","data":{"text":"Метаболизм"}},{"type":"paragraph","data":{"text":"Индапамид выводится в виде неактивных метаболитов, в основном почками (70% принятой дозы) и через кишечник (22%)."}},{"type":"paragraph","data":{"text":"Фармакокинетика у отдельных групп пациентов"}},{"type":"paragraph","data":{"text":"У пациентов с почечной недостаточностью фармакокинетика индапамида не изменяется."}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"Артериальная гипертензия у взрослых"}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"list","data":{"style":"ordered","items":["Повышенная чувствительность к индапамиду, другим производным сульфонамида или к любому из вспомогательных веществ;","тяжёлая почечная недостаточность (клиренс креатинина (КК менее 30 мл/мин);","тяжёлая печёночная недостаточность или печёночная энцефалопатия; гипокалиемия;","беременность, период грудного вскармливания;","возраст до 18 лет (эффективность и безопасность не установлены);","непереносимость лактозы, галактоземия, синдром нарушения всасывания глюкозы/галактозы (препарат содержит лактозу)."]}}]},{"id":10,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"Нарушения функции печени и почек, нарушения водно-электролитного баланса, ослабленные пациенты или пациенты, получающие сочетанную терапию с антиаритмическими препаратами или препаратами, которые могут увеличивать интервал QT (см. раздел «Взаимодействие с другими лекарственными средствами»), сахарный диабет, гиперурикемия (особенно сопровождающаяся подагрой и уратным нефролитиазом), пациенты с удлиненным интервалом QT, гиперпаратиреоз."}}]},{"id":11,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"\u003cb\u003e\u003ci\u003eБеременность\u003c/i\u003e\u003c/b\u003e"}},{"type":"paragraph","data":{"text":"В настоящий момент нет достаточного количества данных о применении индапамида во время беременности (описано менее 300 случаев). Длительное применение тиазидных диуретиков в III триместре беременности может вызывать гиповолемию у матери и снижение маточно-плацентарного кровотока, что приводит к фетоплацентарной ишемии и задержке развития плода."}},{"type":"paragraph","data":{"text":"В исследованиях на животных не было выявлено прямого или непрямого воздействия на беременность."}},{"type":"paragraph","data":{"text":"Следует избегать применения индапамида во время беременности."}},{"type":"paragraph","data":{"text":"\u003cb\u003e\u003ci\u003eПериод грудного вскармливания\u003c/i\u003e\u003c/b\u003e"}},{"type":"paragraph","data":{"text":"Неизвестно, выделяется ли индапамид или его метаболиты с грудным молоком. У новорождённого при этом может развиться повышенная чувствительность к производным сульфонамида и гипокалиемия. В связи с этим, риск для новорождённого/младенца не может быть исключен. Индапамид близок к тиазидным диуретикам, приём которых вызывает уменьшение количества грудного молока или даже подавление лактации."}},{"type":"paragraph","data":{"text":"Не следует применять индапамид в период грудного вскармливания."}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Таблетки принимают внутрь, предпочтительнее в утренние часы, не разжевывая, запивая достаточным количеством жидкости. Суточная доза препарата — 1 таблетка Индапамида МВ ШТАДА (1,5 мг) один раз в день."}},{"type":"paragraph","data":{"text":"При лечении пациентов с артериальной гипертензией увеличение дозы препарата не приводит к увеличению антигипертензивного действия, но усиливает диуретический эффект."}},{"type":"paragraph","data":{"text":"\u003cb\u003e\u003ci\u003eОсобые группы пациентов\u003c/i\u003e\u003c/b\u003e"}},{"type":"paragraph","data":{"text":"\u003ci\u003eПациенты с почечной недостаточностью\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Индапамид противопоказан пациентам с тяжёлой почечной недостаточностью (КК менее 30 мл/мин). Тиазидные и тиазидоподобные диуретики эффективны только у пациентов с нормальной функцией почек или с незначительными её нарушениями."}},{"type":"paragraph","data":{"text":"\u003ci\u003eПациенты с печеночной недостаточностью\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Препарат противопоказан пациентам с тяжёлой печеночной недостаточностью."}},{"type":"paragraph","data":{"text":"\u003ci\u003eПожилые пациенты\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"У пожилых пациентов следует контролировать плазменную концентрацию креатинина с учётом возраста, массы тела и пола."}},{"type":"paragraph","data":{"text":"Индапамид МВ ШТАДА в дозе 1,5 мг/сутки (1 таблетка) можно назначать пожилым пациентам с нормальной или незначительно нарушенной функцией почек (см. раздел «Противопоказания»)."}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Наиболее частыми нежелательными реакциями, о которых сообщалось, были реакции повышенной чувствительности, в основном дерматологические, у пациентов с предрасположенностью к аллергическим и астматическим реакциям, а также макулопапулёзная сыпь."}},{"type":"paragraph","data":{"text":"Большинство нежелательных реакций (лабораторные и клинические показатели) носят дозозависимый характер."}},{"type":"paragraph","data":{"text":"Частота развития неблагоприятных побочных реакций приведена в соответствии с классификацией Всемирной организации здравоохранения: очень часто (≥ 1/10), часто (≥ 1/100, < 1/10), нечасто (≥ 1/1000, < 1/100), редко (≥ 1/10000, < 1/1000), очень редко (< 1/10000), частота неизвестна (невозможно оценить частоту на основании доступных данных)."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения со стороны крови и лимфатической системы:\u003c/i\u003e очень редко — тромбоцитопения, лейкопения, агранулоцитоз, апластическая анемия, гемолитическая анемия."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения со стороны нервной системы:\u003c/i\u003e редко — вертиго, повышенная утомляемость, головная боль, парестезия; частота не известна — обморок."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения со стороны сердца:\u003c/i\u003e очень редко — аритмия; частота неизвестна — полиморфная желудочковая тахикардия по типу «пируэт» (возможно со смертельным исходом) (см. разделы «Особые указания» и «Взаимодействие с другими лекарственными средствами»)."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения со стороны сосудов:\u003c/i\u003e очень редко — понижение артериального давления."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения со стороны желудочно-кишечного тракта:\u003c/i\u003e нечасто — рвота; редко — тошнота, запор, сухость слизистой оболочки полости рта; очень редко — панкреатит."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения со стороны печени и желчевыводящих путей:\u003c/i\u003e очень редко — нарушение функции печени; частота неизвестна — гепатит, возможно развитие печёночной энцефалопатии в случае печёночной недостаточности (см. разделы «Противопоказания» и «Особые указания»)."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения со стороны почек и мочевыводящих путей:\u003c/i\u003e очень редко — почечная недостаточность."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения со стороны кожи и подкожных тканей:\u003c/i\u003e часто — реакции повышенной чувствительности, макулопапулёзная сыпь; нечасто — пурпура; очень редко — ангионевротический отек, крапивница, токсический эпидермальный некролиз, синдром Стивенса-Джонсона; частота неизвестна — возможно обострение уже имеющейся острой системной красной волчанки, фоточувствительность (см. раздел «Особые указания»)."}},{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения со стороны обмена веществ и питания:\u003c/i\u003e очень редко — гиперкальциемия; частота неизвестна — гипонатриемия, снижение концентрации калия и развитие гипокалиемии, особенно значимое для пациентов, относящихся к группе риска (см. раздел «Особые указания»)"}},{"type":"paragraph","data":{"text":"\u003ci\u003eЛабораторные и инструментальные данные:\u003c/i\u003e частота неизвестна — удлинение интервала QT на ЭКГ (см. разделы «Взаимодействие с другими лекарственными средствами» и «Особые указания»), повышение концентрации глюкозы в крови (см. раздел «Особые указания»), повышение концентрации мочевой кислоты (см. раздел «Особые указания»), повышение активности «печёночных» ферментов."}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"Индапамид даже в очень высоких дозах (до 40 мг, т.е. в 27 раз больше терапевтической дозы) не оказывает токсического действия."}},{"type":"paragraph","data":{"text":"Симптомы"}},{"type":"paragraph","data":{"text":"Признаки острого отравления индапамидом в первую очередь связаны с нарушением водно-электролитного баланса (гипонатриемия, гипокалиемия). Из клинических симптомов передозировки могут отмечаться тошнота, рвота, снижение артериального давления, судороги, вертиго, сонливость, спутанность сознания, полиурия или олигурия с возможным переходом в анурию (вследствие гиповолемии)."}},{"type":"paragraph","data":{"text":"Лечение"}},{"type":"paragraph","data":{"text":"Меры неотложной помощи сводятся к выведению препарата из организма: промывание желудка и/или назначение активированного угля с последующим восстановлением водно-электролитного баланса."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"header","data":{"text":"Нежелательные сочетания лекарственных препаратов","level":4}},{"type":"list","data":{"style":"ordered","items":["\u003cb\u003e\u003ci\u003eПрепараты лития:\u003c/i\u003e\u003c/b\u003e при одновременном применении индапамида и препаратов лития, также как и при соблюдении бессолевой диеты, может наблюдаться повышение концентрации лития в плазме крови вследствие снижения его экскреции, сопровождающееся появлением признаков передозировки лития. При необходимости диуретические препараты могут применяться в сочетании с препаратами лития, при этом следует тщательно подбирать дозу препаратов, регулярно контролируя концентрацию лития в плазме крови."]}},{"type":"header","data":{"text":"Сочетания лекарственных препаратов, требующие особого внимания","level":4}},{"type":"paragraph","data":{"text":"\u003cb\u003e\u003ci\u003eПрепараты, способные вызывать полиморфную желудочковую тахикардию по типу «пируэт»:\u003c/i\u003e\u003c/b\u003e"}},{"type":"list","data":{"style":"ordered","items":["антиаритмические препараты IА класса (хинидин, гидрохинидин, дизопирамид);","антиаритмические препараты III класса (амиодарон, соталол, дофетилид, ибутилид);","некоторые нейролептики: фенотиазины (хлорпромазин, циамемазин, левомепромазин, тиоридазин, трифторперазин), бензамиды (амисульприд, сульпирид, сультоприд, тиаприд), бутирофеноны (дроперидол, галоперидол);","другие: бепридил, цизаприд, дифеманил, эритромицин (в/в), галофантрин, мизоластин, пентамидин, спарфлоксацин, моксифлоксацин, астемизол, винкамин (в/в)."]}},{"type":"paragraph","data":{"text":"Увеличение риска желудочковых аритмий, особенно полиморфной желудочковой тахикардии по типу «пируэт» (фактор риска — гипокалиемия)."}},{"type":"paragraph","data":{"text":"Следует определить концентрацию калия в плазме крови и, при необходимости, корректировать его до начала комбинированной терапии индапамидом с указанными выше препаратами. Необходим контроль клинического состояния пациента, контроль содержания электролитов плазмы крови, показателей ЭКГ."}},{"type":"paragraph","data":{"text":"\u003ci\u003eУ пациентов с гипокалиемией необходимо применять препараты, не вызывающие полиморфную желудочковую тахикардию по типу «пируэт».\u003c/i\u003e"}},{"type":"list","data":{"style":"ordered","items":["\u003cb\u003e\u003ci\u003eНестероидные противовоспалительные препараты\u003c/i\u003e\u003c/b\u003e (при системном назначении), включая селективные ингибиторы ЦОГ-2, высокие дозы ацетилсалициловой кислоты (≥ 3 г/сутки):возможно снижение антигипертензивного действия индапамида.","возможно снижение антигипертензивного действия индапамида."]}},{"type":"paragraph","data":{"text":"Существует риск развития острой почечной недостаточности вследствие снижения клубочковой фильтрации. Пациентам необходимо компенсировать потерю жидкости и в начале лечения тщательно контролировать функцию почек."}},{"type":"list","data":{"style":"ordered","items":["\u003cb\u003e\u003ci\u003eИнгибиторы ангиотензинпревращающего фермента (АПФ):\u003c/i\u003e\u003c/b\u003eНазначение ингибиторов АПФ пациентам с изначально сниженной концентрацией ионов натрия в крови (особенно пациентам со стенозом почечной артерии) сопровождается риском внезапной артериальной гипотензии и/или острой почечной недостаточности.Пациентам с \u003ci\u003eартериальной гипертензией\u003c/i\u003e и возможно сниженным вследствие приёма диуретиков содержанием ионов натрия в плазме крови необходимо:за 3 дня до начала лечения ингибитором АПФ прекратить приём диуретиков. В дальнейшем, при необходимости, приём некалийсберегающего диуретика можно возобновить;или начинать терапию ингибитором АПФ с низких доз, с последующим постепенным увеличением дозы в случае необходимости."]}},{"type":"paragraph","data":{"text":"При \u003ci\u003eхронической сердечной недостаточности\u003c/i\u003e лечение ингибиторами АПФ следует начинать с самых низких доз с возможным предварительным снижением доз диуретиков."}},{"type":"paragraph","data":{"text":"\u003ci\u003eВо всех случаях\u003c/i\u003e в первые недели приёма ингибиторов АПФ у пациентов необходимо контролировать функцию почек (содержание креатинина в плазме крови)."}},{"type":"list","data":{"style":"ordered","items":["\u003cb\u003e\u003ci\u003eДругие препараты, способные вызывать гипокалиемию: амфотерицин В (в/в), глюко- и минералокортикостероиды (при системном назначении), тетракозактид, слабительные средства, стимулирующие моторику кишечника: \u003c/i\u003e\u003c/b\u003eувеличение риска развития гипокалиемии (аддитивный эффект)."]}},{"type":"paragraph","data":{"text":"Необходим регулярный контроль содержания калия в плазме крови, при необходимости — его коррекция. Особое внимание следует уделять пациентам, одновременно получающим сердечные гликозиды. Рекомендуется применять слабительные средства, не стимулирующие моторику кишечника."}},{"type":"list","data":{"style":"ordered","items":["\u003cb\u003e\u003ci\u003eБаклофен:\u003c/i\u003e\u003c/b\u003e возможно усиление антигипертензивного действия."]}},{"type":"paragraph","data":{"text":"Пациентам необходимо компенсировать потерю жидкости и в начале лечения тщательно контролировать функцию почек."}},{"type":"list","data":{"style":"ordered","items":["\u003cb\u003e\u003ci\u003eСердечные гликозиды:\u003c/i\u003e\u003c/b\u003e гипокалиемия усиливает токсическое действие сердечных гликозидов."]}},{"type":"paragraph","data":{"text":"При одновременном применении индапамида и сердечных гликозидов следует контролировать содержание калия в плазме крови, показатели ЭКГ, и, при необходимости, корректировать терапию."}},{"type":"header","data":{"text":"Сочетание препаратов, требующее внимания","level":4}},{"type":"list","data":{"style":"ordered","items":["\u003cb\u003e\u003ci\u003eКалийсберегающие диуретики (амилорид, спиронолактон, триамтерен):\u003c/i\u003e\u003c/b\u003e одновременное назначение индапамида с калийсберегающими диуретиками целесообразно у некоторых пациентов, однако при этом не исключается возможность развития гипокалиемии или гиперкалиемии (особенно у пациентов с сахарным диабетом и с почечной недостаточностью)."]}},{"type":"paragraph","data":{"text":"Необходимо контролировать концентрацию калия в плазме крови, показатели ЭКГ и, при необходимости, корректировать терапию."}},{"type":"list","data":{"style":"ordered","items":["\u003cb\u003e\u003ci\u003eМетформин:\u003c/i\u003e\u003c/b\u003e функциональная почечная недостаточность, которая может возникать на фоне приёма диуретиков, особенно «петлевых», при одновременном назначении метформина повышает риск развития молочнокислого ацидоза."]}},{"type":"paragraph","data":{"text":"Не следует применять метформин, если концентрация креатинина превышает 15 мг/л (135 мкмоль/л) у мужчин и 12 мг/л (110 мкмоль/л) у женщин."}},{"type":"list","data":{"style":"ordered","items":["\u003cb\u003e\u003ci\u003eЙодсодержащие контрастные вещества:\u003c/i\u003e\u003c/b\u003e обезвоживание организма на фоне приёма диуретических препаратов увеличивает риск развития острой почечной недостаточности, особенно при применении высоких доз йодсодержащих контрастных веществ."]}},{"type":"paragraph","data":{"text":"Перед применением йодсодержащих контрастных веществ пациентам необходимо компенсировать потерю жидкости."}},{"type":"list","data":{"style":"ordered","items":["\u003cb\u003e\u003ci\u003eТрициклические антидепрессанты, антипсихотические средства (нейролептики): \u003c/i\u003e\u003c/b\u003eпрепараты этих классов усиливают антигипертензивное действие индапамида и увеличивают риск ортостатической гипотензии (аддитивный эффект)."]}},{"type":"list","data":{"style":"ordered","items":["\u003cb\u003e\u003ci\u003eСоли кальция: \u003c/i\u003e\u003c/b\u003eпри одновременном назначении возможно развитие гиперкальциемии вследствие снижения выведения ионов кальция почками."]}},{"type":"list","data":{"style":"ordered","items":["\u003cb\u003e\u003ci\u003eЦиклоспорин, такролимус: \u003c/i\u003e\u003c/b\u003eвозможно увеличение содержания креатинина в плазме крови без изменения концентрации циркулирующего циклоспорина, даже при нормальном содержании жидкости и ионов натрия."]}},{"type":"list","data":{"style":"ordered","items":["\u003cb\u003e\u003ci\u003eКортикостероиды (минерало- и глюкокортикостероиды), тетракозактид (при системном назначении): \u003c/i\u003e\u003c/b\u003eснижение антигипертензивного действия (задержка жидкости и ионов натрия в результате действия кортикостероидов)."]}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"\u003ci\u003eНарушения функции печени\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"При назначении тиазидных и тиазидоподобных диуретиков у пациентов с нарушениями функции печени возможно развитие печеночной энцефалопатии, особенно в случае нарушения электролитного баланса. В этом случае прием диуретиков следует немедленно прекратить."}},{"type":"paragraph","data":{"text":"\u003ci\u003eФоточувствительность\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"На фоне приёма тиазидных и тиазидоподобных диуретиков сообщалось о случаях развития реакций фоточувствительности (см. раздел «Побочное действие»). В случае развития реакций фоточувствительности на фоне приёма препарата следует прекратить лечение. При необходимости продолжения терапии диуретиками рекомендуется защищать кожные покровы от воздействия солнечных лучей или искусственных ультрафиолетовых лучей."}},{"type":"paragraph","data":{"text":"\u003ci\u003eВодно-электролитный баланс\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"\u003ci\u003eСодержание ионов натрия в плазме крови\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"До начала лечения необходимо определить содержание ионов натрия в плазме крови."}},{"type":"paragraph","data":{"text":"На фоне приёма препарата следует регулярно контролировать этот показатель. Необходим постоянный контроль содержания ионов натрия, так как первоначально снижение концентрации натрия в плазме крови может и не сопровождаться появлением патологических симптомов. Наиболее тщательный контроль содержания ив натрия необходим пациентам с циррозом печени и пациентам пожилого возраста (см. разделы «Побочное действие» и «Передозировка»)."}},{"type":"paragraph","data":{"text":"Все диуретические препараты могут вызывать гипонатриемию, приводящую иногда к крайне тяжелым последствиям. Гипонатриемия и гиповолемия могут приводить к обезвоживанию и ортостатической гипотензии. Сопутствующее снижение ионов хлора может приводить к вторичному компенсаторному метаболическому алкалозу: частота и степень выраженности этого эффекта незначительны."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСодержание ионов калия в плазме крови\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"При терапии тиазидными и тиазидоподобными диуретиками основной риск заключается в снижении концентрации калия в плазме крови и развитии гипокалиемии. Необходимо предотвращать риск развития гипокалиемии (содержания калия менее 3,4 ммоль/л) у пациентов группы повышенного риска следующих категорий: пожилого возраста, ослабленных и/или получающих сочетанную медикаментозную терапию, пациентов с циррозом печени, периферическими отеками и асцитом, ишемической болезнью сердца, сердечной недостаточностью. Гипокалиемия у пациентов данных групп усиливает токсическое действие сердечных гликозидов и повышает риск развития аритмий."}},{"type":"paragraph","data":{"text":"Кроме того, к группе повышенного риска относятся пациенты с увеличенным интервалом QT, как врожденным, так и вызванным лекарственными препаратами."}},{"type":"paragraph","data":{"text":"Гипокалиемия, также как и брадикардия, является состоянием, способствующим развитию тяжелых аритмий и, особенно, полиморфной желудочковой тахикардии по типу «пируэт», которые могут приводить к летальному исходу. Во всех описанных выше случаях необходимо регулярно контролировать концентрацию калия в плазме крови. Первое измерение концентрации ионов калия в крови необходимо провести в течение первой недели от начала лечения. При появлении гипокалиемии должно быть назначено соответствующее лечение."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСодержание кальция в плазме крови\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Следует иметь в виду, что тиазидные и тиазидоподобные диуретики могут уменьшать выведение ионов кальция почками, приводя к незначительному и временному повышению концентрации кальция в плазме крови. Выраженная гиперкальциемия может быть следствием ранее не диагностированного гиперпаратиреоза."}},{"type":"paragraph","data":{"text":"Следует отменить приём диуретических препаратов перед исследованием функции паращитовидных желез."}},{"type":"paragraph","data":{"text":"\u003ci\u003eСодержание глюкозы в плазме крови\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Необходимо контролировать концентрацию глюкозы в крови у пациентов с сахарным диабетом, особенно при наличии гипокалиемии."}},{"type":"paragraph","data":{"text":"\u003ci\u003eМочевая кислота\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"У пациентов с подагрой может увеличиваться частота возникновения приступов или обостряться течение подагры."}},{"type":"paragraph","data":{"text":"\u003ci\u003eДиуретические препараты и функция почек\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Тиазидные и тиазидоподобные диуретики эффективны в полной мере только у пациентов с нормальной или незначительно нарушенной функцией почек (концентрация креатинина в плазме крови у взрослых пациентов ниже 25 мг/л или 220 мкмоль/л). У пациентов пожилого возраста концентрацию креатинина в плазме крови рассчитывают с учётом возраста, массы тела и пола."}},{"type":"paragraph","data":{"text":"Следует учитывать, что в начале лечения у пациентов может наблюдаться снижение скорости клубочковой фильтрации, обусловленное гиповолемией, которая, в свою очередь, вызвана потерей жидкости и ионов натрия на фоне приёма диуретических препаратов. Как следствие, в плазме крови может увеличиваться концентрация мочевины и креатинина."}},{"type":"paragraph","data":{"text":"Если функция почек не нарушена, такая временная функциональная почечная недостаточность, как правило, проходит без последствий, однако при уже имеющейся почечной недостаточности состояние пациента может ухудшиться."}},{"type":"paragraph","data":{"text":"\u003ci\u003e\u003cb\u003eСпортсмены\u003c/b\u003e\u003c/i\u003e"}},{"type":"paragraph","data":{"text":"Индапамид может давать положительный результат при проведении допинг-контроля у спортсменов."}}]},{"id":17,"name":"Влияние на способность управлять автомобилем и движущимися механизмами","slug":"","body":[{"type":"paragraph","data":{"text":"Действие веществ, входящих в состав препарата Индапамид МВ ШТАДА, не приводит к нарушению внимания. Однако у некоторых людей могут развиться различные реакции в ответ на снижение артериального давления, особенно в начале терапии или при добавлении к проводимой терапии других гипотензивных средств. В этом случае способность управлять автомобилем или другими механизмами может быть нарушена."}}]},{"id":18,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Таблетки с пролонгированным высвобождением, покрытые пленочной оболочкой, 1,5 мг."}},{"type":"paragraph","data":{"text":"По 10 таблеток в контурную ячейковую упаковку из пленки поливинилхлоридной и фольги алюминиевой печатной лакированной. По 3 контурных ячейковых упаковки вместе с инструкцией по медицинскому применению лекарственного препарата в пачку картонную."}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"В защищенном от света месте при температуре не выше 25 °С."}},{"type":"paragraph","data":{"text":"Хранить в недоступном для детей месте."}}]},{"id":20,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"3 года. Не применять после истечения срока годности, указанного на упаковке."}}]},{"id":21,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"Отпускают по рецепту."}}]},{"id":22,"name":"Производитель","slug":"","body":[{"type":"paragraph","data":{"text":"\u003cb\u003eООО «Хемофарм», Россия\u003c/b\u003e"}},{"type":"paragraph","data":{"text":"249032, Калужская обл., г. Обнинск, Киевское шоссе, д. 62"}},{"type":"paragraph","data":{"text":"Тел.: (48439) 90-500, факс: (48439) 90-525."}}]},{"id":23,"name":"Организация, принимающая претензии потребителей","body":[{"type":"paragraph","data":{"text":"\n\nАО «Нижфарм», Россия"}},{"type":"paragraph","data":{"text":"603950, г. Нижний Новгород, ул. Салганская, д. 7"}},{"type":"paragraph","data":{"text":"Тел.: (831) 278-80-88, факс: (831) 430-72-28"}},{"type":"paragraph","data":{"text":"\u003ca href=\"mailto:med@stada.ru\"\u003emed@stada.ru\u003c/a\u003e"}}]}],"source":null},"description_toggle":false,"short_description":"Индапамид — гипотензивное лекарственное средство, относится к производным сульфонамида с индольным кольцом и по фармакологическим свойствам близок к тиазидным диуретикам, которые ингибируют реабсорбцию ионов натрия в кортикальном сегменте петли нефрона. При этом увеличивается выделение почками ионов натрия, хлора и в меньшей степени ионов калия и магния, что сопровождается увеличением диуреза и антигипертензивным эффектом. В клинических исследованиях II и III фаз при применении индапамида в режиме монотерапии в дозах, не оказывающих выраженного диуретического эффекта, был продемонстрирован 24-часовой антигипертензивный эффект. Антигипертензивная активность индапамида связана с улучшением эластических свойств крупных артерий, уменьшением артериолярного и общего периферического сосудистого сопротивления. Индапамид уменьшает гипертрофию левого желудочка. Тиазидные и тиазидоподобные диуретики при определённой дозе достигают плато терапевтического эффекта, в то время как частота побочных эффектов продолжает увеличиваться при дальнейшем повышении дозы препарата. Поэтому не следует увеличивать дозу препарата, если при приёме рекомендованной дозы не достигнут терапевтический эффект. В коротких, средней длительности и долгосрочных исследованиях с участием пациентов с артериальной гипертензией было показано, что индапамид: - не влияет на показатели липидного обмена, в том числе на содержание триглицеридов, холестерина, липопротеинов низкой плотности и липопротеинов высокой плотности; - не влияет на показатели обмена углеводов, в том числе у пациентов с сахарным диабетом. Всасывание После приёма внутрь высвободившийся индапамид быстро и полностью всасывается в желудочно-кишечном тракте. Приём пищи незначительно увеличивает время всасывания индапамида, не влияя при этом на полноту абсорбции. Максимальная концентрация в плазме крови достигается через 12 часов после приёма внутрь однократной дозы. При повторных приёмах колебания концентрации препарата в плазме крови в промежуток между приёмами препарата сглаживаются. Наблюдается индивидуальная вариабельность показателей всасывания индапамида. Распределение Около 79% индапамида связывается с белками плазмы крови. 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