Many people suffer from problems with blood pressure and cardiovascular diseases. And often such diseases are chronic.
In this case, patients need long-term treatment, so it is very important to choose the most suitable and cost-effective drug. What is Perindopril for? This will be written about in this article.
pharmachologic effect
Perindopril is an original drug that contains a component that, after undergoing metabolic transformations, turns into perindopilate, which is an active metabolite and has the ability to inhibit ACE.
ACE inhibition helps to lower the level of angiotensin II in the blood plasma, and as a result of this process, the activity of renin in the plasma increases, and the aldosterone section also decreases.
Perindoprilum has a vasodilating effect on the body, due to which it effectively helps reduce resistance in the blood vessels of the lungs. When taking this drug, the patient's myocardial minute volume increases and myocardial tolerance to stress increases.
The drug also has a natriuretic effect and a cardioprotective effect, and an hour after taking the tablet, a hypotension effect is observed.
A decrease in blood pressure is not accompanied by the development of tachycardia.
After using this drug, the maximum effect is observed after approximately four to eight hours, and the therapeutic effect will last up to 24 hours.
O not only helps improve blood circulation in the brain, kidneys, and myocardium, but also reduces the oxygen requirements of myocardiocytes during coronary heart disease. The drug has antioxidant properties, which slows down the addiction to nitrates.
There are several forms of the drug that can be found in pharmacies in your city: Perindopril-MIC, Perindopril Teva, Perindopril Sandoz, Perindopril A and others.
Drug interactions
Perindopril is not recommended for use simultaneously with other drugs that can cause hyperkalemia (potassium-sparing diuretics, heparin, ACE inhibitors, aliskiren and aliskiren-containing drugs, angiotensin II receptor antagonists, immunosuppressants, potassium salts, non-steroidal anti-inflammatory drugs).
In patients with impaired renal function or diabetes mellitus, combination with aliskiren is contraindicated, as this group of patients has a high risk of deterioration of renal function, hyperkalemia, cardiovascular disease and mortality.
Double blockade (taking ACE inhibitors and angiotensin II receptor antagonists) in patients with heart failure, established atherosclerosis or diabetes mellitus with target organ damage leads to an increased incidence of syncope, hypotension, deterioration of renal function and hyperkalemia.
Estramustine increases the risk of side effects such as angioedema.
The combination of Perindopril with lithium-containing drugs is not recommended (due to a possible reversible increase in serum lithium concentration and associated toxic effects).
ACE inhibitors can enhance the effect of hypoglycemic agents and lead to the development of hypoglycemia.
When used simultaneously with baclofen, the hypotensive effect of perindopril increases (it may require a change in its dose).
Diuretics may further reduce blood pressure, especially at the beginning of treatment with the drug.
Spironolactone or eplerenone can be used concomitantly with perindopril only in the absence of renal dysfunction and hyperkalemia. In the first month of therapy with this combination, it is recommended to monitor the concentrations of potassium and creatinine in the blood weekly, and then monthly.
Nonsteroidal anti-inflammatory drugs may reduce the antihypertensive effect of ACE inhibitors. The simultaneous use of drugs from these groups is fraught with deterioration of kidney function and an increase in potassium levels in the blood.
The hypotensive effect of perindopril is enhanced when used together with vasodilators and other antihypertensive drugs.
Gliptins increase the risk of developing angioedema.
Antipsychotics, tricyclic antidepressants and drugs for general anesthesia can enhance the hypotensive effect of perindopril, and sympathomimetics can weaken it.
Simultaneous intravenous administration of the drug gold (sodium aurothiomalate) can lead to the development of a symptom complex in which nausea, vomiting, flushing of the facial skin appears and blood pressure decreases.
Indications for use
The medicine Perindopril has the following indications for use:
- with high blood pressure;
- with arterial hypertension;
- to prevent recurrent stroke;
- with stable ischemic heart disease;
- for the purpose of preventing stroke after a transient ischemic attack;
- for chronic heart failure.
It is also prescribed to people who suffer from type I and type II diabetes for high blood pressure.
Many doctors prescribe in combination with a drug with diuretic effects, for example, Perindopril plus Indapamide. Reviews of this treatment are even higher.
Mode of application
Blood pressure tablets Perindopril is recommended to be taken one tablet once every 24 hours before meals, with a sufficient amount of liquid. The dose required for treatment is selected individually, according to the patient’s medical history and blood pressure.
Perindopril Teva
The recommended dose for use is four milligrams once a day. Patients with the RAS (renin-angiotensin-aldosterone system) may have problems lowering blood pressure during the initial dose of the drug.
In this case, the recommended dose is two milligrams, and the course of treatment is strictly under the supervision of the attending physician. After one month of treatment with Perindopril, the daily dose can be increased to eight milligrams.
For patients suffering from hypertension (arterial hypertension) without stopping diuretics, therapy with Perindopril tert-butylamine should be started with a daily dose of no more than two milligrams.
Be sure to monitor kidney function and potassium levels in the blood plasma.
All further medications must be adjusted based on blood pressure readings. If intake therapy is necessary after completing the course of treatment, then it can be resumed.
Elderly people suffering from arterial hypertension are recommended to start taking the drug with one to two milligrams per day, and gradually increase to four milligrams no earlier than after one month.
Patients who have severe heart failure, as well as those people who belong to a high-risk group, are allowed to take the drug only under the supervision of their attending physician.
For patients with stable coronary artery disease (CAD), Perindopril should be used at a dose of four milligrams once daily for two weeks, after which, depending on the state of renal function, it is recommended to increase the dose to eight milligrams per day.
In order to prevent a recurrent stroke, the recommended dose of the drug is two milligrams per day, and should be taken in the morning, with the tablets washed down with a sufficient amount of liquid.
After a two-week period from the moment of first taking the medicine, it is necessary to increase the dose to four milligrams per day. For older people with stable coronary artery disease, the daily dose is two milligrams, and after a week after the first dose of the drug, the dose should be increased to four milligrams over the next seven days.
When increasing the drug intake to eight milligrams per day, it is necessary to rely on the state of kidney function. If the dose needs to be increased, it is necessary to rely on the patient’s tolerability of the drug.
Release form and composition
Perindopril is available in the form of tablets and film-coated tablets in dosages of 2, 4 and 8 mg.
Description of film-coated tablets (manufactured by Izvarino Pharma LLC):
- film-coated tablets 2 mg: biconvex, round, white or almost white, a white or almost white core is visible on the cut;
- film-coated tablets 4 mg: biconvex, round, light green or green in color, a white or almost white core is visible on the cut;
- 8 mg film-coated tablets: biconvex, round, gray-green or green with a grayish tint, a white or almost white core is visible on the cut.
Film-coated tablets are packaged in blisters of 10 pcs. 1, 2, 3, 5, 6 or 9 blisters are placed in a cardboard box along with instructions for using Perindopril.
Description of tablets (manufactured by PRANAFARM LLC):
- 2 mg tablets: biconvex, round, white or almost white, without lines;
- 4 mg tablets: biconvex, round, white or almost white, scored on one side;
- 8 mg tablets: flat-cylindrical, round, white or almost white, with a chamfer and a score on one side.
Perindopril tablets produced by PRANAFARM LLC are packaged in blisters of 7 pcs. (2, 3 or 4 blisters in a cardboard box) or 10 pcs. (1, 2, 3, 4 or 5 blisters in a cardboard package).
Description of tablets (manufactured by Aurobindo Pharma Ltd.):
- 4 mg tablets: oval, white or off-white, engraved “D” on one side and engraved “5” and “8” separated by a score on the other;
- 8 mg tablets: biconvex, round, white or off-white, engraved “D” on one side and engraved “5” and “9” separated by a score on the other.
Tablets manufactured by Aurobindo Pharma Ltd. Packed in blisters of 10 pcs. Every 3 blisters are placed in a laminated foil bag along with silica gel (desiccant), and then 1 bag, along with instructions, is packed in a cardboard pack.
Perindopril tablets produced by Biokhimik OJSC are available in dosages of 2 mg, 4 mg and 8 mg. They have a flat-cylindrical shape with a chamfer, the color is white or white with a slight creamy/yellowish tint, slight marbling is allowed. Packed in blisters of 10 pcs. (1, 2 or 3 blisters in a cardboard pack) or in polymer or glass jars of 20 or 30 pcs. (1 can in a cardboard box).
Tablets produced by JSC Vertex are available only in a dosage of 4 mg. They have a flat-cylindrical round shape with a chamfer, white or almost white. Packed in blisters of 10 pcs. (1 or 3 blisters in a cardboard box), 15 pcs. (2 blisters in a cardboard box) or 30 pcs. (1 blister in a cardboard pack), as well as in polyethylene jars of 10 or 30 tablets, 1 jar in a cardboard pack.
Composition per 1 film-coated tablet:
- active ingredient: perindopril erbumine – 2, 4 or 8 mg;
- auxiliary components of the tablet core: colloidal silicon dioxide, pregelatinized corn starch, crospovidone, magnesium stearate, microcrystalline cellulose;
- film coating: Opadry II white 85F18422 (dosage 2 mg), Opadry II green 85F21738 (dosage 4 mg), Opadry II green 85F21867 (dosage 8 mg).
Composition of 1 tablet:
- active ingredient: perindopril erbumine – 2, 4 or 8 mg;
- auxiliary components: microcrystalline cellulose, magnesium stearate, lactose monohydrate, corn starch.
Contraindications
Perindopril tablets are contraindicated for use in:
- hypersensitivity to the substance or its individual components;
- hypersensitivity to another ACE inhibitor;
- pregnancy;
- lactation.
The use of the drug in combination with another drug that contains the active ingredient aliskiren is prohibited for patients suffering from diabetes mellitus and renal failure.
Use during pregnancy and lactation
Perindopril is contraindicated in pregnant women in any trimester. If pregnancy is confirmed, the drug should be discontinued as soon as possible.
In the second and third trimesters, Perindopril can have a fetotoxic effect on the fetus, causing oligohydramnios, decreased renal function and slowing down the ossification of the skull bones. It can also cause neonatal toxic effects such as hypertension, renal failure and hyperkalemia. If a woman took the drug in the second or third trimesters, it is necessary to do an ultrasound of the fetal skull bones and kidneys.
ACE inhibitors are secreted into breast milk, therefore Perindopril is contraindicated during lactation.
Women of childbearing age taking ACE inhibitors should use reliable methods of protection against pregnancy.
Overdose
Exceeding the dosage will cause a sharp drop in blood pressure.
Signs of overdose include:
- state of shock;
- strong or increased heartbeat;
- feeling of anxiety;
- cough and dry mouth;
- dizziness.
In order to get rid of the symptoms of an overdose, it is recommended to take activated charcoal and perform a gastric lavage, then call an ambulance.
Side effects
If the dosage is not observed or if there is personal intolerance to the drug, side effects from many systems may occur.
The following side effects are observed:
- headache;
- chest pain;
- anemia;
- thrombocytopenia;
- dyspepsia;
- sleep disturbance;
- change in hemoglobin level;
- allergic skin rashes;
- sudden change in taste;
- pancreatitis;
- asthenia;
- lethargy and weakness;
- dry mouth, often accompanied by a dry cough;
- increased concentrations of uric acid may occur;
- dizziness;
- paresthesia;
- hyperkalemia;
- sudden changes in mood;
- convulsions;
- itching;
- bronchospasm;
- arterial hypotension;
- muscle spasms are observed;
- dyspnea.
Instructions:
Clinical and pharmacological group
01.048 (Antihypertensive drug)
Release form, composition and packaging
The tablets are white or almost white, round, biconvex, beveled, with a short line engraved on one side.
| 1 tab. | |
| perindopril erbumine* | 2 mg |
| indapamide | 625 mcg |
Excipients of semi-finished granules: calcium chloride hexahydrate, lactose monohydrate, crospovidone.
Excipients: microcrystalline cellulose, sodium bicarbonate, colloidal silicon dioxide, magnesium stearate.
10 pieces. — contour cell packaging (3) — cardboard packs. 10 pcs. — contour cell packaging (6) — cardboard packs. 10 pcs. — contour cell packaging (9) — cardboard packs.
* — perindopril erbumine K semi-finished granules — 37.515 mg.
The tablets are white or almost white, round, biconvex, scored on one side and chamfered.
| 1 tab. | |
| perindopril erbumine** | 4 mg |
| indapamide | 1.25 mg |
Excipients of semi-finished granules: calcium chloride hexahydrate, lactose monohydrate, crospovidone.
Excipients: microcrystalline cellulose, sodium bicarbonate, colloidal silicon dioxide, magnesium stearate.
10 pieces. — contour cell packaging (3) — cardboard packs. 10 pcs. — contour cell packaging (6) — cardboard packs. 10 pcs. — contour cell packaging (9) — cardboard packs.
** — perindopril erbumine K semi-finished granules — 75.03 mg.
The tablets are white or almost white, round, biconvex, scored on one side.
| 1 tab. | |
| perindopril erbumine*** | 8 mg |
| indapamide | 2.5 mg |
Excipients of semi-finished granules: calcium chloride hexahydrate, lactose monohydrate, crospovidone.
Excipients: microcrystalline cellulose, sodium bicarbonate, colloidal silicon dioxide, magnesium stearate.
10 pieces. — contour cell packaging (3) — cardboard packs. 10 pcs. — contour cell packaging (6) — cardboard packs. 10 pcs. — contour cell packaging (9) — cardboard packs.
*** - perindopril erbumine K semi-finished granules - 150.06 mg.
pharmachologic effect
A combined antihypertensive drug containing an ACE inhibitor - perindopril and a thiazide-like diuretic - indapamide. The drug has antihypertensive, diuretic and vasodilating effects.
Co-Perineva® has a pronounced dose-dependent antihypertensive effect, independent of the patient’s age and body position and 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 hypokalemia caused by diuretic monotherapy.
The antihypertensive effect lasts for 24 hours.
A stable reduction in blood pressure is achieved within 1 month with the use of the drug Co-Perineva® without an increase in heart rate. Discontinuation of treatment does not lead to the development of 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, and reduces the secretion of aldosterone. The use of perindopril does not lead to sodium and fluid retention and 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, perindoprilate. Its other metabolites are inactive.
The action of perindopril leads to varicose veins (reduction of preload on the heart), caused by changes in the metabolism of prostaglandins; reduction of peripheral vascular resistance (reduction of afterload on the heart).
In patients with heart failure, perindopril helps reduce the filling pressure of the left and right ventricles; increased cardiac output and cardiac index; increasing regional blood flow in muscles.
Perindopril is effective for arterial hypertension of any severity: mild, moderate and severe.
The maximum antihypertensive effect develops 4-6 hours after a single oral dose and persists throughout the day.
Discontinuation of therapy does not lead to the development of opirouette syndrome, such as antiarrhythmic drugs (quinidine, hydroquinidine, disopyramide, amiodarone, dofetilide, ibutilide, bretylium, sotalol), some antipsychotics (chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoperazine), benzamides (amisulpride , sulpiride, sultopride, tiapride), butyrophenones (droperidol, haloperidol), other antipsychotics (pimozide); other substances such as bepridil, cisapride, difemanil methyl sulfate, erythromycin (IV), halofantrine, mizolastine, moxifloxacin, pentamidine, sparfloxacin, vincamine IV, methadone, astemizole, terfenadine. It is necessary to monitor the potassium concentration in order to avoid hypokalemia, the development of which requires its correction, and to monitor the QT interval on the ECG.
With simultaneous use of indapamide with amphotericin B (iv), gluco- and mineralocorticoids (when administered systemically), tetracosactide, laxatives that stimulate intestinal motility, the risk of developing hypokalemia increases (additive effect). It is necessary to monitor the potassium content in the blood plasma and, if necessary, correct it. Particular attention should be paid to patients simultaneously receiving cardiac glycosides. Laxatives that do not stimulate intestinal motility should be used.
Hypokalemia enhances the toxic effect of cardiac glycosides. With the simultaneous use of indapamide and cardiac glycosides, the potassium content in the blood plasma, ECG readings should be monitored and, if necessary, the dose of cardiac glycosides should be adjusted.
Caution is required during simultaneous use
When using metformin with diuretics, renal failure may develop.
When used simultaneously with metformin, the risk of developing lactic acidosis increases. Metformin should not be used if serum creatinine exceeds 15 mg/L (135 µmol/L) in men and 12 mg/L (110 µmol/L) in women.
While taking diuretics, there is a decrease in blood volume, and the risk of developing acute renal failure increases, especially when using iodine-containing contrast agents in high doses. Before using iodine-containing contrast agents, it is necessary to compensate for the volumetric volume.
When used simultaneously with calcium supplements, hypercalcemia may develop due to a decrease in calcium excretion by the kidneys.
When used simultaneously with cyclosporine, the risk of developing renal dysfunction (hypercreatininemia) increases.
Use during pregnancy and lactation
The use of Co-Perineva® during pregnancy is contraindicated. Taking the drug during pregnancy may cause fetoplacental ischemia with the risk of slowing fetal development.
The use of Co-Perineva® during lactation is not recommended (indapamide is excreted in breast milk). If it is necessary to use the drug Co-Perineva® during lactation, breastfeeding should be discontinued.
Side effects
Classification of the frequency of side effects (WHO): very common (> 1/10), common (> 1/100 to < 1/10), uncommon (> 1/1000 to < 1/100), rare (> 1/10,000 to <1/1000), very rare (<1/10,000, including isolated reports).
From the hematopoietic system: very rarely - hemorrhagic vasculitis, hemolytic anemia; with long-term use in high doses - thrombocytopenia, leukopenia/neutropenia, agranulocytosis, aplastic anemia, which was recorded while taking ACE inhibitors (patients on hemodialysis or peritoneal dialysis).
From the central nervous system and peripheral nervous system: often - paresthesia, headache, dizziness, vertigo, asthenia; infrequently - mood lability, sleep disturbances, increased sweating; very rarely - confusion.
From the senses: often - visual impairment, tinnitus.
From the cardiovascular system: often - marked decrease in blood pressure, orthostatic hypotension; very rarely - arrhythmias, incl. bradycardia, ventricular tachycardia, atrial flutter, angina pectoris, myocardial infarction or stroke, possibly secondary to severe hypotension in high-risk patients.
From the respiratory system: often - dry, irritating, persistent cough that goes away after discontinuation of the drug, shortness of breath; uncommon - bronchospasm; very rarely - eosinophilic pneumonia, rhinitis.
From the digestive system: often - constipation, dryness of the oral mucosa, loss of appetite, nausea, epigastric pain, abdominal pain, changes in taste, vomiting, dyspepsia, diarrhea; very rarely - pancreatitis, jaundice (cytolytic or cholestatic); frequency has not been established; in case of liver failure, there is a possibility of developing hepatic encephalopathy, intestinal edema.
From the musculoskeletal system: often - muscle cramps.
From the urinary system: infrequently - renal dysfunction; very rarely - acute renal failure.
From the reproductive system: infrequently - impotence.
Dermatological reactions: often - skin itching, maculopapular rashes; in isolated cases - photosensitivity reactions.
Allergic reactions: uncommon - angioedema of the face, mucous membranes of the oral cavity, tongue, uvula of the upper palate, and/or larynx, urticaria; in patients with a burdened allergic history - mainly dermatological reactions of hypersensitivity, purpura; possible exacerbation of systemic lupus erythematosus; very rarely - erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome.
Laboratory indicators: hypokalemia; hyponatremia with hypovolemia, leading to a decrease in blood volume and orthostatic hypotension; increased concentrations 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 cessation of therapy, which often develops against the background of renal artery stenosis or stenosis of the artery of a single kidney, arterial hypertension during diuretic therapy, and in renal failure; transient increase in sodium content in blood plasma; hypochloremia; proteinuria; rarely - hypercalcemia.
Storage conditions and periods
The drug should be stored out of the reach of children at a temperature not exceeding 30°C. Shelf life: 2 years.
Indications
- arterial hypertension.
Contraindications
- history of angioedema (hereditary, idiopathic or angioedema due to taking ACE inhibitors);
— severe renal failure (creatinine clearance less than 30 ml/min);
- azotemia;
- anuria;
- bilateral renal artery stenosis, stenosis of the artery of a single kidney;
— chronic heart failure in the stage of decompensation;
- refractory hyperkalemia;
- hereditary galactosemia, lactase deficiency, glucose-galactose malabsorption;
- age under 18 years (efficacy and safety have not been established);
- severe liver failure (including with encephalopathy);
- pregnancy;
- lactation period;
- hypersensitivity to the components of the drug.
The drug should be used with caution in case of systemic connective tissue diseases (including systemic lupus erythematosus, scleroderma), during therapy with immunosuppressants (risk of developing neutropenia, agranulocytosis), in case of suppression of bone marrow hematopoiesis, decrease in blood volume (taking diuretics, salt-free diet, vomiting) , diarrhea), with angina pectoris, cerebrovascular diseases, renovascular hypertension, diabetes mellitus, chronic heart failure (functional class IV according to the NYHA classification), with hyperuricemia (especially accompanied by gout and urate nephrolithiasis), blood pressure lability, with hemodialysis using high-flow polyacrylonitrile membranes ( risk of developing anaphylactoid reactions), before the LDL apheresis procedure, simultaneously with desensitizing therapy with allergens (for example, hymenoptera venom), in the condition after kidney transplantation, aortic and/or mitral valve stenosis, hypertrophic obstructive cardiomyopathy, simultaneously with drugs that prolong the QT interval, in elderly patients.
special instructions
Co-Perineva®
The simultaneous use of Co-Perineva® with lithium preparations is not recommended.
Therapy with Co-Perineva® is contraindicated in patients with severe renal failure (creatinine clearance less than 30 ml/min). In some patients with arterial hypertension without previous renal impairment, symptoms of acute renal failure may appear during therapy with Co-Perineva®. In this case, treatment with Co-Perineva® should be discontinued. In the future, you can resume combination therapy using low doses of Co-Perineva®, or use perindopril and indapamide in monotherapy. Such patients require regular monitoring of potassium and creatinine levels in the blood serum every 2 weeks after the start of therapy and every subsequent 2 months of therapy with Co-Perineva®.
Acute renal failure often develops in patients with severe chronic heart failure or underlying renal impairment, incl. with bilateral renal artery stenosis or stenosis of the artery of a single functioning kidney. Taking Co-Perineva® is not recommended for patients with bilateral renal artery stenosis or stenosis of the artery of a single functioning kidney.
Hyponatremia is associated with a risk of a sudden decrease in blood pressure (especially in patients with bilateral renal artery stenosis or arterial stenosis of a single functioning kidney). Therefore, during dynamic monitoring of patients, attention should be paid to possible symptoms of dehydration and a decrease in plasma electrolytes, for example, after prolonged diarrhea or vomiting. Such patients require regular monitoring of plasma electrolytes. With a pronounced decrease in blood pressure, intravenous administration of 0.9% sodium chloride solution may be required.
Transient arterial hypotension is not a contraindication for further continuation of therapy. After restoration of blood volume and blood pressure, you can resume therapy with Co-Perineva®, using low doses of the drug, or using the drugs perindopril and indapamide in monotherapy.
The combined use of perindopril and indapamide does not prevent the development of hypokalemia, especially in patients with diabetes mellitus or renal failure. As in the case of the combined use of antihypertensive drugs and a diuretic, regular monitoring of potassium levels in the blood plasma is necessary.
It should be taken into account that the excipients of the drug Co-Perineva® include lactose monohydrate, therefore the drug is contraindicated in patients with hereditary galactosemia, lactase deficiency, and glucose-galactose malabsorption.
Perindopril
In patients taking ACE inhibitors, cases of neutropenia/agranulocytosis, thrombocytopenia and anemia may develop. 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 diseases and simultaneously receiving immunosuppressive therapy, allopurinol or procainamide, especially with existing renal impairment. Such patients may develop a severe infection that does not respond to intensive antibiotic therapy. If perindopril is prescribed, it is recommended to periodically monitor the number of leukocytes in the blood. The patient should be warned that if any signs of an infectious disease appear (sore throat, fever), consult a doctor immediately.
When taking ACE inhibitors, incl. perindopril, in rare cases, the development of angioedema of the face, lips, tongue, uvula, and/or larynx may occur. If these symptoms appear, the drug should be stopped immediately. The patient's condition should be monitored until signs of edema completely disappear.
If angioedema affects only the face and lips, its symptoms usually resolve on their own, or antihistamines can be used to treat symptoms. Angioedema, accompanied by swelling of the tongue or larynx, can lead to airway obstruction and death.
If symptoms of angioedema appear, you should immediately administer subcutaneous epinephrine (adrenaline) at a dilution of 1:1000 (0.3 or 0.5 ml) and/or ensure airway patency.
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.
In rare cases, angioedema of the intestine develops during therapy with ACE inhibitors. In this case, patients experience 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 C-1-esterase levels. The diagnosis is made using computed tomography of the abdominal cavity, ultrasound, or at the time of surgery. Symptoms disappear after stopping ACE inhibitors. In patients with abdominal pain receiving ACE inhibitors, the possibility of developing angioedema of the intestine must be taken into account when making a differential diagnosis.
There are isolated 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 patients prone to allergic reactions undergoing desensitization procedures. Prescription of an ACE inhibitor should be avoided in patients receiving immunotherapy with hymenoptera venom. 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.
In rare cases, life-threatening anaphylactoid reactions may occur in patients receiving ACE inhibitors 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.
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 drug of a different pharmacotherapeutic group.
The combined use of perindopril and potassium-sparing diuretics, as well as potassium preparations and potassium-containing table salt substitutes is not recommended.
During therapy with an ACE inhibitor, a dry cough may occur, which disappears after discontinuation of drugs in this group. If a dry cough appears, you should be aware of the possible connection of this symptom with taking an ACE inhibitor. If the doctor believes that ACE inhibitor therapy is necessary for the patient, taking Co-Perineva® can be continued.
In liver cirrhosis, accompanied by edema and ascites, arterial hypotension, chronic heart failure, significant activation of the RAAS is possible, especially with severe hypovolemia and a decrease in the content of electrolytes in the blood plasma (against the background of a salt-free diet or long-term use of diuretics).
The use of an ACE inhibitor causes blockade of the RAAS, and therefore a sharp decrease in blood pressure and/or an increase in serum creatinine is possible, indicating the development of acute renal failure, which is more often observed when taking the first dose of Co-Perineva® or during the first 2 weeks of therapy.
In elderly patients, before starting to take Co-Perineva®, renal function and potassium levels in the blood plasma should be assessed. The initial dose of Co-Perineva® is selected depending on the degree of reduction in blood pressure, especially with a decrease in blood volume and in chronic heart failure (functional class IV according to the NYHA classification). Such measures help to avoid a sharp decrease in blood pressure.
The risk of arterial hypotension exists in all patients, however, special caution should be observed when using the drug Co-Perineva® in patients with coronary artery disease and cerebrovascular insufficiency. In such patients, treatment with the drug should be started with a dose of 2 mg/625 mcg (initial dose).
In patients with diagnosed or suspected renal artery stenosis, treatment with Co-Perineva® should begin in a hospital setting with a dose of 2 mg/625 mcg under monitoring of renal function and potassium levels in the blood plasma. Some patients may develop acute renal failure, which is reversible after discontinuation of the drug.
In patients with chronic heart failure (functional class IV according to the NYHA classification), treatment with Co-Perineva® should be started with an initial dose of 2 mg/625 mcg under medical supervision.
When prescribing Co-Perineva® to patients with diabetes mellitus receiving oral hypoglycemic agents or insulin, blood glucose concentrations should be regularly monitored during the first month of therapy.
Perindopril (like other ACE inhibitors) has a less pronounced hypotensive effect in patients of the Negroid race compared to representatives of other races.
The use of ACE inhibitors in patients undergoing surgery under general anesthesia can lead to a significant decrease in blood pressure, especially when using general anesthetic agents that have a hypotensive effect.
It is recommended to stop taking ACE inhibitors, incl. perindopril, 12 hours before surgery, warning the anesthesiologist about the use of ACE inhibitors.
ACE inhibitors should be used with caution in patients with left ventricular outflow tract obstruction and aortic and/or mitral stenosis.
In rare cases, while taking ACE inhibitors, cholestatic jaundice occurs, with the progression of which fulminant liver necrosis develops, sometimes with a fatal outcome. If jaundice or a significant increase in the activity of liver transaminases occurs while taking ACE inhibitors, Co-Perineva® should be discontinued.
In patients after kidney transplantation or in patients on hemodialysis, anemia may develop.
During treatment with ACE inhibitors, incl. and perindopril may develop hyperkalemia. Risk factors for hyperkalemia are renal failure, old age, diabetes mellitus, some concomitant conditions (decrease in blood volume, acute heart failure in the stage of decompensation, metabolic acidosis), simultaneous use of potassium-sparing diuretics (such as spironolactone, eplerenone, triamterene, amiloride), as well as drugs potassium or potassium-containing substitutes for table salt and the use of other drugs that increase the content of potassium in the blood plasma (for example, heparin). Hyperkalemia can cause serious heart rhythm problems, sometimes fatal. The combined use of the drugs listed above must be carried out with caution.
Indapamide
There are reports of cases of increased photosensitivity while taking thiazide and thiazide-like diuretics. If a photosensitivity reaction develops while taking Co-Perineva®, treatment should be discontinued. If it is necessary to resume use of the drug Co-Perineva®, you should protect exposed skin from direct exposure to sunlight and artificial ultraviolet rays.
Before starting treatment with Co-Perineva®, it is necessary to determine the sodium content in the blood plasma and, while taking the drug, regularly monitor electrolytes in the blood plasma. All diuretics can cause hyponatremia, leading to serious complications.
Therapy with thiazide and thiazide-like diuretics is associated with a risk of developing hypokalemia (less than 3.4 mmol/l) in elderly patients, malnourished patients, patients with liver cirrhosis, patients with peripheral edema, ascites, coronary artery disease, and chronic heart failure. Hypokalemia in these patients increases the toxic effect of cardiac glycosides and increases the risk of developing arrhythmia. The high-risk group includes patients with an increased QT interval on the ECG. Hypokalemia, like bradycardia, contributes to the development of severe cardiac arrhythmias, especially ventricular arrhythmias, which can be fatal. In all the described cases, regular monitoring of potassium levels in the blood plasma is necessary. The first determination of potassium content in the blood plasma should be carried out within the first week from the start of therapy with Co-Perineva®.
Thiazide and thiazide-like diuretics reduce the excretion of calcium by the kidneys, leading to a slight and temporary increase in calcium levels in the blood plasma. Severe hypercalcemia may be a consequence of latent hyperparathyroidism. Before studying the function of the parathyroid glands, you should stop taking Co-Perineva®.
Glucose concentrations should be monitored in patients with diabetes mellitus.
In patients with increased concentrations of uric acid in the blood plasma during therapy with Co-Perineva®, the frequency of exacerbations of gout may increase.
Hypovolemia as a result of a decrease in blood volume or hyponatremia caused by taking diuretics at the beginning of treatment with Co-Perineva® can lead to a decrease in glomerular filtration rate and be accompanied by an increase in creatinine and urea in the blood plasma.
Indapamide may give a false-positive reaction during doping control.
Use in pediatrics
The drug Co-Perineva® is contraindicated in children and adolescents under 18 years of age due to the lack of data on the effectiveness and safety of use.
Impact on the ability to drive vehicles and operate machinery
Care must be taken when driving vehicles and other technical devices that require increased attention and speed of psychomotor reactions.
Use for renal impairment
Patients with renal failure (creatinine clearance 60 ml/min or more) do not require dose adjustment. For patients with CC 30-60 ml/min, the maximum dose of Co-Perineva® is 2 mg/625 mg (1 tablet) 1 time/day. When CC is less than 30 ml/min, Co-Perineva® is contraindicated.
Use for liver dysfunction
Contraindicated: severe liver failure (including encephalopathy).
Conditions for dispensing from pharmacies
The drug is available with a prescription.
Reviews
Reviews of the drug Prindopril from patients and doctors are in most cases good. The majority of reviews about the drug are left by patients over 40 years of age.
Also, in most cases, it is indicated that the drug is effective and suitable for a long course of treatment, while taking it does not entail side effects.
It is extremely rare to find negative reviews that talk about the occurrence of some side effects, which may be due to non-compliance with the dosage or improper use of the medicine. In terms of the price of Perindopril, there are no negative reviews.
Video on the topic
A short video review of the drug Perindopril: what it helps with, how to use it and in what cases its use is contraindicated:
Perindopril is an effective drug for various diseases of the cardiovascular system. It has mainly found its use in the treatment of arterial hypertension, where it performs well. Side effects from the use of this medicine are extremely rare, which is a big plus for many patients.
The information on the MyMedNews.ru website is for reference and general information, collected from publicly available sources and cannot serve as a basis for making a decision on the use of medications in the course of treatment.
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special instructions
If an episode of unstable angina occurs in the first month of treatment with the drug, the benefit-risk ratio of further therapy with Perindopril should be assessed.
Some patients with CHF and low or normal blood pressure may experience an additional drop in blood pressure during treatment. This effect is expected and, as a rule, does not serve as a basis for discontinuing Perindopril. Arterial hypotension, accompanied by clinical symptoms, may require a dose reduction or complete discontinuation of the drug.
In patients of the Negroid race, the risk of angioedema when taking ACE inhibitors is higher than in patients of other races.
During treatment with Perindopril, it is possible to develop a persistent non-productive dry cough, which stops after discontinuation of the drug. This point must be taken into account when diagnosing cough.
In some cases, the hypotensive effect of ACE inhibitors in elderly patients is more pronounced than in younger people.
Taking high doses of Perindopril and existing renal dysfunction can cause proteinuria.
If jaundice appears or the activity of liver enzymes increases, the drug should be immediately discontinued and the patient monitored, since existing cholestatic jaundice can progress to fulminant liver necrosis (even death).
Impact on the ability to drive vehicles and complex mechanisms
During therapy with Perindopril, patients who drive a car or perform other complex and potentially dangerous work must be careful and especially attentive (due to the risk of dizziness and hypotension).
