Perindopril, pills 4mg 30pcs

Composition

1 tablet contains perindopril erbumin-4 mg

Pharmacological action

Perindopril is an ACE inhibitor (it interacts with zinc ions in the ACE molecule and causes its inactivation). Perindopril acts through its active metabolite, perindoprilate. Eliminates the vasoconstrictor effect of angiotensin II, increases the concentration of bradykinin and vasodilator prostaglandins (ACE translates inactive angiotensin I into angiotensin II, which has a vasoconstrictor effect, and also causes the degradation of bradykinin and prostaglandins with vasodilating activity); reduces the production and release

of aldosterone, suppresses the release of norepinephrine from the endings of sympathetic nerve fibers and the formation of endothelin in the vascular wall. A decrease in angiotensin II production is accompanied by an increase in plasma renin activity (due to inhibition of negative feedback). ACE inhibition is accompanied by an increase in the activity of both the circulating and tissue kallikrein-kinin systems, as well as the prostaglandin system.

Helps restore the elasticity of large arterial vessels (reducing the formation of excessive amounts of subendothelial collagen), reduces pressure in the pulmonary capillaries, with prolonged use reduces the severity of left ventricular hypertrophy and interstitial fibrosis, normalizes the isoenzyme profile of myosin; normalizes heart function.

Reduces preload and afterload (reduces systolic and diastolic blood pressure (BP) in the “lying” and “standing” positions), left and right ventricular filling pressure, total peripheral vascular resistance (OPSS); increases minute blood volume (MOC) and heart index, does not increase heart rate (in patients with chronic heart failure (CHF), it moderately reduces heart rate), increases regional blood flow in the muscles. Increases the concentration of high-density lipoproteins, reduces the concentration of uric acid in patients with hyperuricemia. Increases renal blood flow, does not change the glomerular filtration rate.

Indications

Arterial hypertension. Chronic heart failure.

Contraindications

Hypersensitivity to perindopril and other components of Perindopril or other ACE inhibitors, a history of angioedema during therapy with ACE inhibitors, hereditary or idiopathic angioedema, pregnancy, lactation, age up to 18 years (efficacy and safety have not been established).

With caution:

Aortic valve stenosis, hypertrophic obstructive cardiomyopathy, cerebro-and cardiovascular diseases (including cerebrovascular insufficiency, coronary heart disease, coronary insufficiency – the risk of excessive blood pressure reduction and concomitant ischemia).

Severe autoimmune systemic connective tissue diseases (including systemic lupus erythematosus, scleroderma), inhibition of bone marrow hematopoiesis while taking immunosuppressants (increased probability of neutropenia).

Renovascular hypertension, bilateral renal artery stenosis, single kidney artery stenosis, post-kidney transplantation conditions (risk of renal dysfunction and agranulocytosis), chronic renal failure (especially accompanied by hyperkalemia), hyperkalemia, a sodium-restricted diet, conditions accompanied by a decrease in the volume of circulating blood (including diarrhea, vomiting, diuretics), diabetes mellitus, old age, surgery (general anesthesia).

Side effects

The frequency of side effects is estimated based on: often-1-10%; rarely-0.1-1%; extremely rare, including individual reports-less than 0.1%.

From the cardiovascular system:  often-excessive lowering of blood pressure and associated symptoms, rarely-arrhythmia, angina pectoris, myocardial infarction and stroke.

From the urinary system:  decreased renal function, acute renal failure.

Respiratory system disorders:  often – ” dry ” cough, difficulty breathing; rarely-bronchospasm, rhinorrhea.

From the digestive system:  often – nausea, vomiting, abdominal pain, taste changes, diarrhea or constipation, dry mouth, decreased appetite, cholestatic jaundice, pancreatitis, intestinal edema.

From the central nervous system:  often – headache, asthenia, increased fatigue, dizziness, ringing in the ears, visual disturbances, muscle cramps, paresthesia; rarely-decreased mood, insomnia; extremely rarely-confusion.

Allergic reactions:  often-skin rash, pruritus; rarely-urticaria, angioedema; extremely rarely-erythema multiforme.

Laboratory parameters:  often – hypercreatininemia, proteinuria, hyperkalemia; hyperuricemia; rarely (with prolonged use in high doses) – neutropenia, leukopenia, hypohemoglobinemia, thrombocytopenia, decreased hematocrit; extremely rarely – agranulocytosis, pancytopenia, increased activity of “liver” enzymes, hyperbilirubinemia, hemolytic anemia (against the background of glucose-6 deficiency-phosphate dehydrogenase).

Other services:  increased sweating, impaired sexual function.

Interaction

Increases the severity of the hypoglycemic effect of insulin and sulfonylurea derivatives. Baclofen, tricyclic antidepressants, antipsychotic drugs (neuroleptics), saluretics enhance the hypotensive effect and increase the risk of orthostatic hypotension (additive effect).

Antacids reduce the bioavailability of ACE inhibitors.

Glucocorticosteroids, nonsteroidal anti-inflammatory drugs reduce the severity of hypotensive effects (fluid and electrolyte retention).

Potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium supplements increase the risk of hyperkalemia. Concomitant use of drugs that can cause hyperkalemia and ACE inhibitors is not recommended, except in cases of severe hypokalemia (monitoring of serum potassium).

When used concomitantly with lithium preparations, its elimination from the body may slow down (regular monitoring of the lithium content in the blood is necessary).

Diuretics, general anesthesia medications, and muscle relaxants, such as ethanol, increase the risk of excessive blood pressure reduction. The risk of developing clinically significant hypotension can be reduced by discontinuing diuretics a few days before starting treatment with perindopril.

Myelotoxic drugs – increased myelotoxic effect.

How to take, course of use and dosage

Perindopril is taken orally, in the morning, before meals. The initial dose for the treatment of arterial hypertension is 4 mg / day, if necessary (after 1 month). the dose can be increased to 8 mg/day in one dose.

When prescribing ACE inhibitors to patients receiving diuretic therapy, there may be a sharp decrease in blood pressure, for the prevention of which it is recommended to stop taking diuretics 2-3 days before the expected start of therapy with Perindopril or prescribe the drug in lower doses-2 mg 1 time a day.

In patients with renovascular hypertension, the initial dose is 2 mg once a day. If necessary, the dose can be increased later.

In elderly patients, therapy should begin with a dose of 2 mg per day, and then, if necessary, gradually increase it up to a maximum dose of 8 mg per day.

Treatment of patients with chronic heart failure in combination with a non-potassium-sparing diuretic and / or digoxin is recommended to start under close medical supervision, Perindopril should be prescribed at an initial dose of 2 mg 1 time a day, in the morning. In the future, after 1-2 weeks of therapy, the dose of the drug can be increased to 4 mg once a day.

In patients with impaired renal function, the dose of the drug should be selected taking into account the degree of renal insufficiency: depending on creatinine clearance.

If the creatinine clearance is more than 60 ml / min – 4 mg perindopril per day. With a creatinine clearance of 30-60 ml / min – 2 mg once a day; with a creatinine clearance of 15-30 ml / min-2 mg every other day; patients on hemodialysis (creatinine clearance less than 15 ml / min) – 2 mg on the day of dialysis.

In patients with hepatic impairment, no dose changes are required.

Overdose

Symptoms:  decreased blood pressure, shock, stupor, bradycardia, electrolyte disturbances, renal failure.

Treatment:  gastric lavage, use of enterosorbents, restoration of water-electrolyte balance, intravenous use of 0.9% sodium chloride solution. In case of a marked decrease in blood pressure, the patient should be given a horizontal position with raised legs.

Hemodialysis is effective (do not use highly permeable polyacrylonitrile membranes). With the development of bradycardia -atropine. In severe cases, temporary implantation of a pacemaker is indicated. It is necessary to monitor and correct vital functions of the body.

Special instructions

The risk of developing hypotension and/or renal failure while taking the drug increases with significant loss of sodium and water (strict salt-free diet, and/or diuretics, diarrhea, vomiting) or renal artery stenosis (blockage in these situations of the renin-angiotensin system can lead, especially at the first dose of the drug and during the first 2 weeks of treatment, to a sudden decrease in blood pressure and the development of chronic renal failure). Before starting and during therapy, it is recommended to determine the concentration of creatinine, electrolytes and urea (within 1 month).

In patients with arterial hypertension who are already receiving diuretic therapy, it is necessary to stop taking diuretics (3 days before the start of Perindopril use) and, if necessary, add them to the treatment again in the future.

In patients with chronic heart failure receiving diuretic therapy, if possible, their dose should also be reduced a few days before the start of use.

In patients at risk, especially those with decompensated chronic heart failure, elderly patients, as well as patients with initially low blood pressure, impaired renal function, or receiving high doses of diuretics, the start of the drug should be carried out under the supervision of medical personnel.

In patients undergoing hemodialysis, the use of polyacrylonitrile membranes should be avoided (anaphylactoid reactions may occur). It is necessary to stop taking the drug before the upcoming surgical treatment for 12 hours and warn the anesthesiologist about taking the drug.

Form of production

Pills.

Storage conditions

Store in a dry place, out of reach of children, protected from light at a temperature not exceeding 25 °C.

Shelf

life is 2 years.

Active ingredient

Perindopril

Conditions of release from pharmacies

By prescription

Dosage form

Tablets

Purpose

For adults as directed by your doctor

Indications

Heart failure, Hypertension, Angina, Prevention of heart attacks and strokes