Noliprel A Bi-forte tablets 10 mg + 2.5 mg 30 pcs. in Moscow

Release forms and composition of the drug

The drug is available in the form of standard tablets intended for oral administration, which are packaged in blisters of 14 or 30 pieces. Blisters are placed in special cardboard boxes and are always accompanied by detailed instructions describing all the features and rules of use.

The tablets are small in size, white in color and oblong in shape. They also have a specific aroma and taste. The product contains two active components that have a therapeutic effect - perindopril and indapamide.

The product contains auxiliary ingredients:

• Lactose in the form of monohydrate.
• Magnesium stearate.
• Talc.
• Silica.
• Cellulose.

  
  Noliprel A forte

Additional substances in the tablet product do not have a therapeutic effect. The amount of perindopril in the tablet is 5 mg, the dosage of indapamide is 1.25 mg. Tablets are also produced in which the amount of active ingredients is twice as large, but this product is used less frequently.

What to do?

If one or more of the above conditions occurs, you must urgently call an ambulance.

If it is impossible to call an ambulance for any reason or the wait is prolonged, the following actions should be taken:

1. rinse the stomach to get rid of any remaining drug;
2. drink activated charcoal or another substance that helps remove toxins from the body;
3. lie on your back and place a pillow under your feet so that they are in an elevated position, but not suspended.

The effect of one Noliprel tablet lasts twenty-four hours, so any additional intake of even a small part of it can lead to an overdose.

Pharmacological properties

Noliprel A forte (reviews of the action of the drug help to preliminary assess its effectiveness) has hypotensive and diuretic properties, therefore it is used for the treatment of patients with acute and chronic pathologies of the cardiovascular system, accompanied by an increase in blood pressure and other manifestations.

The drug also helps to maintain numbers and prevents their critical increase due to stressful conditions. The diuretic properties of the drug prevent the appearance of peripheral edema, which is often observed in patients with chronic heart pathologies.

The effectiveness of the active substance in the composition is manifested by a decrease in systolic and diastolic pressure, which allows one to quickly normalize indicators and improve the condition of patients. When used correctly, patients do not need to take additional medications with antihypertensive properties.

Can I drink while pregnant and breastfeeding?

The period of waiting for the birth of a baby is an absolute contraindication to the use of Noliprel Forte tablets. The drug should not be taken during any trimester of pregnancy.

Women planning to conceive are advised to stop using the medication for 1-3 months.

If pregnancy is detected during the therapeutic course of Noliprel Forte, the tablets are immediately discontinued and the patient is prescribed milder and safer antihypertensive drugs.

Use of the drug in the early stages of pregnancy can cause delays in fetal development and even miscarriage.

At later stages, treatment with Noliprel Forte threatens the birth of a baby suffering from renal pathologies, arterial hypertension, and dysfunction of the cardiovascular system.

You should not take blood pressure pills Noliprel Forte during lactation. The active ingredients of the drug penetrate into breast milk, causing the development of hepatitis and hypokalemia in the infant.

The use of diuretic drugs alone reduces the amount of breast milk and even completely suppresses its production.

For this reason, when breastfeeding, a woman must either stop using Noliprel Forte or transfer the baby to artificial formula.

Pregnancy and breastfeeding are contraindications to the use of the drug

Pharmacodynamics and pharmacokinetics

After taking the drug orally, the active components are absorbed into the blood and have a pronounced therapeutic effect. Perindopril in the tablets helps increase renin activity in the blood by reducing the production of aldosterone. Renin promotes vasodilation, which leads to a decrease in pressure on the vascular wall.

As a result, a decrease in systolic and diastolic blood pressure is observed. Additionally, the substance helps keep indicators at the same level. The presence of indapamide in the composition helps improve kidney function and stimulates blood filtration, which helps increase the volume of urine excreted during the day. Stimulating urination reduces the risk of developing peripheral edema.

The drug also has other properties:

• It has a positive effect on the vascular wall, makes it elastic and prevents damage.
• Reduces the severity of symptoms if the patient has a history of left ventricular hypertrophy. A similar effect is achieved by improving tissue nutrition and normalizing blood circulation. Additionally, the load on the myocardium is lightened, which is especially important for patients diagnosed with heart failure or coronary artery disease.
• Reduces the risk of sudden development of hypokalemia, which often occurs during the use of diuretic medications. The drug has a mild diuretic effect, but does not interfere with the functioning of the kidneys.
• Does not provoke tachycardia and does not disrupt heart rhythm. Only in some cases such complications develop, but in patients suffering from severe heart disorders.

Despite the rapid onset of therapeutic action after initial use, the medication is taken for at least 4 weeks to evaluate its effectiveness. Only after this period has expired can you evaluate the effect and make a decision to extend the course. The drug does not affect the level of lipids in the blood and does not disrupt metabolic processes in the body, which is considered its advantage.

After oral administration, the components of the composition are well absorbed in the digestive tract, namely in the small intestine. Substances enter the blood and have a therapeutic effect. Perindopril binds to plasma proteins, but its bioavailability does not exceed 70%. The maximum concentration of the substance in the systemic circulation is observed 4 hours after oral administration.

The substance is eliminated through the kidneys within 2 days after taking the last dose. Indapamide is also rapidly absorbed into the blood, and its maximum concentration is observed after 1 hour.

The ingredient binds to plasma proteins, bioavailability reaches 80%. After processing, which is carried out mainly in the liver, the breakdown products of the active ingredients are evacuated by the kidneys. A small amount of inactive and active metabolites is evacuated in the feces.

Indapamide breakdown products are excreted somewhat faster than perindopril metabolites. In patients with various pathologies of the digestive tract, slower absorption of the drug is observed. The components of the composition accumulate in small quantities in the body, which explains the onset of the maximum therapeutic effect only after 2-4 weeks.

Noliprel® A forte (Noliprel® A forte)

Noliprel® A forte

The use of Noliprel® A forte 5 mg + 1.25 mg is not accompanied by a significant reduction in the frequency of side effects, with the exception of hypokalemia, compared with perindopril and indapamide at the lowest approved doses (see section “Side Effects”). When initiating therapy with two antihypertensive drugs that the patient has not previously received, an increased risk of idiosyncrasy cannot be excluded. Careful monitoring of the patient can minimize this risk.

Renal dysfunction

Therapy is contraindicated in patients with severe renal failure (creatinine clearance less than 30 ml/min). In some patients with arterial hypertension without previous obvious renal impairment, laboratory signs of functional renal failure may appear during therapy. 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 require regular monitoring of potassium and creatinine levels in the blood serum - 2 weeks after the start of therapy and every 2 months thereafter. Renal failure occurs more often in patients with severe chronic heart failure or underlying renal impairment, including renal artery stenosis.

Arterial hypotension and water-electrolyte imbalance

Hyponatremia is associated with a risk of sudden development of arterial hypotension (especially in patients with arterial stenosis of a solitary kidney and bilateral renal artery stenosis). Therefore, during dynamic monitoring of patients, attention should be paid to possible symptoms of dehydration and decreased levels of electrolytes in the blood plasma, for example, after diarrhea or vomiting. Such patients require regular monitoring of plasma electrolyte levels.

In case of severe arterial hypotension, intravenous administration of 0.9% sodium chloride solution may be required.

Transient arterial hypotension is not a contraindication for continued therapy. After restoration of circulating blood volume and blood pressure, therapy can be resumed using low doses of drugs, or drugs can be used as monotherapy.

Potassium level

The combined use of perindopril and indapamide does not prevent the development of hypokalemia, especially in patients with diabetes mellitus or renal failure. As in the case of the combined use of antihypertensive drugs and a diuretic, regular monitoring of the level of potassium in the blood plasma is necessary.

Excipients

It should be taken into account that the excipients of the drug include lactose monohydrate. Noliprel® A forte should not be prescribed to patients with hereditary galactose intolerance, lactase deficiency and glucose-galactose malabsorption.

Lithium preparations

The simultaneous use of a combination of perindopril and indapamide with lithium preparations is not recommended (see section “Contraindications”, “Interaction with other drugs”).

Perindopril

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 weighed.

Angioedema (Quincke's edema)

When taking ACE inhibitors, including perindopril, in rare cases, the development of angioedema of the face, extremities, lips, tongue, glottis and/or larynx may occur. If symptoms appear, perindopril should be discontinued immediately and the patient should be observed until signs of edema completely disappear. If the swelling affects only the face and lips, it usually resolves on its own, although antihistamines may be used to treat symptoms.

Angioedema, accompanied by swelling of the larynx, can be fatal. Swelling of the tongue, glottis, or larynx can lead to airway obstruction. If such symptoms appear, you should immediately administer epinephrine (adrenaline) subcutaneously at a dilution of 1:1000 (0.3 or 0.5 ml) and/or ensure airway patency.

Patients with a history of angioedema not associated with taking ACE inhibitors may have an increased risk of developing it when taking drugs of this group (see section “Contraindications”).

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

Anaphylactoid reactions during desensitization

There are isolated reports of the development of long-term, life-threatening anaphylactoid reactions in patients receiving ACE inhibitors during desensitizing therapy with the venom of hymenoptera insects (bees, wasps). ACE inhibitors should be used with caution in patients prone to allergic reactions undergoing desensitization procedures. Prescription of an ACE inhibitor should be avoided in patients receiving immunotherapy with hymenoptera venom. However, an anaphylactoid reaction can be avoided by temporarily discontinuing the ACE inhibitor at least 24 hours before the procedure.

Anaphylactoid reactions during LDL apheresis

In rare cases, life-threatening anaphylactoid reactions may occur in patients receiving ACE inhibitors, low-density lipoprotein (LDL) apheresis using dextran sulfate, or hemodialysis using high-flux membranes. To prevent an anaphylactoid reaction, ACE inhibitor therapy should be temporarily discontinued at least 24 hours before the apheresis procedure.

Cough

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

Children and teenagers

The drug should not be prescribed to children and adolescents under the age of 18 years due to the lack of data on the effectiveness and safety of the use of perindopril in the form of motor therapy or as part of combination therapy in patients of this age group.

Risk of arterial hypotension and/or renal failure (in patients with heart failure, fluid and electrolyte imbalance, etc.)

In some pathological conditions, significant activation of the renin-angiotensin-aldosterone system may be observed, especially with severe hypovolemia and a decrease in the level of plasma electrolytes (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 plasma creatinine levels, 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 during other periods 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 starting to take the drug, it is necessary to assess 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.

Atherosclerosis

The risk of arterial hypotension exists in all patients, however, special care should be taken when using the drug in patients with coronary heart disease and cerebrovascular insufficiency. In such patients, treatment should be started with low doses.

Patients with renovascular hypertension

The treatment method for renovascular hypertension is revascularization. However, the use of ACE inhibitors has a beneficial effect in this category of patients, both awaiting surgery and in cases where surgery is not possible.

Treatment with Noliprel® A forte 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 renal function and potassium concentration in the blood plasma. Some patients may develop functional renal failure, which disappears when the drug is discontinued.

Other risk groups

In persons with severe heart failure (stage IV) and patients with insulin-dependent diabetes mellitus (risk of spontaneous increase in potassium concentration), treatment should begin with a low dose of the drug and under constant medical supervision.

Hypertensive patients with coronary artery disease should not stop taking beta-blockers: ACE inhibitors should be used together with beta-blockers.

Anemia

Anemia can develop in patients after kidney transplantation or in people on hemodialysis. In this case, the decrease in hemoglobin concentration is greater, the higher its initial value. This effect does not appear to be dose-dependent, but may be related to the mechanism of action of ACE inhibitors.

A slight decrease in hemoglobin concentration occurs during the first 6 months, then it remains stable and is completely restored after discontinuation of the drug. In such patients, treatment can be continued, but hematological tests should be performed regularly.

Surgery / General anesthesia

The use of ACE inhibitors in patients undergoing surgery under general anesthesia can lead to a significant 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, including perindopril, the 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 prescribed with caution to patients with left ventricular outflow tract obstruction.

Liver failure

In rare cases, cholestatic jaundice occurs while taking ACE inhibitors. As this syndrome progresses, liver necrosis may rapidly develop, sometimes with death. The mechanism of development of this syndrome is unclear. If jaundice appears or a significant increase in the activity of liver enzymes while taking ACE inhibitors, you should stop taking the drug and consult a doctor (see section “Side Effects”).

Indapamide

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

Water and electrolyte balance

Content of sodium ions in blood plasma

Before starting treatment, it is necessary to determine the content of sodium ions in the blood plasma. While taking the drug, this indicator should be regularly monitored. All diuretics 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 sodium ion content is indicated for patients with liver cirrhosis and. elderly people (see section “Side effects” and “Overdose”).

Content of potassium ions in blood plasma

Therapy with thiazide and thiazide-like diuretics is associated with a risk of hypokalemia. Hypokalemia (less than 3.4 mmol/l) should be avoided in the following categories of high-risk patients: elderly patients, debilitated patients or those receiving concomitant 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 developing arrhythmias.

The high-risk group also includes patients with an increased QT interval, and it does not matter whether this increase is caused by congenital causes or the effect of drugs.

Hypokalemia, like bradycardia, contributes to the development of severe heart rhythm disturbances, especially arrhythmias, 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 potassium ion concentration should be carried out within the first week from the start of therapy. If hypokalemia is detected, appropriate treatment should be prescribed.

Content of calcium ions in blood plasma

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 a consequence of previously undiagnosed hyperparathyroidism. Before studying the function of the parathyroid gland, you should stop taking diuretics.

Plasma glucose levels

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

Uric acid

In patients with elevated levels of uric acid in the blood plasma during therapy, the frequency of gout attacks may increase.

Diuretics and kidney function

Thiazide and thiazide-like diuretics are fully effective only in patients with normal or slightly impaired renal function (plasma creatinine in adults below 25 mg/l or 220 µmol/l).

At the beginning of diuretic treatment in patients, due to hypovolemia and hyponatremia, a temporary decrease in 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 for patients with unchanged renal function, but its severity may increase in patients with renal failure.

Photosensitivity

Cases of photosensitivity reactions have been reported while taking thiazide and thiazide-like diuretics. 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.

Indications for use

Noliprel A forte can be used for many diseases, if you study the reviews of patients who took the medication.

Main indications for its use:

• Increased blood pressure due to heart disease.
• Essential type hypertension.

• Fluctuations in blood pressure due to type 2 diabetes mellitus or damage to cerebral vessels.
• The risk of damage to the walls of small and large vessels in patients with a tendency to such manifestations.
• Increased blood pressure during prolonged stress.
• The need to eliminate peripheral edema when the patient, for one reason or another, cannot take single-component diuretics. At the same time, the drug further reduces blood pressure, which has a positive effect on the functioning of the heart.

The drug can be used as an independent remedy or in combination with other medications.

Who is the drug prescribed to?

Doctors recommend that patients take Noliprel Forte to reduce blood pressure if they have the following clinical indications:

• Arterial hypertension;
• Hypertonic disease;
• Essential hypertension.

Medical experts advise taking Noliprel Forte for hypertension to patients who feel normal with elevated blood pressure. Despite the absence of painful symptoms, such as headaches, tachycardia, impaired visual and auditory function, blood pressure of 180 per 100 mm Hg. Art. is potentially dangerous, significantly increases the likelihood of developing a stroke, heart attack, angina attacks and other extremely undesirable consequences.

It is impossible to quickly reduce blood pressure with Noliprel Forte tablets, but the drug has a cumulative effect. With proper, regular use, the medication brings blood pressure levels to normal, eliminates the present symptoms characteristic of arterial hypertension, and has a preventive effect.

Taking Noliprel Forte for blood pressure is often recommended for people suffering from diabetes mellitus in order to reduce the risks of developing adverse effects, complications from the renal system and the cardiovascular system.

Contraindications

The medicine is not prescribed to patients who suffer from severe renal or acute liver failure. Use may cause serious complications.

There are other obstacles and absolute contraindications for prescribing medication:

• Intolerance to the main or auxiliary components of the composition.
• The period of bearing a child and breastfeeding.
• Internal bleeding due to damage to the mucous membranes of the digestive tract.
• Oncological pathologies of the digestive organs.
• Acute peptic ulcer of the stomach and duodenum.
• Exacerbation of chronic cholecystitis and pancreatitis.
• Acute cerebrovascular accident. The drug is allowed to be used after the elimination of severe symptoms of the pathology.
• Diagnosis of renal artery stenosis.
• Detection of kidney stones, especially large ones. The use of the medicine can provoke the movement of stones towards the ducts, which often leads to severe pain.
• Reduced potassium levels in the blood.
• Taking antiarrhythmic drugs.
• Diagnosis of lactase deficiency.
• Decompensated form of heart failure in elderly patients.
• Chronic hypotension with frequent exacerbations and a critical decrease in blood pressure.
• Severe cerebrovascular disorders.

With extreme caution, the drug is prescribed to patients diagnosed with severe or subacute angina. In case of frequent fluctuations in blood pressure, the drug is used only when strictly necessary.

Who is contraindicated for taking it?

Medical experts categorically do not recommend using Noliprel Forte for high blood pressure in patients who have the following clinical contraindications:

• Treatment with lithium preparations, diuretics, potassium-containing medications;
• Individual intolerance and hypersensitivity to the active ingredients included in the tablets;
• Carrying out hemodialysis procedures;
• Elevated levels of potassium in the patient’s blood;
• Severe liver failure;
• Acute renal dysfunction;
• The user has a history of angioedema;
• Hepatic encephalopathy;
• Idiopathic edema of a congenital or acquired nature.

The drug should not be used to treat hypertension in young patients under the age of majority!

There are some contraindications for the main active ingredients of the drug. Perindopril should not be taken by persons who have an increased tendency to exhibit allergic reactions. Indapamide is contraindicated in renal and hepatic pathologies occurring in severe, acute forms, hypokalemia, and the use of antiarrhythmic drugs.

The doctor will prescribe the drug only after a complete examination of the patient

Instructions for use, dosage

Take the tablets only orally in the dosage prescribed by a specialist. The standard regimen involves taking 1 tablet per day, always in the morning. This will help maintain the optimal dose of active substances throughout the day, since the effect of use lasts for 24 hours.

Treatment lasts from several weeks to several months. Sometimes a short course is required and the patient’s condition returns to normal; long courses of 2-3 months are often indicated. Usually the drug is not prescribed to be taken on an ongoing basis, since there are other medications that are more suitable for this.

If there is no effect from use, the doctor may increase the dosage or prescribe another medication. It is strictly prohibited to independently extend the course or increase the dose.

How to take Noliprel A and A Bi-Forte for hypertension

Instructions for use Noliprel Forte (A and A Bi) recommends taking tablets in the morning before breakfast. Therapy begins with a small amount of medication. The starting dosage of Noliprel Forte is 1 tablet throughout the day.

If there is no proper result, the doctor can increase the daily dose of the drug on an individual basis, taking into account all the features of a particular clinical case.

The average duration of the therapeutic course is from 1 to 3 months.

Side effects

Noliprel A forte (reviews about the product can be negative, especially if used incorrectly) can provoke various adverse reactions. Complications affect the functioning of internal organs and systems, which significantly worsens the condition.

The degree of neglect of the allergic reaction depends on the duration of use of the medication and the characteristics of the patient’s body.

For impaired renal function

The use of Noliprel A forte is contraindicated in severe renal failure (creatinine clearance less than 30 ml/min).

In case of renal failure in patients with CC 30–60 ml/min, the combination drug should be prescribed after preliminary monotherapy with each of the active components. It is necessary to use doses that allow achieving the most acceptable therapeutic effect.

In case of renal failure with CC 60 ml/min or higher, the usual doses of Noliprel A forte are prescribed, accompanying treatment with regular monitoring of the level of creatinine and potassium in the blood plasma.

Overdose

The drug does not often provoke an overdose, only when taken over a long period in large doses. At the same time, the condition worsens significantly, all negative reactions are aggravated.

There is severe nausea, vomiting and severe headache. Patients may also lose consciousness and experience severe weakness, which is associated with a critical decrease in blood pressure.

In case of an overdose, severe arrhythmia may develop, in which the patient feels pain in the heart area, shortness of breath and cough occur as a result of disruption of the heart.

Symptoms of kidney failure may occur with an overdose of the drug. In this case, there is pain in the area of ​​​​the projection of the organ, as well as a violation of the blood filtration process, an increase or decrease in the volume of daily diuresis.

An overdose is almost always accompanied by an acute allergic reaction, which significantly worsens the patient's condition and can even cause death.

If complications or symptoms of overdose occur, you should immediately stop taking the medication and seek help. Typically, therapy is carried out in a hospital setting, using medications that help eliminate symptoms. Over the course of several days, the patients' condition returns to normal. The treatment regimen is different in each case.

NOLIPREL FORTE: SIDE EFFECTS

Effects due to perindopril

From the cardiovascular system: excessive decrease in blood pressure, orthostatic hypotension; in some cases - myocardial infarction, angina, stroke, arrhythmia.

From the urinary system: rarely - decreased renal function, proteinuria (in patients with glomerular nephropathy); in some cases - acute renal failure. A slight increase in the concentration of creatinine in urine and blood plasma (reversible after discontinuation of the drug) is most likely in case of renal artery stenosis, treatment of arterial hypertension with diuretics, or the presence of renal failure. There may be a (usually temporary) increase in plasma potassium concentration.

From the central nervous system and peripheral nervous system: headache, increased fatigue, asthenia, dizziness, mood lability, visual disturbances, tinnitus, sleep disturbance, convulsions, paresthesia, anorexia, impaired taste perception; in some cases - confusion.

From the respiratory system: dry cough; rarely - difficulty breathing, bronchospasm; in some cases - rhinorrhea.

From the digestive system: abdominal pain, nausea, vomiting, constipation, diarrhea; rarely - dry mouth; in some cases - cholestatic jaundice, pancreatitis, increased activity of liver transaminases, hyperbilirubinemia.

From the side of water and electrolyte balance: hypokalemia is possible. Perindopril, which is part of the drug, has the ability to increase potassium concentrations by inhibiting the renin-angiotensin-aldosterone system, leading to a reduction in potassium loss caused by indapamide. It was shown that while taking Noliprel forte, the decrease in potassium concentration was less than 3.4 mmol/l after 12 weeks of therapy in 2% of patients. Basically, the decrease in potassium concentration after 12 weeks of therapy was 0.1 mmol/l.

From the hematopoietic system: anemia (in patients after kidney transplantation, hemodialysis); rarely - hypohemoglobinemia, thrombocytopenia, decreased hematocrit; in some cases - agranulocytosis, pancytopenia; hemolytic anemia is possible (due to deficiency of glucose-6-phosphate dehydrogenase).

Allergic reactions: skin rashes, itching; rarely - urticaria, angioedema; in some cases - erythema multiforme.

Other: rarely - increased sweating, decreased potency.

Effects due to indapamide

From the central nervous system and peripheral nervous system: rarely - dizziness, headache, asthenia, paresthesia (usually disappear when the dose of the drug is reduced).

From the digestive system: rarely - nausea, constipation, dry mouth; in some cases - pancreatitis; With liver failure, the development of hepatic encephalopathy is possible.

From the side of water and electrolyte balance: hypokalemia is possible (especially in patients at risk), a decrease in sodium levels, accompanied by hypovolemia, dehydration of the body and orthostatic arterial hypotension. The simultaneous loss of chloride ions can lead to compensatory metabolic alkalosis (the incidence of alkalosis and its severity are low). In some cases, an increase in calcium levels.

From the metabolic side: an increase in the content of urea and glucose in the blood plasma is possible.

From the hematopoietic system: in some cases - thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia, hemolytic anemia, bone marrow aplasia.

Dermatological reactions: possible skin rashes, hemorrhagic vasculitis, exacerbation of SLE.

Allergic reactions: in predisposed patients - skin manifestations.

special instructions

Noliprel A forte (reviews of the medicine are usually left by people who have taken it for a long period of time) should be used only as prescribed by a doctor. Otherwise, there is a risk of developing severe complications. If negative reactions occur, you should not ignore them; it is important to contact a specialist in a timely manner.

Taking pills requires constant monitoring of blood pressure, which will eliminate the risk of complications if they are reduced critically. If necessary, only a doctor can increase the dosage of the drug. It is strictly forbidden to do this yourself.

When using the medicine, it is important to take enough fluids, since in the first few days there may be a strong decrease in blood pressure.

Test results while taking medication

Indicators of laboratory tests of urine and blood often change somewhat during the therapeutic course with the drug Noliprel Forte. Research results may be as follows:

• Natremia;
• Hypokalemia;
• Increased uric acid levels;
• Wollemia;
• Hyperkalemia;
• Increased blood sugar levels;
• Hypercalcemia.

The test results are carefully studied by the attending physician, on the basis of which the specialist decides on the possibility of offering treatment with Noliprel Forte tablets, adjusts the dosage and regimen of the drug, or prescribes a more suitable analogue to the patient.

While taking Noliprel, test results may be distorted

Drug interactions

The drug is not prescribed simultaneously with other antihypertensive and diuretic drugs, since a critical decrease in blood pressure and impaired renal function are possible. Do not use the medication in combination with Erythromycin, since arrhythmia or bradycardia may develop when the antibiotic interacts with indapamide.

Neuroleptics and tricyclic antidepressants can provoke a strong decrease in blood pressure when combined with Noliprel. The hypotensive properties of the drug are suppressed when combined with glucocorticosteroids.

The drug is not used in combination with laxatives, which may slightly reduce the effectiveness. Simultaneous use with antacids and enterosorbents is not recommended. You should take a break between such medications for at least 2 hours.

Patients who regularly take hypoglycemic drugs should take into account that when they are combined with Noliprel, there is a risk of developing hypoglycemia. In each case, the combination of a particular medicine should be agreed with a specialist.

Treatment of hypertension in patients with type 2 diabetes

For people suffering from this form of diabetes, Noliprel Forte has shown fairly high rates of effectiveness in treatment. As practice has shown, women and men suffering from diabetes from high blood pressure, the levels of which reach 180/100 mm, quickly got rid of unpleasant symptoms. A positive result in diabetics with hypertension was achieved within three months. In more than 80% of patients, the pressure normalized to 130/80 mmHg.

For many people suffering from diabetes, the combination drug Nomiprel Forte has become a real salvation, since other medications did not give a similar result. The main advantage of this treatment regimen is not only the ability to normalize blood pressure, but also improve metabolism, which automatically has a positive effect on the overall course of diabetes.

Analogs

If it is impossible to use the original medication, it is allowed to select a substitute with similar properties.

The most common analogues:

• Co-Diroton is a combination drug that contains hydrochlorothiazide and lisinopril as the main active ingredient. The first ingredient has diuretic properties, the second helps lower blood pressure. The combination of two ingredients helps remove excess fluid from the body and improve the condition. The drug is prescribed to patients with chronic arterial hypertension and the presence of concomitant cardiac pathologies. It is considered effective and is used in short and long courses to maintain blood pressure levels.
• Prestarium contains perindopril as the main active ingredient. The drug does not contain diuretic components, therefore it is used for the treatment of hypertension in patients who do not suffer from peripheral edema. The medicine quickly and effectively reduces blood pressure and helps maintain it at the same level when prescribing the minimum effective dosage.
• Enap N – an antihypertensive medication based on enalapril, which additionally contains hydrochlorothiazide as an active component with diuretic properties. The drug not only helps reduce blood pressure, but also stimulates the removal of excess fluid from the body, preventing the appearance of peripheral edema. It is often used for patients suffering from heart failure, as well as severe hypertension.

• Enalazide also contains enalapril and hydrochlorothiazide. The combined medication has pronounced properties and helps to improve the condition, prevents the development of a hypertensive crisis with a critical increase in indicators. It is prescribed to patients in long courses, since the therapeutic effect must be maintained.

Analogues of the product are available in tablet form and are considered very effective. This does not allow the use of substitutes independently and without prior examination by a specialist.

Precautionary measures

Special precautions are taken if the patient has the following pathologies and malfunctions in the body:

• Acute heart failure, especially that accompanied by adverse renal failure;
• Cirrhosis of various forms of development, accompanied by ascites and severe edema;
• Presence of gastrointestinal disorder - vomiting, diarrhea.

Acute heart failure Cirrhosis of various forms of development Presence of gastrointestinal disorders - vomiting, diarrhea
Caution in administration is observed because the use of the drug can cause a sharp decrease in pressure parameters. This acutely manifests itself after the initial intake of the medication and during the first couple of weeks of the prescribed treatment. In addition, there is always a risk of sudden and unnecessary decline in performance when following a strict salt-restricted diet.

During treatment with Noliprel, it is very important to regularly check the body for clinical signs of electrolyte deficiency and dehydration.

It is worth understanding that the rapid decrease in blood pressure characteristic of the first days of treatment cannot be a reason to stop taking the medication. Doctors usually simply reduce the previously prescribed dosage or temporarily switch the patient to using Indapamide or Perindopril separately. If the drug is prescribed to very elderly patients, specialists conduct an examination of their body before taking it. Blood tests are required to adequately assess the overall functionality of the kidneys, as well as the level of potassium concentration and volume.

Indapamide Perindopril

Patients who have been prescribed Noliprel Forte or other ACE inhibitors for high blood pressure by their attending physician are prescribed creatinine levels to be checked. This is an important point, since consumption can lead to a rapid decline in kidney function. It is for this reason that the medicine is prescribed to patients with such diseases with extreme initial caution, and the dosage is increased gradually.

Price

The cost of the product in pharmacies is approximately 500-600 rubles. per package. The price differs depending on the region of distribution and the specific pharmacy.

Noliprel A forte is considered an effective and relatively safe medication with a hypotensive and diuretic effect. Reviews about the effect of the drug can be negative and positive, depending on the characteristics of the application and the patient’s body. When used correctly, the risk of complications is significantly reduced.