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Servier Bangladesh OperationProduct Description
**Natrilix SR (Indapamide) Summary**
**Indications**
* Treatment of essential hypertension (effective even in patients with renal function impairment, though its diuretic effect is reduced).
* Management of salt and fluid retention associated with congestive heart failure.
**Mechanism & Pharmacology**
* **Class:** Thiazide-like diuretic / Antihypertensive.
* **Action:** Works via both vascular and renal mechanisms. Inhibits sodium reabsorption at the proximal segment of the distal renal tubule, leading to sodium and chloride excretion. Also exerts direct vascular actions (reduces arterial wall thickening, decreases cardiac hypertrophy, and acts as a free radical scavenger to stimulate vasodilator eicosanoids).
* **Pharmacokinetics:** Sustained-release formulation with total absorption from the GI tract; peak serum levels occur ~12 hours post-dose. Highly bound to erythrocytes (80%) and plasma proteins (79%). Plasma elimination half-life is 14–24 hours (mean 18 hours). Extensively metabolized in the liver and eliminated mainly via urine (70%) and feces (22%) as inactive metabolites.
**Dosage & Administration**
* **Adult Dose:** 1 tablet (1.5 mg) once daily, preferably in the morning.
* **Combination Therapy:** May be combined with other antihypertensive classes in more severe cases.
* **Pediatric Use:** Safety and effectiveness have not been established.
**Contraindications**
* Hypersensitivity to indapamide, sulfonamides, or any formulation components.
* Severe renal failure or serious liver disease (hepatic encephalopathy).
* Pre-existing hypokalemia.
**Key Interactions**
* **Other Antihypertensives:** May potentiate the blood pressure-lowering effect of other antihypertensive agents.
* **Norepinephrine:** May slightly reduce arterial responsiveness to norepinephrine, though pressor effects remain clinically effective.
**Side Effects & Safety Precautions**
* **Common Side Effects:** Dizziness, headache, nausea, vomiting, anorexia, constipation, diarrhea, and postural hypotension.
* **Electrolyte/Metabolic Disturbances:** Hypokalemia, hyponatremia, hypochloremic alkalosis, and hyperuricemia (gout exacerbation).
* **Rare/Severe Effects:** Hypersensitivity skin rashes, cholestatic jaundice, and blood dyscrasias (e.g., thrombocytopenia, leukopenia, aplastic anemia).
* **Precautions:** Exercise caution in patients with disturbed fluid/electrolyte balance, diabetes, gout, or kidney disease. Serum potassium and uric acid levels should be monitored periodically.
* **Pregnancy & Lactation:** Not recommended during pregnancy due to lack of adequate safety data; breastfeeding should be avoided while taking this medication.
**Storage**
* Store in a cool, dry place. Protect from light and moisture. Keep out of reach of children.
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