Indications

Repres SR tablet is indicated in the treatment of essential hypertension. It is effective in treating hypertension in patients with renal function impairment, although its diuretic effect is reduced. Repres SR is also indicated for the treatment of salt and fluid retention associated with congestive heart failure. One tablet daily, preferably in the morning. In more severe cases, Repres SR tablet can be combined with other categories of antihypertensive agents.

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Pharmacology

Indapamide is an oral antihypertensive agent. The mechanism whereby Indapamide exerts its antihypertensive action has not been completely elucidated; both vascular and renal actions have been implicated. The possible beneficial pharmacological effects of Indapamide in the treatment of hypertension include a reduction in cardiac hypertrophy and a reduction in the thickening of arterial walls, a prevention of the accumulation of the embryonic isoform of fibronectin in coronary vessels, free radical scavenging leading to stimulation of vasodilator eicosanoid formation, and interaction with renal carbonic anhydrase. The renal site of action of Indapamide is the proximal segment of the distal tubule. Indapamide appears to have natriuretic properties (sodium and chloride being excreted in equivalent amounts) with less effect on kaliuresis or uric acid excretion. Only at doses greater than 1.5 mg Indapamide sustained release tablet/day is an appreciable increase in urinary volume observed in man. No significant changes in plasma sodium levels have been observed in clinical studies. Significant hypokalemia (plasma potassium <3.2 mmol/L) has been reported in 4% of patients.

Absorption: The fraction of Indapamide released is rapidly and totally absorbed via the gastrointestinal digestive tract. Ingestion with food slightly increases the rate and extent of absorption. These changes are unlikely to be clinically significant. Peak serum level following a single dose occurs about 12 hours after ingestion; repeated administration reduces the variation in serum levels between 2 doses.

Distribution: Indapamide is widely distributed throughout the body, with extensive binding to some specific sites. In blood, it is highly bound to red blood cells (80%) and more specifically to carbonic anhydrase (98%) without having any significant inhibiting activity on this enzyme. Binding of Indapamide to plasma proteins is 79%. The plasma elimination half-life is 14 to 24 hours (mean 18 hours). The drug has a volume of distribution of approximately 60L. Steady state is achieved after 7 days. Repeated administration does not lead to accumulation.

Metabolism: The drug is extensively metabolized in the liver, with only 5 to 7% of the dose excreted in the urine as unchanged drug.

Elimination: Elimination is essentially urinary (70% of the dose) and faecal (22%) in the form of inactive metabolites.

Dosage & Administration

One tablet daily preferably in the morning. In more sever case Indapamide can be combine with other categories of anti-hypertensive agent. The safety and effectiveness in pediatric patients have not been established.

Use in Pediatric Patients: The safety and effectiveness in pediatric patients have not been established.

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Interaction

Other Antihypertensive: Repres SR may add to or potentiate the action of other antihypertensive drugs. In limited controlled trials that compared the effect of Repres SR combined with other antihypertensive drugs with the effect of the other drugs administered alone, there was no notable change in the nature or frequency of adverse reactions associated with the combined therapy.

Norepinephrine: Repres SR, like the thiazides, may decrease arterial responsiveness to norepinephrine, but this diminution is not sufficient to preclude effectiveness of the pressor agent for therapeutic use.

Contraindications

This drug must not be taken in the following conditions: known allergy to this drug or to sulphonamides, renal failure, serious liver disease, hypokalemia.

Side Effects

Side effects include dizziness, headache, anorexia, nausea, vomiting, constipation, diarrhea and postural hypotension. Electrolyte imbalances include hypochloremic alkalosis, hyponatremia, hypokalemia and hyperuricemia; hypersensitivity reactions which include skin rashes, cholestatic jaundice and blood dyscrasias including thrombocytopenia, leucopenia, aplastic anemia.

Pregnancy & Lactation

There is no adequate and well-controlled studies in pregnant women and so Indapamide is not recommended. Mothers taking Indapamide should not breastfeed.

Precautions & Warnings

The drug should be used cautiously in the following situations- disturbed water/electrolyte balance, diabetes, gout and kidney problems. Monitoring of potassium and uric acid serum levels is also recommended.

Therapeutic Class

Thiazide diuretics & related drugs

Storage Conditions

Store in a cool and dry place. Protect from light and moisture.