Noliprel A Forte tabs 5mg + 1.25mg #30

Instruction for Noliprel A Forte

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Noliprel A forte is a combined antihypertensive drug that includes an angiotensin-converting enzyme (ACE) inhibitor and a diuretic.

Release form and composition

The drug is available in the form of film-coated tablets: oblong, white (in polypropylene bottles with a dispenser: 14 or 29 pcs., In a cardboard box with first opening control 1 bottle; 30 pcs., In a cardboard box with first opening control 1 or 3 vials; in hospital packages - 30 vials each in cardboard pallets, 1 pallet in cardboard boxes and instructions for use of Noliprel A forte).
1 tablet contains:
    active ingredients: perindopril arginine - 5 mg (equivalent to the content of 3.395 mg perindopril), indapamide - 1.25 mg;
    auxiliary components: lactose monohydrate, colloidal anhydrous silicon dioxide, maltodextrin, sodium carboxymethyl starch (type A), magnesium stearate;
    composition of the film shell: premix for white film shell SEPIFILM 37781 RBC [hypromellose, macrogol 6000, glycerol, titanium dioxide (E171), magnesium stearate], macrogol 6000.

Pharmacodynamics

Noliprel A forte is an antihypertensive drug, the action of which is due to the antihypertensive properties of perindopril and indapamide, enhanced as a result of their combination.
Perindopril is an ACE inhibitor that is responsible for the conversion of angiotensin I to the vasoconstrictor, angiotensin II. In addition, ACE (or kininase II) converts bradykinin into an inactive heptapeptide. Bradykinin in the body has a vasodilating effect. As a result of ACE inhibition, the secretion of aldosterone decreases, a negative feedback process is triggered, which increases the activity of renin in the blood plasma. Due to a decrease in preload and afterload, the work of the myocardium is normalized. Long-term use of perindopril helps to reduce the total peripheral vascular resistance (OPSS), which is mainly caused by its effect on the vessels in the muscles and kidneys. Effects are achieved without retention of sodium and fluid ions or the development of reflex tachycardia.
It has been established that in chronic heart failure (CHF), perindopril provides a decrease in filling pressure in the left and right ventricles of the heart, a decrease in systemic vascular resistance, an increase in cardiac output and an increase in muscle peripheral blood flow.
Indapamide is a sulfonamide with similar pharmacological properties to thiazide diuretics. It inhibits the reabsorption of sodium ions in the cortical segment of Henle's loop, increasing the excretion of chlorine, sodium and, to a lesser extent, magnesium and potassium ions through the kidneys. This increases urine output and causes a decrease in blood pressure (BP).
The antihypertensive effect of Noliprel A forte is dose-dependent; in the standing and lying position, it is equally manifested in relation to diastolic and systolic blood pressure. After taking the pill, the effect of the drug lasts for 24 hours. The therapeutic effect is stable after 30 days of treatment.
Discontinuation of therapy is not accompanied by a withdrawal syndrome.
Against the background of the use of Noliprel A forte, there is a decrease in the systemic vascular resistance, a decrease in the degree of left ventricular hypertrophy (LVH), and an improvement in the elasticity of the arteries. The drug does not affect lipid metabolism and the content of total cholesterol, high density lipoprotein cholesterol (HDL) and low density lipoprotein (LDL) or triglycerides.
With arterial hypertension and LVOT, in the case of the use of a combination of perindopril and indapamide, there is a more significant decrease in the left ventricular mass index (LVMI) and antihypertensive effect compared with enalapril.
The study of the effect of Noliprel A forte on the main macro- and microvascular complications in patients with type 2 diabetes mellitus was carried out as an addition to both standard therapy for glycemic control and the strategy of intensive glycemic control (IGC) (target HbA1c less than 6.5%). The study involved a group of patients, the average indicators of which were: age - 66 years, blood pressure - 145/81 mm Hg, weight mass index - 28 kg per 1 m2 of body surface, HbA1c (glycosylated hemoglobin) - 7.5%. Most of the patients were on hypoglycemic and concomitant therapy (including antihypertensive, lipid-lowering, antiplatelet drugs).
The research results (the follow-up period was about 5 years) showed a 10% reduction in the relative risk of the combined incidence of macro- and microvascular complications in the IHC group (mean HbA1c 6.5%) compared with the standard control group (mean HbA1c 7.3%).
The factors of a significant decrease in the relative risk included a 14% decrease in the main microvascular complications, a 21% decrease in the occurrence and progression of nephropathy, a 9% decrease in microalbuminuria, a 30% decrease in macroalbuminuria, and a decrease in the development of renal complications by 11%.
The benefits of antihypertensive therapy were independent of those achieved with IGC.
The antihypertensive efficacy of perindopril has been confirmed for the treatment of arterial hypertension of any severity. After a single oral administration, the maximum effect of Noliprel A forte is achieved in 4-6 hours and lasts for 24 hours. A pronounced residual (about 80%) inhibition of ACE is observed 24 hours after its administration.
Perindopril has a hypotensive effect with low and normal renin activity in blood plasma.
The combination with thiazide diuretics enhances the severity of the antihypertensive effect, reducing the risk of hypokalemia associated with taking diuretics.
Combination therapy with an ACE inhibitor and an angiotensin II receptor antagonist (ARA II) in patients with a history of cardiovascular or cerebrovascular diseases, patients with type 2 diabetes mellitus (with confirmed target organ damage), type 2 diabetes mellitus and diabetic nephropathy was not detected clinically a significant positive effect on the occurrence of renal and / or cardiovascular events or on mortality rates. But after comparing it with monotherapy, it was found that against the background of a combination of an ACE inhibitor and ARA II, the risk of developing hyperkalemia, acute renal failure and / or arterial hypotension increases.
Taking into account that the intragroup pharmacodynamic properties of ACE inhibitors and ARA II are similar, these results can be expected with the combination of perindopril and ARA II.
It is not recommended to simultaneously use ACE inhibitors and ARA II in patients with diabetic nephropathy.
The addition of aliskiren to standard therapy with an ACE inhibitor or ARA II for type 2 diabetes and chronic kidney disease and / or cardiovascular pathologies increases the risk of adverse outcomes, including cardiovascular death, stroke, hyperkalemia, arterial hypotension and renal dysfunction ...
The use of indapamide in doses that have a minimal diuretic effect causes a decrease in the systemic vascular resistance, improves the elastic properties of large arteries, which provides it with an antihypertensive effect. Without affecting the level of lipids in the blood plasma (triglycerides, total cholesterol, LDL, HDL) and carbohydrate metabolism (including patients with diabetes mellitus), indapamide helps to reduce LVOTH.

Pharmacokinetics

The pharmacokinetic characteristics characteristic of monotherapy with each of the drugs do not change with the combination of perindopril and indapamide.
After oral administration, absorption of perindopril occurs quickly, its bioavailability can range from 65 to 70%. About 20% of the absorbed amount of the drug is biotransformed into the active metabolite perindoprilat. Its maximum concentration (Cmax) in blood plasma is reached in 3-4 hours. Concomitant food intake reduces the conversion of perindopril to perindoprilat without significant clinical consequences.
After rapid absorption of indapamide from the gastrointestinal tract in full from the dose taken, its Cmax in blood plasma is reached within 1 hour from the moment of ingestion.
Plasma protein binding: perindopril - less than 30%, indapamide - 79%.
The dissociation of perindoprilat associated with ACE is slowed down, therefore the effective half-life (T1 / 2) of perindopril is 25 hours. The equilibrium state is reached after 96 hours.
Perindopril crosses the placental barrier.
Regular intake of Noliprel A forte does not lead to the accumulation of its active components in the body.
Perindoprilat is excreted by the kidneys, T1 / 2 is 3-5 hours.
T1 / 2 of indapamide averages 19 hours. It is excreted in the form of inactive metabolites: through the kidneys - 70% of the dose taken, through the intestines - 22%.
The clearance of perindoprilat during dialysis is 70 ml / min.
In renal and heart failure, as well as in elderly patients, the excretion of perindoprilat is slowed down.
In liver cirrhosis, the hepatic clearance of perindopril is reduced by 2 times, but this does not affect the amount of perindoprilat, therefore, dose adjustment is not required.
In patients with renal insufficiency, the pharmacokinetics of indapamide does not change.

Indications for use

    essential hypertension;
    arterial hypertension in patients with type 2 diabetes mellitus - in order to reduce the risk of macrovascular complications caused by cardiovascular pathologies and microvascular complications from the kidneys.

Contraindications

    severe liver failure, including those complicated by encephalopathy;
    severe renal failure with creatinine clearance (CC) less than 30 ml / min;
    bilateral renal artery stenosis;
    the presence of one functioning kidney;
    the use of hemodialysis;
    hypokalemia;
    untreated decompensated heart failure;
    concomitant therapy with drugs that prolong the QT interval;
    combination with antiarrhythmic drugs that can cause ventricular arrhythmias of the "pirouette" type;
    simultaneous use with drugs containing aliskiren in patients with diabetes mellitus or impaired renal function (GFR less than 60 ml / min per 1.73 m2 of body surface area);
    syndrome of glucose-galactose malabsorption, galactosemia, lactase deficiency;
    hereditary or idiopathic angioedema;
    an indication of a history of angioedema, including against the background of the use of ACE inhibitors;
    period of pregnancy;
    breast-feeding;
    age under 18;
    established hypersensitivity to other ACE inhibitors or sulfonamides;
    individual intolerance to the components of the drug.
It is recommended to prescribe Noliprel A forte with caution to patients with chronic heart failure of functional class IV according to the NYHA classification (New York Heart Association), angina pectoris, renovascular hypertension, aortic valve stenosis, hypertrophic obstructive cardiomyopathy, inhibition of bone marrow circulation, decreased blood volume (O (including as a result of taking diuretics, adherence to a salt-free diet, with vomiting, diarrhea or hemodialysis), cerebrovascular diseases, diabetes mellitus, liver failure, systemic connective tissue diseases (including scleroderma, systemic lupus erythematosus), with lability of blood pressure, hyperuricemia (especially accompanied by urate nephrolithiasis and gout), in old age, as well as professional athletes and patients of the Negroid race.
In addition, it is recommended to exercise caution with the simultaneous use of immunosuppressants, lithium preparations, hemodialysis using high-flow membranes, desensitization, in the period before the LDL apheresis procedure, anesthesia, after kidney transplantation.

Noliprel A forte, instructions for use: method and dosage

Noliprel A forte tablets are taken orally, preferably in the morning, before meals, once a day.
Recommended dosage:
    essential hypertension: 1 pc. It is preferable to prescribe an individual dose of the drug after the selection of doses while taking one-component drugs;
    arterial hypertension in patients with type 2 diabetes mellitus: initial dose - ½ pcs. With good tolerance after 90 days of therapy, the daily dose can be increased to 1 pc.
Prescribing treatment to elderly patients is necessary taking into account the results of a preliminary study of renal function and blood pressure. Starting treatment with a low dose, the dose of Noliprel A forte is selected individually, taking into account the degree of blood pressure reduction. This avoids a sharp drop in blood pressure.
In renal failure in patients with CC 30-60 ml / min, the appointment of Noliprel A forte should be performed after preliminary monotherapy with each of the active components. It is necessary to use doses that allow the most acceptable therapeutic effect to be achieved.
In renal failure with a CC of 60 ml / min and above, the usual doses are prescribed, accompanying treatment with regular monitoring of the level of creatinine and potassium in the blood plasma.
With a moderate degree of hepatic impairment, dose adjustment of Noliprel A forte is not required.

Side effects

    from the central nervous system: often - headache, vertigo, dizziness, asthenia, paresthesia; infrequently - mood lability, sleep disturbance; very rarely - confusion of consciousness; frequency not established - syncope;
    from the lymphatic and circulatory systems: very rarely - leukopenia, neutropenia, thrombocytopenia, agranulocytosis, aplastic anemia, hemolytic anemia, anemia (after kidney transplantation, hemodialysis);
    on the part of the cardiovascular system: often - a pronounced decrease in blood pressure (including orthostatic hypotension); very rarely - heart rhythm disturbances (including bradycardia, ventricular tachycardia, atrial fibrillation), angina pectoris, myocardial infarction; the frequency has not been established - arrhythmia of the "pirouette" type, including fatal ones;
    from the senses: often - tinnitus, visual impairment;
    on the part of the respiratory system, chest and mediastinal organs: often - a transient dry cough (due to prolonged use of perindopril), shortness of breath; infrequently - bronchospasm; very rarely - rhinitis, eosinophilic pneumonia;
    from the digestive system: often - a violation of taste, dryness of the oral mucosa, loss of appetite, nausea, vomiting, epigastric pain, abdominal pain, constipation, diarrhea, dyspepsia; very rarely - pancreatitis, intestinal angioedema, cholestatic jaundice, cytolytic or cholestatic hepatitis; frequency not established - hepatic encephalopathy (with concomitant hepatic failure);
    allergic reactions: infrequently - urticaria, angioedema of the face, lips, tongue, extremities, mucous membrane of the vocal folds and / or larynx, in case of a predisposition to broncho-obstructive and allergic reactions - hypersensitivity reactions;
    dermatological reactions: often - itching, skin rash, maculopapular rash; infrequently - worsening of the course of the acute form of systemic lupus erythematosus, purpura; very rarely - toxic epidermal necrolysis, erythema multiforme, Stevens-Johnson syndrome, photosensitivity;
    from the musculoskeletal system: often - muscle spasms;
    from the reproductive system: infrequently - impotence;
    from the urinary system: infrequently - renal failure; very rarely - acute renal failure;
    laboratory parameters: rarely - hypercalcemia; the frequency has not been established - an increase in the QT interval on the electrocardiogram, an increase in the level of glucose and uric acid in the blood, an increase in the activity of liver enzymes, hypokalemia, hyponatremia, hypovolemia, hyperkalemia, a slight increase in the concentration of creatinine in the urine and in the blood plasma;
    general reactions: often - asthenia; infrequently - increased sweating.

Overdose

Symptoms: a pronounced decrease in blood pressure, which is accompanied by nausea, vomiting, dizziness, drowsiness, convulsions, confusion, oliguria, sometimes turning into anuria as a result of hypovolemia, disturbances in water and electrolyte balance (hyponatremia and hypokalemia).
Treatment: immediate gastric lavage, the appointment of activated charcoal, restoration of water and electrolyte balance. With severe hypotension, the patient should be placed on his back and his legs raised. Ensure careful monitoring of the patient's condition, in case of hypovolemia - conduct an intravenous (intravenous) infusion of 0.9% sodium chloride solution.
Dialysis is possible.

Special instructions

The use of Noliprel A forte is accompanied by side effects characteristic of monotherapy with perindopril and indapamide in the lowest therapeutic doses. In patients who have not previously received therapy with two antihypertensive drugs, there is an increased risk of idiosyncrasy, and therefore requires careful monitoring to minimize this risk.
If laboratory signs of functional renal failure are found during therapy, treatment with the drug should be discontinued. To resume combination therapy, it is recommended to use low doses of each of the drugs or to prescribe only one of them. In this case, patients need regular monitoring of serum potassium and creatinine levels. Studies are carried out 14 days after the start of treatment and then once every 60 days.
In patients with severe chronic heart failure and underlying renal impairment (including renal artery stenosis), renal failure occurs more frequently.
Sudden development of arterial hypotension is most likely with initial hyponatremia, especially in patients with renal artery stenosis. Therefore, after diarrhea or vomiting, it is necessary to take into account the possible dehydration of the body and a decrease in the content of electrolytes in the blood plasma. With severe arterial hypotension, intravenous administration of 0.9% sodium chloride solution is indicated.
Transient arterial hypotension is not a reason for discontinuation of therapy. After the restoration of BCC and blood pressure, treatment can be resumed using low doses of two active ingredients or one of them.
Treatment should be accompanied by regular monitoring of plasma potassium levels, especially in diabetes mellitus and renal failure.
The use of Noliprel A forte should be discontinued 24 hours before the onset of desensitization.
The ACE inhibitor should be temporarily discontinued before each LDL apheresis with dextran sulfate.
In patients on therapy with perindopril, high-flow membranes should not be used during hemodialysis. They should be replaced with other membranes or the patient should be prescribed alternative antihypertensive therapy using drugs of a different pharmacotherapeutic group.
When diagnosing a persistent dry cough that has arisen during therapy, it should be borne in mind that the cause of its appearance may be the use of an ACE inhibitor.
Due to the high risk of developing neutropenia, agranulocytosis, thrombocytopenia and anemia, special care should be taken when prescribing perindopril to patients with systemic connective tissue diseases who are simultaneously taking immunosuppressants, procainamide or allopurinol, especially with initially impaired renal function. These patients are at high risk of developing severe infections, often resistant to intensive antibiotic therapy. The use of Noliprel A forte in this category of patients is recommended to be accompanied by periodic monitoring of the number of leukocytes in the blood. They should be informed about the need for immediate medical attention if they develop a sore throat, fever and other symptoms of infectious diseases.
With a decrease in the content of blood plasma electrolytes and severe hypovolemia, initially low blood pressure, renal artery stenosis, chronic heart failure, or cirrhosis of the liver with edema and ascites, a significant activation of the renin-aldosterone-angiotensin system (RAAS) can be observed, due to the blockade of this system by perindopril. The patient's condition may be accompanied by a sharp decrease in blood pressure, an increase in the level of creatinine in the blood plasma, and the development of functional renal failure. Usually these phenomena are observed during the first 14 days of therapy. It is recommended to resume taking the drug from the appointment of a lower dose.
For hypertension in patients with coronary artery disease (CHD), cerebrovascular accident, severe heart failure and / or type 1 diabetes mellitus, treatment should be started with low doses. Patients with coronary artery disease should take ACE inhibitors along with beta-blockers.
Because of the risk of anemia in patients undergoing kidney transplantation or hemodialysis, treatment should be accompanied by hematological tests.
Before major surgery, Noliprel A forte should be discontinued 24 hours before the start of general anesthesia.
It should be borne in mind that in patients of the Negroid race, the antihypertensive effect of perindopril is less pronounced.
In case of impaired liver function, taking indapamide can cause the development of hepatic encephalopathy, requiring immediate discontinuation of the drug.
The appointment of Noliprel A forte should be made taking into account the results of the study of the water-electrolyte balance (including the content of sodium, potassium and calcium ions in the blood plasma) of the patient, after which his regular laboratory monitoring is required.
Hypokalemia in elderly patients, malnourished patients, patients with heart failure, ischemic heart disease, liver cirrhosis (with edema or ascites) increases the toxic effect of cardiac glycosides and increases the risk of arrhythmias.
With diuretic therapy, elevated plasma uric acid levels may increase the incidence of gout attacks.
The effectiveness of therapy with thiazide and thiazide-like diuretics can be fully guaranteed only with normal or slightly impaired renal function. The plasma creatinine concentration in adult patients should be below 2.5 mg / dL or 220 μmol / L. For older patients, it is adjusted for age, gender and weight using the Cockcroft formula. The normative indicator for the concentration of creatinine in blood plasma in men is determined by multiplying the difference (140 minus age) by the patient's weight in kilograms and dividing the result by the concentration of creatinine in plasma (μmol / l) multiplied by 0.814. To determine the indicated indicator for women, the final result must be multiplied by 0.85.
For patients with normal renal function, the onset of transient functional renal failure is not dangerous. In case of initial renal failure, a decrease in GFR, an increase in the concentration of urea and creatinine in the blood plasma can be more pronounced and severe.
Due to the risk of developing photosensitivity reactions during the period of application of Noliprel A forte, it is recommended to avoid exposure to direct sunlight or artificial ultraviolet radiation.
It should be borne in mind that during doping control of athletes, indapamide can give a positive reaction.

Influence on the ability to drive vehicles and complex mechanisms

Noliprel A forte does not cause disturbances in psychomotor reactions. However, due to the existing risk of developing adverse events that occur against the background of a decrease in blood pressure or during the correction of therapy, it is recommended to be careful when driving vehicles and complex mechanisms, especially at the beginning of therapy.

Application during pregnancy and lactation

The use of Noliprel A forte is contraindicated during gestation and breastfeeding.
When planning pregnancy or in case of conception during therapy, the drug should be discontinued and an antihypertensive agent approved for use during pregnancy should be prescribed.
The use of ACE inhibitors in the II – III trimesters of pregnancy can cause serious fetal development disorders (decreased renal function, slowed ossification of the skull bones, oligohydramnios) and the development of complications in the newborn (renal failure, arterial hypotension and / or hyperkalemia).
In addition, long-term therapy with thiazide diuretics in the third trimester of pregnancy negatively affects the uteroplacental blood flow and causes hypovolemia in the mother.

Childhood use

Due to the lack of information on the safety and efficacy of the drug for the treatment of children and adolescents, Noliprel A forte should not be prescribed to patients under the age of 18 years.

With impaired renal function

The use of Noliprel A forte is contraindicated in severe renal failure (CC less than 30 ml / min).
In renal failure in patients with CC 30–60 ml / min, the prescription of the combined drug should be performed after preliminary monotherapy with each of the active components. It is necessary to use doses that allow the most acceptable therapeutic effect to be achieved.
In renal failure with a CC of 60 ml / min and above, the usual doses of Noliprel A forte are prescribed, accompanying treatment with regular monitoring of the level of creatinine and potassium in the blood plasma.

For violations of liver function

The use of Noliprel A forte is contraindicated in severe liver dysfunction.
With a moderate degree of liver dysfunction, dose adjustment is not required.

Use in the elderly

With caution, taking into account the results of a preliminary study of renal function and blood pressure, Noliprel A forte should be prescribed to patients in old age.

Drug interactions

    lithium preparations: the combination of an ACE inhibitor and lithium preparations increases the risk of a reversible increase in the concentration of lithium in the blood plasma and the development of toxic effects. The presence of thiazide diuretics only aggravates the emerging processes. The appointment of concomitant therapy with lithium preparations is not recommended. If it is necessary to carry out a combination therapy, regular monitoring of the lithium content in the blood plasma is required;
    baclofen: enhances the hypotensive effect. For timely dose adjustment of drugs, renal function and blood pressure should be monitored;
    non-steroidal anti-inflammatory drugs (NSAIDs) (including acetylsalicylic acid in a daily dose above 3 g): cyclooxygenase-2 (COX-2) inhibitors, non-selective NSAIDs and anti-inflammatory doses of acetylsalicylic acid reduce the antihypertensive effect of perindopril renal function and increase the risk of acute renal impairment , increase the content of potassium in the blood serum (especially with initially reduced renal function);
    tricyclic antidepressants, neuroleptics (antipsychotics): with the simultaneous use of Noliprel A forte, they enhance the hypotensive effect, increasing the risk of orthostatic hypotension;
    corticosteroids, tetracosactide: cause a decrease in the antihypertensive effect. The action of corticosteroids promotes fluid and sodium ion retention;
    other antihypertensive drugs and vasodilators: may enhance the antihypertensive effect of the drug. Nitroglycerin, nitrates, and vasodilators can further lower blood pressure;
    potassium-sparing diuretics (including amiloride, spironolactone, eplerenone, triamterene), potassium preparations, potassium-containing substitutes for table salt: these agents can cause a significant increase in serum potassium levels, including fatal ones. In this regard, with confirmed hypokalemia, their combination with the drug must be accompanied by regular monitoring of the potassium content in the blood plasma and ECG parameters;
    estramustine: the risk of developing angioedema and similar adverse events increases;
    insulin and sulfonylurea derivatives (oral hypoglycemic agents): in patients with diabetes, the hypoglycemic effect of insulin and sulfonylurea derivatives may increase;
    allopurinol, immunosuppressive and cytostatic agents, corticosteroids for systemic use, procainamide: the combination with these agents may increase the likelihood of developing leukopenia;
    general anesthesia drugs: the use of general anesthesia agents enhances the antihypertensive effect;
    thiazide and "loop" diuretics: high doses of diuretics can lead to hypovolemia and arterial hypotension;
    linagliptin, sitagliptin, vildagliptin, saxagliptin (gliptins): increase the risk of angioedema;
    sympathomimetics: possibly weakening of the antihypertensive effect;
    gold preparations: against the background of intravenous administration of gold preparations, the development of nitrate-like reactions (hyperemia of the skin of the face, arterial hypotension, nausea, vomiting) is possible;
    quinidine, disopyramide, hydroquinidine (class IA antiarrhythmics), ibutilide, amiodarone, dofetilide, bretylium tosylate (class III antiarrhythmics), sotalol, chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoperazine sulpriidapridaprideptics, amiodarone, droperidol, haloperidol, pimozide, bepridil, diphemanil methyl sulfate, cisapride, erythromycin and vincamine (i.v.), mizolastine, moxifloxacin, pentamidine, halofantrine, sparfloxacin, methadone, terfenadine, astemizolipreum may contribute to a decrease in the content of nizol in blood plasma and arrhythmia of the "pirouette" type. If it is necessary to prescribe these funds, special care must be taken to monitor the potassium content in the blood plasma and the QT interval;
    amphotericin B (i.v.), systemic glucocorticoids and mineralocorticoids, tetracosactide and laxatives that stimulate intestinal motility: increase the risk of hypokalemia;
    cardiac glycosides: it should be borne in mind that hypokalemia can increase the toxic effect of cardiac glycosides, therefore, it is recommended to monitor the potassium content in the blood plasma and ECG parameters and make appropriate adjustments to therapy;
    metformin: one should take into account the presence of functional renal failure, which has arisen against the background of taking a diuretic, which, when combined with metformin, increases the risk of developing lactic acidosis. If the concentration of creatinine in the blood plasma in men exceeds 15 mg / l, and in women - 12 mg / l, metformin cannot be prescribed;
    iodine-containing contrast agents: high doses of iodine-containing contrast agents against the background of dehydration (caused by the intake of diuretic drugs) of the body increase the risk of developing acute renal failure, and therefore require compensation for fluid loss before using iodine-containing contrast agents;
    calcium salts: a decrease in the excretion of calcium ions by the kidneys is possible, which increases the risk of developing hypercalcemia;
    cyclosporine: the concentration of cyclosporine in the blood plasma does not change, but an increase in the level of creatinine in the blood plasma is possible, including with a normal content of water and sodium ions.

Terms and conditions of storage

Keep out of the reach of children.
Store at room temperature.
Shelf life is 3 years.

Reviews about Noliprel A Forte

Reviews about Noliprel A forte are positive. Patients with experience in the treatment of arterial hypertension report that switching to Noliprel A forte allowed them to normalize their blood pressure, and regular use ensured the stability of the condition. Pointing to the effectiveness of the drug, users are advised not to start taking the drug without consulting a doctor.

Terms of sell

A prescription is not required to buy Noliprel A Forte online.