Natrilix SR
Generic Name
Indapamide Sustained Release
Manufacturer
Servier
Country
France
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| natrilix sr 15 mg tablet | ৳ 11.00 | ৳ 110.00 |
Description
Overview of the medicine
Indapamide SR is a thiazide-like diuretic primarily used to treat essential hypertension. It works by increasing the excretion of sodium and water from the body, thereby reducing blood volume and blood pressure. The sustained-release formulation ensures a prolonged effect, allowing for once-daily dosing.
Uses & Indications
Dosage
Adults
The usual dose is one 1.5 mg tablet once daily, preferably in the morning. The maximum daily dose is 1.5 mg.
Elderly
No specific dose adjustment is generally required for elderly patients. However, close monitoring of renal function and electrolyte levels is advisable.
Renal_impairment
No dose adjustment is necessary for mild to moderate renal impairment (creatinine clearance ≥ 30 ml/min). Indapamide SR is contraindicated in severe renal failure (creatinine clearance < 30 ml/min).
How to Take
Take the tablet orally, preferably in the morning. Swallow the tablet whole with water, do not chew or crush it. It can be taken with or without food.
Mechanism of Action
Indapamide acts primarily in the cortical diluting segment of the kidney, where it inhibits the reabsorption of sodium and chloride. This leads to increased excretion of sodium, chloride, and water, resulting in diuresis and a reduction in blood volume. Additionally, it has a direct vascular effect, reducing peripheral vascular resistance.
Pharmacokinetics
Onset
Diuretic effect onset within 1-2 hours. Full antihypertensive effect may take several days to weeks to manifest.
Excretion
Approximately 70% of the dose is eliminated via urine and 20-23% via feces in the form of inactive metabolites.
Half life
Approximately 14 to 24 hours, allowing for once-daily administration.
Absorption
Rapidly and completely absorbed from the gastrointestinal tract. Peak plasma concentrations are reached about 12 hours after administration of the sustained-release tablet.
Metabolism
Extensively metabolized in the liver, with less than 5% excreted unchanged in urine.
Side Effects
Contraindications
- Hypersensitivity to indapamide, other sulfonamides, or any excipients of the tablet.
- Severe renal failure (creatinine clearance < 30 ml/min).
- Hepatic encephalopathy or severe hepatic impairment.
- Hypokalemia.
- Lactation.
Drug Interactions
Digoxin
Hypokalemia induced by indapamide increases the risk of digitalis toxicity.
Lithium
Increased plasma lithium levels with signs of overdose (due to reduced renal clearance of lithium).
NSAIDs (e.g., ibuprofen, diclofenac)
May reduce the antihypertensive effect of indapamide and increase the risk of acute renal failure, especially in dehydrated patients.
Antidepressants (tricyclic antidepressants, neuroleptics)
Increased antihypertensive effect and risk of orthostatic hypotension.
Potassium-depleting drugs (e.g., corticosteroids, amphotericin B, stimulating laxatives)
Increased risk of hypokalemia.
Storage
Store below 30°C in a dry place, protected from light and moisture. Keep out of reach and sight of children.
Overdose
Symptoms of overdose may include nausea, vomiting, weakness, electrolyte disturbances (hypokalemia, hyponatremia), and profound diuresis leading to dehydration and hypotension. Treatment involves gastric lavage/emesis, correction of fluid and electrolyte imbalances. Symptomatic and supportive treatment should be provided.
Pregnancy & Lactation
Not recommended during pregnancy unless strictly essential, due to potential risks of fetal jaundice, thrombocytopenia, and effects on electrolyte balance. Indapamide is excreted in breast milk, so avoid during lactation or discontinue breastfeeding while on treatment.
Side Effects
Contraindications
- Hypersensitivity to indapamide, other sulfonamides, or any excipients of the tablet.
- Severe renal failure (creatinine clearance < 30 ml/min).
- Hepatic encephalopathy or severe hepatic impairment.
- Hypokalemia.
- Lactation.
Drug Interactions
Digoxin
Hypokalemia induced by indapamide increases the risk of digitalis toxicity.
Lithium
Increased plasma lithium levels with signs of overdose (due to reduced renal clearance of lithium).
NSAIDs (e.g., ibuprofen, diclofenac)
May reduce the antihypertensive effect of indapamide and increase the risk of acute renal failure, especially in dehydrated patients.
Antidepressants (tricyclic antidepressants, neuroleptics)
Increased antihypertensive effect and risk of orthostatic hypotension.
Potassium-depleting drugs (e.g., corticosteroids, amphotericin B, stimulating laxatives)
Increased risk of hypokalemia.
Storage
Store below 30°C in a dry place, protected from light and moisture. Keep out of reach and sight of children.
Overdose
Symptoms of overdose may include nausea, vomiting, weakness, electrolyte disturbances (hypokalemia, hyponatremia), and profound diuresis leading to dehydration and hypotension. Treatment involves gastric lavage/emesis, correction of fluid and electrolyte imbalances. Symptomatic and supportive treatment should be provided.
Pregnancy & Lactation
Not recommended during pregnancy unless strictly essential, due to potential risks of fetal jaundice, thrombocytopenia, and effects on electrolyte balance. Indapamide is excreted in breast milk, so avoid during lactation or discontinue breastfeeding while on treatment.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 24-36 months from the date of manufacture, specific details on packaging.
Availability
Pharmacies, hospitals
Approval Status
Approved by major regulatory bodies
Patent Status
Expired
WHO Essential Medicine
YesClinical Trials
Indapamide has been extensively studied in several large-scale clinical trials demonstrating its efficacy and safety in the management of hypertension and cardiovascular risk reduction, including the LIVE (Left Ventricular Hypertrophy in Hypertension) and HYVET (Hypertension in the Very Elderly Trial) studies, particularly its sustained-release formulation.
Lab Monitoring
- Regular monitoring of serum electrolytes (especially potassium and sodium) is crucial, particularly in elderly, malnourished, or those on concomitant medications.
- Renal function (creatinine, BUN) should be assessed periodically.
- Liver function tests in patients with hepatic impairment.
- Serum uric acid levels (as it may increase uric acid).
- Blood glucose levels (especially in diabetic patients).
Doctor Notes
- Emphasize the importance of electrolyte monitoring, particularly potassium, in all patients, especially those at higher risk.
- Advise caution when prescribing with other medications that can affect potassium levels or blood pressure.
- Regularly assess renal and hepatic function, particularly in elderly patients or those with pre-existing conditions.
- Educate patients on symptoms of hypokalemia and when to seek medical attention.
Patient Guidelines
- Take the medicine exactly as prescribed by your doctor; do not stop taking it without consulting them, even if you feel better.
- Report any unusual symptoms, especially severe dizziness, muscle weakness, or irregular heartbeat, to your doctor immediately.
- Maintain adequate fluid intake as advised by your doctor to prevent dehydration.
- Avoid excessive exposure to sunlight or artificial UV light, as indapamide can cause photosensitivity.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.
Driving Precautions
Natrilix SR may cause dizziness or fatigue, especially at the start of treatment or when the dose is changed. Patients should be cautioned about driving or operating machinery if they experience these symptoms.
Lifestyle Advice
- Follow a low-sodium diet as recommended by your doctor to enhance the antihypertensive effect and reduce fluid retention.
- Engage in regular physical activity as part of a healthy lifestyle for blood pressure control.
- Limit alcohol consumption, as it can further lower blood pressure and interact with the medication.
- Quit smoking, as it is a major risk factor for cardiovascular disease.
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