Antihypertensive drug

Release form, composition and packaging

red-brown, round, biconvex; in cross section, the nucleus is white or almost white.

Excipients: microcrystalline cellulose - 44.1125 mg, lactose monohydrate - 86.8 mg, colloidal silicon dioxide - 0.45 mg, magnesium stearate - 0.75 mg.

The composition of the film shell: dye Wincoat WT-01985 brown - 5 mg (hypromellose - 2.8 mg, macrogol 400 - 0.45 mg, titanium dioxide - 0.77 mg, talc - 0.23 mg, macrogol 6000 - 0.27 mg, iron dye red oxide - 0.5 mg).

Film-coated tablets orange, round, biconvex; in cross section, the nucleus is white or almost white.

Excipients: microcrystalline cellulose - 43.425 mg, lactose monohydrate - 84.6 mg, colloidal silicon dioxide - 0.45 mg, magnesium stearate - 0.75 mg.

The composition of the film shell: Vunkout WT-01097 orange dye - 5 mg (hypromellose - 2.22 mg, macrogol 400 - 0.35 mg, titanium dioxide - 0.61 mg, talc - 0.18 mg, macrogol 6000 - 0.22 mg, sunset yellow dye - 1.43 mg).

10 pieces. - blisters (1) - packs of cardboard.
10 pieces. - blisters (2) - packs of cardboard.
10 pieces. - blisters (3) - packs of cardboard.
14 pcs. - blisters (1) - packs of cardboard.
14 pcs. - blisters (2) - packs of cardboard.
14 pcs. - blisters (3) - packs of cardboard.

pharmachologic effect

A combination drug containing an ACE inhibitor - perindopril and a thiazide-like diuretic - indapamide. The drug has antihypertensive, diuretic and vasodilating effects.

Perindide has a pronounced dose-dependent antihypertensive effect that does not depend on the age and position of the patient's body and is not accompanied by reflex tachycardia. Does not affect lipid metabolism (total cholesterol, LDL, VLDL, HDL, triglycerides and carbohydrates), incl. in patients with diabetes mellitus. Reduces the risk of developing hypokalemia due to diuretic monotherapy.

The antihypertensive effect persists for 24 hours.

A stable decrease in blood pressure is achieved within 1 month against the background of the use of the drug Perindide without an increase in heart rate. Termination of treatment does not lead to the development of the "withdrawal" syndrome.

Perindopril is an ACE inhibitor, the mechanism of action of which is associated with inhibition of ACE activity, leading to a decrease in the formation of angiotensin II, eliminates the vasoconstrictor effect of angiotensin II, reduces the secretion of aldosterone.

The use of perindopril does not lead to sodium and fluid retention, does not cause reflex tachycardia during long-term treatment. The antihypertensive effect of perindopril develops in patients with low or normal plasma renin activity.

Perindopril acts through its main active metabolite, perindoprilat. Its other metabolites are inactive.

The action of the drug Perindide leads to:

- varicose veins due to changes in prostaglandin metabolism (decrease in preload on the heart);

- decrease in OPSS (decrease in afterload on the heart).

In patients with heart failure, perindopril contributes to:

— decrease in filling pressure of the left and right ventricles;

- increase in cardiac output and cardiac index;

- increased regional blood flow in the muscles.

Perindopril is active in arterial hypertension of any severity: mild, moderate and severe. The maximum antihypertensive effect develops 4-6 hours after a single oral administration and persists for a day. Termination of therapy does not lead to the development of the "withdrawal" syndrome.

It has vasodilating properties and restores the elasticity of large arteries. The addition of a thiazide diuretic enhances the antihypertensive (additive) effect of perindopril.

Indapamide refers to sulfonamide derivatives, is a thiazide diuretic. Indapamide inhibits sodium reabsorption in the cortical segment of the renal tubules, which increases the excretion of sodium and chlorine by the kidneys, and leads to increased diuresis. To a lesser extent, increases the excretion of potassium and magnesium. Possessing the ability to selectively block "slow" calcium channels, indapamide increases the elasticity of arterial walls and reduces peripheral vascular resistance. It has a hypotensive effect in doses that do not have a pronounced diuretic effect. Increasing the dose of indapamide does not increase the antihypertensive effect, but increases the risk of adverse events. Indapamide in patients with arterial hypertension does not affect:

- lipid metabolism: TG, LDL and HDL.

- metabolism of carbohydrates, even in patients with diabetes mellitus and arterial hypertension.

Pharmacokinetics

The combined use of perindopril and indapamide does not change their pharmacokinetic parameters compared with the separate administration of these drugs.

Perindopril

Suction and distribution

After oral administration, it is rapidly absorbed from the gastrointestinal tract. Bioavailability is 65-70%. Eating reduces the conversion of perindopril to perindoprilat. T 1/2 from blood plasma is 1 hour.

Cmax in blood plasma is achieved 3-4 hours after ingestion. Since the intake with food reduces the conversion of perindopril to perindoprilat and the bioavailability of the drug, perindopril should be taken 1 time / day in the morning, before breakfast. When taking perindopril 1 time / day, a stable concentration is achieved within 4 days.

Communication with blood plasma proteins is dose-dependent and amounts to 20%. Perindoprilat easily passes through histohematic barriers, excluding the BBB, a small amount passes through the placenta and into breast milk.

Metabolism and excretion

In the liver, it is metabolized to form the active metabolite of perindoprilat.

In addition to the active metabolite of perindoprilat, perindopril forms 5 more inactive metabolites. It is excreted by the kidneys, T 1/2 of perindoprilat is about 17 hours. It does not accumulate.

In elderly patients, in patients with renal and heart failure, the excretion of perindoprilatase is slowed down.

The kinetics of perindopril is changed in patients with cirrhosis of the liver: hepatic clearance is reduced by half. However, the amount of perindoprilat formed does not decrease, which does not require dose adjustment.

Indapamide

Suction and distribution

Quickly and almost completely absorbed in the gastrointestinal tract. Eating somewhat slows down absorption, but does not significantly affect the amount of absorbed indapamide.

C max in plasma is reached 1 hour after a single dose. It binds to plasma proteins by 79%.

Metabolism and excretion

Metabolized in the liver. It is excreted by the kidneys (70%) mainly in the form of metabolites (the fraction of the unchanged drug is about 5%) and the intestine with bile in the form of inactive metabolites (22%). T 1/2 is from 14 to 24 hours (on average, 18 hours). Does not accumulate.

Pharmacokinetics in special clinical situations

In patients with renal insufficiency, the pharmacokinetic parameters of the drug do not change significantly.

Dosage

The drug is administered orally, 1 time / day, preferably in the morning before breakfast, with a sufficient amount of liquid.

Initial dose - 1 tab. drug Perindid (0.625 mg + 2 mg) 1 time / day. If after 1 month of taking the drug it is not possible to achieve adequate control of blood pressure, the dose of the drug should be increased to 1 tab. drug Perindid (1.25 mg + 4 mg) 1 time / day.

Elderly patients

Initial dose - 1 tab. (0.625 mg + 2 mg) Perindid 1 time per day.

Patients with impaired renal function

Patients with renal insufficiency (CC 60 ml / min or more) dose adjustment is not required. Against the background of therapy, regular monitoring of the concentration of creatinine and potassium in the blood plasma is necessary.

For patients with CC 30-60 ml / min, the maximum dose of Perindid is (0.625 mg + 2 mg) 1 time / day.

In severe renal impairment (CC less than 30 ml / min), Perindid therapy is contraindicated.

Patients with impaired liver function

In patients with moderate hepatic impairment, dose adjustment is not required.

Children and teenagers

Perindide should not be used in children and adolescents under 18 years of age, as efficacy and safety have not been established.

Overdose

Symptoms

The most likely symptom of an overdose is a pronounced decrease in blood pressure, sometimes combined with nausea, vomiting, convulsions, dizziness, drowsiness, confusion and oliguria, which can turn into anuria (as a result of hypovolemia). Electrolyte disturbances (hyponatremia, hypokalemia) may also occur.

Treatment

Emergency measures are reduced to the removal of the drug from the body: gastric lavage and / or the appointment of activated charcoal, followed by restoration of water and electrolyte balance.

With a pronounced decrease in blood pressure, the patient should be transferred to the supine position with raised legs, if necessary, correct hypovolemia (for example, intravenous infusion of 0.9% sodium chloride solution). Perindoprilat, the active metabolite of perindopril, can be removed from the body by dialysis.

drug interaction

Perindid

Lithium preparations

With the simultaneous use of lithium preparations and ACE inhibitors, a reversible increase in the concentration of lithium in the blood plasma and associated toxic effects may occur. The additional appointment of thiazide diuretics may further increase the concentration of lithium and increase the risk of toxicity. The simultaneous use of a combination of perindopril and indapamide with lithium preparations is not recommended. In the case of such therapy, regular monitoring of the concentration of lithium in the blood plasma is necessary.

Combination of drugs requiring special attention

Baclofen

May enhance the antihypertensive effect. Blood pressure and renal function should be monitored, if necessary, dose adjustment of antihypertensive drugs is required.

NSAIDs, including high doses of acetylsalicylic acid (more than 3 g / day)

The appointment of NSAIDs can lead to a decrease in diuretic, natriuretic and antihypertensive effects. With a significant loss of fluid, as well as in elderly patients, acute renal failure may develop (due to a decrease in the glomerular filtration rate). Patients need to compensate for fluid loss and regularly monitor kidney function at the beginning of treatment.

Tricyclic antidepressants, antipsychotics (neuroleptics)

These classes of drugs enhance the antihypertensive effect and increase the risk of orthostatic hypotension (additive effect).

Glucocorticosteroids, tetracosactide

Decreased antihypertensive effect (fluid retention and sodium ions due to the action of glucocorticosteroids).

Other antihypertensives: may increase the antihypertensive effect.

Perindopril

Undesirable drug combination

Potassium-sparing diuretics (amiloride, spironolactone, triamterene both in monotherapy and in combination) and potassium preparations

ACE inhibitors reduce the loss of potassium in the kidneys caused by the diuretic. Concomitant use of potassium-sparing diuretics (eg, spironolactone, triamterene, amiloride), potassium preparations, and potassium-containing table salt substitutes can lead to a significant increase in serum potassium, up to death. If it is necessary to simultaneously use an ACE inhibitor and the above drugs (in the case of confirmed hypokalemia), care should be taken and regular monitoring of the content of potassium in the blood plasma and ECG parameters should be carried out.

Oral hypoglycemic agents (sulfonylurea derivatives) and insulin

The following effects have been described for captopril and enalapril. ACE inhibitors may enhance the hypoglycemic effect of insulin and sulfonylurea derivatives in patients with diabetes mellitus. The development of hypoglycemia is observed very rarely (due to an increase in glucose tolerance and a decrease in the need for insulin).

A combination of funds that needs attention

Allopurinol, cytotoxic and immunosuppressive agents, glucocorticosteroids (with systemic use) and procainamide

Simultaneous use with ACE inhibitors may be accompanied by an increased risk of leukopenia.

Means for general anesthesia

The combined use of ACE inhibitors and general anesthesia may lead to an increase in the antihypertensive effect.

Diuretics (thiazide and "loop")

The use of diuretics in high doses can lead to hypovolemia, and the addition of perindopril to therapy can lead to arterial hypotension.

Preparations of gold

When prescribing ACE inhibitors, including perindopril, to patients receiving infusion preparations of gold (sodium aurothiomalate), nitrate-like reactions (flushing of the skin of the face, nausea, vomiting, arterial hypotension) were noted.

Indapamide

Combination of funds requiring special attention

Drugs that can cause torsades de pointes arrhythmias

Due to the risk of hypokalemia, caution should be exercised when using indapamide with drugs that can cause torsades de pointes, for example, antiarrhythmic drugs (quinidine, hydroquinidine, disopyramide, amiodarone, dofetilide, ibutilide, bretylium tosylate, sotalol); some antipsychotics (chloriromazine, cyamemazine, levomepromazine, thioridazine, trifluoperazine); benzamides (amisulpride, sulpiride, sultopride, tiapride); butyrophenones (droperidol, haloperidol); other antipsychotics (pimozide); other drugs such as bepridil, cisapride, diphemanyl methyl sulfate, erythromycin IV, halofantrine, mizolastine, moxifloxacin, pentamidine, sparfloxacin, vincamine IV, methadone, astemizole, terfenadine. The development of hypokalemia should be avoided and, if necessary, its correction should be carried out; control the QT interval.

Drugs that can cause hypokalemia

Amphotericin B (in / in), gluco- and mineralocorticosteroids (with systemic administration), tetracosactide, laxatives that stimulate gastrointestinal motility: increased risk of hypokalemia (additive effect). It is necessary to control the content of potassium in the blood plasma, if necessary, its correction. Particular attention should be paid to patients simultaneously receiving cardiac glycosides. Laxatives that do not stimulate gastrointestinal motility should be used.

cardiac glycosides

Hypokalemia enhances the toxic effect of cardiac glycosides. With the simultaneous use of indapamide and cardiac glycosides, the content of potassium in the blood plasma and ECG parameters should be monitored and, if necessary, therapy should be adjusted.

A combination of funds that needs attention

Metformin

Functional renal failure, which can occur while taking diuretics, especially loop diuretics, while prescribing mstformin increases the risk of developing lactic acidosis. Metformin should not be used if plasma creatinine concentrations exceed 15 mg/l (135 µmol/l) in men and 12 mg/l (110 µmol/l) in women.

Dehydration while taking diuretics increases the risk of developing acute renal failure, especially when using high doses of iodine-containing contrast agents. Before using iodine-containing contrast agents, patients need to compensate for BCC.

Calcium salts

With simultaneous administration, hypercalcemia may develop due to a decrease in the excretion of calcium ions by the kidneys.

Cyclosporine

It is possible to increase the concentration of creatinine in the blood plasma without changing the content of circulating cyclosporine, even with a normal content of fluid and sodium ions.

Pregnancy and lactation

The use of the drug Perindid is contraindicated during pregnancy. When planning pregnancy or diagnosing it while taking the drug, you should immediately stop taking the drug and prescribe another antihypertensive therapy. Appropriate controlled studies of ACE inhibitors in pregnant women have not been conducted. The limited data available on the effects of the drug in the first trimester of pregnancy indicate that the drug did not lead to malformations associated with fetotoxicity. It is known that prolonged exposure to ACE inhibitors on the fetus in the II and III trimesters of pregnancy can lead to a violation of its development (decrease in kidney function, oligohydramnios, slowing of the ossification of the skull bones) and the development of complications in the newborn (such as renal failure, arterial hypotension, hyperkalemia) . Long-term use of thiazide diuretics in the third trimester of pregnancy can cause hypovolemia in the mother and a decrease in uteroplacental blood flow, which leads to fetoplacental ischemia and fetal growth retardation. In rare cases, while taking diuretics shortly before delivery, newborns develop hypoglycemia and thrombocytopenia.

If the patient received Perindid during the second or third trimester of pregnancy, it is recommended to perform a fetal ultrasound to assess the condition of the skull bones and kidney function.

The use of the drug Perindid is contraindicated during breastfeeding. It is not known whether perindopril is excreted in breast milk.

Indapamide is excreted in breast milk. Taking thiazide diuretics causes a decrease in the amount of breast milk or suppression of lactation. At the same time, the newborn may develop hypersensitivity to sulfonamide derivatives, hypokalemia and "nuclear" jaundice.

Since the use of perindopril and indapamide during lactation can cause severe complications in an infant, it is necessary to evaluate the significance of therapy for the mother and decide whether to stop breastfeeding or stop taking these drugs.

Side effects

The frequency of adverse reactions that may occur during therapy is given as the following gradation: very often (> 1/10), often (from> 1/100 to< 1/10), нечасто (от >1/1000 to< 1/100), редко (от >1/10000 to< 1/1000), очень редко (< 1/10000, включая отдельные сообщения), неуточненной частоты (частота не может быть подсчитана по доступным данным).

From the side of the cardiovascular system: infrequently - a pronounced decrease in blood pressure, incl. orthostatic hypotension; very rarely - cardiac arrhythmias, including bradycardia, ventricular tachycardia, atrial fibrillation, as well as angina pectoris and myocardial infarction, possibly due to an excessive decrease in blood pressure in high-risk patients.

From the respiratory system, chest organs and mediastinum: often - against the background of the use of ACE inhibitors, a dry cough may occur, which persists for a long time while taking this group of drugs and disappears after their cancellation; dyspnea; infrequently - bronchospasm; very rarely - eosinophilic pneumonia, rhinitis.

From the hematopoietic and lymphatic systems: very rarely - thrombocytopenia, leukopenia / neutropenia, agranulocytosis, aplastic anemia, hemolytic anemia. In certain clinical situations (patients after kidney transplantation, patients on hemodialysis), ACE inhibitors can cause anemia.

From the side of the central and peripheral nervous system: often - paresthesia, headache, dizziness, asthenia; infrequently - sleep disturbance, mood lability, increased sweating; very rarely - confusion.

From the digestive system: often - dryness of the oral mucosa, nausea, vomiting, abdominal pain, epigastric pain, impaired taste perception, loss of appetite, dyspepsia, constipation, diarrhea; rarely - angioedema of the intestine, cholestatic jaundice; very rarely - pancreatitis; unspecified frequency - hepatic encephalopathy in patients with liver failure.

From the skin and subcutaneous fat: often - skin rash, itching, maculo-papular rash; infrequently - angioedema of the face, lips, limbs, mucous membrane of the tongue, folds and / or larynx, urticaria, hypersensitivity reactions in patients predisposed to asthmatic and allergic reactions, hemorrhagic vasculitis. In patients with acute systemic lupus erythematosus, an exacerbation of the course of the disease is possible; very rarely - erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome. Photosensitivity reactions have been reported.

From the musculoskeletal system: often - muscle cramps.

From the urinary system: infrequently - kidney failure; rarely - acute renal failure.

From the reproductive system : infrequently - impotence.

From the sense organs: often - visual impairment, tinnitus.

From the side of laboratory indicators: hypokalemia, hyponatremia with hypovolemia, leading to a decrease in BCC and orthostatic hypotension, an increase in the concentration of uric acid and glucose in the blood serum; a slight increase in the concentration of creatinine and urea in the blood plasma, reversible after discontinuation of therapy, which often develops against the background of stenosis of the renal arteries or stenosis of the artery of a single kidney, arterial hypertension against the background of diuretic therapy in renal failure; transient increase in sodium in blood plasma; hypochloremia; proteinuria; rarely - hypercalcemia.

Terms and conditions of storage

The drug should be stored in a dry, dark place, out of the reach of children, at a temperature not exceeding 25°C. Shelf life - 2 years.

Indications

- arterial hypertension (in patients who are indicated for combination therapy).

Contraindications

Perindopril

- angioedema (Quincke's edema) in history associated with taking an ACE inhibitor;

- hereditary / idiopathic angioedema;

- pregnancy;

- Hypersensitivity to perindopril and other ACE inhibitors.

Indapamide

- severe liver failure (including with encephalopathy);

- hypokalemia;

- simultaneous use with drugs that can cause arrhythmia of the "pirouette" type;

- pregnancy;

- the period of breastfeeding;

- age up to 18 years (efficacy and safety have not been established);

- Hypersensitivity to indapamide and other sulfonamides.

Perindid

- severe renal failure (CC less than 30 ml / min);

- simultaneous administration with potassium-sparing diuretics, potassium and lithium preparations, and in patients with an increased content of potassium ions in the blood plasma;

- lactose intolerance, lactase deficiency, glucose-galactose malabsorption syndrome;

- concomitant use of drugs that prolong the QT interval;

- hemodialysis (no experience of use);

- chronic heart failure (in the stage of decompensation);

- age up to 18 years (efficacy and safety have not been established);

- hypersensitivity to excipients that make up the drug.

WITH caution the drug should be prescribed for systemic connective tissue diseases (including systemic lupus erythematosus, scleroderma), immunosuppressant therapy (risk of developing neutropenia, agranulocytosis), inhibition of bone marrow hematopoiesis, reduced BCC (diuretics, salt-free diet, vomiting, diarrhea), coronary artery disease , cerebrovascular diseases, renovascular hypertension, diabetes mellitus, chronic heart failure (IV functional class according to the NYHA classification), hyperuricemia (especially accompanied by gout and urate nephrolithiasis), blood pressure lability, elderly patients; when performing hemodialysis using high-flow membranes (for example, AN 69 ®) or desensitization, when performing LDL apheresis, with renal artery stenosis (including bilateral), condition after kidney transplantation, aortic valve stenosis / hypertrophic obstructive cardiomyopathy.

special instructions

Impaired kidney function

Therapy with Perindid is contraindicated in patients with severe renal insufficiency (CC less than 30 ml / min). In some patients with arterial hypertension without previous impaired renal function, signs of acute renal failure may appear during therapy with Perindide. In this case, treatment with Perindide should be discontinued. In the future, combination therapy can be resumed using low doses of Perindide, or perindopril and indapamide can be used as monotherapy.

Such patients require regular monitoring of the content of potassium and creatinine in the blood serum every 2 weeks after the start of therapy and every subsequent 2 months of therapy with Perindide.

Acute renal failure often develops in patients with severe CHF or initial impaired renal function, including bilateral renal artery stenosis or stenosis of the artery of the only functioning kidney.

Arterial hypotension and disturbance of water and electrolyte balance

Hyponatremia is associated with a risk of sudden development of arterial hypotension (especially in patients with bilateral renal artery stenosis or stenosis of the artery of a single functioning kidney). Therefore, during dynamic monitoring of patients, attention should be paid to possible symptoms of dehydration and a decrease in the content of electrolytes in the blood plasma, for example, after prolonged diarrhea or vomiting. Such patients require regular monitoring of electrolytes in blood plasma.

With severe arterial hypotension, intravenous administration of a 0.9% sodium chloride solution may be required.

Transient arterial hypotension is not a contraindication for further continuation of therapy. After the restoration of BCC and blood pressure, therapy with Perindide can be resumed using low doses of the drug, or perindopril and indapamide can be used as monotherapy.

The combined use of perindopril and indapamide does not prevent the development of hypokalemia, especially in patients with diabetes mellitus or renal insufficiency. As in the case of the combined use of antihypertensive drugs and a diuretic, regular monitoring of the content of potassium in the blood plasma is necessary.

Perindopril

Neutropenia/Agranulocytosis

In patients taking ACE inhibitors, there may be cases of neutropenia/agranulocytosis, thrombocytopenia and anemia. In patients with normal renal function in the absence of other complications, neutropenia rarely develops and resolves spontaneously after discontinuation of ACE inhibitors.

Perindopril should be used with great caution in patients with connective tissue disease and concomitantly receiving immunosuppressive therapy, allopurinol or procainamide, especially in existing renal dysfunction. These patients may develop severe infections that are not amenable to intensive antibiotic therapy. In the case of the appointment of perindopril, it is recommended to periodically monitor leukocytes in the blood. The patient should be warned that in case of any signs of an infectious disease (sore throat, fever), you should immediately consult a doctor.

Hypersensitivity/angioedema (Quincke's edema)

When taking ACE inhibitors, incl. perindopril, in rare cases, angioedema of the face, lips, tongue, uvula of the upper palate and / or larynx may develop. If these symptoms appear, the drug should be stopped immediately, the patient should be observed until the signs of edema disappear completely.

If angioedema affects only the face and lips, then its manifestations usually go away on their own or antihistamines can be used to treat its symptoms. Angioedema, accompanied by swelling of the tongue or larynx, can lead to airway obstruction and death.

If such symptoms appear, epipephrine (adrenaline) (at a dilution of 1:1000 (0.3 or 0.5 ml)) should be immediately injected subcutaneously and / or the airway should be secured.

Patients with a history of Quincke's edema, not associated with the use of ACE inhibitors, may be at an increased risk of its development when taking drugs of this group.

In rare cases, during therapy with ACE inhibitors, angioedema of the intestine develops. At the same time, patients have abdominal pain as an isolated symptom or in combination with nausea and vomiting, in some cases without previous angioedema of the face and with a normal level of C1-esterase. The diagnosis is established by computed tomography of the abdominal cavity, ultrasound or at the time of surgery. Symptoms disappear after discontinuation of ACE inhibitors. In patients with abdominal pain receiving ACE inhibitors, the possibility of developing intestinal angioedema should be considered in the differential diagnosis.

Anaphylactoid reactions during desensitization procedures

There are separate reports of the development of prolonged, life-threatening anaphylactoid reactions in patients receiving ACE inhibitors during desensitizing therapy with hymenoptera venom (bees, wasps). ACE inhibitors should be used with caution in allergic patients undergoing desensitization procedures. The use of an ACE inhibitor in patients receiving hymenoptera venom immunotherapy should be avoided. However, the development of anaphylactoid reactions can be avoided by temporarily discontinuing the ACE inhibitor at least 24 hours before the start of the desensitization procedure.

Anaphylactoid reactions during LDL apheresis

Rarely, patients receiving ACE inhibitors may develop life-threatening anaphylactoid reactions during LDL apheresis using dextran sulfate. To prevent an anaphylactoid reaction, ACE inhibitor therapy should be discontinued before each LDL apheresis procedure using high-flux membranes.

Hemodialysis

Anaphylactoid reactions have been reported in patients receiving ACE inhibitors during hemodialysis using high flow membranes (eg AN 69®). Therefore, it is desirable to use a membrane of a different type or use an antihypertensive drug of a different pharmacotherapeutic group.

Potassium-sparing diuretics and potassium supplements

The simultaneous use of perindopril and potassium-sparing diuretics, as well as potassium preparations and potassium-containing table salt substitutes is not recommended.

Cough

During therapy with an ACE inhibitor, a dry cough may occur, which disappears after discontinuation of drugs in this group. When a dry cough occurs, one should be aware of the possible connection of this symptom with taking an ACE inhibitor. If the doctor considers that ACE inhibitor therapy is necessary for the patient, Perindide may be continued.

Pediatric use

The drug Perindid is contraindicated in children and adolescents under 18 years of age due to the lack of data on the effectiveness and safety of use.

Risk of arterial hypotension and / or renal failure (in patients with CHF, impaired water and electrolyte balance and other disorders)

With cirrhosis of the liver, accompanied by edema and ascites, arterial hypotension, CHF, there may be a significant activation of the renin-angiotensin-aldosterone system (RAAS), especially with severe hypovolemia and a decrease in the content of electrolytes in the blood plasma (on the background of a salt-free diet or long-term use of diuretics).

The use of an ACE inhibitor causes blockade of the RAAS, in connection with this, a sharp decrease in blood pressure and / or an increase in plasma creatinine concentration is possible, indicating the development of acute renal failure, which is more often observed when taking the first dose of Perindide or during the first two weeks of therapy.

Elderly patients

Before you start taking the drug Perindid should assess the function of the kidneys and the content of potassium in the blood plasma. The initial dose of the drug Perindid is selected depending on the degree of reduction in blood pressure, especially with a decrease in BCC and CHF (IV functional class according to the NYHA classification). Such measures help to avoid a sharp decrease in blood pressure.

Atherosclerosis

The risk of arterial hypotension exists in all patients, however, special care should be taken when using Perindide in patients with coronary artery disease and cerebrovascular insufficiency. In such patients, treatment should be started with a dose (0.625 mg + 2 mg) of Perindide (initial dose).

Renovascular hypertension

Treatment with Perindide in patients with diagnosed or suspected renal artery stenosis should be started in a hospital setting with a dose of Perindide (0.625 mg + 2 mg), monitoring renal function and plasma potassium levels. Some patients may develop acute renal failure, which is reversible after discontinuation of the drug.

Other risk groups

In patients with CHF (IV functional class according to the NYHA classification) patients with type 1 diabetes mellitus (danger of a spontaneous increase in potassium content), treatment should be started with an initial dose (0.625 mg + 2 mg) of the drug Perindid and under medical supervision.

Patients with diabetes

When prescribing the drug Perindid to patients with diabetes mellitus receiving oral hypoglycemic agents or insulin, during the first month of therapy, it is necessary to regularly monitor the concentration of glucose in the blood.

Ethnic features

Peripdopril (like other ACE inhibitors), has a less pronounced an

Hypertension and heart failure are very common diagnoses in the modern world. Both elderly people and patients aged thirty years complain about them. Nowadays, these ailments are rejuvenated. Of course, there are more reasons for them in modern times. Stress, malnutrition, nervous tension, overwork have never had an excellent effect on good health.

Arterial hypertension: effective interventions

Treatment of diseases of the circulatory system requires special attention. When the pressure jumps sharply, measures should be taken, by itself it will not stabilize. If this is not done, a person can get a myocardial infarction or stroke, the consequences of which can be very sad.

Since the composition of the drug has been improved over the course of several years, the drug Prestarium A, an analogue of Perindopril, appeared in pharmacies. So the differences between them are in the trade name of the drug and one component. The drug "Prestarium A" instead of erbumine salt includes arginine. Their effect on the human body is identical. Arginine only allowed the drug to be stored for three years longer.

That's just the drug "Prestarium A" is more expensive than the drug "Perindopril", its price is 700 rubles per pack.

Many doctors advise patients to use in the treatment of hypertension a cheap analogue of Perindopril (hence, Prestarium A drugs) - Perinev tablets, which also include perindopril. Its cost varies from 200 to 300 rubles.

The group of analogues of the drug "Perindopril" includes such drugs as "Parnavel" (costs 300 rubles), "Hypernik" (300 rubles), "Piristar" (250-400 rubles), "Stopress" (360 rubles), " Arentopres" (400 rubles), "Parnavel" (280 rubles).

If you select substitutes for drugs such as Prestarium A, which contain arginine in addition to perindopril, the analogs listed above are also suitable for replacing them.

Cheap analogues of "Perindopril" that do not contain perindopril

If substitute medicines are identical both in composition and in their effect on the patient's body, then other similar medicines may contain other components, but be characterized by the same effect in the treatment of heart failure and arterial hypertension.

For example, the drug Lisinopril is an analogue of Perindopril, which contains an active substance that is similar in action to perindopril - lisinopril. This is also a remedy from the group of ACE inhibitors.

The average cost of this analogue is 200 rubles. It is also available in the form of tablets. You can also find in pharmacies the medicine "Lizinopril" of Ukrainian production, German or Israeli. Buyers give preference to a drug manufactured in Germany.

This remedy is ideal for obese and diabetic people who find it very difficult to find drugs to lower blood pressure, since many of them have a large list of side effects that are life-threatening for such patients.

The drug "Lizinopril" is widely used in the treatment of patients with pathological diseases of the heart and vascular system.

Of course, this remedy, along with its advantages, also has disadvantages, it can cause dizziness, nausea, dry cough, diarrhea.

The drug is contraindicated for use in diseases of the kidneys and liver, during pregnancy, breastfeeding, children under 18 years of age, with hereditary Quincke's edema, with intolerance to lisinopril and other components of the drug.

Choosing analogues for the drug "Perindopril", you can also stop at the drug "Enalapril". Its composition includes a substance similar in effect on the body of a patient with perindopril, enalapril maleate. This medicine is also an ACE inhibitor, therefore, lowers blood pressure and at the same time reduces the workload on the heart, preventing the complex consequences of hypertension.

The medicine is produced in Serbia, Macedonia. The drug has established itself in medical practice as reliable. Release form - tablets. The cost of one package of pills is from 100 to 200 rubles.

It is necessary to pay attention to the fact that this drug is contraindicated in diabetes mellitus, pregnancy, renal and hepatic insufficiency, breastfeeding, and is not intended for the treatment of children.

May cause the following side effects: dizziness, asthenia, skin rash and itching, fatigue, drowsiness, anxiety, dry cough. Also, this drug can cause a sharp decrease in pressure, so its intake should be accompanied by the supervision of the attending doctor, since the wrong dose can cause an overdose, therefore, a deterioration in the patient's condition.

There are many substitutes for the drug "Perindopril". Analogues of the drug can also be selected from the group of ACE inhibitors containing in their composition the active substance captopril, similar to perindopril. This is the drug "Captopril", which is applicable in the treatment of arterial hypertension, coronary heart disease and heart failure.

The drug is produced in Slovenia and Ukraine. The average cost of this medicine is 300 rubles.

The drug "Capotopril" is not prescribed during pregnancy, lactation, children under 18 years of age, with severe dysfunction of the kidneys and liver, cardiogenic shock, in the presence of obstructions in the outflow of blood from the left ventricle of the heart, Quincke's edema.

This medicine may also cause side effects such as blurred vision, fatigue, headaches, thrombocytopenia, decreased appetite, stomatitis, pruritus, tachycardia, acidosis.

Before using cheap analogues of the drug "Perindopril", you should carefully study the instructions for them. Only the attending physician should prescribe them. Each of them has its own list of side effects and a list of contraindications that should not be underestimated.

The treatment of hypertension is not simple, each patient has his own tendency to tolerate one or another component of medicines, and it is not so easy to choose the right drug that will not cause discomfort during treatment.

It is possible to choose an individual therapeutic agent only by testing drugs.

"Noliprel", "Co-Pyreneva": perindopril + indapamide

For many patients, taking only the Perindopril medication is not sufficient to normalize the pressure, the therapy is supplemented with several more effective means. To facilitate the work of doctors, pharmacists have created combined preparations with the basis of perindopril.

So, perindopril + perindopril with an increased effect on the patient's body are composed of such as "Noriprel" and "Co-Pyreneva". Naturally, combined preparations are more expensive than pure perindopril. The cost of the drug "Noriprel" (perindopril + arginine + indapamide) is 800 rubles, the drug "Co-Pyreneva" (perindopril + erbumine + indapamide) - 650 rubles.

Cheaper, containing indapamide and perindopril, analogues-synonyms from the group of combined drugs: tablets "Prilamid" costing from 200 to 400 rubles, tablets "Co-Prenessa" - 400 rubles, "Perindid" - 300 rubles. The difference in price, as you can see, is palpable.

The combination "perindopril plus indapamide" analogs can also be selected from the group of combined ACE inhibitors, which include other active substances. For example, Ampril Hd tablets (ramipril + hydrochlorothiazide) cost 400 rubles, and similar Euroramipril tablets cost 200 rubles.

Medicines "Prestans", "Dalneva": perindopril + amlodipine

On indapamide, the experiments did not end, because perindopril shows its effect very well in combination with amlodipine. Recently, the combined preparations Prestans (perindopril + arginine + amlodipine) have appeared, their cost ranges from 700 to 900 rubles, and Dalneva (perindopril + erbumine + amlodipine) - 500 rubles.

Which of the drug combinations is suitable for the patient, only the doctor knows, who has before his eyes a picture of the diagnosis after a thorough examination of the patient. If you need to choose cheaper analogues for the drug "Perindopril", then the attending physician also deals with this task, since only he can evaluate in practice the effectiveness of the action of a particular drug.

The drug perindopril is prescribed to patients with hypertension or heart failure. In some cases, it is prescribed for ischemic heart disease. The drug class is an ACE inhibitor. Often, the medication is prescribed for type 2 diabetes and for pressure surges in elderly patients.

In the original, the medication has a name - Prestarium. An equally effective analogue is being produced - Perinev. In the review, we will consider contraindications, prescriptions and dosage of the drug in more detail.

Description of the medication

Perindopril is produced by various companies, but two are most famous: KRKA (Russia) and Servier (manufactured in Russia using French technologies). The composition of the drug is the same, but differs in the degree of purification. It is believed that the French medicine has fewer additives, therefore it is more effective. This version has not been scientifically confirmed.

Both manufacturers pack tablets in contour cells and place them in a cardboard box. There can be 90 or 60 pieces in a carton. tablets. From above the pack has control of the first opening. Additional protection is needed to avoid re-sorting by expiration date and fakes.

The medication should be stored at normal room temperature. The expiration date of the tablets is indicated on the package, the standard is two years. After the expiration date, the effectiveness of the drug falls, you should not take expired tablets.

Pharmacology

The drug belongs to the group of angiotensin-converting enzyme inhibitors, abbreviated as ACE. In the patient's body, after taking the drug, the metabolite perindoprilat is formed. When exposed to the body, the process of converting angiotensin 1 to 2 slows down. The process is due to a sharp compression of blood vessels.

In the blood plasma, the content of angiotensin II decreases and the vessels gradually expand. The load on the heart muscle decreases and the minute volume of the heart increases. The decrease in blood pressure occurs within the first hour after taking the drug.

The maximum effect of the drug occurs within 4-6 hours after ingestion, the substance acts within one day. Therefore, the tablets are drunk once a day, and the dosage is determined individually by the doctor.

During metabolic processes in the patient's body, 20% of active perindopril and about 5% of inactive bonds are formed. The drug is excreted from the body through the kidneys. When the drug is taken with food, the effect of the components on the body slows down.

In elderly patients with cardiovascular insufficiency, the components of the drug are excreted from the body longer. With slow output, the components still have a cumulative effect.

Purpose

The drug is prescribed to patients suffering from the following ailments:

• Arterial hypertension;
• Ischemic heart disease;
• Heart failure in a chronic form;
• As a prophylactic for patients after the first stroke.

The drug is prescribed as a quick and effective remedy for high blood pressure, even for people with diseased kidneys.

For patients after a stroke or suffering from ischemic attacks, perindopril is prescribed in combination with diuretics. Regular use according to the scheme prescribed by the doctor reduces the likelihood of a second stroke by 75%.

Hypertensive crises often occur against the background of type 2 or type 1 diabetes. Perindopril is safe for any type of diabetes, as it increases insulin sensitivity and speeds up metabolic processes. It is often prescribed simultaneously with various medications to maintain the functioning of the cardiovascular system.

And also the drug reduces dementia in the elderly. Older people, taking perindopril, stay sane longer, have a clear mind and more easily concentrate on trifles. Due to the effect within 24 hours, the drug is well tolerated by a weakened body.

Do not take the drug as an ambulance when you need to quickly relieve high blood pressure. It is impossible to stop a hypertensive crisis with lightning speed with the help of perindopril.

In what cases is it contraindicated

The main component of perindopril tablets is erbumine or arginine. As additional ingredients, the pill includes: lactose and starch in the form of a dry mixture, magnesium stearate, aspartame, acesulfame potassium. Components rarely cause a negative reaction from the patient's body. A mild dry cough may appear, but this disappears over time.

Perindopril is contraindicated in the following cases:

• During pregnancy;
• While breastfeeding a baby;
• Age under 18;
• Individual sensitivity to the components of the drug.

It is not contraindicated in patients with diabetes mellitus, elderly people suffering from renal insufficiency. But at the reception, tests are regularly given. With the manifestation of deterioration in the work of the kidneys, the drug is stopped, the patient immediately consults a doctor.

Particularly dangerous are the components of the drug for the fetus. It is better to stop taking it at the stage of planning a child. But if pregnancy occurs during the reception, it is recommended to immediately stop taking the medicine. If during pregnancy the tablet was accidentally swallowed, it is recommended to undergo an ultrasound scan and evaluate the development of the child: bone formation, kidney functionality.

The components of the drug easily pass into breast milk, so feeding the baby at the time of admission should be stopped.

Side effects

According to scientists, perindopril rarely causes side effects. But one in a hundred patients may experience the following symptoms:

1. Dizziness. It is possible to alleviate the condition by slowly taking a sitting position for 5-10 minutes. If the symptom occurs frequently, it is recommended to consult a doctor. You should not stop taking the medicine on your own;
2. Hacking cough. Gargling with a solution of soda or sea salt helps to alleviate the condition. If the symptom becomes more frequent, the medication is stopped immediately. The specialist prescribes an analogue or another drug;
3. Liquid stool. The appearance of diarrhea may be associated not only with the ingredients of the drug. Control the menu, no need to introduce new dishes, hot spices and dressings into the diet. The menu will help ease the condition. Drug treatment with activated charcoal is allowed;
4. Constipation. If hypertension manifests itself against the background of type 2 diabetes and is associated with excessive obesity, then it is recommended to follow a light vegetable diet;
5. Headaches of various nature. Do not stop taking perindopril if you experience prolonged pain. You can alleviate the condition with the help of an antispasmodic: nurofen, spasmalgon. Citramon is not recommended. In case of acute pain or aching of a prolonged nature, it is recommended to stop taking it and immediately consult a treating specialist;
6. Vision deteriorates, fog appears in the eyes. This symptom is associated with an overdose of perindopril. The pressure drops below the norm and the person feels weak. It is recommended to immediately consult a doctor and adjust the dosage of the drug. At the time of the appointment, it is worth refusing to drive a vehicle and perform work where clarity of action and focus on trifles are necessary;
7. Tinnitus or goosebumps. associated with pressure fluctuations. Rest and rest helps to alleviate the condition. It is not recommended to stop taking the tablets;
8. Skin rash, itching. The symptom is associated with an allergic reaction. Caused by the patient's intolerance to one of the components of the drug. The medication is stopped. Antihistamines will help alleviate the condition: Fenkarol, Zirtek, Tavegil. If swelling occurs, it is recommended to immediately call an ambulance;
9. Yellowing of the whites of the eyes. The symptom is associated with an overdose of the drug. The liver can not cope, and signs of jaundice appear: the white of the eye turns yellow, urine has a dark, almost brown color. If symptoms of jaundice appear, you should immediately contact a specialist.

If side symptoms appear, the doctor will definitely examine the patient and prescribe another drug. In some cases, it is necessary to adjust the dosage.

In each case, an individual decision is made related to the underlying disease of the patient, the complexity of side effects.

Medication dosage

The dosage of the drug is prescribed by the doctor, taking into account the characteristics of the patient:

• Age;
• underlying disease;
• Accompanying symptoms: the state of the kidneys, the level of blood pressure.

Pharmacology offers perindopril dosage of 10, 8, 4 and 5 mg. Depending on the dosage, the patient drinks 1 or ½ pills per day. Do not choose the dosage yourself, the medicine is prescribed only by specialists.

The tablet is drunk at the same time, more often in the morning before meals. The first week you can take the medicine at bedtime, as the following manifestations are possible: drowsiness, increased fatigue. But after a few days of using the drug, the patient's body adapts and the symptoms disappear.

When taken together with other drugs, the level of potassium in the patient's blood may increase. Hyperkalemia is life-threatening and the medication is stopped immediately.

The risk group includes the simultaneous administration of the following drugs with perindopril:

• Heparin-containing;
• Diuretics with potassium containing composition;
• Non-steroidal substances with anti-inflammatory effect;
• Substances containing potassium.

1. Reduce salt intake by 2-2.5 times;
2. Do not use potassium-containing analogues instead of salt;
3. Some dietary supplements contain potassium, so inform your healthcare professional about taking the safest drugs.

More detailed interaction with various drugs can be found in the instructions for use, which is in the box along with the tablets.

The drug should be taken every day, even if the pressure is normal and hypertension has receded. It is not recommended to increase or decrease the dosage on your own.

Reception of combined funds

Not always taking perindopril in its pure form gives the desired effectiveness. To enhance the effect, combined agents are prescribed or indapamidom or amlodipine are prescribed at the same time.

The effectiveness of the combined use of these drugs to reduce pressure from 100/160 mm Hg. column and above is proven by scientists in the year 200. Combined administration is suitable for patients of advanced age and those suffering from type 2 and type 1 diabetes mellitus.

Patients with complications of diseases of the cardiovascular system and those suffering from severe hypertension are prescribed simultaneously:, perindopril and.

To make it easier to take several drugs, pharmacology offers combined drugs:

• Noliprel. As part of indapamide and perindopril at the same time. The price of a pack is on average 900 rubles. An analogue of Ko-Perinev at a price of 700 rubles;
• Prestance. Contains perindopril and amlodipine. An analogue with the name Dalneva is being produced, which has a more acceptable cost. The cost in the pharmacy chain is from 570 rubles;
• Perineva. It contains both perindopril and erbumin. The average price is from 300 rubles.

Combined drugs allow the doctor to painlessly transfer the patient to taking several medications at once and enhance treatment.

Various and convenient dosages make it easy to switch to stronger pills. At the same time, the pill is taken once a day.

First aid for overdose

An overdose of perindopril is characterized by low blood pressure. In this case, the patient has additional symptoms:

• slight dizziness;
• Weakness;
• Increased heart rate;
• Anxiety appears;
• Irritation of the throat with dry cough and wheezing.

When the first signs of an overdose appear, the patient needs gastric lavage. You can do the procedure at home as follows:

1. Dilute 1 liter of a weak solution of potassium permanganate;
2. Give the patient a drink
3. By pressing the fingers on the root of the tongue, induce an emetic effect.

The procedure is repeated 1-2 times. Then it is recommended to drink a few tablets of activated charcoal or Smektu. In order for the blood to circulate better, it is recommended to put the victim on a flat surface, raise the legs with a roller. This will increase blood flow to the brain and heart. After providing first aid, an ambulance is immediately called.

In a hospital, the drug can be removed from the patient's blood using dialysis. Intravenous injections of sodium chloride (0.9%), catecholamines are prescribed.

How to replace an expensive drug?

Perindopril has many inexpensive and least effective analogues that are easy to find in the pharmacy chain of any city. The table below shows several analogues from various manufacturers:

Analogues do not always have the same effect and, unlike perindopril, may not be prescribed for diabetes and overweight. Therefore, it is not recommended to independently replace one medicine with another.

Instructions for use

Additional Information

Perindopril is a medicine for hypertension and heart failure. It is also prescribed for coronary heart disease. According to the classification, it belongs to ACE inhibitors. This drug is taken once a day at the dosage indicated by the doctor. Perindopril is often prescribed to elderly patients with hypertension, as well as to people who have type 2 diabetes. The original drug is called Prestarium, the analogue is Perineva. Indications for use, contraindications, dosage, side effects are described below. Real testimonials from patients are given. Learn in detail about the combined tablets perindopril + indapamide (, Ko-Perineva), perindopril + amlodipine (Prestans, Dalneva).

Drug card

Perindopril: instructions for use

pharmachologic effect	Perindopril belongs to the group of ACE inhibitors. It is a prodrug from which the active metabolite perindoprilat is formed in the body. Under the action of the drug, the conversion of angiotensin-I to angiotensin-II, which is a powerful vasoconstrictor, slows down. Vasodilating effect - due to the fact that the concentration of angiotensin-II in the blood plasma decreases. Increased cardiac output and exercise tolerance. Blood pressure drops within an hour after taking the medicine. The effect reaches a maximum by 4-8 hours and lasts throughout the day.
Pharmacokinetics	In the process of metabolism, it is transformed with the formation of an active metabolite - perindoprilat (about 20%) and 5 inactive compounds. The maximum plasma concentration of perindoprilat is reached between 3 and 5 hours after taking the tablet. The drug is excreted by the kidneys. If you take the pill with food, then its effect will slow down. In elderly patients, as well as in renal and heart failure, the excretion of perindoprilat slows down, but still it does not accumulate in the body.
Indications for use	The main indications are arterial hypertension, stable coronary heart disease, chronic heart failure. Also, the prevention of recurrent stroke - perindopril is the only ACE inhibitor that has such an indication for use. As a rule, in patients who have had a stroke or transient ischemic attack, this medicine is prescribed along with a diuretic medicine. Often perindopril is prescribed for hypertension in patients with type 1 and type 2 diabetes.

Read detailed articles about the treatment of diseases:

Watch also a video about the treatment of coronary artery disease and angina pectoris

Learn how to take control of heart failure

Dosage	Perindopril is taken 1/2 or 1 tablet once a day. This drug is available in the form of tablets with different dosages (see). Suitable pills are selected by the doctor. In this case, the doctor takes into account the patient's diagnosis, blood pressure indicators, how well the kidneys work. Do not prescribe your own dosage! Usually this drug is taken in the morning. In the first 1-3 days, you can take it at night, because at the beginning of treatment, fatigue, drowsiness may appear, and then the body adapts.
Side effects	The drug is usually well tolerated. Severe symptoms rarely occur. A common side effect is a dry cough. You should have regular blood and urine tests while you are taking this drug to check your kidney function. The level of creatinine in the blood may temporarily increase. The doctor will decide how serious it is. Read also "".
Contraindications	Contraindications - pregnancy, breastfeeding, childhood, hypersensitivity to ACE inhibitors. Are not contraindications - diabetes mellitus, renal failure, old age. Patients in these groups can be treated with perindopril. In this case, you need to regularly take blood and urine tests to monitor kidney function. If the test results worsen, tell the doctor and he will decide what to do.
Pregnancy and breastfeeding	All ACE inhibitors are contraindicated during pregnancy and during breastfeeding. If you are planning a pregnancy or realize you are pregnant, stop taking this medicine immediately. Because it can disrupt the development of the fetus. If a patient accidentally took the wrong pill during pregnancy, you should not panic, but do an ultrasound of the fetus, assess the condition of its skull bones and kidney function.
drug interaction	Some medicines, when taken with perindopril, can increase blood potassium levels too much. This is called hyperkalemia and can be deadly. Risky drugs - angiotensin II receptor antagonists, nonsteroidal anti-inflammatory drugs, heparin, potassium-sparing diuretics. Do not take medicines containing potassium. Do not eat salt substitutes containing potassium. Tell your doctor about all medications, herbs, and supplements you are taking. A detailed description of the drug interaction of perindopril - read the instructions for use, which is in the box with the medicine.
Overdose	An overdose causes an excessive decrease in blood pressure. Symptoms - shock, palpitations, dizziness, anxiety, cough. Treatment - gastric lavage, activated charcoal. To improve blood flow to the heart and brain, the patient is placed on his back with his legs elevated. Call an ambulance! Intravenous injections - 0.9% sodium chloride solution, catecholamines. Perindoprilat, the active metabolite of perindopril, can be removed from the body by dialysis.
Release form	30 and 90 tablets in a polypropylene bottle. The bottle is placed in a cardboard box. On the pack - control of the first opening.
Terms and conditions of storage	Special storage conditions are not required. Keep out of the reach of children. Shelf life - 2 years (perindopril erbumine), 3 years (perindopril arginine). Do not use after the expiry date stated on the packaging.
Compound	The active substance is perindopril arginine or perindopril erbumine. Excipients - acesulfame potassium, aspartame, magnesium stearate, anhydrous colloidal silicon dioxide, dry mixture of lactose and starch.

Prices for drugs whose active ingredient is perindopril

Prestarium - the original drug,

Perineva - analogue

Online pharmacy delivers in Moscow and Russia

Prices for combined tablets perindopril + indapamide

Name	Active ingredients	Number of tablets per pack	Price, rub
Noliprel A	Perindopril arginine 5 mg + indapamide 1.25 mg
Noliprel A B forte	Perindopril arginine 10 mg + indapamide 2.5 mg
Noliprel A	Perindopril arginine 2.5 mg + indapamide 0.625 mg
Ko-Perineva	Indapamide 1.25 mg + perindopril erbumine 4 mg
Ko-Perineva	Indapamide 2.5 mg + perindopril erbumine 8 mg
Ko-Perineva	Indapamide 0.625 mg + perindopril erbumine 2 mg
Ko-Perineva	Indapamide 1.25 mg + perindopril erbumine 4 mg, discount big pack

Prices for combination tablets perindopril + amlodipine

The use of perindopril

Perindopril is prescribed for the treatment of hypertension caused by any cause, including kidney problems. With stable coronary heart disease, this drug reduces the risk of a first and second heart attack. It is especially often prescribed to patients with type 2 diabetes. Perindopril is the only ACE inhibitor that has been shown to be effective in preventing recurrent stroke. It inhibits the development of senile dementia, allows patients to retain memory, clear thinking and concentration for longer.

Perindopril itself moderately lowers blood pressure, acts smoothly for 24 hours, and is usually well tolerated. In overweight people and diabetics, it increases the sensitivity of tissues to insulin, and has a beneficial effect on metabolism. Often, perindopril is used along with other medicines for hypertension and cardiovascular disease. This drug is not suitable in situations where you need to quickly lower the pressure, stop the hypertensive crisis.

Side effects: in detail

Perindopril is usually well tolerated, but sometimes causes side effects, like any other medication. Below is a table that you may find useful. The symptoms listed there are experienced by 1-10% of patients treated with this drug.

Side effects of perindopril	What to do
Dizziness, especially when standing up	Get up slowly from a sitting or lying position, do not rush. If you feel dizzy, sit down for a few minutes. If dizziness when standing up does not go away for several days, consult your doctor.
Dry cough	This is a common side effect that requires the abolition of perindopril. Instead, another drug is usually prescribed - an angiotensin-II receptor blocker. Contact your doctor.
Abdominal pain, indigestion, diarrhea	Eat simple foods that are easy to digest. For a while, give up hot spices, exotic dishes. Eat small meals, but more often.
Constipation	The site is promoting the site for the treatment of hypertension in obese people. This diet often causes constipation. How to fix a chair without taking harmful laxatives - the technique has been worked out. Read more "What to do if there is constipation".
Headache	If the headache is severe, see a doctor
Weakness, blurred vision	This side effect can occur if perindopril lowers blood pressure too much. Do not drive or do dangerous work until you feel better and your vision is clear.
Goosebumps, tinnitus, difficulty breathing, taste disturbances, rash, muscle cramps	These are rare but still possible side effects. If any of them cause you serious trouble, consult a doctor.

After a few days of taking the medicine, the body adapts and the side effects may subside. However, sometimes (rarely!) There are severe symptoms:

• Difficulty breathing, swelling of the face, mouth, tongue, or throat. These are signs of an allergic reaction.
• The skin or whites of the eyes turn yellow. Urine may darken. Jaundice is a rare but possible side effect.
• Severe rash on the skin.

If you experience any of the above, stop taking perindopril and contact your doctor as soon as possible.

Clinical Research Overview

Perindopril has a significant evidence base, on the basis of which its indications for use were formulated. The main studies were carried out in the 1990s - the first half of the 2000s. Below are three large international studies involving more than 29,000 patients. All of these studies were designed and conducted in such a way as to obtain reliable results.

The authors of the EUROPA study wanted to test how perindopril works in patients with coronary heart disease. The results of this study were published in 2003. It turned out that the drug reduces the risk of heart failure, has a beneficial effect on blood vessels and inhibits the development of atherosclerosis. The frequency of heart attacks decreases during treatment with this medicine, because the arteries that feed the heart are less likely to clog with blood clots. Atherosclerotic plaques remain stable and grow more slowly.

PROGRESS is a study that examined the effect of perindopril on the risk of recurrent stroke. 6105 patients who had already suffered a stroke participated. The results were published in 2001. The study drug reduced the rate of recurrent stroke, as well as all cardiovascular complications, by 26%. According to the results of the PROGRESS study, secondary prevention of stroke was added to the indications for the use of perindopril.

Pharmaceutical companies try to exaggerate the merits of their drugs and compromise the drugs of competitors. International clinical trials are being conducted to avoid this. Patients do not know whether they are taking real medicine or a dummy. Even doctors who give pills to patients do not know this. Such studies are called double-blind, placebo-controlled. Their results are considered reliable.

The ADVANCE study is the largest and was published in 2007. It proved that perindopril reduces the risk of death in patients with type 2 diabetes. The ACE inhibitor inhibited the development of vascular complications of diabetes along with the rest of the treatment that the patients received. Diabetics generally tolerate perindopril treatment well. This drug can be given with other blood pressure medications and blood sugar lowering pills.

A combined analysis of the EUROPA, PROGRESS, and ADVANCE studies was presented at the 2008 American Heart Association meeting. It has been confirmed that perindopril reduces the risk of cardiovascular complications in hypertension, including in diabetics. This drug reduced overall mortality by 11%, cardiovascular mortality and the risk of heart attack by 18%. It or another ACE inhibitor is advisable to prescribe to all patients who have a high cardiovascular risk.

perindopril arginine and its benefits

In Prestarium A tablets, the active substance is perindopril arginine. It is an ACE inhibitor linked to the amino acid arginine. In the name of the drug, A stands for arginine. Prior to the advent of the arginine salt, perindopril erbumine was used. Analogue preparations from other manufacturers (Perineva, KRKA) still contain erbumine salt. The new version with arginine has the advantage of increasing the shelf life of the tablets from 2 to 3 years. Otherwise, perindopril arginine and erbumine are one and the same.

The effectiveness of perindopril has been proven in numerous studies involving more than 50,000 patients. In most of these studies, patients were prescribed erbumine salt. Perindopril arginine entered the market in the second half of the 2000s. At first, doctors doubted that the new active substance would be as effective. Conducted clinical trials that proved that erbumine and arginine salts act the same way. Both versions of the tablets are enough to take 1 time per day. Each dose taken lasts 24 hours or longer.

Official recommendations allow prescribing perindopril in the form of both erbumine and arginine. Indications for use are the same. The choice of a particular medication is at the discretion of the doctor. Information about the effectiveness of various drugs that doctors accumulate from their practical experience play a role. Analogues are cheaper than the original drug Prestarium. Articles in medical journals promote Perinev's tablets for the treatment of elderly patients who need affordable drugs.

Combined drugs

For most patients, a single antihypertensive drug is not enough to bring the pressure down to normal. If the pressure is 160/100 mm Hg. Art. and above, then two drugs are usually immediately prescribed for simultaneous administration. In severe cases, combinations of 3-4 antihypertensive drugs can be taken. Perindopril is most often prescribed with or. The effectiveness of such combinations has been confirmed by the results of large studies, which are described below. Combined drugs based on perindopril are effective and safe for patients with type 2 diabetes mellitus, as well as for other categories of patients.

If the patient has severe hypertension and a high cardiovascular risk, then perindopril, indapamide and amlodipine may be prescribed to him at the same time. The effectiveness and good tolerability of this triple combination has been proven by the results of studies conducted in English-speaking countries and in Russia. And if the simultaneous intake of 3-4 drugs for pressure does not help, then the method of sympathetic denervation of the renal arteries is used.

See for example the article "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 (PRACTICE study)". Authors - Sirenko Yu.N., Mankovsky B.N., Radchenko A.D., Kushnir S.N., journal "Arterial hypertension" No. 4/2012.

Noliprel is a combined tablet containing perindopril and indapamide. If Noliprel at the maximum dose did not help enough, then amlodipine was added to it. The study lasted 3 months. A combination of three antihypertensive medications kept my blood pressure below 140/90 mmHg. Art. in 74.8% of patients. In the group of patients with type 2 diabetes, blood pressure is below 135/85 mm Hg. Art. reached 62.4% of study participants.

Perindopril + amlodipine - medicine Prestans

The combination of drugs perindopril + amlodipine is widely used in the West and in Russian-speaking countries to treat hypertension and reduce the risk of cardiovascular complications. It is theoretically substantiated and proved to be effective in practice. A popular medicine that contains perindopril and amlodipine is Prestanz. He also has an analogue of Dalnev, more affordable.

After Prestans entered the Russian market, the Russian Medical Society for Arterial Hypertension (RMOAH) initiated the BREAKTHROUGH program - "Prestans in the treatment of uncontrolled arterial hypertension - a real chance in improving blood pressure control." This is a large study in which 4115 patients took part. It confirmed the high efficacy of the combination of perindopril and amlodipine. According to some reports, this combination reduces blood pressure by 33/20 mm Hg. Art, according to others - by 36/17 mm Hg. Art. About 80% of patients reach the target level of blood pressure, while the treatment is well tolerated.

Combination tablets containing perindopril and amlodipine greatly lower blood pressure and are well tolerated. If amlodipine causes swelling of the legs, then it is replaced with lercanidipine.

The drug Prestans is available in four versions, with different doses of active ingredients. This provides the clinician with sufficient flexibility in selecting the optimal dosage for the patient. If necessary, the patient can be transferred from weak tablets to more powerful ones. In severe cases, a third and even a fourth blood pressure medicine is added. In particular, patients diagnosed with coronary heart disease are also prescribed beta-blockers.

Perindopril + indapamide - drug Noliprel

The combination of perindopril and indapamide is popular because it significantly lowers blood pressure, reduces the risk of death from all causes, as well as the likelihood of heart attack and stroke. In this case, the treatment is usually well tolerated. The main category of patients who are prescribed perindopril and indapamide together are obese patients with hypertension who have metabolic syndrome or type 2 diabetes. Also, this drug combination is recommended for older people who have isolated systolic hypertension.

Patients are more comfortable taking perindopril and indapamide when both of these drugs are contained in one tablet. Such drugs are Noliprel and its analogue Ko-Perinev. The large international study ADVANCE involved 11,140 patients with hypertension and type 2 diabetes. The results were published in 2007. Noliprel in patients with type 2 diabetes reduced overall mortality by 14%, and the risk of death from cardiovascular diseases by 18%, compared with placebo.

Combination medicines for hypertension containing perindopril and indapamide are often prescribed for patients with type 2 diabetes.

The drug Noliprel is available in three varieties, and Ko-Perinev - in four, with different dosages of active ingredients. If necessary, the doctor can transfer the patient from weak tablets to stronger ones, which also need to be taken 1 time per day. If necessary, amlodipine can be added as a third drug. Complications of diabetes in the kidneys are not contraindications to the appointment of Noliprel, but the patient needs to take blood tests for creatinine and urine for protein more often.

Patient reviews

Perindopril is not a very powerful medicine for pressure, and patients note this in their reviews. But it acts gently and rarely causes side effects, except for a dry cough.

Olga Larina

I have been taking perindopril erbumine (Perineva) for 3 months now. A month after the start of treatment, my blood pressure leveled off within a day, it stays no higher than 130/80 mm Hg. Art. And before every day it rose in the evening.

You were lucky to find a cure. Please note that it does not eliminate the causes of the disease, but only muffles the symptoms. Hypertension is caused by an unhealthy lifestyle. It gradually destroys blood vessels. If you continue in the same spirit, in a few years the condition of the vessels will worsen. More and more powerful pills will be needed. In the end, and they will not be able to control the pressure. Normalize your lifestyle in middle age if you still want to live in retirement.

Artem Kruzhalov

The cardiologist prescribed me perindopril. I have been on this medication for 4 months now. Usually the pressure is not higher than 130/85 mm Hg. Art. But when the weather changes, it rises, despite taking the pills. It reaches 170/110 mm Hg. Art., headache and other symptoms. I want to switch to some other drug, stronger.

Study the article "", then examine and follow the recommendations. The transition to a healthy lifestyle is the main treatment for hypertension. And any pills only complement it. You can continue to lead a sedentary lifestyle and eat garbage. But in this case, after a few years, no medication will be able to take your pressure under control. This can happen even before retirement. And what will you do then?

Larisa Radchenko

I took perindopril for hypertension for six months. These tablets kept the pressure well, there was never a sharp increase. But he had a constant cough. The doctor said to switch to Losartan and add a diuretic. Now I'm starting treatment with a new drug. How good such a replacement will be - I do not know yet.

The drug Losartan belongs to the group. If perindopril causes a dry cough, then these medicines are usually prescribed instead of him. How well a new drug will help cannot be predicted in advance. At the moment, pressure pills are selected by trial and error, because there is no more accurate way. Each patient has their own individual reaction. Over time, genetic research will make it possible to accurately predict, but this is still a long way off.

Frequently Asked Questions and Answers

What to do if perindopril does not lower blood pressure enough? Adding other drugs to it also does not help much. What pills for hypertension are the most effective?

Blood pressure drops quickly and strongly if you take 2-3 medicines at the same time. Now most often prescribe drugs that contain 2-3 active ingredients in one tablet. Read more "". However, drugs do not eliminate the cause of the disease, but only muffle the symptoms. If you continue to lead an unhealthy lifestyle, then after a few years the condition of the vessels will worsen. In the end, even the most powerful pills will not be able to control the pressure. Study the article "". Be examined and follow the recommendations that are outlined in it, in addition to taking medications.

The doctor prescribed perindopril 4 mg one tablet per day. Can I take 1/2 tablet in the morning and evening?

This medication is recommended to be taken once a day. What will happen if the daily dose is divided into 2 doses - there is no data. Taking the medicine once a day is convenient. Each dose is effective for 24 hours or longer. Therefore, it makes no sense to divide it into two doses.

Do I need to take breaks in taking these pills?

Perindopril should be taken every day, without interruption, even when your blood pressure is normal. If the effect of the drug weakens, discuss with your doctor what other drugs can be added. It is impossible to stop taking or replace pills without permission. It is also necessary to carry out activities for the transition to a healthy lifestyle.

For several years I have been taking perindopril for hypertension, also glycine, and Okumed (timolol) eye drops for glaucoma. Recently I was transferred to Prestarium A (perindopril arginine). There were side effects - the face was swollen and covered with a rash. Could this be a reaction to arginine? Should I switch to perindopril without arginine (Perinev)? Or stop ACE inhibitors altogether?

What caused the side effects you describe is hard to say. It is unlikely that this is arginine, because its pressure pills contain an insignificant dose. This amino acid needs to be taken 100-200 times more in order for it to somehow work. First of all, it is worth suspecting an allergy. normalizes blood pressure and excludes most allergens from food, except for chicken eggs. It's a good idea to get tested to find out what foods and chemicals you're allergic to, and get blood tests done for liver function tests. Together with your doctor, try to cancel or replace some medications - and evaluate the effect in 1-2 weeks.

Noliprel helps me with hypertension. Can it be replaced with two separate tablets of perindopril and indapamide? The reason - Noliprel became unaffordable.

Noliprel is a combination medicine that contains perindopril and indapamide in one tablet. It has proven itself well, but this is an original drug, not very cheap. Replace with two separate tablets - after all, you will not use the original preparations Prestarium and Arifon retard, but cheaper analogues. How effective they will be is impossible to predict. Try it and find out. Manufacturers claim that analogues work no worse than original drugs. But this is not always true.

They prescribed Prestans (perindopril + amlodipine) and Arifon retard for hypertension. The pressure is well lowered, but swelling of the legs is disturbing. I assume it's from amlodipine. Can amlodipine be substituted for lercanidipine, which has less swelling?

Is it possible to replace amlodipine with lercanidipine - yes, but check with your doctor. Be prepared that you will have to take 3 separate tablets every day. Pay attention to taurine from edema. Read also the detailed article "". It presents data from studies on how much lercanidipine reduces edema compared to amlodipine.

Proven effective and cost-effective blood pressure supplements:

Read more about the methodology in the article "". How to Order Hypertension Supplements from the USA - . Get your blood pressure back to normal without the harmful side effects that Noliprel and other "chemical" pills cause. Improve heart function. Become calmer, get rid of anxiety, sleep like a baby at night. Magnesium with vitamin B6 works wonders for hypertension. You will have excellent health, to the envy of your peers.

After a stroke, my father was prescribed to take perindopril, indapamide, amlodipine and also vinpocetine. Confused in the appointment of the dosage of perindopril 10 mg. Isn't this a typo? The instructions for the drug say the maximum daily dose of 8 mg.

Perindopril comes in the form of one of two salts - arginine or erbumine. The maximum daily dose of 8 mg is for erbumine salt. Your father has been prescribed tablets containing perindopril arginine. It is taken at 5 or 10 mg per day. So there is no typo, everything is correct.

conclusions

After reading the article, you have learned everything you need about the drug perindopril, which is prescribed for hypertension and cardiovascular diseases. Above is an instruction for the use of this drug, adapted for patients who do not have a medical education. Indications for use and dosages for various diseases are described in detail. Pay attention also to contraindications and interactions with other drugs. Perindopril acts gently, side effects are relatively rare. For hypertension, it is usually prescribed along with other drugs. Most often it is (combined tablets Noliprel) and (tablets Prestans).

Manufacturers inflate the benefits of perindopril over other ACE inhibitors. For this, paid articles are published in medical journals. But in practice, the benefits are not very noticeable. If you need to save money, then perindopril is replaced with other ACE inhibitors, cheaper, which can be taken 1 time per day. The most commonly prescribed are enalapril, lisinopril or ramipril. It is impossible to carry out such a replacement without permission, it must be agreed with the doctor. No pressure pills can replace the transition to a healthy lifestyle - good nutrition, physical activity, stress reduction.

1. Larisa

   I am 44 years old, 163 cm tall and weigh 90 kg. I suffer from hypertension of the 2nd degree. I take perindopril arginine 10 mg once a day. The pressure became 140/80. Can you please tell me if this is a big dose? It seems such a large dose, as if I have 4 degrees of hypertension. Nothing else has been assigned. And how long can this medicine be taken? At this dose? Can the pressure stabilize and should I take a maintenance dose?

2. Andrey

   I am 51 years old. Height 176 cm, weight 95 kg. I don't know about other diseases besides hypertension. I tried Enalapril on my own - the pressure from 180/100 decreased slightly and I was tormented by a strong cough. Refused. Now I drink perindopril arginine 10 mg once a day in the morning + Cardiomagnyl. The pressure became 130-140 / 85-90. By the afternoon it is below 120/80, but by the evening it grows. Cough, though less than from Enalapril, but already got it. You don't go to doctors. Can you recommend another drug that has fewer side effects?

3. Valery

   51 years old, 175 cm, 85 kg, urolithiasis.
   I have been taking perindopril (Perineva) for 5 years. Does this drug affect potency?

4. dena

   I am 57 years old, height 156 cm, weight 75 kg, high blood pressure for 12 years. She was treated with enalapril, there were two crises with a pressure of 220/140, now she began to drink Perineva in the morning, concor, amlodipine at night. Legs swell, shoes do not fit. What to do? This treatment was prescribed by a doctor from cardiology. Kidneys and heart within the age norm. We don't have a cardiologist, we have to go to the city of Saratov. I didn’t take amlodipine for a day, but the swelling remained, diuretics do not help.

5. Yuri

   I am 40 years old, height 180, weight 74. I live in the tropics. Until recently, I was hypotensive. Recently there was a period of two weeks when I lived in difficult conditions. He ate exclusively raw mackerel with bread, kept in weak brine for five days, and oranges with tangerines - they grew there. And drank moonshine. Didn't use anything else. He got a little cold, but he didn't get sick. I moved a little more than usual, there were no loads. When I returned home, my blood pressure increased and has not dropped for two months. Could the pressure have risen from those two weeks spent in such conditions? The climate hasn't changed.
   I ask because I need to go there again and I may find myself in the same conditions.
   Regards, Yuri.

6. Yuri

   Good afternoon. thanks for the information provided. Please tell me the following:
   My mother probably has more than type 2 diabetes, we inject insulin from time to time, and so we drink Repodiab.
   The pressure lately is 140-150/80, and as the evening comes - 180-200/80. Mom drinks in the morning Concor, indapamide and Lozap, in the afternoon an additional dose of Lozap, but it does not help. According to the latest tests, creatinine has risen to 177, which is a lot. I'm afraid it's because of the vine. And so the tests are in order and liver tests and cholesterol and so on, with the exception of ESR. I’m thinking about switching to co-preness or co-diroton. Tell me, please, which is better? I understand that I need to see a cardiologist, but still ... weight 52 kg, height 150 cm, age 72. Diabetic nephropathy is diagnosed due to diabetes.
   Regards, Yuri.

7. Karlygash

   Good afternoon. I'm 36 years old. Height 160 cm, weight 68 kg. I suffer from hypertension since the age of 25, the first rise in pressure occurred during childbirth. After examination of the whole body, no pathologies were found. They put the VVD, appointed Arifon. I did not take medicine all the time, because I moved to another country, where the climate suited me more and the pressure did not torment me so much. After returning home (I live in a mountainous area), headaches began to bother me, up to nausea and vomiting. I went to the doctor, who diagnosed hypertension of the 2nd degree and prescribed perindopril. The heart was in order, the kidneys - pyelonephritis. This year, after a morning burning sensation in the region of the heart, I measured the pressure of 200/125. The doctor examined: heart-hypertrophy of the left ventricle. Kidney-pyelonephritis, urolithiasis. ZhKB. Checked all the vessels - excellent condition. Blood and urine tests are normal. Cholesterol, triglycerides as well as TSH, T3, T4 are normal. The diagnosis is already hypertension grade 3 risk 4. I don't smoke, I don't drink, I lead an active lifestyle, training daily for 1.5 hours of high activity. With this lifestyle, the pressure nevertheless progresses and already affects the target organs, which is doubly offensive. Now I take Lozap in the morning and in the evening, concor, cardiomagnyl. The pressure on the pills became 120/80, even fly into space. Tell me - is it likely that following your instructions it will be possible to get away from taking chemicals? Since there is no objective reason other than psychological (pressure rises after severe stress)?

8. Tatyana

   Hello! I have this question: I drink perindopril arginine, but now there is no such finance, everything has become very expensive! Can you advise me if I can replace it with something similar? I am 49 years old, I have problems with the thyroid gland - nodes. I also take Diaformin tablets. There are headaches, mostly when the weather changes. Thanks in advance for your reply.

9. Gennady

   Hello. I am 52 years old, weight 97 kg, height 180 cm. In March 2014, I suffered a mild stroke. Nothing was found on the tomogram. Previously, there was a pressure of 140-150 over 90. After a stroke, I take prestarium, the pressure became 120 over 80, sometimes even lower. But for the last 3 weeks I have been waking up at about 8 am from internal anxiety - it turned out that in the morning the pressure was again 150-140 to 80. I take prestarium - and in an hour everything is normal. Advise, please, maybe something to take in the evening?

10. Victor

    57 years old, height 164, weight 78 kg.
    In addition to hypertension of the 2nd degree, nothing was found.
    Medicines: in the evening perindopril arginine and concor + cardiomagnyl.
    Slightly high cholesterol.
    In the morning the pressure is normal, in the evening from 9 pm to 11 pm it rises to 150-160/80 once every 2 weeks.

11. Gennady

    66 years old, 175 cm, blood pressure 160/100, weight 95 kg. I take perindopril - there is practically no effect. Previously, he took Enap - the pressure decreased, but perindopril does not help. Analyzes, including sugar, are normal.

12. Svetlana Kalinichenko

    My blood pressure is usually 100/70, rarely rising to 140/90 when kidney stones come out. Last night it jumped to 200/130. They called an ambulance. She was prescribed to take perindopril and indapamide daily. Now my blood pressure has dropped to the usual 100/70. Do I need to continue taking these pills? When the weather changes, my blood pressure often drops, and my heart rate rises to 75-80 beats per minute. When the weather improves, everything returns to normal. Last night, when the pressure jumped, my pulse was 106, tachycardia. I am 53 years old, height 164 cm, weight 68 kg. Thanks in advance for your reply.

13. Ludmila

    I am 66 years old. Height 158 ​​cm, weight 80 kg. Hypertension for over 30 years. She suffered an ischemic stroke in 2010. I am on losartan and indapamide tablets. I also take aspirin cardio and simvastatin. But the pressure constantly jumps to 210/120. Now I read about perindopril. Maybe switch to it? I went to a cardiologist, but in our hospital they say that I have this age and hereditary. My mother had a stroke and was in bed for 20 years.

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or, conversely, criticize the quality of the site materials Dosage form:  film-coated tablets Compound:

1 tablet contains: active substance perindopril tosylate 2.50 mg/5.00 mg/10.00 mg; Excipients: lactose monohydrate 35.981 mg / 71.962 mg / 143.924 mg; corn starch 1.35 mg / 2.70 mg / 5.40 mg; sodium bicarbonate 0.793 mg / 1.586 mg / 3.172 mg; pregelatinized corn starch 3.60 mg / 7.20 mg / 14.40 mg; povidone-KZO 0.90 mg / 1.80 mg / 3.60 mg; magnesium stearate 0.45 mg / 0.90 mg / 1.80 mg;

shell for 2.5 mg tablets: OpadryIIwhite 85F18422 (polyvinyl alcohol partially hydrolyzed 0.9000 mg; titanium dioxide (13171) 0.5625 mg; macrogol-3350 0.4545 mg; talc 0.3330 mg);

shell for 5 mg tablets: OpadryIIgreen85 F210014 (polyvinyl alcohol partially hydrolyzed 1.8000 mg; titanium dioxide (E171) 1.0935 mg; macrogol-3350 0.9090 mg; talc 0.6660 mg; indigo carmip (K 132) 0.0144 mg: brilliant blue dye (E133) 0.0081 mg; yellow iron oxide dye (13172) 0.0045 mg, quinoline yellow dye (E104) 0.0045 mg);

shell for 10 mg tablets: OpadryIIgreen85 F2 J0013 (polyvinyl alcohol partially hydrolyzed 3.6000 mg; titanium dioxide (E171) 2.1330 mg; macrogol-3350 1.8180 mg; talc 1.3320 mg; indigo carmip (E132) 0.0495 mg; brilliant blue dye (E13.3) 0.0315 mg; iron oxide yellow dye (E172) 0.0180 mg; dye quinoline yellow (EL 04) 0.0180 mg).

Description:

Tablets 2.5 mg. Round, biconvex, white film-coated tablets. On one side - engraved "T". On a transverse section, the core is white or almost white.

Tablets 5 mg. Light green, oval, biconvex, film-coated tablets with a decorative score along the edge of the tablet on both sides. On one side is engraved "T". On a transverse section, the core is white or almost white.

Tablets 10 mg. Round, biconvex, green film-coated tablets. On one side - engraved "10", on the other - "T". On a transverse section, the core is white or almost white.

Pharmacotherapeutic group:angiotensin-converting enzyme (ACE) inhibitor. ATX:  

C.09.A.A.04 Perindopril

Pharmacodynamics:

Perindopril is an angiotensin-converting enzyme (ACE) inhibitor. ACE, or kininase, is an exopeptidase that converts angiotensin 1 into the vasoconstrictor angiotensin II, as well as the destruction of bradykinin, which has a vasodilating effect, to an inactive heptapeptide.

Suppression of ACE activity leads to a decrease in the concentration of angiotensin II in the blood plasma, as a result of which the activity of renin in the blood plasma increases (due to the inhibition of negative feedback, which prevents the release of renin) and the secretion of aldosterone decreases. Since ACE inactivates bradykinin, ACE suppression is accompanied by an increase in the activity of both the circulating and tissue kallikrein-kinin systems, while the prostaglandin system is activated. It is possible that this effect is part of the mechanism of the antihypertensive action of ACE inhibitors. as well as the mechanism of development of some undesirable reactions of drugs in this group (for example, cough).

Perindopril has a therapeutic effect due to the active metabolite, perindoprilat. Other metabolites of the drug do not have an inhibitory effect on ACEinvitro.

Arterial hypertension

With arterial hypertension on the background of the use of perindonril, there is a decrease in both systolic and diastolic blood pressure (BP) in the "lying" and "standing" positions. reduces total peripheral vascular resistance (OPSS), which leads to a decrease in blood pressure. At the same time, peripheral blood flow is accelerated, but the heart rate (HR) does not increase. Renal blood flow usually increases while glomerular filtration rate does not change. The maximum antihypertensive effect is achieved 4-6 hours after a single oral administration of perindonril; the antihypertensive effect persists for 24 hours, and after 24 hours the drug still provides from 87% to 100% of the maximum effect. The reduction in blood pressure is achieved fairly quickly. Stabilization of the antihypertensive effect is observed after 1 month of therapy and persists for a long time.Termination of therapy is not accompanied by a "withdrawal" syndrome.

Perindopril has a vasodilating effect, helps to restore the elasticity of large arteries and the structure of the vascular wall of small arteries, and also reduces left ventricular hypertrophy. Simultaneous administration of thiazide diuretics enhances the antihypertensive effect. In addition, the combination of an ACE inhibitor and a thiazide diuretic also reduces the risk of hypokalismia while taking diuretics.

Chronic heart failure(XCH)

Perindopril normalizes the work of the heart, reducing preload and afterload. In patients with CHF who received , there was a decrease in filling pressure in the left and right ventricles of the heart, a decrease in peripheral vascular resistance, an increase in cardiac output and an increase in cardiac index.

Cerebrovascular diseases

When using perindopril tertbutylamine 2-4 mg / day (equivalent to 2.5-5 mg perindopril arginine or perindopril tosylate) both in monotherapy and in combination with indapamide, simultaneously with standard therapy for stroke and / or arterial hypertension or other pathological conditions, in patients with a history of cerebrovascular disease (stroke or transient ischemic attack) over the past 5 years, the risk of recurrent stroke (both ischemic and hemorrhagic nature) is significantly reduced. Additionally, the risk of developing fatal or disabling strokes is reduced; major cardiovascular complications, including myocardial infarction, incl. fatal; stroke-related dementia; severe cognitive impairment.

These therapeutic benefits are seen in both hypertensive and normal BP patients. regardless of age, gender, presence or absence of diabetes and type of stroke.

Stable coronary heart disease (CHD)

Therapy with perindopril tertbutylamine 8 mg (equivalent to K) mg of perindopril arginine or perindopril tosylate) in patients with stable coronary heart disease without signs of heart failure, with a history of myocardial infarction and coronary revascularization in history, while using with antiplatelet agents,lipid-lowering drugs and beta-blockers leads to a significant reduction in the absolute risk of the primary endpoint (cardiovascular death, non-fatal myocardial infarction and / or cardiac arrest followed by successful resuscitation).

Pharmacokinetics:

Use of eplerenone or spironolactone at doses of 12.5 mg to 50 mg per day and low doses of ACE inhibitors:

In the treatment of heart failure II - IV functional class according to the NYMA classification with left ventricular ejection fraction< 40% и ранее применявшимися ингибиторами АПФ и "петлевыми" диуретиками, существует риск гиперкалиемии (с возможным летальным исходом), особенно в случае несоблюдения рекомендаций относительно этой комбинации препаратов.

Before using this combination of drugs, you need to make sure that there is no hypercalysmia and impaired renal function. It is recommended to regularly monitor the concentration of creatinine and potassium in the blood: weekly in the first month of treatment and monthly thereafter. NSAIDs. including high doses of acetylsalicylic acid (more than 3 g / day).

With the simultaneous use of lithium preparations and AG1F inhibitors, a reversible increase in the content of lithium in the blood serum and lithium toxicity may develop. The simultaneous use of ACE inhibitors with thiazide diuretics can further increase the content of lithium in the blood serum and increase the risk of developing its toxic effects. Simultaneous use of the drug Psrindopril-Tsva and lithium preparations is not recommended. If necessary, such a combination therapy is carried out under regular monitoring of the content of lithium in the blood serum. Non-steroidal anti-inflammatory drugs (NSAIDs), including doses of 3 g/day or more

Therapy with PPVG1 may weaken the antihypertensive effect of ACE inhibitors. In addition, PPVP and ACE inhibitors have an additive effect in terms of increasing the content of potassium in the blood serum, which can provoke a deterioration in kidney function. This effect is usually reversible. In rare cases, acute renal failure may develop, especially in patients with pre-existing impaired night function, such as elderly patients or against the background of dehydration.

Other antihypertensives and vasodilators

Simultaneous use of the drug Perindopril-Teva with other antihypertensive drugs may enhance the antihypertensive effect of perindopril. The simultaneous use of nitroglycerin, other nitrates or vasodilators may lead to an additional antihypertensive effect.

Hypoglycemic agents

The simultaneous use of AI 1F inhibitors and hypoglycemic agents (insulin or oral hypoglycemic agents) can enhance the hypoglycemic effect, up to the development of hypoglycemia. As a rule, this phenomenon occurs in the first weeks of combination therapy in patients with renal insufficiency.

Acetylsalicylic acid, thrombolytic agents, beta-blockers and nitrates

The drug Perindopril-Teva can be combined with acetylsalicylic acid (as an antiplatelet agent), thrombolytic agents and beta-blockers and / or nitrates.

Tricyclic antidepressants/antipsychotics (neuroleptics)/general anesthetics (general anesthetics)

Simultaneous use with AP F inhibitors may lead to an increase in the antihypertensive effect.

Sympathomimetics

Sympathomimetics can weaken the anti-inflammatory effect of ACE inhibitors. When using such a combination, the effectiveness of ACE inhibitors should be regularly evaluated.

With simultaneous use with myelotoxic agents, it is possible to increase the myelotoxic effect.

Special instructions:

Special Instructions Stable coronary artery disease

With the development of an episode of unstable angina (significant or not) during the first month of therapy with Perindopril-Teva, it is necessary to evaluate the benefit / risk ratio for therapy with this drug.

Arterial hypotension

ACE inhibitors can cause a sharp drop in blood pressure. In patients with uncomplicated hypertension, symptomatic hypotension rarely occurs after the first dose. The risk of an excessive decrease in blood pressure is increased in patients with reduced BCC during diuretic therapy, with a strict salt-free diet, hemodialysis, as well as with diarrhea or vomiting, or with severe renin-dependent arterial hypertension. Severe arterial hypotension was observed in patients with severe CHF, both in the presence of concomitant renal insufficiency, and in the absence of it. Most often, severe arterial hypotension can develop in patients with more severe CHF, taking high doses of loop diuretics, as well as against the background of hyponatremia or renal failure. These patients are recommended careful medical supervision at the beginning of therapy and when titrating doses of the drug. The same applies to patients with coronary artery disease or cerebrovascular disease, in whom an excessive decrease in blood pressure can lead to myocardial infarction or cerebrovascular complications.

In the event of arterial hypotension, it is necessary to give the patient a horizontal position with raised legs, and, if necessary, inject 0.9% sodium chloride solution intravenously to increase BCC. Transient arterial hypotension is not a contraindication for further therapy. After the restoration of BCC and LD, treatment can be continued subject to careful selection of the dose of the drug.

In some patients with CHF and normal or low LD during therapy with Perindopril-Teva, an additional decrease in blood pressure may occur. This effect is expected and is usually not a reason to stop the drug. If arterial hypotension is accompanied by clinical manifestations, it may be necessary to reduce the dose or discontinue the drug -Teva Impaired kidney function

In patients with renal insufficiency (CC less than 60 ml / min), the initial dose of the drug Perindopril-Teva should be selected in accordance with the CC (see the section "Method of administration and dose") and then - depending on the therapeutic response. For such patients, regular monitoring of potassium content and serum creatinine concentration is necessary.

In patients with symptomatic heart failure, arterial hypotension that develops during the initial period of therapy with ACE inhibitors. may lead to deterioration of kidney function. These patients have occasionally experienced acute renal failure, which is usually reversible.

In some patients with bilateral renal artery stenosis or renal artery stenosis of a single kidney (especially in the presence of renal insufficiency), during therapy with ACE inhibitors, an increase in serum urea and creatinine concentrations was noted, reversible after discontinuation of therapy.

In patients with renovascular hypertension during therapy with ACE inhibitors, there is an increased risk of developing severe arterial hypotension and renal failure. Treatment of such patients should begin under close medical supervision, with small doses of the drug and with further adequate dose selection. During the first weeks of therapy with Perindopril-Teva, it is necessary to cancel diuretics and regularly monitor kidney function.

In some patients with arterial hypertension, in the presence of previously undiagnosed renal failure, especially with concomitant diuretic therapy, there was a slight and temporary increase in the concentration of urea and creatinine in the blood serum. In this case, it is recommended to reduce the dose of Perindopril-Teva and / or cancel the diuretic.

Patients on hemodialysis

In patients on dialysis using high-flow membranes and taking concomitant ACE inhibitors, there have been several cases of persistent, life-threatening anaphylactic reactions. If hemodialysis is required, a different type of membrane must be used.

kidney transplant

There is no experience with the use of the drug Perindopril-Teva in patients after a recent transplantation of the night.

hypersensitivity, angioedema

Rarely in patients taking ACE inhibitors, incl. developed angioedema of the face, limbs, lips. tongue, vocal folds and/or larynx. This condition can develop at any time during treatment. With the development of angioedema, treatment should be stopped immediately, the patient should be under medical supervision until the symptoms disappear completely. Angioedema of the lips and face usually does not require treatment; Antihistamines may be used to reduce symptoms. Angioedema of the tongue, vocal cords, or larynx can lead to a legal outcome. With the development of angioedema, it is necessary to immediately inject subcutaneously (adrenaline) and ensure the patency of the respiratory tract. Patients with a history of angioedema not associated with the use of ACE inhibitors may be at high risk of developing angioedema while taking an ACE inhibitor.

Anaphylactoid reactions during low-density lipoprotein apheresis (LDL apheresis)

In patients treated with ACE inhibitors while undergoing LDL apheresis with sulfate, in rare cases, an anaphylactic reaction may develop. Temporary withdrawal of the ACE inhibitor before each apheresis procedure is recommended.

Anaphylactic reactions during desensitization

In patients receiving ACE inhibitors during a course of desensitization (for example, hymenoptera venom), in very rare cases, life-threatening anaphylactic reactions may develop. Temporary withdrawal of the ACE inhibitor is recommended prior to each desensitization procedure.

Liver failure

During therapy with ACE inhibitors, it is sometimes possible to develop a syndrome that begins with cholestatic jaundice and then progresses to fulminant hepatic necrosis, sometimes with a fatal outcome. The mechanism by which this syndrome develops is unclear. If jaundice occurs while taking a DPF inhibitor or an increase in the activity of "liver" enzymes is observed, the ACE inhibitor should be immediately discontinued, and the patient should be closely monitored. It is also necessary to conduct an appropriate examination.

Neutropenia, agranulocytosis, thrombocytopenia, anemia

In patients treated with ACE inhibitors, there have been cases of neutropenia, agranulocytosis, thrombocytopenia and anemia. With normal renal function in the absence of other complications, neutropenia rarely develops. The drug Perindopril-Teva must be used with great caution in patients with systemic connective tissue diseases (eg, systemic lupus erythematosus, scleroderma), who are simultaneously receiving immunosuppressive therapy, or when combining all of the above factors, especially with existing impaired renal function. These patients may develop severe infections that are not amenable to intensive antibiotic therapy. When conducting therapy with Perindopril-Teva in patients with the above factors, it is recommended to periodically monitor the number of leukocytes in the blood and warn the patient about the need to inform the doctor about any symptoms of infection.

In patients with congenital deficiency of glucose-6-phosphate dehydrogenase, isolated cases of hemolytic anemia have been noted.

Negroid race

Like other ACE inhibitors. less effective in reducing blood pressure in patients of the black race, possibly due to the greater prevalence of low-renin conditions in the population of this group of patients with arterial hypertension.

During therapy with ACE inhibitors, a persistent, unproductive cough may develop, which stops after discontinuation of the drug. This should be considered in the differential diagnosis of cough.

Surgery and general anesthesia

In patients whose condition requires extensive surgery or general anesthesia with drugs that cause arterial hypotension, ACE inhibitors. including, can block the formation of angiotensin II with compensatory renin release. The day before surgery, therapy with ACE inhibitors should be discontinued. If the ACE inhibitor cannot be canceled, then arterial hypotension, which develops according to the described mechanism, can be corrected by an increase in BCC.

Hyperkalemia

Against the background of therapy with ACE inhibitors, including, in some patients, the content of potassium in the blood may increase. The risk of hyperkalemia is increased in patients with renal and/or heart failure, decompensated diabetes mellitus, and in patients taking potassium-sparing diuretics, potassium supplements, or other drugs that cause hyperkalismia (eg, heparin). If necessary, the simultaneous appointment of these drugs, it is recommended to regularly monitor the content of potassium in the blood serum.

Diabetes

In patients with diabetes mellitus taking oral hypoglycemic agents or insulin, blood glucose concentrations should be carefully monitored in the first few months of therapy with ACE inhibitors.

Perindopril-Teva tablets contain lactose. Therefore, patients with hereditary lactose intolerance, lactase deficiency or malabsorption syndrome should not take this drug.

Double blockade of RA AS

Cases of arterial hypotension, syncope, stroke, hyperkalemia and impaired renal function (including acute renal failure) have been reported in susceptible patients, especially when used simultaneously with drugs that affect this system. Therefore, dual blockade of the RAAS by combining an ACE inhibitor with ARAP or aliskiren is not recommended. The combination with aliskiren is contraindicated in patients with diabetes mellitus or impaired night function (GFR<60 мл/мин/1,73м2).

Influence on the ability to drive transport. cf. and fur.:It is necessary to take into account the possibility of developing arterial hypotension or dizziness, which can affect the ability to drive vehicles and work with technical equipment that require increased concentration and speed of psychomotor reactions. Release form / dosage:

Film-coated tablets, 2.5 mg. 5 mg and 10 mg.

30 tablets in a white polypropylene container with a polyethylene cap with a drying insert, equipped with a polyethylene restrictor with first opening control.

1 container together with instructions for use in a cardboard box.

Package: (30) - polypropylene containers (1) - cardboard packs Storage conditions:

Store at a temperature not exceeding 25°C. Keep out of the reach of children.

Best before date:

2 of the year. Do not use after the expiration date.

Conditions for dispensing from pharmacies: On prescription Registration number: LP-002979 Instructions