Noliprel And forte

Noliprel A forte contains substances - perindopril and indapamide, that belong to a variety of categories and types of medicines aimed at treating hypertension.

Indapamide is an effective diuretic medicine, and perindopril is an ACE inhibitor. Each substance quickly and effectively lowers blood pressure indicators - each in its own way. Their simultaneous action becomes much more powerful.

Noliprel forte very often helps in such situations, when other drugs from high blood pressure do not have the desired result. For the most part, this is the basis for a higher cost of the drug.

Clinical and pharmacological group

Antihypertensive drug.

Conditions of leave from pharmacies

It is released on prescription.

Price list

How much is Noliprel A forte in pharmacies? The average price is at the level of750 rubles.

Form of issue and composition

NOLLIPREL FORTE A are white tablets of elongated shape with a film coating. One film-coated tablet contains 5 mg perindopril arginine and 1.25 mg indapamide.

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Active substances: perindopril arginine and indapamide. One film-coated tablet contains 5 mg perindopril arginine, which corresponds to 3.395 mg perindopril and 1.25 mg indapamide.
Other components that make up the central part of the tablet are lactose monohydrate, magnesium stearate (E470B), maltodextrin, colloidal anhydrous silica (E551), sodium starch glycolate (type A); film coating: glycerol (E422), hypromellose (E464), macrogol 6000, magnesium stearate (E470B), titanium dioxide (E171).

14 or 30 tablets in a white tube of polypropylene, with a packing of low density polyethylene with a metering hole for gradual dispensing of tablets, with a cork of low density polyethylene containing a white siccative gel.

It is possible that not all sizes of packages are on sale.

Pharmacological effect

Noliprel is a combined preparation containing perindopril (ACE inhibitor) and indapamide (thiazide-like diuretic). 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 synergism of the antihypertensive effect compared to each of the components alone.

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

Indications for use

Noliprel A forte is prescribed to people with such diseases:

essential hypertension;
in patients with arterial hypertension and type 2 diabetes to reduce the risk of developing microvascular complications (from the side of the kidneys) and macrovascular complications from cardiovascular diseases.

Contraindications

hypokalemia;
bilateral stenosis of the renal arteries or the presence of one functioning kidney;
severe hepatic insufficiency (including with encephalopathy);
simultaneous reception of drugs that extend the QT interval;
simultaneous use with non-antiarrhythmic agents capable of inducing ventricular arrhythmia of the "pirouette" type (cf. section "Drug Interactions");
pregnancy; the period of breastfeeding;
age under 18 years (effectiveness and safety not established);
hypersensitivity to perindopril and other ACE inhibitors, to indapamide and other sulfonamides, as well as to other auxiliary components of the drug;
angioedema in the anamnesis (including against the background of the administration of other ACE inhibitors) (see below). section "Special instructions");
hereditary / idiopathic angioedema;
severe renal failure (CK <30 mL / min);
simultaneous use with aliskiren-containing drugs in patients with diabetes mellitus or renal dysfunction (GFR less than 60 ml / min / 1.73 m2 body surface area) (see. sections "Pharmacological action" and "Drug interaction");
simultaneous use with non-antiarrhythmic agents capable of inducing ventricular arrhythmia of the "pirouette" type (cf. section "Drug Interactions");
presence of lactase deficiency, galactosemia or glucose-galactose malabsorption syndrome (the preparation contains lactose).

Because of a lack of sufficient clinical experience, Noliprel A Forte should not be used in patients with untreated decompensated heart failure and in patients on hemodialysis.

With caution should prescribe the drug for systemic diseases of connective tissue (including systemic lupus erythematosus, scleroderma), immunosuppressant therapy (risk of development neutropenia, agranulocytosis), hepatic insufficiency, hyperuricemia (especially accompanied by gout and urate nephrolithiasis), lability of blood pressure; hemodialysis with high-flux membranes, desensitization, therapy with lithium drugs, oppression of bone marrow hematopoiesis, reduced BCC (diuretic intake, salt-free diet, vomiting, diarrhea, hemodialysis); angina pectoris, cerebrovascular diseases, renovascular hypertension, diabetes, chronic heart failure (NYHA FC IV), before the procedure apheresis of LDL; after renal transplantation; stenosis of the aortic valve / hypertrophic obstructive cardiomyopathy; with anesthesia; as well as elderly patients; patients of the Negroid race (less pronounced effect from the application); athletes (possible a positive reaction in doping control).

Use in pregnancy and lactation

Noliprel is not recommended for pregnancy. His reception in the first trimester is strictly prohibited. Planning pregnancy or its occurrence against the background of drug therapy is a direct indication for the withdrawal of the drug and the selection of another scheme for antihypertensive therapy. Appropriate controlled trials of ACE inhibitors in pregnant women have not been conducted. There are limited data on the effects of Noliprel in the first trimester of pregnancy, indicating that treatment did not increase the risk of malformations caused by fetotoxicity.

The effect of the drug on the fetus over a long period of time in the second and third trimesters of pregnancy can cause disruption of its development (delayed ossification skull bones, oligohydramnion, decreased renal function) and provoke complications in the newborn (hyperkalemia, arterial hypotension, renal failure).

Long-term use of thiazide diuretics in the third trimester of pregnancy can cause maternal hypovolemia, and also deterioration of uteroplacental blood flow, which causes fetoplacental ischemia and delayed fetal development. Occasionally, diuretics are treated with thrombocytopenia and hypoglycaemia shortly before the onset of labor.

If a woman took Noliprel during the second or third trimester of pregnancy, ultrasound examination of the fetus should be performed to assess the kidney function and the condition of the bones of the skull.

The lactation period is a contraindication to the prescription of the drug. Information on the possible penetration of perindopril in breast milk is not considered reliable. Indapamide penetrates into breast milk. Taking thiazide diuretics can lead to suppression of lactation or a decrease in the production of breast milk. The child sometimes develops an increased sensitivity to derivatives of sulfonamides, nuclear jaundice and hypokalemia.

Since the appointment of Noliprel during lactation can cause severe complications in the infant, it is recommended that weigh the importance of therapy for the mother and decide whether to stop breastfeeding or to cancel the drug.

Dosage and route of administration

The instructions for use indicate that Noliprel A forte is taken orally, preferably in the morning, before eating.

Essential hypertension:

Assign 1 tab. 1 time / day.

If possible, taking the drug starts with the selection of doses of one-component drugs. In the case of clinical necessity, one can consider the possibility of prescribing a combination therapy with Noliprel A forte immediately after monotherapy.

In patients with arterial hypertension and type 2 diabetes mellitus, to reduce the risk of microvascular complications (from the kidneys) and macrovascular complications from cardiovascular diseases it is recommended to start therapy with a combination of perindopril / indapamide in a dose of 2.5 mg / 0.625 mg (drug Noliprel A) 1 time / day. After 3 months of therapy, under condition of good tolerability, it is possible to increase the dose - 1 tab. Nolipret A forte 1 time / day.

To patients of advanced ageshould be prescribed treatment with the drug after monitoring the function of the kidneys and blood pressure.

The drug is contraindicatedpatients with severe renal insufficiency (CC <30 mL / min). For patients with moderate renal insufficiency (KK 30-60 ml / min), it is recommended to start therapy with the necessary doses of drugs (in monotherapy) that are part of Noliprel A forte. Patients with QC ≥ 60 mL / min dose adjustment are not required. On the background of therapy, regular monitoring of the concentration of creatinine and potassium in the blood plasma is necessary.

The drug is contraindicatedpatients with severe hepatic insufficiency.With moderate hepatic insufficiency, dose adjustment is not required.

Nolipret A forte should not be given to children and adolescents under the age of 18 due to a lack of data on the efficacy and safety of the drug in patients of this age group.

Side effects

Taking medication can be the cause of a number of adverse reactions:

Allergic manifestations: skin itching, rash, swelling, urticaria.
In the functions of the respiratory system: cough, shortness of breath, bronchospasm, discharge from the nose.
In the functions of the gastrointestinal tract: dyspepsia, abdominal pain, pancreatitis, cholestasis, increased activity of transaminases, hyperbilirubinemia.
In the functions of the blood system: on the background of hemodialysis or after kidney transplantation, patients may develop anemia, in rare cases - thrombocytopenia, pancytopenia, agranulocytosis, hemolytic anemia.
In the functions of the cardiovascular system: pronounced hypotension, orthostatic collapse, in rare cases: arrhythmia, stroke, myocardial infarction.
In the functions of the genitourinary system: impairment of kidney function, proteinuria in people with glomerular nephropathy, in rare cases - acute renal failure. There may be a decrease in potency.
In the functions of the central and peripheral NA: severe fatigue, dizziness, headache, asthenia, unstable mood, hearing loss, vision, loss of appetite, cramps, in some cases - stupor.
In patients with hepatic insufficiency, hepatic encephalopathy can develop. People with a disturbed water-electrolyte balance may exhibit hyponatremia, hypovolemia, hypokalemia, dehydration.

Overdose

It is important to remember that you should not take the drug without the advice of a doctor. If the dosage of this powerful drug is exceeded, severe consequences and even fatal outcome are possible. Independent appointment Noliprel can cause the following negative phenomena:

nausea;
drowsiness;
fainting condition;
a decrease in blood pressure;
violation of water-salt balance;
muscle cramps;
dizziness;
vomiting reflex;
perspiration;
decrease in the level of electrolytes of blood plasma.

If one of these symptoms occurs, you should immediately call for emergency help and take the following steps:

rinse the stomach;
To remove toxins from the body by taking activated carbon;
restore the water-electrolyte balance;
lie on a flat plane, resting your legs on the pillow.

special instructions

Special instructions for the drug Nolipret A forte:

At the very beginning of the treatment course, the likelihood of idiosyncrasy can not be ruled out.
The composition contains lactose monohydrate, so patients with lactase deficiency / intolerance galactose, as well as glucose-galactose malabsorption syndrome, these tablets are not prescribed.
Kidney failure: with severe manifestations, the drug is contraindicated. With the symptomatology indicating the developed deficiency of the kidneys, the patient is abolished and transferred to a monotherapy.
Abnormal electrolyte balance and hypotension arterial: observation of the dynamics of existing symptoms and appropriate treatment;
Combination with potassium: control over laboratory blood indicators.
Lithium medications: combination is undesirable.

Specific guidance for the substance indapamide:

Urinary acid: the likelihood of frequent gout attacks.
Renal functionality and diuretics: periodic monitoring of patient analyzes.
Development of hepatic encephalopathy: the application is discontinued.
Violations of the electrolyte balance: a constant control of the patient's tests.
The level of glucose in the blood: regular examinations.
Athletes: the substance is able to give a positive result in doping control.
Transport management: the concentration of attention is rarely reduced.
Photosensitivity: the therapy is stopped. It is necessary to carefully protect the skin from sun exposure.

Specific guidance for perindopril:

Anemia: monitoring blood levels.
Hypotension arterial / insufficiency of the kidney: correction of the chosen dosage is carried out.
Agranulocytosis / neutropenia: individual dosage is important.
Quincke's Edema: symptomatic therapy is performed. The drug is immediately canceled. Cases of edema of the intestine by the angioedema type are rarely recorded.
Anaphylaxis on the background of desensitization: ACE inhibitors are prescribed with caution, especially when immunotherapy with Poisons of Hymenoptera type.
Anaphylaxis during the period of LDL: for the avoidance of anaphylaxis, the administration of ACE inhibitors is suspended for a day (minimum!) Before apheresis.
Cough: if necessary, therapy can be prolonged.
General anesthesia / surgical manipulations: probably a sharp decrease in blood pressure. The doctor should be informed about the receipt of the remedy. Tablets are canceled a day before the necessary intervention.
Cardiomyopathy of the hypertrophic type / aortic stenosis: tablets are appointed very carefully, especially in the presence of obstruction of the left ventricular outflow tract.
Liver insufficiency: cholestatic jaundice is likely. If there is progression, then hepatic necrosis develops, which can be accompanied by the death of the patient. The treatment is discontinued and the doctor is consulted for an unscheduled consultation.
Atherosclerosis: increased caution in patients with IHD or circulatory insufficiency in the brain.
Renovascular hypertension: when adjusting the dosage, the drug treatment in such patients shows a beneficial effect.
Risk groups: with heart failure in severe manifestations, as well as with diabetes insulin-dependent diabetes, low dosage and medical supervision are recommended.
Elderly: Preliminary study of laboratory indicators of the patient's analyzes. Dosage is selected strictly in an individual way.
Pediatrics: Do not use until age 18.

In the elderly, pills are prescribed very carefully after a preliminary examination of the patient.

Drug Interactions

When using the drug, it is necessary to take into account the interaction with other drugs:

Simultaneous application of calcium salts can provoke hypercalcemia.
When combining indapamide with vincamine, bepridilom, sultopride, halofantrine, as well as with simultaneous intravenous administration of erythromycin, arrhythmia and bradycardia may occur.
With simultaneous treatment with potassium-sparing diuretics or drugs with potassium, the concentration of potassium in the blood can increase. This combination is recommended only for hypokalemia.
Sometimes with simultaneous treatment with insulin and Noliprelum may develop hypoglycemia.
When treating with Noliprelum and neuroleptics or tricyclic antidepressants, orthostatic hypotension may develop.
When taking non-steroidal anti-inflammatory drugs, the hypotensive properties of Noliprel are suppressed. In the case of dehydration, this combination of drugs can cause kidney damage or kidney failure.
In view of the possibility of hypokalemia, the risk of toxic effects of cardiac glycosides increases.
When combined with metformin, lactic acidosis may develop.
Before using iodine-containing X-ray contrast preparations with Noliprel it is necessary to conduct adequate hydration of the organism.
In view of the delay in the body of water and electrolytes with the simultaneous treatment of Noliprel and mineralocorticoids, glucocorticosteroids, stimulating laxative, tetracosactide, amphotericin B reduces hypotensive effect and increases the likelihood of hypokalemia.
Do not take Noliprel at one time with lithium preparations. If it is impossible to cancel one of the drugs, you should clearly control the lithium content in the blood.
Simultaneous treatment with cyclosporine may increase the level of creatinine in the blood.

Reviews

We picked up some feedback from people who used Nolipret A forte:

Oksana, the doctor. I prescribe Noliprel for the majority of my patients who suffer from hypertension. They are very satisfied, there are practically no failures and side effects, as I carefully study the medical history of everyone and carefully prescribe the rules of therapy. The results of treatment with this drug are simply stunning.
Rita. Mom was discharged with arterial hypertension, for permanent use, the dose was prescribed - 1 tablet a day, applied a month, the pressure did not decrease, it was necessary to reduce Kapotenom, in the end, the doctor added another 1 tablet per day Prestarium (10 mg !!!), plus Veroshpiron in the afternoon, and this is the "treatment" for a year, and the pressure, like jumping, and galloping. They insisted on a more thorough examination (it was insisted, the doctor did not offer anything), after she suggested adding another Noliprel tablet in the morning. We now do not understand how much to take this drug, so that there is a positive dynamic ...
Galina. Already three years take Noliprel fort. Almost immediately it was possible to reduce the pressure values, moreover, my weight was gradually normalized. For me, there is no more effective medicine - the metabolism is completely normalized, and unpleasant symptoms of high blood pressure do not bother anymore.