Lozol
Lozol
Lozol (Indapamide)Pharmacological action
The antihypertensive (diuretic) preparation. On pharmacological properties Lozol is close to the diuretics which action is bound to inhibition of return absorption of ions of sodium in a cortical segment of a loop of a nephron. Lozol (Indapamide) enlarges allocation with urine of ions of sodium, chlorine and, to a lesser degree, potassium and magnesium ions that is accompanied by diuresis intensifying. Lozol (Indapamide) antihypertensive an effect in the doses which are not possessing expressed diuretic effect has. Besides, hypotensive action is bound to ability of a preparation to raise elasticity of walls of arteries.
The Lozol action mechanism is caused by change of a transmembrane current of ions (first of all - calcium), that leads to intensifying of synthesis of Prostaglandinums PGE2.
The preparation promotes reduction of a hypertrophy of a left ventricle of heart.
Clinical Lozol tests have shown, that at monotherapy the proof hypotensive effect remaining during 24 h develops; moderate intensifying of a diuresis was thus observed.
Irrespective of duration of Lozol application does not influence the maintenance of lipids in a blood plasma (triglycerides, cholesterol/lpnp, cholesterol/lpvp); does not change carbohydrate metabolism parametres (including at patients with an arterial hypertensia and a diabetes).
Lozol is effective at the patients having one kidney.
Lozol antihypertensive an effect in the doses which are not possessing expressed diuretic effect has.
At Lozol application in high doses hypotensive action amplifies, but the diuresis is enlarged.
Indications
- An essential arterial hypertensia.
Dosage regimen
Lozol prescribe on 1 tab./24h (it is desirable in the morning) irrespective of disease severity level.
The maximum daily dose - 2.5 mg.
Side effect
From vodno-electrolytic balance: depression of level of a potassium and hypopotassemia development (especially expressed at the patients concerning group of risk) are possible. According to clinical researches a hypopotassemia (concentration of ions of a potassium in a blood plasma <3.4 mmol/l) were observed at 10 % of the patients Lozol receiving. Depression of the maintenance of a potassium below 3.2 mmol/l in 4-6 weeks of Lozol reception is noted at 4 % of patients. In 12 weeks of reception of a preparation average reduction of concentration of ions of a potassium in a blood plasma made 0.23 mmol/l.
The hyponatremia accompanied by a hypovolemia, dehydration of an organism and an orthostatic hypotension is possible. Simultaneous loss of ions of chlorine can lead to a compensatory metabolic alkalosis, frequency of development and which expression is insignificant.
Extremely seldom - rising of level of calcium in an organism.
From a metabolism: the augmentation of the maintenance of urea and a glucose in a blood plasma is possible.
From hemopoiesis system: seldom - a thrombocytopenia, a leukopenia, an aplastic anaemia, a hemolitic anaemia, an agranulocytosis.
From the alimentary system: seldom - a nausea, a constipation, dryness in a mouth; exclusively seldom - a pancreatitis. At patients with hepatic insufficiency probably development of a hepatic encephalopathy.
Allergic reactions: at the patients predisposed to allergic reactions and development of attacks of a bronchial asthma, dermal implications of a hypersensibility to a preparation are possible; seldom - a hemorrhagic vasculitis.
From party TSNS: seldom - giddiness, an asthenia, paresthesias, a headache (these effects usually pass at a preparation dose decline).
Contraindications
- Serious renal insufficiency;
- A hepatic encephalopathy;
- A hypopotassemia;
It is necessary to avoid simultaneous Lozol reception and the preparations extending interval QT.
Pregnancy and lactemia
As a rule, Lozol is not recommended to apply at pregnancy, including to putting off of physiological edemas. It is necessary to mean, that diuretics can cause a fetoplacental ischemia and lead to fetation disturbance.
Because Lozol is allocated with thoracal milk, appointment of a preparation in thoracal feeding also is not recommended. If therapy carrying out is necessary, feeding of the child by a breast should be stopped.
Special indicatings
At Lozol appointment with a diabetes it is the extremely important to patients to supervise glucose level, especially in the presence of a hypopotassemia.
At patients with the raised maintenance of urinary acid the tendency to augmentation of number of attacks of a gout becomes perceptible.
In such cases preparation reception should be stopped immediately.
At patients of advanced age normal level of a creatinine in a blood plasma is counted taking into account age, by masses of a body and a floor of the patient under formula
ClCR = (140-age in years/) x mass bodies (kg)/0.814 x a creatinine plasmas (mkmol/l).
This formula is applied at calculation of level of a creatinine at men, for women the end result should be increased on 0.85.
It is necessary to consider, that in the beginning of treatment at patients the depression of a glomerular filtration caused by a hypovolemia which is caused by loss of water and ions of sodium against reception of diuretics can be observed. As consequence, in a blood plasma concentration of urea and a creatinine can be enlarged. If function of kidneys is not broken, such time renal insufficiency, as a rule, passes without consequences. However at already available renal insufficiency the condition of the patient can worsen.
Prior to the beginning of treatment it is necessary to define the maintenance of ions of sodium in a blood plasma. In the course of treatment the regular control of this indicator as originally depression of concentration of sodium in a blood plasma can and not be accompanied by occurrence of pathological symptoms is necessary. Especially often such analysis should be spent at patients with a cirrhosis and at persons of advanced age.
The hypopotassemia at these patients leads to intensifying of toxic action of warm glycosides and raises risk of development of arrhythmias. Besides, patients concern group of the raised risk with a bradycardia or with enlarged interval QT on an electrocardiogram, thus not very well, such augmentation is caused by the congenital reasons or presence of pathological process.
Hypopotassemia as well as the bradycardia, is a condition promoting development of serious warm arrhythmias, especially type the "pirouette", often leading to lethal outcomes. In all cases described above it is necessary to define more often the maintenance of ions of a potassium in a blood plasma. The first measurement of concentration of ions of a potassium should be spent to bloods within the first week from the treatment beginning.
At hypopotassemia occurrence it is necessary to prescribe corresponding treatment, thus not supposing application of the preparations causing arrhythmias of type "pirouette". At occurrence of similar disturbance of a rhythm it is not necessary to apply antiarrhytmic preparations, and it is necessary to establish the artificial driver of a rhythm.
It is necessary to cancel reception of diuretics before the beginning of research of function of parathyroid glands.
In need of appointment against Lozol therapy of purgatives, it is necessary to prescribe the preparations which are not influencing a peristalsis of an intestine.
Against Lozol reception the positive take is possible at carrying out of the doping control at sportsmen.
At simultaneous application with other antihypertensive preparations Lozol dose should be reduced, at least, in the treatment beginning.
Use in pediatrics
In the absence of enough of clinical data the preparation is not recommended to be applied at children and teenagers till 18 years.
Influence on ability to driving of motor transport and to management of mechanisms
Action of the substances which are Lozol part, does not lead to disturbance of psychomotor reactions. However it is necessary to consider, that in some cases at BP dropping there can be individual reactions (especially in the beginning of therapy or at a combination of several antihypertensive preparations). In this case ability to perform the works demanding special attention and speed of psychomotor reactions, can be lowered.
Overdosage
Lozol even in very high concentration (to 40 mg, i.e. in 27 times more a therapeutic dose) does not render toxic action.
Symptoms: disturbances of vodno-electrolytic balance (a hyponatremia, a hypopotassemia), a nausea, vomiting, an arterial hypotension, cramps, giddiness, drowsiness, confusion of consciousness.
Treatment: the urgent measures referred on excision of a preparation from an organism: a lavage GASTROINTESTINAL TRACT and-or appointment of the activated coal with the subsequent restoration of normal vodno-electrolytic balance.
Medicinal interaction
In need of appointment of the given combination it is necessary to supervise concentration of lithium in a blood plasma.
At simultaneous Lozol application with other preparations which can cause a hypopotassemia, including with Amphotericinum B (i.v.), gljuko - and mineralocorticoids (at system application), the purgatives, stimulating an intestine peristalsis, the risk of development of a hypopotassemia (the constant control over potassium level in a blood plasma and is required, at the necessity, corresponding treatment) raises.
At simultaneous application with warm glycosides probably intensifying of toxic action of the last (it is necessary to supervise potassium level in a blood plasma and electrocardiogram indicators).
At simultaneous Lozol application with Baclofenum intensifying of hypotensive effect (it is necessary to compensate loss of water and in the treatment beginning carefully to supervise function of kidneys) becomes perceptible.
At simultaneous application of diuretics and Metforminum probably occurrence of a lactic acidosis which is bound, apparently, with development of the functional renal insufficiency caused by action of diuretics (in larger degree "loopback").
At simultaneous Lozol application and cyclosporine probably augmentation of the maintenance of a creatinine in a blood plasma that is observed even at the normal maintenance of water and sodium ions.
Conditions and periods of storage
The preparation should be stored in a dry place at temperature not above 30 C. The Period of validity - 5 years.
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