Noliprel instructions for use. Noliprel: instructions for use and what it is for, price, reviews, analogues. Special instructions and precautions

Noliprel: instructions for use and reviews

Noliprel is a combined antihypertensive agent.

Release form and composition

Dosage form - tablets: oblong, white, with a dividing line on both sides (14 or 30 pcs. In blisters, packed in sachets, in a cardboard box, 1 sachet).

Perindopril erbumine (perindopril tert-butylamine) - 2 mg, equivalent to 1.669 mg perindopril base;
Indapamide - 0.625 mg.

Auxiliary components: microcrystalline cellulose, anhydrous colloidal silicon dioxide, magnesium stearate, lactose monohydrate.

Pharmacological properties

Noliprel is a combination drug that includes indapamide (a diuretic belonging to the group of sulfonamide derivatives) and perindopril (an angiotensin-converting enzyme inhibitor). Its pharmacological properties are a combination of the individual properties of each of the components. The combination of indapamide and perindopril enhances the action of each.

Pharmacodynamics

Noliprel has a dose-dependent hypotensive effect, affecting both systolic and diastolic blood pressure in the supine or standing position. The antihypertensive effect of the drug is prolonged and lasts for 1 day. The therapeutic effect is observed less than 1 month after the start of treatment and is not accompanied by tachycardia. Cancellation of Noliprel does not provoke the development of withdrawal syndrome. Indapamide and perindopril are characterized by a synergistic antihypertensive effect compared to monotherapy with these drugs.

The drug reduces the degree of left ventricular hypertrophy, increases the elasticity of the arteries, helps to reduce the total peripheral vascular resistance and does not affect the metabolism of lipids (low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, total cholesterol, triglycerides).

The effect of Noliprel on cardiovascular morbidity and mortality is not well understood.

Perindopril

Perindopril is an inhibitor of the enzyme responsible for the conversion of angiotensin I to angiotensin II (an ACE inhibitor). Kinase (angiotensin-converting enzyme) is an exopeptidase that carries out both the transition of angiotensin I to the vasoconstrictor compound angiotensin II and the destruction of bradykinin, which is characterized by a vasodilating effect, with the formation of an inactive heptapeptide.

As a result, perindopril reduces the production of aldosterone, in accordance with the principle of negative feedback, increases the activity of renin in the blood plasma and, with prolonged therapy, lowers the total peripheral vascular resistance, which is mainly caused by the effect on the vessels localized in the kidneys and muscles.

These effects are not accompanied by the occurrence of reflex tachycardia or salt and fluid retention.

Perindopril normalizes myocardial function by reducing preload and afterload.

Studies of hemodynamic parameters in patients with chronic heart failure have revealed that this substance increases muscle peripheral blood flow, enhances cardiac output and increases cardiac index, decreases filling pressure in both ventricles of the heart and decreases total peripheral vascular resistance.

Perindopril is effective in the treatment of hypertension of varying severity. The antihypertensive effect of the drug reaches its peak 4-6 hours after a single dose and lasts 24 hours. One day after the application of Noliprel, there is a pronounced (about 80%) inhibition of residual ACE.

Perindopril has an antihypertensive effect in patients with both reduced and normal renin activity in blood plasma. The compound is characterized by a vasodilating effect, ensures the regeneration of the structure of the vascular wall of small arteries and restoration of the elasticity of large arteries, and also minimizes left ventricular hypertrophy.

The combination of Noliprel with thiazide diuretics makes the antihypertensive effect more pronounced. Also, the simultaneous administration of a thiazide diuretic and an ACE inhibitor reduces the risk of hypokalemia during the appointment of diuretics.

Indapamide

Indapamide is part of the sulfonamide group and is similar in pharmacological characteristics to thiazide diuretics. The substance slows down the reabsorption of sodium ions in the cortical element of the loop of Henle, which causes more intensive excretion through the kidneys of chlorine, sodium ions and, to a lesser extent, magnesium and potassium ions. This helps to increase urine output and lower blood pressure.

Indapamide as a monotherapy drug has an antihypertensive effect lasting 24 hours. It becomes noticeable when the drug is taken in doses that have a minimal diuretic effect. The compound improves the elastic properties of large arteries, reduces the total peripheral vascular resistance and reduces left ventricular hypertrophy.

At a certain dose of indapamide, thiazide and thiazide-like diuretics reach a plateau of therapeutic effect, while the frequency of side effects continues to increase with a further increase in the dose of the drug. Therefore, an increase in the dose of indapamide is not justified if there is no therapeutic effect when taking the recommended dose.

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

Pharmacokinetics

With the combined use of indapamide and perindopril, their pharmacokinetic parameters do not change compared with the separate administration of these drugs.

Perindopril

When taken orally, perindopril is absorbed at a significant rate. Its maximum content in blood plasma is recorded 1 hour after administration. The half-life of a substance from blood plasma is 1 hour. Pharmacological activity is not characteristic of perindopril. Approximately 27% of the dose taken orally enters the bloodstream after conversion to the active metabolite perindoprilat. In addition to perindoprilat, 5 more metabolites are formed that do not exhibit pharmacological activity. The maximum content of perindoprilat in blood plasma is observed 3-4 hours after oral administration. Food intake inhibits the transition of perindopril to perindoprilat, affecting its bioavailability. Therefore, the drug should be taken once a day, in the morning and on an empty stomach.

A linear dependence of the content of perindopril in the blood plasma on its dose was revealed. The volume of distribution of unbound perindoprilat is about 0.2 l / kg. Perindoprilat binds to blood plasma proteins, mainly ACE, and the degree of binding is determined by the level of perindopril in the blood and is approximately 20%.

Perindoprilat is excreted in the urine. The effective half-life is approximately 17 hours, so equilibrium concentrations are reached within 4 days.

The excretion of perindoprilat is slowed down in elderly patients, as well as in patients with renal and heart failure. The dialysis clearance of perindoprilat is 70 ml / min. The pharmacokinetics of perindopril changes in patients with liver cirrhosis: the hepatic clearance of the compound is reduced by 2 times. However, the amount of perindoprilat formed does not show a tendency to decrease, so there is no need for dose adjustment.

Indapamide

Indapamide is rapidly absorbed and completely absorbed from the gastrointestinal tract. The maximum level of the compound in the blood plasma is recorded 1 hour after oral administration.

Indapamide binds to plasma proteins by 79%. The half-life is 14-24 hours (mean -18 hours). Repeated intake of the drug does not cause its accumulation in the tissues of the body. Indapamide is excreted mainly through the kidneys (70% of the dose taken) and through the intestines (22% of the dose taken) as inactive metabolites. Renal failure does not affect the pharmacokinetics of the compound.

Indications for use

The use of Noliprel is indicated for the treatment of essential arterial hypertension.

Contraindications

Chronic heart failure in the stage of decompensation in untreated patients;
Hypokalemia;
Elevated plasma potassium;
A history of angioedema (Quincke's edema);
Idiopathic or hereditary angioedema;
Severe renal (creatinine clearance (CC) less than 30 ml / min) and / or hepatic (including encephalopathy) failure;
Glucose-galactose malabsorption syndrome, lactase deficiency, galactosemia;
Simultaneous use of potassium-sparing diuretics, potassium and lithium preparations, antiarrhythmic drugs (risk of developing arrhythmias of the "pirouette" type), drugs that lengthen the QT interval;
The period of pregnancy and breastfeeding;
Age under 18;
Hypersensitivity to angiotensin-converting enzyme (ACE) inhibitors and sulfonamides;
Hypersensitivity to drug components.

Also, Noliprel is contraindicated in patients on hemodialysis.

The drug should be prescribed with caution in case of systemic diseases of the connective tissue (including systemic lupus erythematosus, scleroderma), inhibition of bone marrow hematopoiesis, treatment with immunosuppressants (due to the risk of agranulocytosis, neutropenia), reduced circulating blood volume (while taking diuretics, salt-free diet, vomiting , diarrhea), cerebrovascular diseases, renovascular hypertension, diabetes mellitus, angina pectoris, stenosis of the aortic valve, hypertrophic cardiomyopathy, chronic heart failure IV functional class (NYHA classification), hyperuricemia (especially accompanied by urate nephrolithiasis and gout), hemodialysis , lability of blood pressure (BP); during the period after kidney transplantation; elderly patients.

Instructions for the use of Noliprel: method and dosage

Noliprel is taken orally, preferably before breakfast.

Prescribing the drug to elderly patients should be made on the basis of data on the level of potassium concentration in blood plasma and functional activity of the kidneys. Treatment should begin with an individual dose selection taking into account the degree of blood pressure reduction, especially in patients with dehydration and electrolyte loss. Treatment should be started with 1 tablet 1 time per day.

In patients with moderate renal failure (CC 30-60 ml / min), the daily dose should not exceed 1 tablet, with CC 60 ml / min and higher, dose adjustment is not required. Treatment must be accompanied by monitoring the level of potassium and creatinine in the blood plasma (after two weeks of therapy and then once every 2 months).

If laboratory signs of functional renal failure appear against the background of Noliprel's use, the drug should be canceled. The combination treatment should be resumed only with the use of low doses of the drug or in the monotherapy regimen. Patients with underlying renal dysfunction, including renal artery stenosis and severe heart failure, are at risk of developing renal failure.

No dose adjustment is required in patients with moderate hepatic impairment.

Side effects

General disorders: often - asthenia; infrequently - sweating;
Cardiovascular system: infrequently - a strong decrease in blood pressure, including orthostatic hypotension; very rarely - bradycardia, atrial fibrillation, ventricular tachycardia, angina pectoris, myocardial infarction and other cardiac arrhythmias;
Lymphatic and circulatory systems: very rarely - leukopenia or neutropenia, thrombocytopenia, agranulocytosis, hemolytic anemia, aplastic anemia; in patients after kidney transplantation who are on hemodialysis, anemia may develop;
Digestive system: often - dry mouth, constipation, diarrhea, nausea, abdominal pain, vomiting, epigastric pain, loss of appetite, impaired taste, dyspepsia; rarely - cholestatic jaundice, angioedema of the intestine; very rarely - pancreatitis; possibly - hepatic encephalopathy (in patients with liver failure);
Organ of vision: often - visual impairment;
Hearing organ: often - tinnitus;
Nervous system: often - headache, paresthesia, asthenia, dizziness; infrequently - mood lability, sleep disturbance; very rarely - confusion of consciousness;
Respiratory system: often - transient dry cough, shortness of breath; infrequently - bronchospasm; very rarely - rhinitis, eosinophilic pneumonia;
Musculoskeletal system and connective tissues: often - muscle spasms;
Reproductive system: infrequently - impotence;
Urinary system: infrequently - renal failure; very rarely - acute renal failure;
Dermatological and allergic reactions: often - skin rash, itching, maculopapular rash; infrequently - urticaria, angioedema of the larynx and / or glottis, mucous membranes of the tongue, lips, face, limbs, hypersensitivity reactions (more often skin, in predisposed patients), hemorrhagic vasculitis; exacerbation of disseminated lupus erythematosus; very rarely - toxic epidermal necrolysis, erythema multiforme, Stephen-Jones syndrome, photosensitivity reactions;
Laboratory indicators: hypovolemia and hyponatremia, hypokalemia, a transient increase in the level of glucose and uric acid in the blood, transient hyperkalemia, a slight increase in the level of creatinine and urea in the blood plasma (more often with renal artery stenosis, renal failure, during therapy of arterial hypertension with diuretics); rarely, hypercalcemia.

Overdose

When taking high doses of Noliprel, the most common symptom of an overdose is a pronounced decrease in blood pressure, sometimes combined with drowsiness, dizziness, blurred consciousness, convulsions, nausea, vomiting and oliguria, which can turn into anuria (due to hypovolemia). Also, electrolyte disturbances often develop: hypokalemia or hyponatremia.

Emergency care consists in removing Noliprel from the body by washing the stomach and / or prescribing activated charcoal, followed by the subsequent normalization of the water-electrolyte balance. With a significant decrease in blood pressure, the patient is placed in a supine position with his legs raised. If necessary, hypovolemia is corrected (for example, by intravenous infusion of 0.9% sodium chloride solution). Perindoprilat, the active metabolite of perindopril, is effectively removed from the body by dialysis.

special instructions

At the beginning of therapy, careful monitoring of patients who have not previously taken two antihypertensive drugs (perindopril, indapamide) at the same time is required, since the risk of idiosyncrasy increases.

Since hyponatremia can cause the sudden development of arterial hypotension, regular monitoring of the level of electrolyte concentration in blood plasma is required, especially in patients with renal artery stenosis after vomiting or diarrhea. To restore the water-electrolyte balance, intravenous administration of 0.9% sodium chloride solution is recommended. Therapy can be continued after normalization of blood pressure and blood volume, using a low dose of the drug or switching to monotherapy.

Treatment should be accompanied by regular monitoring of plasma potassium levels.

The risk of developing neutropenia while using the drug increases in patients with functional kidney disorders, more often with scleroderma, systemic lupus erythematosus. Symptoms of neutropenia are dose-dependent.

With concomitant therapy with immunosuppressive drugs in patients with diffuse connective tissue pathologies, the level of leukocytes in the blood should be monitored. When symptoms of sore throat, fever and others appear infectious diseases you need to see a doctor.

If signs of hypersensitivity to the drug appear in the form of angioedema, the drug should be immediately canceled and the patient should be prescribed appropriate therapy. For swelling of the tongue, larynx, or glottis, airway management and immediate subcutaneous administration of epinephrine (adrenaline) are recommended.

When conducting a differential diagnosis in patients with pain in the abdominal region, the possibility of developing angioedema of the intestine should be considered.

Simultaneous administration with immunotherapy with hymenopteran insect venom is not recommended (in order to prevent the development of anaphylactoid reaction, Noliprel should be temporarily discontinued 24 hours before the start of the desensitization procedure).

There is a risk of anaphylactoid reactions during low-density lipoprotein (LDL) apheresis using dextran sulfate, and the drug should be discontinued before each apheresis procedure.

Taking pills can cause a dry cough in the patient.

To avoid a sharp drop in blood pressure, treatment should be started with low doses of the drug and then gradually increased, taking into account the tolerance and laboratory parameters of the level of creatinine in the blood plasma.

Treatment of patients with coronary heart disease and cerebrovascular insufficiency should be started with low doses.

With renovascular hypertension, the use of the drug should be started only in a hospital setting with low doses with regular monitoring of renal function and potassium content in blood plasma.

With arterial hypertension and ischemic disease cardiac use of the drug should be carried out together with beta-blockers.

Treatment of patients with diabetes mellitus, who are on insulin or hypoglycemic agents for oral administration, during the first month, should be accompanied by regular monitoring of blood glucose levels, especially with hypokalemia.

With planned surgery, the drug is stopped 12 hours before the start of general anesthesia.

In the case of a significant increase in the activity of liver enzymes or the appearance of jaundice, the use of Noliprel should be canceled.

Anemia may develop in patients on hemodialysis or after kidney transplantation.

With the development of hepatic encephalopathy, the use of diuretics should be discontinued.

Avoid exposure to direct sunlight and ultraviolet radiation. If photosensitivity reactions develop against the background of drug treatment, it should be discontinued.

Before starting the use of the drug and during the period of treatment, it is necessary to regularly determine the concentration of sodium ions in the blood plasma, especially in elderly patients and patients with liver cirrhosis.

Elderly patients, malnourished patients on concomitant medication, patients with cirrhosis of the liver, peripheral edema or ascites, with an increased QT interval, heart failure, and ischemic heart disease are most at risk of developing hypokalemia while using Noliprel. In this category of patients, hypokalemia contributes to the appearance of severe cardiac arrhythmias, so they need to ensure regular monitoring of the level of potassium ions in the blood plasma from the first week of treatment.

An increase in plasma uric acid levels increases the risk of gout attacks.

Before conducting a study of the function of the parathyroid gland, it is necessary to stop taking diuretics.

During doping control, Noliprel may give a positive reaction.

During the period of use of the drug, patients should be careful when driving vehicles and mechanisms.

Application during pregnancy and lactation

According to the instructions, Noliprel is not recommended to be prescribed during pregnancy. His admission in the first trimester is strictly prohibited. Planning pregnancy or its occurrence against the background of drug therapy is a direct indication for discontinuation of the drug and the selection of another scheme of antihypertensive therapy. Appropriate controlled studies 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 with it did not increase the risk of malformations caused by fetotoxicity.

The effect of the drug on the fetus for a long period of time in the II and III trimesters of pregnancy can cause disturbances in its development (delayed ossification of the skull bones, oligohydramnios, decreased renal function) and provoke complications in the newborn (hyperkalemia, arterial hypotension, renal failure).

Prolonged use of thiazide diuretics in the third trimester of pregnancy can cause hypovolemia in the mother, as well as deterioration of uteroplacental blood flow, which causes placental ischemia and fetal growth retardation. Occasionally, against the background of treatment with diuretics, shortly before the onset of labor, thrombocytopenia and hypoglycemia occur in newborns.

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

The lactation period is a contraindication to the administration of the drug. Information about the possible penetration of perindopril into breast milk is not considered reliable. Indapamide passes into breast milk. Taking thiazide diuretics can lead to suppression of lactation or a decrease in breast milk production. At the same time, the child sometimes develops an increased sensitivity to sulfonamide derivatives, kernicterus and hypokalemia.

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

Drug interactions

The safety of the simultaneous administration of Noliprel with other drugs can only be determined by the attending physician, taking into account the patient's condition and comorbidities.

Analogs

Noliprel's analogs are: Co-prenesa, Prestarium, Co-perineva, Perindopril-Indapamid Richter, Noliprel A Bi-forte.

Terms and conditions of storage

Keep out of reach of children at room temperature.

Shelf life - 3 years, after opening the sachet - 2 months.

Noliprel is a combined antihypertensive agent used in the treatment of essential arterial hypertension. The active ingredients are perindopril and indapamide.

As an ACE inhibitor, it prevents the formation of angiotensin II. As a result, vasodilation occurs, sodium and water retention decreases - blood pressure decreases. The condition of patients with signs of chronic heart failure (CHF) improves. The class effect is nephroprotection.

Refers to diuretics from the sulfonamide group. The main effects are associated with the removal of excess sodium and water from the body. A decrease in the volume of blood circulating in the vascular bed leads to a drop in pressure.

The combination of active ingredients enhances each other's action and leads to a persistent decrease in blood pressure in patients with arterial hypertension (hypertension).

The drug is produced only in the form of tablets with a white film shell. The shape is oblong, there are risks on both sides. Noliprel contains perindopril arginine - 2.5 mg, as well as indapamide - 0.625 mg.

The auxiliary components are: silicon dioxide, lactose, magnesium stearate, sodium carboxymethyl starch, maltodextrin. The shell contains macrogol, magnesium stearate, glycerol, titanium dioxide.

In tablets - 5 mg of perindopril and 1.25 mg of indapamide. In Noliprel A Bi-forte - 10 mg of perindopril and 2.5 mg of indapamide.

Indications for use

What does Noliprel help with? The drug is prescribed in the following cases:

for the treatment of essential arterial hypertension.

Instructions for use of Noliprel, dosages

The tablets are intended for oral administration, preferably in the morning. Adult patients, including the elderly, are prescribed 1 Noliprel tablet 1 time per day.

Patients with renal insufficiency with creatinine clearance ≥30 ml / min do not require dose adjustment.

During treatment, it is necessary to systematically monitor the plasma concentration of creatinine and potassium, the appearance of clinical signs of salt loss and dehydration, and regularly measure the concentration of electrolytes in the plasma.

Side effects

According to the instructions for use, the appointment of Noliprel may be accompanied by the following side effects:

orthostatic hypotension, excessive decrease in blood pressure;
increased fatigue, headache, dizziness, asthenia, mood lability, ringing in the ears, visual impairment, convulsions, sleep disturbances, taste disturbances, anorexia, paresthesia;
constipation, diarrhea, nausea, vomiting, abdominal pain; rarely - dryness of the oral mucosa;
dry cough;
anemia (in patients after hemodialysis or kidney transplantation);
itching and rash;
decreased potency, increased sweating.

More rarely, there may be other side effects from taking the drug.

Contraindications

It is contraindicated to prescribe Noliprel in the following cases:

severe renal failure;
severe liver failure (including encephalopathy);
hypokalemia;
a history of angioneurotic edema (including while taking angiotensin-converting enzyme (ACE) inhibitors);
simultaneous use of drugs that lengthen the qt interval;
the period of pregnancy and breastfeeding;
children and adolescents up to 18 years of age (since the safety and effectiveness of the drug have not been established);
hypersensitivity to perindopril and / or other APF inhibitors, indapamide and sulfonamides.

Overdose

The most common symptom of an overdose is a pronounced decrease in blood pressure, sometimes combined with drowsiness, dizziness, blurred consciousness, seizures, nausea, vomiting, and oliguria, which can turn into anuria (due to hypovolemia). Electrolyte disturbances also develop: hypokalemia or hyponatremia.

Emergency care consists in removing Noliprel from the body by washing the stomach and / or prescribing activated charcoal, followed by the subsequent normalization of the water-electrolyte balance.

With a significant decrease in blood pressure, the patient is placed in a supine position with his legs raised. If necessary, hypovolemia is corrected (for example, by intravenous infusion of 0.9% sodium chloride solution). Perindoprilat, the active metabolite of perindopril, is effectively removed from the body by dialysis.

Analogues of Noliprel, price in pharmacies

If necessary, you can replace Noliprel with an analogue for the active substance - these are drugs:

Ko-prenesa,
Perindopril-Indapamide Richter,

When choosing analogues, it is important to understand that the instructions for the use of Noliprel, the price and reviews for drugs of a similar action do not apply. It is important to consult a doctor and not make your own replacement of the drug.

Price in Russian pharmacies: Noliprel tablets 30 pcs. - from 569 rubles to 685 rubles (A forte).

Store in a dry, dark place, out of reach of children, at a temperature not exceeding +30 ° C. The shelf life is 3 years. Leave in pharmacies with a prescription.

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

Noliprel (Bi) Forte is a drug with a double dosage of active substances (Perindopril 4 mg + Indapamide 1.25 mg). If it is necessary to use maximum doses in patients high risk (diabetes mellitus, smoking, hypercholesterolemia) Bi-forte is prescribed (Perindopril 10 mg + Indapamide 2.5 mg).

ATX

C09BA04 Perindopril in combination with diuretics.

Forms of release and composition

Active ingredient: Perindopril 2 mg + Indapamide 0.625 mg.

pharmachologic effect

Contributes to the normalization of both systolic and diastolic blood pressure (BP) within 24 hours. Full effects are realized after a month of regular use. Completion of admission does not lead to the development of withdrawal symptoms

The drug reduces the rate of myocardial remodeling processes, reduces the resistance of peripheral arteries, without affecting the level of lipids and blood glucose.

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

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

The joint appointment of perindopril and indapamide enhances the effectiveness of therapy for hypertension, reduces the risk of hypokalemia (a side effect of taking diuretics).

Pharmacokinetics

The pharmacokinetics of active substances do not differ when they are used together or separately.

When taken orally, approximately 20% of the total dose of perindopril is metabolized to its active form. This value may decrease when consumed with food. The maximum content in the blood is recorded 3-4 hours after ingestion. A small part of perindopril binds to blood proteins. It is excreted in the urine.

The elimination of perindopril may be slowed down in renal failure, especially in elderly patients.

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

Indications for use

Hypertension (arterial hypertension).

Contraindications

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

How to use

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

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

Can I divide a pill

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

Forms of the drug with the prefix "forte" have no risks and are covered with a film shell. You cannot divide them.

How to treat type 2 diabetes

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

Side effects

Gastrointestinal tract

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

Hematopoietic organs

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

central nervous system

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

From the respiratory system

Cough that appears with the beginning of the application, persists during the entire time of taking the drug and disappears after its withdrawal; difficulty breathing; airway spasm; rarely - mucous discharge from the nose.

From the urinary system

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

Allergies

Itching, hives-type rash; Quincke's edema; hemorrhagic vasculitis; rarely, erythema multiforme.

special instructions

Alcohol compatibility

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

Influence on the ability to control mechanisms

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

If liver function is impaired

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

With renal failure

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

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

During pregnancy and lactation

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

In old age

Before starting the intake, it is necessary to monitor the indicators of renal function (creatinine, urea), liver enzymes (AST, ALT), electrolytes. Therapy starts with low doses and is selected individually, taking into account the decrease in blood pressure.

Prescribing Noliprel for children

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

Overdose

Signs of overdose: severe hypotension, nausea, vomiting, convulsive syndrome, anuria, decreased heart rate.

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

Interaction with other drugs

Carefully

When used together with antidepressants or neuroleptics, an increase in the effect on blood pressure with the development of hypotension may occur.

Glucocorticosteroids reduce the antihypertensive effect.

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

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

The planned X-ray contrast study requires the prevention of dehydration.

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

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

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

When taken orally with NSAIDs against the background of dehydration, it can lead to acute pathology of renal filtration.

Analogs

Ko-Perineva, Ko-Parnawel, Perindapam, Perindid.

Conditions of dispensing from a pharmacy

Dispensed by prescription.

Price for Noliprel

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

Storage conditions of the drug Noliprel

Keep out of the reach of children. No special storage conditions are required.

Noliprel is a medicine for pressure of combined action, that is, this tablet contains two different substances that act simultaneously. These substances - and - belong to different classes of drugs for hypertension. Indapamide is a diuretic and perindopril is an ACE inhibitor. They lower blood pressure in different ways, and their combined effect is very powerful.

Noliprel pressure pills - everything you need to know:

Instructions for use;
Indications for appointment, contraindications;
How to take, in what doses;
What is the difference between Noliprel Bi-Forte and Noliprel A;
Feedback from patients and doctors;
How to treat type 2 diabetes
How to replace Noliprel, how to give up harmful "chemistry".

Read the article!

Prices for Noliprel tablets and their analogues in an online pharmacy with delivery in Moscow and Russia

Name	Active ingredients	Number of tablets in a package	Price, rub
perindopril arginine 5 mg + indapamide 1.25 mg
Noliprel A Bee Forte	perindopril arginine 10 mg + indapamide 2.5 mg
perindopril arginine 2.5 mg + indapamide 0.625 mg
Ko-Perineva	indapamide 1.25 mg + perindopril erbumin 4 mg
Ko-Perineva	indapamide 2.5 mg + perindopril erbumin 8 mg
Ko-Perineva	indapamide 0.625 mg + perindopril erbumin 2 mg
Ko-Perineva	indapamide 1.25 mg + perindopril erbumin 4 mg, big discount packaging

Noliprel often helps in cases where other drugs for hypertension are powerless, and this justifies its relatively high price.

Along with this medicine, they often look for:

Nevertheless, if you do not look for and treat the causes of hypertension, but only "extinguish" high pressure pills, then there will be little sense even from the most powerful drugs. You will get a little respite, extend your life by several years, but its quality will be low due to persistent health problems. Use "chemical" pills as a temporary measure, and focus on finding and eliminating the causes of hypertension.

Noliprel is one of the most powerful hypertension medications that doctors now have at their disposal. It often turns out that this drug lowers blood pressure too much. As a result, patients feel chronic fatigue, lethargy, drowsiness, and sometimes even pain in the heart, because the heart muscle does not have enough oxygen and nutrition. In such cases, you need to switch to Noliprel tablets with a lower dosage of active ingredients. This is discussed in detail below in the article. If the hypertension is mild, and Noliprel turns out to be too effective medicine, then you need to consult your doctor to replace it with another drug. With a high probability, it will be possible to do without drugs at all, if you use the technique outlined in the block “It is possible to recover from hypertension in 3 weeks!”.

Noliprel - instructions

Our article consists of instructions for the drug Noliprel, including Noliprel Bi-forte, which is supplemented by information from medical journals, as well as reviews of visitors to our site about this drug. The official instructions for use are written in detail, but very difficult, not clear for patients.

We have tried to present the information conveniently so that you can quickly find answers to questions that interest you.

Proven effective and cost-effective blood pressure supplements:

Read more about the technique in the article ““. How to order hypertension supplements from USA -. Bring your blood pressure back to normal without the harmful side effects of Noliprel and other "chemical" pills. Improve heart function. Become calmer, relieve anxiety, sleep like a child at night. Magnesium with vitamin B6 works wonders for hypertension. You will have excellent health, to the envy of your peers.

Indications for appointment

The main indication for the appointment of Noliprel pressure pills is essential hypertension. Essential - means primary, not secondary, that is, an increase in blood pressure in a person is not caused by problems with the kidneys, thyroid gland, adrenal glands or other serious illness.

Also, this drug is often prescribed if the patient has hypertension combined with type 2 diabetes. In all these cases, ours helps. If you have blood pressure above 160/100, then take Noliprel and follow our simple recommendations in parallel. When you feel better and the pressure readings go down, then, in consultation with your doctor, try to lower the dosage in order to gradually completely abandon the "chemical" pills.

What are the varieties of Noliprel

The drug for pressure Noliprel is produced in several varieties. It is useful for doctors and patients to understand them. Recall that Noliprel is a combined drug for hypertension, the active ingredients of which are perindopril and indapamide.

Varieties of combined tablets perindopril + indapamide

Noliprel A Bi-Forte is the most potent of these pills and is the most commonly prescribed. If it turns out to be too effective, then they switch to tablets with lower dosages of active ingredients.

If Noliprel A Bi-forte is too powerful for you, that is, it lowers blood pressure excessively, you need to switch to another version of this drug. It is also possible to take perindopril and indapamide separately.

Noliprel A - means that in these tablets, perindopril is bound to the amino acid arginine. Regular Noliprel - Perindopril erbumine (perindopril tert-butylamine) is used. It may be better to use Noliprel A because the amino acid arginine has an additional beneficial effect on the cardiovascular system. But this effect is unlikely to be significant, because the dosages of arginine are small. Read what arginine is and how it is useful.

How to take these tablets (dosages)

Modern combined pressure pills are enough to take only 1 time per day, and this is their great advantage. This mode of administration is the most convenient for patients, especially for the absent-minded elderly. The doctor will prescribe you a more or less powerful version of Noliprel and in this way will determine the initial dosage of the medicine. Later, the doctor, after 4-6 weeks, adjusts the dose according to the results achieved. If you need to enhance the effect of lowering blood pressure, then you can switch to a more powerful variety or add another medicine to Noliprel. As we remember, the Noliprel tablet contains two active ingredients. If they decide to add one more medicine, then there are already three active substances. Typically, it is chosen as an adjunctive drug.

Noliprel is taken one tablet per day. Patients - do not choose one or another dosage of perindopril and indapamide for yourself! Because an overdose is deadly, it can cause a heart attack. And in any case, you will feel bad if you lower the pressure too much.

Overdose symptoms (call an ambulance!):

Excessive decrease in blood pressure;
Dizziness, weakness, apathy, drowsiness;
Nausea, vomiting, convulsions;
Frequent urge to urinate, or vice versa, the cessation of urine output;
A very low pulse - bradycardia;
Cold sweat, fainting.

It can be expected that Noliprel will lower the “top” pressure by 27 mm Hg. Art., and "lower" - by 13 mm Hg. Art. Although each patient is different.

The healing effect of Noliprel

Noliprel is a combination drug for hypertension, which contains perindopril and indapamide. Both active substances lower the upper and lower blood pressure, and mutually reinforce each other.

Benefits of Noliprel tablets for the treatment of hypertension:

The effectiveness of the combination of perindopril and indapamide has been extensively proven in practice.
This drug does not have a harmful effect on metabolism, does not worsen blood test values \u200b\u200bfor cholesterol, triglycerides and glucose, and is suitable for diabetes.
Indapamide is considered one of the safest diuretics and is very effective.
The action of each Noliprel tablet lasts 24 hours, so it is enough to take the drug once a day.
After stopping treatment, withdrawal syndrome does not develop, that is, the pressure does not ricochet.
The drug potently lowers both systolic and diastolic blood pressure when standing and lying down.
The degree of left ventricular hypertrophy of the heart decreases, i.e., the risk of heart attack decreases. This effect is independent of the decrease in blood pressure.

Contraindications

Noliprel is contraindicated for use during pregnancy and during breastfeeding. It is especially undesirable to take this medicine in the 2nd and 3rd trimesters of pregnancy, but it is not necessary in the first either.

It is usually recommended to stop treating hypertension with “chemical” pills a few weeks before conception. If pregnancy occurs while taking pressure pills, then there is no need to interrupt it, but the woman should immediately stop taking potentially dangerous medications, conduct an ultrasound examination of the fetus and consult a doctor on how to treat hypertension further.

Noliprel is not suitable for the treatment of hypertension if the patient has manifestations of hypersensitivity to ACE inhibitors, in particular to perindopril. The most severe of these manifestations is Quincke's edema. If a dry cough becomes unbearable, then the drug must be canceled. The doctor will replace it with a hypertension drug from a different class.

The drug is not prescribed or used with extreme caution in severe kidney problems:

bilateral renal artery stenosis;
artery stenosis of the only functioning kidney;
glomerular filtration rate of 30 ml / min and below.

Precautions in special cases

With extreme caution, Noliprel should be prescribed in the following situations:

severe heart failure with or without renal failure;
cirrhosis of the liver, which is accompanied by edema and ascites;
the patient has recently had vomiting and / or diarrhea.

In all these cases, the use of the drug can immediately cause a sharp decrease in blood pressure, especially after the first pill intake, and then during the first 2 weeks of therapy. There is also a risk of an excessive decrease in blood pressure in patients who follow a strict salt-free diet.

While taking Noliprel, you should regularly check for clinical signs of dehydration and electrolyte deficiency in the blood plasma. At the same time, the pronounced decrease in blood pressure as a result of the first dose is not an obstacle to further use of this drug. The doctor may recommend a lower dose or switch to taking or alone, without the second component of the combination tablets. For elderly patients, it is strongly recommended to take blood tests before starting to take Noliprel to assess the functional activity of the kidneys and the concentration of potassium in the plasma.

A patient who has been prescribed Noliprel or other ACE inhibitors for hypertension should regularly check the concentration of creatinine in the blood plasma. Because blocking the renin-angiotensin-aldosterone system by perindopril or other ACE inhibitors can lead to functional kidney failure, sometimes acute. This complication rarely occurs, however, it is recommended to start drug therapy of hypertension carefully, and increase the dose of tablets gradually. You also need to regularly monitor the concentration of potassium in the blood plasma. Its permissible level is 3.4 mmol / l and higher. If the level of potassium in the blood falls below normal, then this means a strong risk of cardiac arrhythmia, which can even be fatal.

Noliprel for pressure: patient reviews

Most patient reviews on Noliprel tablets confirm that this drug is effective in lowering blood pressure. Usually it helps to keep the pressure below 140/90 or even below 130/80 mm Hg. Art. and thus reduces the risk of heart attack, stroke, renal failure. Noliprel often helps even in cases where other drugs are useless, and this justifies its relatively high price.

Galina Myuzukova

I am 41 years old, height 168 cm, weight 72 kg, until recently I was 79 kg. I have been taking Noliprel A Forte for hypertension for 3 years. Recently I managed to lose weight, but after that the medicine began to work worse. There are pains in the area of \u200b\u200bthe heart, sometimes the head is spinning. The pressure drops excessively. I am deciding whether to switch to Physiotens, a weaker drug. Perhaps I will take Indapamide or Perindopril (Prestarium) separately.

The powerful effect of Noliprel is confirmed not only by patients, but also by doctors in their informal reviews, as well as in studies, the results of which are published in medical journals. Problems that arise in patients with hypertension in connection with taking this medication appear when patients do not follow the doctor's recommendations and / or the instructions for the drug.

Yuri Bystryakov

Noliprel kept my pressure well for 8 years. Above 130/90, it practically did not rise. Regular headaches have gone since last week. Measured the pressure - 140 / 100-150 / 110, and this is in the morning after sleep. For some reason, the medicine stopped working. The body is used to it or the state of health has deteriorated with age. Now thinking: to increase the dose of Noliprel or change to another drug? I am 47 years old, I am overweight. Office work, managerial, nervous.

Noliprel, like other pills for hypertension, must be taken constantly, every day, and not in courses or when you feel a surge in pressure.

Svetlana Shestakova

For several years I have been taking Noliprel A in the morning for hypertension. A couple of months ago, an acquaintance (not a doctor) advised me to add another Cardiomagnet to it before bed. I am very pleased with the result. The pressure didn't drop, because Noliprel held it so well. But it seems that magnesium and aspirin dilate blood vessels, facilitate blood flow through them, and therefore feel better. Perhaps the Noliprel + Cardiomagnet scheme will be useful to someone else.

People often complain of side effects because this drug lowers blood pressure too much. In such cases, weakness, lethargy, fatigue, apathy, lack of energy for work may be felt. This means that you need to switch to tablets with a reduced dosage of both active ingredients that are part of the combined medicine. Or, if the hypertension is mild, then Noliprel is too powerful pills, and you need to replace them with milder ones. Do not do this arbitrarily, but consult your doctor.

Dmitry Zheludev

Noliprel is a powerful blood pressure pill, but not a panacea. For a long time I have been taking this drug every morning - 2 mg of perindopril and 0.625 mg of indapamide in one tablet. For several years everything was fine, but now the pressure began to rise. I went to the doctor - he said to add more Nebilet. I followed the recommendation - it really helped. But I understand that this is a temporary measure. I decided to switch to a healthy lifestyle in order to give up drugs. So I got to your site. Even the most expensive pills cannot relieve pressure forever. It's time to take care of your health.

Patients in their reviews often complain about the side effects of powerful combination drugs for pressure, including Noliprel. These side effects are usually unpleasant, but not so severe that you need to stop taking the pills. Moreover, they can and should be neutralized by switching to a healthy lifestyle.

As a result of normalization of blood pressure while taking the drug, headaches usually disappear, consciousness clears up. From this, the state of health improves more than it worsens due to side effects. A dry cough is common but is usually a psychosomatic symptom. That is, if the patients did not know that perindopril, like other ACE inhibitors, causes a dry cough, then they most likely would not have this side effect.

Evidence of effectiveness

There have been many studies that have confirmed the effectiveness and relative safety and separately for the treatment of hypertension. Later, these blood pressure lowering agents were combined to create the powerful combination drug Noliprel. In the 2000s, it was extensively tested, first in the laboratory and then on real patients, to test the effectiveness and frequency of side effects.

Studies of Noliprel pressure tablets

Study title	Year of publication of results	Link to source
SKIF-2	2010	Mankovsky B.N., Ivanov D.D. The effect of antihypertensive therapy on renal function in patients with type 2 diabetes mellitus: results of a prospective study "SKIF-2" // Liki Ukrainy. - 2010. - No. 8. - S. 50-54.
PIXEL	2005	Dahlof B., Grosse P., Gueret P. et al. Perindopril / indapamide combination more effective than enalapril in reducing blood pressure and left ventricular mass: the PIXEL study // J. Hypertension. - 2005. - Vol. 23. - P. 2063–70
Falco forte	2010	Safarik R. Total Cardiovascular Risk Level Determines Approach to Antihypertensive Treatment. Results of the Scientific Program Falco Forte: Pp.5.179 // Journal of Hypertension. - 2010. - Vol. 28 .-- P. 101.
STRATEGY A	2012	Chazova I., Ratova L., Martynyuk T. on behalf of the team of authors. Results of the Russian study STRATEGY A (Russian multicenter program to evaluate the effectiveness of Noliprel A Forte in patients with high-risk arterial hypertension with insufficient blood pressure control) // Consilium Medicum. - 2012. - T. 14, No. 1
PRACTICE	2012	Sirenko Yu.N., Mankovsky B.N., Radchenko A.D., Kushnir S.N. on behalf of the research participants. Results of a prospective open-label study evaluating the antihypertensive efficacy and tolerability of Noliprel Bi-Forte in patients with uncontrolled arterial hypertension and type 2 diabetes mellitus (PRACTIC study) // Arterial hypertension. - 2012. - №4 (24)

The results of these studies have convinced medical practitioners that Noliprel is not only very effective, but also sufficient safe drug... Therefore, it began to be frequently prescribed to patients. We will separately dwell on the topic of treating hypertension in patients with type 2 diabetes mellitus using these tablets.

Treatment of hypertension in patients with type 2 diabetes

In 2012, the results of the Ukrainian PRACTIC study were published. It studied the efficacy and safety of prescribing Noliprel tablets for blood pressure to patients in whom hypertension is combined with diabetes. The study participants - 762 men and women over 40 years of age, whose arterial hypertension is complicated by type 2 diabetes. These patients had blood pressure readings of 160/100 mm Hg. up to 200/120 mm Hg. Previously, they all did not take pills for pressure or took, but the drugs could not lower their pressure below 140/90 mm Hg. Art.

Doctors prescribed Noliprel Bi-forte to all these patients, 1 tablet per day. All the blood pressure medications that diabetics had previously taken were canceled. After a month of therapy with Noliprel Bi-Forte, the first control of the result was carried out. If the blood pressure level remained above 140/90 mm Hg, then another 5 mg was added once a day. Later, if necessary, the dose of amlodipine was increased to 10 mg per day.

"Triple Impact" treatment for severe hypertension:

The patient is prescribed Noliprel Bi-Forte tablets 1 time per day. Perindopril 10 mg + indapamide 2.5 mg is a double hit.
If after a month the pressure remains above 140/90 mm Hg. Art., then add more amlodipine 5 mg 1 time per day.
After 2-4 weeks, the dose of amlodipine can be increased to 10 mg per day, if the pressure does not decrease to the target.

The mean decrease in upper (systolic) blood pressure in study participants was 44.7 mm Hg. Art., and the lower (diastolic) pressure - 21.2 mm Hg. Art. After 3 months, 62.4% of patients with hypertension and diabetes were able to achieve the target blood pressure level< 135/85 мм рт.ст., а давление < 140/90 мм рт.ст. зарегистрировали у 74,8% пациентов.

Index	Treatment stages
Index	Baseline (762 people)	7th day (762 people)	30th day (762 people)	60th day (762 people)	90th day (762 people)
Office systolic (upper) pressure, mm Hg Art.	174.3 ± 0.5	154.0 ± 0.5	143.3 ± 0.5	134.6 ± 0.4	129.6 ± 0.3
Office diastolic (lower) pressure, mm Hg Art.	100.6 ± 0.4	91.0 ± 0.3	86.0 ± 0.3	81.8 ± 0.3	79.4 ± 0.2
< 140/90 мм рт. ст., кол-во (%)	-	39 (5,1)	201 (26,5)	406 (53,5)	565 (74,8)
Proportion of patients who reached blood pressure level< 135/85 мм рт. ст., кол-во (%)	-	31 (4,1)	150 (19,8)	334 (44,0)	471 (62,4)
Proportion of patients who reached blood pressure level< 130/80 мм рт. ст., кол-во (%)	-	6 (0,8)	31 (4,1)	72 (9,5)	146 (19,3)
The proportion of patients whose upper pressure decreased by 20 and lower - by 10 mm Hg. Art.,%	-	43,6	73,1	89,6	94,6

The proportion of patients who responded by a decrease in systolic (upper) blood pressure by? 20 mm Hg and diastolic (lower) pressure on? 10 mm Hg was 94.6%. This indicates a very high efficiency of the treatment of hypertension according to the methodology used in the study.

63% of study participants were able to achieve blood pressure< 140/90 мм рт.ст., используя только Нолипрел. Остальным пришлось назначать еще дополнительные лекарства, в подавляющем большинстве случаев - амлодипин. По результатам анализа данных обнаружили, что чем выше исходное артериальное давление у больного, тем сильнее оно снижается в результате приема таблеток.

Prior to the start of the study, among patients with hypertension with type 2 diabetes, 390 people (51.2%) were characterized as patients with a high risk of heart attack and stroke, and 372 (48.8%) - with a very high risk. After 3 months of treatment, the proportion of patients in the high-risk group increased to 69.6% due to the transfer of some patients from the very high-risk group. Also, many study participants were able to move to the moderate risk group. There were 232 of them (30.4%). Thus, a reduction in the risk of cardiovascular catastrophe was achieved in 604 (79.3%) patients with type 2 diabetes and arterial hypertension.

All 762 patients who started the study completed it safely. Some side reactions while taking Noliprel Bi-Forte pressure pills were observed only in 8 (1.1%) patients. These side effects included:

dry cough and sore throat (0.3%);
excessive decrease in blood pressure (0.3%);
weakness (0.1%);
nature is not specified (0.4%).

There were no serious side effects that would require discontinuation or replacement of the drug. Thus, patients with hypertension and type 2 diabetes mellitus tolerated therapy with combined indapamide and perindopril tablets.

Noliprel does not worsen the results of blood tests for sugar, "good" and "bad" cholesterol, triglycerides, does not remove potassium from the body.

The authors of the PRAKTIK study recommend that doctors prescribe combined pressure medications to patients who have hypertension associated with type 2 diabetes. Noliprel may be one suitable combination pill option. Therapy with this drug allowed to reduce blood pressure to< 140/90 мм рт.ст. у 74,8% больных, для которых предыдущее лечение было малоэффективным. С другой стороны, современные клинические руководства рекомендуют поддерживать у диабетиков давление < 130/80 мм рт.ст., а такого результата удалось достигнуть лишь 19% больных. И это несмотря на то, что врачи использовали самые мощные средства из своего арсенала “химических” лекарств.

Side effects

Frequent side effects of Noliprel:

excessive decrease in blood pressure, headache;
increased fatigue, dizziness, mood swings;
dry cough;
abdominal pain, nausea, constipation, diarrhea;
orthostatic hypotension (discomfort if you stand up suddenly);
a slight increase in the concentration of creatinine in urine and blood, which stops after the drug is discontinued;
a temporary increase in the concentration of potassium in blood plasma or vice versa hypokalemia;
skin rash, itching

vomiting, impaired appetite and taste perception;
convulsions, confusion, fainting;
decreased kidney function, increased excretion of protein in the urine;
difficulty breathing, bronchospasm;
dry mouth;
tinnitus;
deterioration in blood test results for liver function tests;
with a high content of uric acid in the blood, the risk of gout increases
urticaria, angioedema.

Severe but extremely rare side effects:

myocardial infarction, angina pectoris, arrhythmia;
acute renal failure;
pancreatitis;
thrombocytopenia, leukopenia, agranulocytosis, anemia.

Conclusions on side effects:

Study the contraindications to the treatment of hypertension with Noliprel, as well as in which cases it is prescribed with caution.
While on treatment with this drug, check your potassium regularly with blood tests.

conclusions

Noliprel - combined pressure pills, which include active ingredients and. It is one of the most powerful drugs for hypertension currently in the arsenal of doctors, and at the same time it is relatively safe. Side effects sometimes occur, but they are not so severe that it is necessary to cancel the drug or replace it with another. Patients quickly feel a beneficial effect on their well-being due to the fact that their blood pressure is lowered.

To treat hypertension with a potent combination drug, you only need to take one tablet a day. This is convenient for the patient and increases the chance that the patient will follow the doctor's recommendations, that is, do not forget to take the medicine every day. These tablets come in several varieties, with different dosages. If the pressure drops too much, then you can switch to another version of Noliprel, with a lower content of active ingredients in each tablet, or be treated separately with one of the components - perindopril or indapamide.

The potent medicine Noliprel often helps even when other pressure pills do not work. This justifies not the small price that the original drug produced by the French company has. Also in the article, we highlighted in detail the issue of treating hypertension, which is combined with type 2 diabetes, using this medication.

Noliprel is a combined antihypertensive agent used in the treatment of essential arterial hypertension. The active ingredients are perindopril and indapamide.

Perindopril

Indapamide is a diuretic from the sulfonamide group. The main effects are associated with the removal of excess sodium and water from the body. A decrease in the volume of blood circulating in the vascular bed leads to a drop in pressure.

The combination of active ingredients enhances each other's action and leads to a persistent decrease in blood pressure in patients with arterial hypertension (hypertension).

The drug is produced only in the form of tablets with a white film shell. The shape is oblong, there are risks on both sides. Noliprel contains perindopril arginine - 2.5 mg, as well as indapamide - 0.625 mg.

The auxiliary components are: silicon dioxide, lactose, magnesium stearate, sodium carboxymethyl starch, maltodextrin. The shell contains macrogol, magnesium stearate, glycerol, titanium dioxide.

Noliprel A Forte tablets contain 5 mg of perindopril and 1.25 mg of indapamide. In Noliprel A Bi-forte - 10 mg of perindopril and 2.5 mg of indapamide.

What does Noliprel help with? The drug is prescribed in the following cases:

for the treatment of essential arterial hypertension.

Instructions for use of Noliprel, dosages

The tablets are intended for oral administration, preferably in the morning. Adult patients, including the elderly, are prescribed 1 Noliprel tablet 1 time per day.

Patients with renal insufficiency with creatinine clearance ≥30 ml / min do not require dose adjustment.

In patients with moderate renal failure (CC 30-60 ml / min), the daily dose should not exceed 1 tablet, with CC 60 ml / min and higher, dose adjustment is not required. Treatment must be accompanied by monitoring the level of potassium and creatinine in the blood plasma (after two weeks of therapy and then once every 2 months).

Side effects

According to the instructions for use, the appointment of Noliprel may be accompanied by the following side effects:

orthostatic hypotension, excessive decrease in blood pressure;
increased fatigue, headache, dizziness, asthenia, mood lability, ringing in the ears, visual impairment, convulsions, sleep disturbances, taste disturbances, anorexia, paresthesia;
constipation, diarrhea, nausea, vomiting, abdominal pain; rarely - dryness of the oral mucosa;
dry cough;
anemia (in patients after hemodialysis or kidney transplantation);
itching and rash;
decreased potency, increased sweating.

More rarely, there may be other side effects from taking the drug.

Contraindications

It is contraindicated to prescribe Noliprel in the following cases:

severe renal failure;
severe liver failure (including encephalopathy);
hypokalemia;
a history of angioneurotic edema (including while taking angiotensin-converting enzyme (ACE) inhibitors);
simultaneous use of drugs that lengthen the qt interval;
the period of pregnancy and breastfeeding;
children and adolescents up to 18 years of age (since the safety and effectiveness of the drug have not been established);
hypersensitivity to perindopril and / or other APF inhibitors, indapamide and sulfonamides.

Overdose

Emergency care consists in removing Noliprel from the body by washing the stomach and / or prescribing activated charcoal, followed by the subsequent normalization of the water-electrolyte balance.

Perindopril

at - an active metabolite of perindopril - is effectively removed from the body by dialysis.

Analogues of Noliprel, price in pharmacies

If necessary, you can replace Noliprel with an analogue for the active substance - these are drugs:

Ko-prenesa,
Prestarium,
Ko-perineva,
Perindopril

Indapamid Richter,
Noliprel A forte.

When choosing analogues, it is important to understand that the instructions for the use of Noliprel, the price and reviews for drugs of a similar action do not apply. It is important to consult a doctor and not make your own replacement of the drug.

Price in Russian pharmacies: Noliprel tablets 30 pcs. - from 569 rubles to 685 rubles (A forte).

Store in a dry, dark place, out of reach of children, at a temperature not exceeding +30 ° C. The shelf life is 3 years. Leave in pharmacies with a prescription.

Composition of Noliprel A

Active substances:

perindopril arginine 2.5 m,
which corresponds to 1.6975 mg of perindopril and 0.625 mg of indapamide.

Manufacturers

Servier Industry Laboratories (France), Servier Industry Laboratories, packed by Serdix (France), Serdix (Russia)

Side effect of Noliprel A

On the part of the water-electrolyte balance:

hypokalemia is possible,
lower sodium levels
accompanied by hypovolemia,
dehydration of the body and orthostatic arterial hypotension.

The simultaneous loss of chlorine ions can lead to compensatory metabolic alkalosis (the incidence of alkalosis and its severity is low).

In some cases, an increase in calcium levels.

On the part of the cardiovascular system:

excessive decrease in blood pressure, orthostatic hypotension;
in some cases - myocardial infarction, angina pectoris, 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 the urine and blood plasma (reversible after discontinuation of the drug) is most likely in case of renal artery stenosis, treatment of arterial hypertension with diuretic drugs, and the presence of renal failure.

From the side of the central nervous system and peripheral nervous system:

headache, increased fatigue, asthenia, dizziness, mood lability, visual disturbances, ringing in the ears, sleep disturbances, convulsions, paresthesia, anorexia, impaired taste;
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 hepatic transaminases, hyperbilirubinemia, with hepatic failure, hepatic encephalopathy may develop.

From the hematopoietic system:

anemia (in patients after kidney transplantation, hemodialysis); rarely - hypoglobinemia, thrombocytopenia, leukopenia, decreased hematocrit;
in some cases - agranulocytosis, pancytopenia, aplastic anemia, hemolytic anemia.

From the side of metabolism:

an increase in the content of urea and glucose in the blood plasma is possible.

Allergic reactions:

skin rashes, itching;
rarely - urticaria, angioedema;
in some cases - erythema multiforme, hemorrhagic vasculitis, exacerbation of SLE.

temporary hyperkalemia;
rarely - increased sweating, decreased potency.

Contraindications Noliprel A

Hypersensitivity to perindopril and other ACE inhibitors, to indapamide and sulfonamides, as well as to other auxiliary components of the drug; a history of angioneurotic edema (including while taking other ACE inhibitors); hereditary / idiopathic angioedema; severe renal failure (CC< 30 мл/мин); стеноз артерии единственной почки; двусторонний стеноз почечных артерий или стеноз артерии единственной почки; выраженная печеночная недостаточность (в т.ч. с энцефалопатией); одновременный прием препаратов, удлиняющих интервал QT; одновременный прием антиаритмических средств, которые могут вызывать желудочковую аритмию типа «пируэт»; беременность; период лактации (грудного вскармливания); Не рекомендуется одновременный прием препарата с калийсберегающими диуретиками, препаратами калия и лития и при гиперкалиемии.

Method of administration and dosage

Inside, preferably in the morning, before meals, 1 tablet of the drug 1 time per day.

If a month after the start of therapy the desired hypotensive effect has not been achieved, the dose of the drug can be doubled to a dosage of 5 mg + 1.25 mg.

Elderly patients.

Therapy should be started with 1 tablet once a day.

Renal failure

The drug is contraindicated in patients with severe renal insufficiency (CC less than 30 ml / min.).

For patients with moderate renal impairment (CC 30-60 ml / min), the maximum dose of the drug is 1 tablet per day.

Patients with CC equal to or exceeding 60 ml / min do not need dose adjustment.

During therapy, regular monitoring of the level of creatinine and potassium in the blood plasma is necessary.

Liver failure.

The drug is contraindicated in patients with severe hepatic impairment.

With moderate hepatic insufficiency, dose adjustment is not required.

Children and adolescents.

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

Overdose

Symptoms:

pronounced decrease in A,
nausea
vomiting
convulsions
dizziness
insomnia,
decreased mood
polyuria or oliguria,
which can turn into anuria (as a result of hypovolemia,
bradycardi,
electrolyte disturbances.

gastric lavage,
appointment of adsorbent,
correction of water and electrolyte balance.

With a significant decrease in blood pressure, the patient should be transferred to a horizontal position with raised legs.

Perindopril

am can be removed from the body by dialysis.

Interaction

An increase in the concentration of lithium can lead to symptoms and signs of a lithium overdose. (due to a decrease in the excretion of lithium by the kidneys).

The combination of perindopril with potassium-sparing diuretics and potassium preparations can lead to a significant increase in the concentration of potassium in the blood serum (especially against the background of renal failure) and even death.

It should be taken into account that indapamide in combination with potassium-sparing diuretics or potassium preparations does not exclude the development of hypokalemia or hyperkalemia (especially in patients with diabetes mellitus and renal failure).

With the simultaneous use of erythromycin (for intravenous administration), pentamidine, sultopride, vincamine, halofantrine, bepridil and indapamide, arrhythmias of the "pirouette" type may develop (provoking factors include hypokalemia, bradycardia or prolonged QT interval).

When using ACE inhibitors, it is possible to increase the hypoglycemic effect of insulin and sulfonylurea derivatives.

The development of hypoglycemia is extremely rare.

With the simultaneous use of Noliprel and baclofen, the hypotensive effect is enhanced.

With the simultaneous use of indapamide and NSAIDs in case of dehydration of the body, the development of acute renal failure is possible.

It should also be borne in mind that NSAIDs weaken the hypotensive effect of ACE inhibitors.

It has been found that NSAIDs and ACE inhibitors have an additive effect on hyperkalemia, while it is also possible to reduce renal function.

With the simultaneous use of Noliprel and tricyclic antidepressants, neuroleptics, an increase in the hypotensive effect and an increase in the risk of developing orthostatic hypotension (additive effect) is possible.

GCS, tetracosactide reduce the hypotensive effect of Noliprel.

With the simultaneous use of indapamide with antiarrhythmic drugs IA (quinidine, hydroquinidine, disopyramide) and class III (amiodarone, bretylium, sotalol), arrhythmias of the "pirouette" type may develop (provoking factors include hypokalemia, bradycardia or prolonged QT interval).

With the development of arrhythmias of the "pirouette" type, antiarrhythmic drugs should not be used (an artificial pacemaker must be used).

With the simultaneous use of indapamide and drugs that reduce the level of potassium (including amphotericin B IV, gluco- and mineralocorticoids with systemic use, tetracosactide, stimulating laxatives), the risk of hypokalemia increases.

The potassium concentration should be monitored and adjusted if necessary.

If it is necessary to prescribe laxatives, drugs without a stimulating effect on intestinal motility should be used.

With the simultaneous use of Noliprel with cardiac glycosides, it should be borne in mind that low potassium levels can enhance the toxic effect of cardiac glycosides.

The level of potassium and ECG should be monitored, and if necessary, adjust the therapy.

Lactic acidosis while taking metformin is apparently associated with functional renal failure, which is caused by the action of indapamide.

Do not use metformin if the creatinine level exceeds 15 mg / L (135 μmol / L) in men and 12 mg / L (110 μmol / L) in women.

With significant dehydration of the body, which is caused by taking diuretic drugs, the risk of developing renal failure increases with the use of iodine-containing contrast agents in high doses.

Rehydration is required before using iodine-containing contrast media.

With simultaneous use with calcium salts, it is possible to increase the calcium content in the blood plasma as a result of a decrease in its excretion in the urine.

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

Storage conditions

The drug should be stored out of the reach of children at a temperature not exceeding 30 ° C.

Vacation procedure

Dispensed by prescription.

Constant high blood pressure has a medical term - hypertension. Treatment of the disease must be carried out, since the development of pathology can lead to serious heart problems. To normalize blood pressure, the specialist recommends the course use of Noliprel. If there are contraindications, or there is no possibility of purchasing an expensive drug, you can change the original medication for an analog, but only with the permission of the attending physician.

About the drug

The drug Noliprel (manufactured in Russia) is an effective antihypertensive drug. The medicine affects the diastolic and systolic blood pressure in the arteries. The drug belongs to the dose-dependent group of medicines.

Noliprel is produced in the form of tablets containing a complex of two active substances: indapamide and erbumin perindopril.

In addition to the usual form of the drug, manufacturers produce:

Noliprel Forte;
Noliprel A Forte;
Noliprel A bi Forte.

The main indication for taking Noliprel tablets is maintaining a constant state with respect to an increase in blood pressure.

Due to their effect on the circulatory system, the drug has the following contraindications:

hypokalemia;
excess potassium in the blood;
heart failure;
quincke's edema;
angioedema;
renal failure;
children's age of the patient;
pregnancy (1 trimester);
period of breastfeeding;
an allergic reaction to an existing drug composition.

With uncontrolled admission or the presence of contraindications, as well as with possible

individual reaction of the body, the effect may side effects Noliprel tablets:

asthenia;
anemia;
a sharp decrease in pressure below normal;
upset stomach / intestines;
deviation of vision;
noise in ears;
migraine;
muscle spasms;
dermatological allergy;
dry cough attacks.

Noliprel tablets are classified as prescription drugs. Their price in a pharmacy ranges from 550 rubles and more.

Cheaper analogues

Despite the effectiveness of Noliprel, sometimes it becomes necessary to replace the original medication with an analogue that has a similar pharmachologic effect... Whether there is an analogue of Noliprel with identical characteristics, you should ask your doctor. You should not search for substitutes yourself or trust pharmacists.

Noliprel's analogs, which are cheaper:

Perindopril

Indapamide;
Ko-perineva;
Prestarium;
Co-prenees;
Lorista.

How to replace Noliprel is determined by the doctor based on the general indications of the patient, taking into account the concomitant pathologies and individual characteristics of the body.

Perindopril

- Indapamide

Antihypertensive medication

Perindopril

Indapamide is classified as an inhibitor containing an enzyme that lowers blood pressure. The drug has a dose-dependent effect.

A cheap analogue of Noliprel A is used to reduce persistently high blood pressure. The action of the medication is designed for a cumulative effect, therefore a course reception is required. The result is noted only after 2 - 4 weeks.

The drug is produced in the form of tablets. Their composition is based on the content of perindopril erbumine and indapamide.

An analogue of Noliprel is prescribed by a doctor when diagnosing persistent hypertension of arterial type. Although the substitute is cheaper, the tablets have a similar effect due to the similar composition.

Perindopril

- Indapamide as cheap analog Noliprela is not recommended for the following indications:

sensitivity to drug components;
failure of the kidneys or heart;
hemodialysis;
childhood;
lactation or pregnancy.

Possible development of symptoms of side effects in the form of:

iron deficiency in the blood;
asthenia;
dysfunction of the gastrointestinal tract;
pathology of vision;
migraine;
muscle spasms;
noise in the ears;
allergic rash;
dry paroxysmal cough.

Cheap analogue of Noliprel A Bi -

Perindopril

–Indapamide, sold in pharmacy chains with a doctor's prescription. Tablets cost from 330 rubles.

Ko-Perineva

The release of the drug is carried out in the form of tablets. The mechanism of action on the body is based on their components: indapamide in combination with perindopril.

In accordance with the indications indicated in the instructions for use, cheap tablets - an analogue of the drug Noliprel are prescribed with the development of stable hypertension.

Contraindications to Ko-Perinev:

pathology of renal functionality;
quincke's edema or angioedema;
reflex hyperkalemia;
renal artery stenosis;
heart pathology;
dialysis;
individual intolerance to the composition;
the patient's age is less than 18 years;
lactation;
period of bearing children.

Adverse reaction to a cheap analogue of Noliprel A B:

dizziness or migraine;
thrombocytopenia;
lowering pressure;
vision problems;
disruption of the digestive tract;
noise in ears;
spasmodic muscle attacks;
dermatological allergy.

Co-Perinev is cheaper than Noliprel A B tablets. The average price for the drug is 400 rubles.

Prestarium

Considering cheap generics of Noliprel, you can also select the drug Prestarium, the action of which is aimed at reducing the pressure in the arterial vessels, as well as strengthening their walls.

The drug is produced in tablet form, containing perindopril arginine. Tablets are recommended if the patient has:

hypertension;
ischemia of a stable form;
heart failure.

Taking a cheap drug Prestarium in rare cases leads to the appearance of:

kidney problems (dysfunction);
temporary cough;
pancreatitis;
erythema;
loss of appetite.

An adverse reaction of the Noliprel substitute may occur as a result of an individual reaction or in the presence of contraindications:

galactosemia;
lactation;
allergy to ingredients;
angioedema;
pregnancy;
quincke's edema;
age less than 18 years.

The price for an analogue of Noliprel is quite good - from 350 rubles.

Ko Prenesa

When replacing Noliprel Bi Forte with analogs, they also use a cheap drug - Co-Prenesa. The analogue is used for therapeutic purposes while maintaining a constant elevated pressure.

As well as in the composition of other substitutes, the analogue of Co-Prenes contains the components - indapamide and perindopril. A cheap substitute for Noliprel is prescribed by a doctor when determining persistent hypertension.

The use of a cheap analogue of Noliprel is not desirable if the patient has:

allergy to one or more components of the composition;
edema of the angioedema type;
hypovolemia or hypokalemia;
kidney pathology.

Adverse reaction:

a sharp drop in pressure;
headaches;
shortness of breath or cough;
dysfunction of the gastrointestinal tract;
dermatological reaction in the form of allergies;
kidney pathology.

The cost of a cheap analogue of Noriprel Ko-Prenes is from 300 rubles.

Lorista

The drug Lorista is prescribed when observing a patient with high blood pressure in the arterial vessels, as well as in case of cardiac insufficiency.

Noliprel's analogue - Lorista contains an active ingredient - losartan, which affects the state of the circulatory system.

Indications for a cheap substitute for Noliprel:

hypertrophy developing in the left ventricle;
arterial hypertension;
heart failure;
progression of nephrology in diabetes mellitus.

low blood pressure;
hyperkalemia;
dehydration;
intolerance to the composition;
lactation;
allergy to the components of the composition;
pregnancy;
category of patients under 18 years of age.

Side effect:

insomnia;
depression;
memory impairment;
migraine;
tachycardia;
cough;
gastritis;
dysfunction of the urinary tract;
muscle pain;
vision problems;
gout;
allergic swelling or rash.

The cost for Russian tablets of the analogue of Lorista is on average 400 rubles.

Conclusion

Only a specialist can determine what is best for treating arterial hypertension. It is not recommended to independently choose which drug is more effective - Noliprel or analogues, since the action of medicines is individual for each organism.

Noliprel is a potent medicine for high blood pressure. The drug is often prescribed for hypertensive patients.

Types of Noliprel

Release form

Noliprel A - 2.5 mg;
Noliprel A Forte - 5 mg;
Noliprel A Bi-Forte - 10 mg.

Noliprel forte - analogues

Lizopres. Treats hypertension.
Mipril. Reduces blood pressure.

Reviews

Tatyana, 54 years old: I was prescribed Noliprel two years ago. With the help of it, I even lost weight. But then it began to seem to me that he began to adversely affect me, this was expressed in constant headaches and dizziness. I had to go to the doctor, who explained this by the fact that its initial dosage was calculated for my previous weight and pressure value, and now both of these indicators became less, and it was high time for me to reduce the amount of medicine. After that, everything worked out for me, I take it further.

Elvira, 63 years old: I always drink Noliprel A in the morning, otherwise the pressure goes off scale, and recently began to take it together with Cardiomagnil. I observe that my sleep has improved, as I take this medicine in the evening. He did not affect my pressure in any way, every day I measure it after sleep, but he improved my health.

What the drug consists of

One of the combined drugs is Noliprel - pressure pills. The therapeutic effect is provided by two active components of the substance:

perindopril;
indapamide.

To give the necessary technological properties, the medicine contains auxiliary components:

microcrystalline cellulose,
lactose monohydrate,
magnesium stearate;
silica.

In what form is the medicine released

Noliprel is produced in the form of oblong white tablets with risks on both sides. The carton contains 30 tablets and instructions for use.

The principle of action of ACE inhibitors

How does the drug work in the body

The therapeutic result of "Noliprel" is provided by its active substances, which enhance the action of each other.

The first of these (perindopril) belongs to the class of angiotensin-converting enzyme inhibitors. ACE inhibitors slow down the transformation of the inactive hormone angiotensin I into the active hormone angiotensin II, which constricts blood vessels and increases blood pressure. They also inhibit the breakdown of vasodilating bradykinin and reduce blood pressure-promoting aldosterone levels.

As a result, both systolic and diastolic pressure are reduced.

Perindopril also dilates blood vessels, reduces left ventricular hypertrophy, and restores elasticity of the arteries.

Indapamide belongs to the group of diuretics. It inhibits the reabsorption of sodium in the nephrons of the kidneys. As a result, the excretion of sodium and chlorine increases with urine.

Indapamide differs in that it lowers blood pressure at doses that practically do not increase the diuretic effect.

Perindopril and indapamide are rapidly absorbed into the bloodstream. The bioavailability of the first substance reaches 70 percent, the bioavailability of indapamide is 95 percent. The maximum concentration of indapamide is observed one hour after administration, perindopril - after three to four hours.

Both substances are excreted from the body through the kidneys.

What diseases does Noliprel treat?

The drug is used in the treatment of hypertension. This diagnosis is made when the pressure stubbornly remains above 140/90 mm Hg. Art. Hypertension must be distinguished from high blood pressure, which can appear after strong emotional or physical exertion. In this case, the pressure automatically returns to its original level. In hypertension, pressure correction is possible only with antihypertensive drugs.

The negative effect of hypertension on organs

Symptoms of hypertension depend on the stage of development of the disease and the degree of damage from certain target organs.

At the initial stage, blood pressure does not exceed 180/115 mm Hg. Art. The central nervous system and organs are not affected at this stage.
At the second stage, the pressure ranges from 180-210 / 115-125 mm Hg. Art. There is a narrowing of the retinal vessels, an increase in the size of the left ventricle, transistor ischemic attacks. Hypertensive crises appear.

Tests detect protein in the urine and an increase in creatinine in the blood.

The last stage of the disease is characterized by severe hypertensive crises. The pressure can reach 300/130 mm Hg. Art. Left ventricular failure, thrombosis of the cerebral vessels, stratification of retinal vessels, edema of the optic nerve, and renal failure develop.

Complications of high blood pressure are:

angina pectoris;
heart attack;
stroke;
pulmonary edema;
cardiac asthma;
aortic aneurysm;
retinal detachment;
self-poisoning of the body due to kidney damage.

When "Noliprel" cannot be treated

The use of the drug is excluded when the patient has increased sensitivity to its components.

Quincke's edema

A contraindication is a person's tendency to angioedema.
A medicine is not prescribed for a low potassium content in the body.
Another contraindication is severe renal failure.
The use of severe liver failure is excluded.
Due to the presence of lactose in the composition of the drug, it cannot be prescribed to people who are unable to digest milk sugar due to enzyme deficiency.

The drug is prohibited when breastfeeding

Not applicable during pregnancy and breastfeeding, since the active substances of "Noliprel" are able to overcome the placental barrier, as well as penetrate into breast milk.

The effect of perindopril on the fetus in the second and third trimesters can result in the development of hypotension in the newborn, impaired renal function, and damage to the skull bones. There was a decrease in the amount of amniotic fluid. Indapamide can cause delayed fetal development.

If pregnancy occurs during treatment with Noliprel, the drug is discontinued.

In addition to direct contraindications, there are situations in which Noliprel should be used with caution.

There is a long list of pathologies in which taking the medicine is fraught with undesirable consequences, such as a sharp drop in blood pressure, a violation of water-salt metabolism. These include renal artery stenosis, aortic valve stenosis, systemic lupus erythematosus, diabetes mellitus, hyperuricemia.

People suffering from coronary artery disease or with insufficient blood flow to the brain should begin treatment with a lower dose.

Elderly patients should check kidney function and blood potassium levels before taking the medication. This is necessary to reduce the risk of hypotension.

People with severe heart failure, low blood volume, and cirrhosis of the liver are at risk.

Noliprel therapy requires constant monitoring of the level of basic electrolytes in the blood plasma (potassium, magnesium, calcium, sodium, chlorine, iron). Such control is of particular importance for old people and those weakened by various chronic diseases, forced to take other medicines.

How to take your medicine

The drug is prescribed for hypertension of all degrees. The standard dosage for adults is one tablet per day.

The dosage for the elderly is the same. It is recommended to take the pill in the morning.

The therapeutic effect after taking it lasts for a day. A lasting therapeutic result is achieved in less than a month. When treatment is interrupted, there is no withdrawal effect.

What are the side effects

They are determined by the body's response to perindopril and indapamide. The first component of "Noliprel" can lead to an excessive decrease in blood pressure, provoke orthostatic hypotension. In rare cases, angina pectoris, arrhythmia, myocardial infarction, stroke are not excluded.

The urinary system can react with the development of acute renal failure, an increase in protein in the urine.

Perindopril may cause headache

Various reactions from the nervous system are possible. These include weakness and fatigue, dizziness, headache, mood swings, tingling and creeping sensations on the skin, ringing in the ears, anorexia, and sleep problems.

Dry cough, bronchospasm, profuse watery discharge from the nose (very rare) may occur.

The negative effects of perindopril on the digestive system can lead to abdominal pain, diarrhea or constipation, nausea, and a feeling of dry mouth. In rare cases, inflammation of the pancreas, intrahepatic cholestasis (bile stasis), hyperbilirubinemia (increased content of bilirubin in the blood) developed.

Skin manifestations are reduced mainly to itching and rashes, urticaria and angioedema are rarely observed.

Tests can record a decrease in hemoglobin and platelet levels.

Other reactions - increased sweating, deterioration of potency.

The negative effect of indapamide on the central nervous system is manifested by headache, dizziness, paresthesia, weakness.

Nausea, drying of the oral mucosa may be observed. Sometimes pancreatitis and hepatic encephalopathy are possible.

The hematopoietic system can react with leukopenia, thrombocytopenia, anemia.

Dermatological effects are most often expressed in skin rashes, manifestations of hemorrhagic vasculitis.

Indapamide can reduce the concentration of sodium, chlorine, and sometimes potassium. Low sodium content can provoke a decrease in circulating blood volume, dehydration of the body.

What to do if an overdose occurs?

If, as a result of self-medication or by mistake, an excessive amount of Noliprel was taken, intoxication is possible. Its symptoms are:

a sharp drop in pressure;
vomiting;
depressed mood;
insomnia;
slowing down of heart rate;
polyuria (increased urine production) or oliguria (decreased urine output);
violations of water and electrolyte balance.

If signs of drug poisoning appear, it is necessary to rinse the stomach. To cleanse the stomach, you need to drink five to six glasses of warm water with the addition of a small amount of soda or salt. To induce vomiting, you need to press on the root of the tongue with two fingers.

After washing, you can take a sorbent (activated carbon).

If a poisoned person has a strong drop in pressure, he should be laid on his back, his legs should be raised, placing an object under them.

How Noliprel is combined with other medicines

When treating with noliprel, it is not recommended to use drugs with lithium used to treat manic and hypomanic phases of bipolar disorder, severe depression. ACE inhibitors and diuretics slow down the elimination of lithium from the body, which can lead to poisoning of the body with this chemical element.

With lithium intoxication, various neurological and mental disorders (tremors, impaired coordination of movements, epileptic seizures) occur.

If the medication with lithium cannot be discarded, it is required to constantly monitor its content and make adjustments to the treatment course.

The combination with potassium-containing drugs is unfavorable, since the development of hyperkalemia is not excluded. This pathological condition leads to serious changes in the work of the heart, which can threaten a person's life.
Perindopril may increase the sugar-lowering effect of insulin.
Joint use with certain drugs (erythromycin, pentamidine, vincamine, bepridil, halofantrine) should be avoided, since the development of dangerous arrhythmias such as pirouette is not excluded.
The same threat exists when combined with antiarrhythmic drugs (quinidine, amiodarone, sotalol).
Muscle relaxant of central action baclofen enhances the hypotensive effect of "Noliprel".
A similar result is obtained in combination with some antipsychotics and tricyclic antidepressants.
Ibuprofen, diclofenac and other non-steroidal anti-inflammatory drugs, glucocorticosteroids reduce the antihypertensive effect.

If NSAIDs are taken together with ACE inhibitors, a cumulative effect that contributes to hyperkalemia is not excluded. This threat is especially high when the patient has a low potassium concentration, a prolonged QT interval, or bradycardia.

Medicines that reduce potassium in the body (laxatives, glucose with insulin, calcium), when interacting with indapamide, can lead to hypokalemia.

Noliprel increases the toxicity of cardiac glycosides against the background of a lack of potassium in the body.
Disorders in the functioning of the kidneys may appear when using X-ray contrast agents containing iodine.
Cyclosporine, an immunosuppressant, can increase blood creatinine levels.

One of the analogues of "Noliprel"

What can replace the drug?

If it is impossible to purchase noliprel, it can be replaced with analogues. Among them are such well-known medicines:

"Prestarium arginine combi";
Prilamid;
"Ko-prenesa".

They have the same active ingredients as Noliprel. There are slight differences in the list of auxiliary components, therefore, before using analogs, you must carefully read the description of the medicine.

Analogs differ in price, which depends on the country in which this or that drug was produced. Noliprel is an effective drug against hypertension. However, it is not recommended to use it without a medical prescription due to the presence of contraindications and side effects.

Additional information on the topic "Noliprel (instructions for use): at what pressure should I drink the medicine?" can be obtained from the video:

You can learn more about hypertension in the following video:

Noliprel is a potent medicine for high blood pressure. The drug is often prescribed for hypertensive patients.

For those whose value of this indicator is not too high, sometimes it is worth reducing the dosage of the medication indicated in the instructions for the drug, but in any case, you should not self-medicate, the appointment and dosage should be prescribed by a doctor. All the nuances of taking the medicine, its instructions and reviews about it are given in the article.

Noliprel is a potent medicine for high blood pressure. The drug is often prescribed for hypertensive patients.

Types of Noliprel

This medication is available in several varieties. They differ in the dosage of active substances. It has two of them. The table below shows their exact content.

In preparations, the prefix "A" means that in this type of tablets the substance perindopril is found together with the amino acid arginine. The acid has an additional beneficial effect on the condition of the heart and blood vessels. The most effective and pressure-lowering drug is Noliprel A Bi-forte, but sometimes its dosage is too strong, and the doctor prescribes less powerful varieties after it, with a lower content of active agents.

On which hand to measure pressure correctly - read in this article.

Why does blood pressure rise after eating?

Algorithm for setting a hypertensive enema.

Release form

Noliprel is produced in the form of oblong white oval tablets, on both sides of them there is a risk, which makes it easier to break the pill when you need to take a half dose. Tablets of different types of this remedy are by weight:

Noliprel A - 2.5 mg;
Noliprel A Forte - 5 mg;
Noliprel A Bi-Forte - 10 mg.

One blister can hold 7 or 10 pills. There are 14 or 30 of them in a pack.

Noliprel forte - analogues

Among the worthy substitutes for this drug are:

Akkuzid. It is used for patients who are prescribed a complex treatment of a diuretic and quinapril.
Iruzid. Treats people with mild to moderate hypertension if they have a stable course of therapy.
Capotiazide. It is used in conjunction with other antihypertensive drugs, treats any form of arterial hypertension.
Quinard. It is prescribed for chronic insufficiency and hypertension.
Ko-Renitek. It is used for patients undergoing complex therapy.
Lisinopril / hydrochlorothiazide. The drug is intended for the treatment of mild to moderate hypertension.
Lizopres. Treats hypertension.
Liprazide. Designed to treat any form of hypertension, including renovascular.
Mipril. Reduces blood pressure.
Rami compositum. It is a solution for those patients who cannot control their blood pressure with monotherapy.
Tritace. It is used both for complex treatment and can be used in conjunction with other calcium antagonists and diuretics. Helps with congestive heart failure.
Phozid. It is prescribed for arterial hypertension.
Ena Sandoz. It is used for essential hypertension, chronic heart failure, it is used for the prevention of heart attack.

Noliprel should be taken with normal dehydration of the body to avoid severe hypotension. During its use, creatinine, electrolytes and blood pressure are monitored. If the patient suffers from heart failure, then the drug should be combined with beta-blockers. It should be noted that Noliprel gives a positive reaction on doping tests.