Perindopril plus, 30 pcs., 2.5 mg+8 mg, tablets

4 / 5 ( 1 voice )

Perindopril is an ACE inhibitor. It is customary to include it in therapy aimed at treating patients who have been diagnosed with diseases such as heart failure and arterial hypertension. The action of the medication is aimed at significantly reducing the amount of angiotensin II. It is due to this that the dilation of blood vessels occurs. As a result, blood pressure decreases.

pharmachologic effect

Manufacturer: IZVARINO PHARMA, Russia
Release form: tablets

Active ingredient: perindropil

The active ingredient is an ACE inhibitor. The substance has a therapeutic effect due to the active metabolite perindoprilate. The drug reduces not only the upper, but also the lower blood pressure levels. During administration, peripheral blood flow improves, but the heart rate does not change. Therefore, the drug is considered safe.

The greatest effect is observed after 5 hours from the time of administration, the duration of which is no more than a day. Patients do not experience addiction to Perindopril, which is an inherent advantage. Complete stabilization of the condition and blood pressure indicators occurs after a month's course. It is also worth noting that when abruptly stopping the drug, there is no “withdrawal” syndrome, i.e. it is suitable for elderly patients.

The active component dilates blood vessels, restores their elasticity and structure, and reduces myocardial hypertrophy of the left ventricle. Experts recommend taking the drug simultaneously with diuretics to enhance the antihypertensive effect of Perindopril. Excess fluid in the body often causes hypertension.

The drug should also be prescribed to patients with chronic stage heart failure, as there is a significant improvement in the condition of the heart after the course. Patients with liver pathologies and renal failure should take it with caution.

Analogues and substitutes

Perindopril is rightfully considered a powerful drug that can help in the fight against heart and vascular diseases. However, like any other medication, it has certain contraindications. The most common contraindication is hypersensitivity. Moreover, the human body can be especially sensitive not only to the action of the main substance. Allergies to additional components are also widespread. In addition, contraindications may include certain conditions or diagnosed diseases. This is why there is a need to replace the medicine. Let us consider in more detail not the drug Perindopril, but its analogues.

Today, replacing one product with another is not particularly difficult. Because the drug market is updated with new developments every day. If we talk specifically about analogues and substitutes for a medication such as Perindopril, then they may have a similar mechanism of action. However, there are also drugs whose mechanism of action is radically different. Their composition is often different. That is why it is possible to replace the drug with one to which the patient is not allergic.

The most popular and frequently used analogues in medical practice include the following drugs:

• Prestarium;
• Perineva;
• Indapamide;
• Amlodipine;
• Ramipril;
• Valsartan.

The above-mentioned substitutes and analogues are in most cases used by doctors to treat patients who have problems with the vascular system and heart. They are highly effective and can help normalize the patient’s condition. Perindopril, whose analogues are cheaper, in some cases can be used in combination with them.

Perindopril or Prestarium: which is better?

This analogue cannot be called cheap, since it costs an order of magnitude more than the original medicine. The active ingredient of these two drugs is the same. But its concentration in Prestarium is 1.7 mg.

The drug can not only normalize the functioning of the heart muscle and reduce vascular resistance. It may also have a preventive effect. That is why it is usually included in therapy aimed at preventing the development of stroke or ischemic attacks. The main contraindication to the use of the drug is angioedema.

Perindopril or Perineva

The drug is available in the form of granules that contain 76 mg of active substance. The active ingredient is perindopril erbumine. Do not be afraid of such a large dosage, because it corresponds to the standard dosage of the drug Perindopril.

This drug also belongs to the category of ACE inhibitors. But it is prescribed exclusively to those patients who have been diagnosed with high blood pressure. The effect of lowering blood pressure is achieved due to the fact that vascular resistance decreases. Although patients experience increased blood flow while taking the medication, this does not have a negative effect on heart rate.

Perindopril or Indapamide: what to choose

Indapamide is a sulfonamide diuretic. A hypertensive effect can only be achieved if a small dosage has been prescribed. At this dose it is impossible to achieve a diuretic effect. The action of the medication is aimed at:

• reduce the contractility of smooth muscles;
• stimulate the synthesis of certain substances that promote vasodilation.

Please note that the drug can only be used to treat essential type hypertension. In addition, it should not be prescribed to patients who have kidney or liver disease or are being treated for hypokalemia.

Perindopril or Amlodipine

The active ingredients of these two drugs are different. Since Amlodipine is a calcium antagonist. With its help, it is possible to completely block the entry of calcium ions into the myocardium and smooth muscles. It is due to this that the load on the heart is reduced and the pressure is lowered. Its effect on the body is similar to that of the original medicine.

This drug can also be used if the patient has been diagnosed with liver and kidney diseases. However, it is imperative to see a doctor. Only he can choose the correct and gentle dosage.

Perindopril or Ramipril: which is better?

The drug belongs to the category of ACE inhibitors. It is widely used in cardiology. With its help, you can reduce the risk of myocardial development and stabilize the patient's condition.

Moreover, with the help of the drug Ramipril, diabetic nephropathy is treated. The drug is not prescribed to girls during pregnancy and lactation. It is also contraindicated for children, as it has many side effects.

Perindopril or Valsartan

Valsartan is a good replacement for the drug Perindopril. It is included in therapy, which is aimed at normalizing the patient’s condition. This may be a post-infarction condition or an exacerbation of heart failure. It can also be used to treat arterial hypertension, of various types.

The main contraindication to the use of the medication is if the patient has problems with the functioning of an organ such as the liver. In addition, it should not be used not only by pregnant women, but also by women who are planning to become pregnant in the near future. The product has a very negative effect on the woman’s reproductive system.

Other substitutes

Listed above are the most frequently used substitutes. However, there are others that can also be prescribed in certain cases. We are talking about the following analogues:

• Captopril;
• Lisinopril;
• Diroton.

The main advantage of these analogues is their price. All of them cost an order of magnitude cheaper than the original product. That is why in some cases doctors recommend their patients to use these substitutes.

Indications for use of Perindopril

Perindopril is prescribed to patients over 18 years of age for pathologies and disorders of the cardiovascular system. These include:

1. High blood pressure.
2. As a prophylactic agent after suffering an acute disruption of the blood supply to the brain.
3. Risk of developing cardiovascular complications after myocardial infarction or coronary revascularization.

If there is a negative reaction from the body to this drug, it is recommended to consult a specialist and start a course with another analogue of Perindopril 4 mg.

Perindopril

Stable coronary heart disease (CHD)

If an episode of unstable angina (significant or not) develops during the first month of perindopril therapy, it is necessary to evaluate the benefit/risk ratio of further use of the drug Perindopril.

Arterial hypotension ACE inhibitors can cause a sharp decrease in blood pressure. In patients with uncomplicated hypertension, symptomatic hypotension rarely occurs after the first dose. The risk of excessive reduction in blood pressure is increased in patients with reduced blood volume during diuretic therapy, while following a strict salt-free diet, hemodialysis, as well as with diarrhea or vomiting, or in patients with severe renin-dependent hypertension. Severe arterial hypotension was observed in patients with severe CHF, both in the presence of concomitant renal failure and in its absence. The most common arterial hypotension can develop in patients with more severe CHF, taking loop diuretics in high doses, as well as against the background of hyponatremia or renal failure. Close medical monitoring is recommended for these patients during initiation of therapy and during dosage titration. The same applies to patients with coronary artery disease or cerebrovascular diseases, in whom an excessive decrease in blood pressure can lead to myocardial infarction or cerebrovascular complications. If arterial hypotension develops, it is necessary to place the patient in a horizontal position with raised legs, and, if necessary, administer sodium chloride solution intravenously to increase the blood volume. Transient arterial hypotension is not a contraindication for further therapy. After restoration of blood volume and blood pressure, treatment can be continued subject to careful selection of the dose of the drug.

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

Renal dysfunction and renovascular hypertension

In patients with renal failure (creatinine clearance less than 60 ml/min), the initial dose of perindopril should be adjusted in accordance with the clinical clearance (see section “Dosage and Administration”) and then depending on the therapeutic response to therapy. For such patients, regular monitoring of potassium and creatinine levels in the blood plasma is necessary.

In patients with symptomatic heart failure, arterial hypotension that develops during the initial period of therapy with ACE inhibitors can lead to deterioration of renal function. Cases of acute renal failure, usually reversible, have sometimes been reported in such patients.

In some patients with bilateral renal artery stenosis or renal artery stenosis of a solitary kidney (especially in the presence of renal failure), an increase in serum concentrations of urea and creatinine was observed during therapy with ACE inhibitors, which was 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 perindopril therapy, diuretics should be discontinued and renal function should be regularly monitored.

In some patients with arterial hypertension, in the presence of previously undetected renal failure, especially with concomitant diuretic therapy, there was a slight and temporary increase in serum urea and creatinine concentrations. In this case, it is recommended to reduce the dose of perindopril and/or discontinue the diuretic.

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

In patients prescribed ACE inhibitors during the procedure of low-density lipoprotein (LDL) apheresis using dextran sulfate, in rare cases, an anaphylactic reaction may develop. It is recommended to temporarily discontinue the ACE inhibitor (at least 24 hours) before each apheresis procedure. Anaphylactic reactions during desensitization There are isolated reports of prolonged life-threatening anaphylactoid reactions in patients taking ACE inhibitors during desensitizing therapy with hymenoptera (bees, wasps) venoms. ACE inhibitors should be prescribed with caution to patients with allergies and those receiving desensitization therapy. However, these reactions can be prevented by temporarily discontinuing the ACE inhibitor at least 24 hours before each desensitization procedure.

Increased sensitivity/angioedema Rare in patients taking ACE inhibitors, incl. perindopril, angioedema of the face, extremities, lips, mucous membranes, tongue, vocal folds and/or larynx developed. This condition can develop at any time during treatment. If angioedema develops, treatment should be stopped immediately, and the patient should be under medical supervision until symptoms disappear completely. Angioedema of the lips and face usually does not require treatment; Antihistamines can be used to reduce the severity of symptoms.

Angioedema of the tongue, vocal folds, or larynx can be fatal. If angioedema develops, it is necessary to immediately administer epinephrine (adrenaline) subcutaneously and ensure patency of the airway.

ACE inhibitors are more likely to cause angioedema in black patients. 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.

In rare cases, angioedema of the intestine develops during therapy with ACE inhibitors.

In this case, patients experience abdominal pain, possibly in combination with nausea and vomiting; in some cases without previous angioedema of the face and normal C1-esterase levels.

Diagnosed using computed tomography or ultrasound examination of the abdominal organs, or during surgery. Symptoms disappear after discontinuation of ACE inhibitor therapy. In patients receiving ACE inhibitors, the possibility of developing angioedema of the intestine should be taken into account in the differential diagnosis of abdominal pain.

Cough

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

Elderly patients

In elderly patients, the hypotensive effect of ACE inhibitors may be more pronounced compared to young patients.

It is recommended to begin the course of treatment with low doses and evaluate renal function when starting to take the drug.

Hyperkalemia

During therapy with ACE inhibitors, including perindopril, potassium levels in the blood may increase in some patients. The risk of hyperkalemia is increased in patients with renal and/or heart failure, decompensated diabetes mellitus, and in patients using potassium-sparing diuretics, potassium supplements, or other drugs that cause hyperkalemia (eg, heparin).

If it is necessary to prescribe these drugs simultaneously, it is recommended to regularly monitor the potassium content in the blood serum.

Surgical intervention/general anesthesia

In patients whose condition requires major surgery or general anesthesia with drugs that cause hypotension, ACE inhibitors, including perindopril, may block the formation of angiotensin II with compensatory renin release. One day before surgery, therapy with ACE inhibitors must be discontinued. If the ACE inhibitor cannot be canceled, then arterial hypotension developing according to the described mechanism can be corrected by increasing the volume of blood volume.

Aortic or mitral valve stenosis/hypertrophic obstructive cardiomyopathy

ACE inhibitors, incl. and perindopril should be administered with caution to patients with mitral valve stenosis and left ventricular outflow tract obstruction (aortic valve stenosis and hypertrophic obstructive cardiomyopathy).

Neutropenia/Agranulocytosis/Anemia

Cases of neutropenia/agranulocytosis, thrombocytopenia and anemia have been reported in patients receiving ACE inhibitor therapy. With normal renal function in the absence of other complications, neutropenia rarely develops. Perindopril should be used with great caution in patients with systemic connective tissue diseases (for example, systemic lupus erythematosus, scleroderma) who were simultaneously receiving immunosuppressive therapy, allopurinol or procainamide, as well as when combining all of these factors, especially with existing renal impairment. Such patients may develop severe infections that do not respond to intensive antibiotic therapy. When carrying out perindopril therapy 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 the appearance of any symptoms of infection.

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

Diabetes

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

Proteinuria

Proteinuria can develop in patients who already have impaired renal function, as well as during the use of high doses of ACE inhibitors.

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 liver necrosis, sometimes with death. The mechanism of development of this syndrome is unclear. If jaundice appears or an increase in the activity of liver transaminases occurs while taking an ACE inhibitor, the ACE inhibitor should be immediately discontinued, and the patient should be under close medical supervision.

Negroid race

The risk of developing angioedema in black patients.

Perindopril - instructions for use

According to the instructions for use, Perindopril is prescribed for oral administration before meals. It is recommended to take the tablets in the morning. The dosage of the drug is adjusted depending on the diagnosis and the body’s reaction.

The dosage of Peridopril, like its analogues, is also adjusted depending on the levels of potassium and creatinine in the blood serum.

Perindopril plus, 30 pcs., 2.5 mg+8 mg, tablets

Common to indapamide and perindopril

Renal dysfunction

Therapy is contraindicated in patients with moderate and severe renal failure (creatinine clearance less than 60 ml/min). In some patients with arterial hypertension without previous obvious renal impairment, laboratory signs of functional renal failure may appear during therapy. In this case, treatment should be stopped. In the future, you can resume combination therapy using low doses of a combination of indapamide and perindopril, or use only one of the drugs.

Such patients require regular monitoring of potassium levels and creatinine concentrations in the blood serum - 2 weeks after the start of therapy and every 2 months thereafter. Renal failure occurs more often in patients with severe chronic heart failure or underlying renal impairment, including renal artery stenosis. The drug Perindopril PLUS is not recommended in cases of bilateral renal artery stenosis or stenosis of the artery of a single functioning kidney.

Arterial hypotension and water-electrolyte imbalance

In the case of initial hyponatremia, there is a risk of sudden development of arterial hypotension, especially in patients with renal artery stenosis. Therefore, during dynamic monitoring of patients, attention should be paid to possible symptoms of dehydration and decreased electrolyte levels in the blood plasma, for example, after diarrhea or vomiting. Such patients require regular monitoring of blood plasma electrolyte levels.

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

Transient arterial hypotension is not a contraindication for continued therapy. After restoration of circulating blood volume and blood pressure, therapy can be resumed using low doses of drugs, or only one of the drugs can be used.

Potassium content

The combined use of perindopril and indapamide does not prevent the development of hypokalemia, especially in patients with diabetes mellitus or renal failure. As with any antihypertensive drug or diuretic, regular monitoring of potassium levels in the blood plasma is necessary.

Excipients

It should be taken into account that the excipients of the drug include lactose monohydrate. The drug Perindopril PLUS should not be prescribed to patients with hereditary galactose intolerance, lactase deficiency and glucose-galactose malabsorption.

Lithium preparations

The simultaneous use of the drug Perindopril PLUS with lithium preparations is not recommended (see section “Interaction with other drugs”).

Childhood

The drug should not be prescribed to children and adolescents under the age of 18 years due to the lack of data on the effectiveness and safety of the use of indapamide and perindopril, both separately and together, in patients in this age group.

Perindopril

Dual blockade of the renin-angiotensin-aldosterone system (RAAS)

There is evidence of an increased risk of arterial hypotension, hyperkalemia and renal dysfunction (including acute renal failure) when ACE inhibitors are used simultaneously with ARB II or aliskiren. Therefore, double blockade of the RAAS by combining an ACE inhibitor with ARA II or aliskiren is not recommended (see sections “Interaction with other drugs” and “Pharmacodynamics”).

If a double blockade is absolutely necessary, then this should be performed under the strict supervision of a specialist with regular monitoring of renal function, plasma electrolytes and blood pressure.

The use of ACE inhibitors in combination with ARA II receptor antagonists is contraindicated in patients with diabetic nephropathy and is not recommended in other patients (see section "Contraindications").

Potassium-sparing diuretics, potassium supplements, potassium-containing table salt substitutes and food supplements

The simultaneous administration of perindopril and potassium-sparing diuretics, as well as potassium preparations, potassium-containing table salt substitutes and food additives is not recommended (see section “Interaction with other drugs”).

Neutropenia/agranulocytosis/thrombocytopenia

There are reports of the development of neutropenia/agranulocytosis, thrombocytopenia and anemia while taking ACE inhibitors. In patients with normal renal function and without concomitant risk factors, neutropenia rarely occurs. Perindopril should be used with extreme caution against the background of systemic connective tissue diseases (including systemic lupus erythematosus, scleroderma), as well as while taking immunosuppressants, allopurinol or procainamide, or a combination of these factors, especially in patients with initially impaired renal function .

Some patients developed severe infectious diseases, in some cases resistant to intensive antibiotic therapy. When prescribing perindopril to such patients, it is recommended to periodically monitor the number of leukocytes in the blood. Patients should tell their doctor about any signs of infectious diseases (for example, sore throat, fever) (see sections "Interaction with other drugs" and "Side effects").

Anemia

Anemia may develop in patients after kidney transplantation or in those on hemodialysis. In this case, the decrease in hemoglobin is greater, the higher its initial value. This effect does not appear to be dose-dependent, but may be related to the mechanism of action of ACE inhibitors.

A slight decrease in hemoglobin occurs during the first 6 months, then it remains stable and is completely restored after discontinuation of the drug. In such patients, treatment can be continued, but hematological tests should be performed regularly.

Hypersensitivity/angioedema

When taking ACE inhibitors, including perindopril, in rare cases, the development of angioedema of the face, extremities, lips, tongue, vocal folds and/or larynx may occur (see section “Side effects”). This can happen at any time during therapy. If symptoms appear, Perindopril PLUS should be stopped immediately and the patient should be observed until signs of swelling have completely disappeared. If the swelling affects only the face and lips, it usually goes away on its own, although antihistamines can be used as symptomatic therapy.

Angioedema, accompanied by swelling of the larynx, can be fatal. Swelling of the tongue, vocal folds, or larynx can lead to airway obstruction. If such symptoms appear, you should immediately begin appropriate therapy, for example, subcutaneously administer epinephrine (adrenaline) at a dilution of 1:1000 (0.3 - 0.5 ml) and/or ensure airway patency.

A higher risk of developing angioedema has been reported in black patients.

Patients with a history of angioedema not associated with taking ACE inhibitors may have an increased risk of developing it when taking drugs of this group (see section “Contraindications”).

In rare cases, angioedema of the intestine develops during therapy with ACE inhibitors. In this case, patients experienced abdominal pain as an isolated symptom or in combination with nausea and vomiting, in some cases without previous angioedema of the face and with normal levels of C-1 esterase. Diagnosis was made using abdominal computed tomography, ultrasound, or at the time of surgery. Symptoms resolved after discontinuation of ACE inhibitors. Therefore, in patients with abdominal pain receiving ACE inhibitors, when carrying out differential diagnosis, it is necessary to take into account the possibility of developing angioedema of the intestine.

mTOR (mammalian target of rapamycin) inhibitors (eg, sirolimus, everolimus, temsirolimus)

In patients receiving concomitant therapy with mTOR inhibitors, the risk of developing angioedema (including swelling of the airways or tongue with or without respiratory impairment) may be increased (see section "Interaction with other drugs").

Anaphylactoid reactions during desensitization

There are isolated reports of the development of prolonged, life-threatening anaphylactoid reactions in patients receiving ACE inhibitors during desensitizing therapy with hymenopteran insect venom (bees, wasps). ACE inhibitors should be used with caution in patients prone to allergic reactions undergoing desensitization procedures. Prescription of an ACE inhibitor should be avoided in patients receiving immunotherapy with hymenoptera venom. However, an anaphylactoid reaction 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

In rare cases, life-threatening anaphylactoid reactions have developed in patients receiving ACE inhibitors during LDL apheresis using dextran sulfate. To prevent an anaphylactoid reaction, ACE inhibitor therapy should be temporarily discontinued before each apheresis procedure.

Hemodialysis

Anaphylactoid reactions have been reported in patients receiving ACE inhibitors during hemodialysis using high-flux membranes (eg, AN69®). Therefore, it is advisable to use a different type of membrane or use an antihypertensive agent of a different pharmacotherapeutic group.

Cough

During therapy with an ACE inhibitor, a dry persistent cough may occur, which disappears after discontinuation of drugs of this group and disappears after their discontinuation. If a patient develops a dry cough, one should be aware of the possible iatrogenic nature of this symptom. If the attending physician believes that ACE inhibitor therapy is necessary for the patient, it is possible to continue taking the drug.

Risk of arterial hypotension and/or renal failure (in patients with heart failure, fluid and electrolyte imbalance, etc.)

In some pathological conditions, significant activation of the RAAS may be observed, especially with severe hypovolemia and a decrease in the content of electrolytes in the blood plasma (due to a salt-free diet or long-term use of diuretics), in patients with initially low blood pressure, renal artery stenosis, chronic heart failure or cirrhosis of the liver with edema and ascites.

The use of ACE inhibitors causes blockade of the RAAS and therefore may be accompanied by a sharp decrease in blood pressure and/or an increase in the concentration of creatinine in the blood plasma, indicating the development of functional renal failure. These phenomena are more often observed when taking the first dose of the drug and during the first two weeks of therapy. In rare cases, these conditions develop acutely and during other periods of therapy. In such cases, it is recommended to restart therapy at a lower dose and then gradually increase the dose.

Elderly age

Before starting to take perindopril, it is necessary to assess the functional activity of the kidneys and the content of potassium ions in the blood plasma. At the beginning of therapy, the dose of the drug is selected taking into account the degree of reduction in blood pressure, especially in the case of dehydration and loss of electrolytes. 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 the drug in patients with coronary heart disease and cerebrovascular insufficiency. In such patients, treatment should begin with low doses of the drug.

Renovascular hypertension

The treatment method for renovascular hypertension is revascularization. However, the use of ACE inhibitors may have a positive effect in this category of patients, both awaiting surgery and in cases where surgery is not possible.

Treatment with Perindopril PLUS is not indicated in patients with diagnosed or suspected renal artery stenosis, because Therapy should be started in a hospital setting with lower doses of the combination of indapamide and perindopril.

Heart failure/severe heart failure

In patients with chronic heart failure (NYHA functional class IV), treatment should begin with lower doses of the combination of indapamide and perindopril and under close medical supervision.

Patients with arterial hypertension and coronary heart disease should not stop taking beta-blockers: an ACE inhibitor should be added to beta-blocker therapy.

Diabetes

In patients with type 1 diabetes mellitus, a spontaneous increase in potassium levels in the blood is possible. Treatment of such patients with the drug Perindopril PLUS is not indicated, since it should begin with minimal doses and be under constant medical supervision.

During the first month of therapy with ACE inhibitors, plasma glucose concentrations should be carefully monitored in patients with diabetes mellitus receiving oral hypoglycemic agents or insulin (see section "Interaction with other drugs").

Ethnic differences

Perindopril, like other ACE inhibitors. has a clearly less pronounced antihypertensive effect in patients of the Negroid race compared to representatives of other races. This difference may be due to the fact that black patients with arterial hypertension are more likely to have low renin activity.

Surgery / General anesthesia

Carrying out general anesthesia against the background of ACE inhibitors can lead to a pronounced decrease in blood pressure, especially when using general anesthesia agents that have an antihypertensive effect.

It is recommended, if possible, to stop taking long-acting ACE inhibitors, including perindopril, the day before surgery. It is necessary to warn the anesthesiologist that the patient is taking ACE inhibitors.

Aortic or mitral stenosis / Hypertrophic obstructive cardiomyopathy

ACE inhibitors should be prescribed with caution to patients with left ventricular outflow tract obstruction.

Liver failure

In rare cases, cholestatic jaundice occurs while taking ACE inhibitors. As this syndrome progresses, fulminant liver necrosis develops, sometimes with death. The mechanism of development of this syndrome is unclear. If jaundice appears or if there is a significant increase in the activity of liver enzymes while taking ACE inhibitors, the patient should stop taking the ACE inhibitor and consult a doctor (see section “Side Effects”).

Hyperkalemia

Hyperkalemia may develop during treatment with ACE inhibitors, including perindopril. Risk factors for hyperkalemia are renal failure, impaired renal function, age over 70 years, diabetes mellitus, some concomitant conditions (dehydration, acute cardiac decompensation, metabolic acidosis), concomitant use of potassium-sparing diuretics (such as spironolactone and its derivative eplerenone, triamterene, amiloride ), as well as potassium preparations or potassium-containing substitutes for table salt, as well as the use of other drugs that help increase the content of potassium in the blood plasma (for example, heparins, ACE inhibitors, angiotensin II receptor antagonists, acetylsalicylic acid at a dose of 3 g/day or more, inhibitors cyclooxygenase-2 (COX-2) and non-selective NSAIDs, immunosuppressants such as cyclosporine or tacrolimus, trimethoprim).

The use of potassium supplements, potassium-sparing diuretics, and potassium-containing table salt substitutes can lead to a significant increase in potassium levels in the blood, especially in patients with reduced renal function.

Hyperkalemia can cause serious, sometimes fatal, abnormal heart rhythms. If simultaneous use of the above drugs is necessary, treatment should be carried out with caution against the background of regular monitoring of potassium levels in the blood serum (see section “Interaction with other drugs”).

Indapamide

Hepatic encephalopathy

In the presence of liver dysfunction, taking thiazide and thiazide-like diuretics can lead to the development of hepatic encephalopathy. In such a situation, you should immediately stop taking the diuretic.

Water and electrolyte balance

Content of sodium ions in blood plasma

The content of sodium ions in the blood plasma must be determined before starting treatment, and then regularly monitored while taking the drug.

Hyponatremia at the initial stage may not be accompanied by clinical symptoms, so regular laboratory monitoring is necessary. More frequent monitoring of sodium ion levels is indicated for patients with liver cirrhosis and elderly patients (see sections “Side effects” and “Overdose”). Treatment with any diuretics can cause hyponatremia, sometimes with very serious consequences. Hyponatremia accompanied by hypovolemia can lead to dehydration and orthostatic hypotension.

A simultaneous decrease in the content of chlorine ions can lead to the development of secondary compensatory metabolic alkalosis: the frequency of its occurrence and the severity of its manifestations are insignificant.

Content of potassium ions in blood plasma

Therapy with thiazide and thiazide-like diuretics is associated with a risk of hypokalemia. Hypokalemia (less than 3.4 mmol/L) should be avoided in the following high-risk patients: elderly patients, malnourished patients (both those receiving and not receiving concomitant drug therapy), patients with cirrhosis (with edema and ascites) , coronary heart disease, heart failure. Hypokalemia in these patients increases the toxic effect of cardiac glycosides and increases the risk of developing arrhythmia.

Patients with a prolonged QT interval, either congenital or drug-induced, are also at increased risk.

Hypokalemia, like bradycardia, contributes to the development of severe heart rhythm disturbances, especially arrhythmias, which can be fatal. In all the cases described above, more frequent monitoring of the content of potassium ions in the blood plasma is necessary. The first measurement of potassium ion content should be carried out within the first week from the start of therapy.

If hypokalemia is detected, appropriate correction should be made.

Content of calcium ions in blood plasma

Thiazide and thiazide-like diuretics can reduce the excretion of calcium ions by the kidneys, leading to a slight and temporary increase in calcium levels in the blood plasma. Severe hypercalcemia may be a consequence of previously undiagnosed hyperparathyroidism. Before studying the function of the parathyroid glands, you should stop taking diuretics.

Plasma glucose concentration

It is necessary to monitor blood glucose concentrations in patients with diabetes mellitus, especially in the presence of hypokalemia.

Uric acid

When the concentration of uric acid in the blood plasma increases during therapy, the frequency of gout attacks may increase.

Diuretics and kidney function

Thiazide and thiazide-like diuretics are fully effective only in patients with normal or slightly impaired renal function (plasma creatinine concentration in adults below 25 mg/l or 220 µmol/l).

In elderly patients, plasma creatinine levels should be assessed taking into account age, weight and sex, according to the Cockroft formula:

Creatinine clearance (CC) = (140 - age) x weight / 0.814 x plasma creatinine concentration

where: age in years, weight in kg, plasma creatinine concentration in µmol/l.

The formula is suitable for older men; for older women, the result should be multiplied by a factor of 0.85.

At the beginning of diuretic treatment in patients, due to hypovolemia (due to the excretion of water and sodium ions), a temporary decrease in glomerular filtration rate and an increase in the concentration of urea and creatinine in the blood plasma may be observed. This transient functional renal failure is not dangerous for patients with initially normal renal function, but its severity may increase in patients with renal failure.

Photosensitivity

While taking thiazide and thiazide-like diuretics, cases of photosensitivity reactions have been reported (see section "Side effects"). If photosensitivity reactions develop while taking the drug, treatment should be discontinued. If it is necessary to continue diuretic therapy, it is recommended to protect the skin from exposure to sunlight or artificial ultraviolet rays.

Athletes

Indapamide may give a positive reaction during doping control.

Acute myopia and secondary angle-closure glaucoma

Sulfonamides and their derivatives can cause the development of idiosyncratic reactions leading to temporary (transient) myopia and acute angle-closure glaucoma. Without proper treatment, acute angle-closure glaucoma can lead to vision loss. First of all, you need to stop taking the drug as soon as possible. If intraocular pressure continues to be high, immediate medical or surgical treatment may be required. Risk factors that may lead to the development of acute angle-closure glaucoma include a history of allergies to sulfonamides or penicillin.

Analogues of Perindopril

Existing analogues and substitutes for Perindropil, presented on pharmacy shelves, differ in price category and pharmacological effect. Before purchasing this or that product, it is recommended to take into account the composition and course of administration. Also, you should not ignore existing restrictions, as this will lead to a worsening of the condition and further development of the pathology.

When choosing a Perindopril analogue from the list, you should pay attention to the information specified in the instructions. It is not recommended to engage in self-therapy and adjust the dosage and duration of the course, as this may contribute to complications.

Prices for Perindopril analogues

As for Perindropil analogues without side effects, there are none. Any drug has such a list.

Perindopril or Prestarium - which is better?

Manufacturer: SERVIER, Russia
Release form: tablets, dispersible tablets

Active ingredient: perindropil

Prestarium is an analogue of Perindopril 8 mg, which is an ACE inhibitor. The product has the same active ingredient, therefore it has a similar pharmacological effect. Prescribed to patients over 18 years of age with high blood pressure, chronic heart failure, as a prophylactic agent after a stroke, and with stable coronary heart disease.

The drug is also recommended for patients to reduce the risk of complications in the cardiovascular system. Perindopril, like its analogue Prestarium, has positive reviews from doctors and patients, since these drugs are distinguished by their effectiveness in treating these disorders.

Reviews

• Anna Nikolaevna, 36 years old. Perindopril, of course, is a budget drug that many can afford. And that's where its advantages end. I took it for a long time and I can’t say that the remedy is effective. It helped me slightly lower my blood pressure. At the same time, I continued to feel discomfort in the form of headaches. And so I turned to the doctor with a request to replace the drug with another one. The doctor listened to my request, and now I am taking Amlodipine. There are no side effects.
• Svetlana, 29 years old. The drug did not suit me, there were no positive dynamics, so I had to replace it with Valsartan. I also took it during pregnancy. The pressure remained no higher than 120 over 70.
• Ivan, 48 years old. I have taken both Perindopril and its analogues - Amlodipine and Indapamide over the past few years. All of these drugs helped in complex therapy. Therefore, now I will focus on price, choosing a more inexpensive product.

Perindopril or Lisinopril - which is better?

Manufacturer: BIOCHIMIC, Russia
Release form: tablets

Active ingredient: lisinopril

Lisinopril is a cheap analogue of Perindopril in Russia. The drug helps patients with high blood pressure, as it has a vasodilating effect. It is also recommended to take the drug for acute myocardial infarction and diabetic nephropathy. For arterial hypertension, it is better to use Perindopril, as it is more effective than its analogue.

Perindopril or Enalapril - which is better and more effective, what is the difference

Manufacturer: NIZHFARM, Russia
Release form: tablets

Active ingredient: enalapril

What else can replace Perindopril 4 mg? Enalapril is an inexpensive analogue that is an ACE inhibitor. Prescribed to patients over 18 years of age with disorders and pathologies of the cardiovascular system.

Perindopril is a more effective remedy for high blood pressure and heart pathologies, and is also better for obese men than its analogue Enalapril.

Perindopril or Perineva - which is better, what is the difference

Manufacturer: KRKA, Russia
Release form: tablets

Active ingredient: perindopril

Perineva is a substitute for Perindopril tablets, an ACE inhibitor and is prescribed to patients suffering from high blood pressure. It is recommended to take the drug only under the supervision of a doctor, who adjusts the dosage of the drug depending on the diagnosis.

The purpose of Perinev's analogue is the same as Perindopril Plus. This is explained by the fact that the composition includes the same active ingredient.

Reviews about these drugs are equally positive, so they can replace each other in therapy for arterial hypertension.

Losartan

Manufacturer: VERTEX, Russia
Release form: tablets

Active ingredient: losartan

Losartan is an inexpensive replacement for Perindopril Teva. The drug helps fight high blood pressure and has a vasodilating effect. The drug is quickly absorbed from the gastrointestinal tract and excreted along with urine and feces.

This analogue of Perindopril 5 mg is prescribed to patients over 18 years of age with arterial hypertension, chronic heart failure, and also to protect the kidneys in type 2 diabetes mellitus with proteinuria.

Captopril

Manufacturer: Pharmakor Production, Russia
Release form: tablets

Active ingredient: captopril

How to replace Perindopril for blood pressure? A good option is Captopril, a domestically produced drug that has an antihypertensive effect.

The drug is an ACE inhibitor and has a vasodilating effect. This analogue of Perindopril tablets is prescribed to patients over 18 years of age for disorders and pathologies that are accompanied by increased blood pressure. The dosage of Captopril is adjusted by the cardiologist depending on the general condition of the patient.

Perindopril analogues are antihypertensive drugs with a vasodilating effect, which are prescribed to patients with pathologies and disorders of the cardiovascular system. They help normalize blood pressure in a short time, but subject to the prescribed dosage. Analogs are recommended for patients over 18 years of age and without contraindications.

Perindopril

ACE inhibitor (interacts with Zn2+ in the ACE molecule and causes its inactivation). The drug acts through its active metabolite perindoprilate. Eliminates the vasoconstrictor effect of angiotensin II, increases the concentration of bradykinin and vasodilator Pg (ACE converts inactive angiotensin I into angiotensin II, which has a vasoconstrictor effect, and also causes degradation of bradykinin and Pg, which have 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 the formation of angiotensin II is accompanied by an increase in plasma renin activity (due to inhibition of negative feedback). Suppression of ACE is accompanied by an increase in the activity of both the circulating and tissue kallikrein-kinin system, as well as the Pg system.

Helps restore the elasticity of large arterial vessels (reducing the formation of excess amounts of subendothelial collagen), reduces pressure in the pulmonary capillaries; with long-term administration of the drug, this drug reduces the severity of LV myocardial hypertrophy and interstitial fibrosis, normalizes the myosin isoenzyme profile; normalizes heart function. Reduces preload and afterload (reduces systolic and diastolic blood pressure in the “lying” and “standing” positions), filling pressure of the left and right ventricles, peripheral vascular resistance; increases IOC and cardiac index, does not increase heart rate (in patients with CHF it moderately reduces heart rate), increases regional blood flow in the muscles. Increases the concentration of HDL, in patients with hyperuricemia it reduces the concentration of uric acid. Increases renal blood flow, does not change glomerular filtration rate.

In patients with CHF, it causes a significant decrease in the severity of clinical signs of HF, increases tolerance to physical activity (according to the bicycle ergometer test), and does not significantly reduce blood pressure. After oral administration of an average single dose, the maximum hypotensive effect is achieved after 4-6 hours and persists for 24 hours. Stabilization of the hypotensive effect of the drug is observed after 1 month of therapy and persists for a long time. Termination of treatment is not accompanied by the development of withdrawal syndrome.