Perineva is a domestic drug for stabilizing blood pressure. Available in two dosages - 4 and 8 mg. Prescribed and prescribed by a doctor. With prolonged use, adverse reactions are possible, for example, cough and bronchospasm.
The price of the medication depends on the dosage and the number of tablets (30 or 90 pcs.) And ranges from 250 to 1200 rubles.
With intolerance to the active substance, the inability to acquire it due to the high cost or defect, inefficiency and other factors, the issue of selecting analogues of the Perinev drug is relevant.
The choice of substitutes should be agreed with the doctor - they are available on prescription, have restrictions on the appointment and side effects.
As part of perindopril from the group of ACE inhibitors. When it enters the body, it turns into the active component perindoprilat, which provides the following therapeutic effects:
- reduces blood pressure and maintains 24 hours with constant intake and accumulation;
- increases the endurance of the heart to physical activity;
- reduces the risk of developing hemorrhagic and ischemic stroke;
- reduces the likelihood of stroke, leading to death or disability;
- helps to reduce the incidence of myocardial infarction in patients, disorders of the heart and blood vessels, deterioration of cognitive functions (memory, mental performance);
- reduces the likelihood of complications with angina pectoris.
The medication is indicated for a one-component treatment or in case of ineffectiveness in combination with diuretics (indapamide) and other antihypertensive drugs (amlodipine).
Indications for use of Perinev
The medicine is used in the following cases:
- to stabilize high blood pressure;
- chronic heart failure;
- after a primary stroke for the prevention of complications in conjunction with indapamide;
- stable angina pectoris.
The drug is strictly prescription, dosage and combinations with other medicines are prescribed by a therapist or cardiologist.
Perineva - instructions for use
The medication is taken once a day, the course of treatment is from 2 weeks to several years.
The drug Perinev is cumulative, you should not cancel the reception without prior agreement with the doctor. In some cases, undesirable reactions occur - allergies, coughs, bronchospasm.
The initial dosage is 2 or 4 mg. If necessary, the doctor may prescribe Perinev 8 mg or supplement with amlodipine, indapamide. Possible replacement for combined drugs.
How to take Perineva - before or after meals
The tablets should be taken before meals with plenty of water. The preferred time is morning.
Perinev's analogs
The replacement of the drug must be agreed with the doctor. Analogues are dispensed according to the appointment of a specialist and a prescription issued in a certain way.
Perinev's substitutes contain the same substance - perindopril, other components or supplemented with other active substances. Before purchasing, you should read the instructions for use, ask your doctor for clarifying questions.
Approximate prices of Perinev analogues with indication of the country of origin
| Analogue | Price, in rubles | The country of manufacture |
| 250-1200 | Russia | |
| 350-700 | France or Ireland | |
| Perindopril | 90-400 | Russia |
| Perindopril-Richter | 200-390 | Germany |
| Perindopril-Teva | 200-350 | Israel |
| 350-1100 | Russia | |
| Preduct | 800-1600 | France and Russia |
| Noliprel A | 550-850 | |
| Kapoten | 180-400 | Russia |
| Telmista | 330-1200 | Slovenia |
| Amprilan | 220-450 | |
| 8-120 | Russia, Israel, Germany, Belarus, India, Macedonia | |
| 15-200 | ||
| 290-650 | Slovakia | |
| 190-550 | Russia | |
| 20-150 | Russia, Israel, India |
Dalnev's domestic analogue combines the properties of two drugs at once - amlodipine and perindopril (Perineva). As a result, it has the following actions:
- reduces blood pressure indicators, stabilizes the condition with hypertension;
- dilates blood vessels;
- reduces the load on the myocardium;
- reduces myocardial oxygen demand;
- improves the quality of life, reduces the risk of death and complications after a stroke and heart attack.
Dalnev's analog is used if Perinev's medicine is ineffective or for convenience in multi-component treatment.
Preductal OD 80 mg
Analogue Preductal OD is a French drug based on trimetazidine. It is an antianginal agent, that is, it reduces oxygen deprivation of the myocardium in ischemia and angina pectoris, reduces the frequency of coronary heart disease attacks, and improves the quality of life of patients. Dispensed by prescription.
Noliprel A
The drug Noliprel A is a complex remedy for arterial hypertension. Contains perindopril, like Perineva, and the diuretic component indapamide. As a result, blood pressure is reduced faster and more efficiently. An analogue is prescribed in cases where therapy with Perineva or Perindopril is ineffective. Other cases of application are associated arterial hypertension with kidney pathologies and diabetes mellitus.
Kapoten
Analogue Capoten is a Russian drug from the group of ACE inhibitors containing captopril. It is prescribed for high blood pressure, chronic heart failure and after myocardial infarction. It is taken 2-3 times a day. Serves as an ambulance to quickly relieve pressure. There are two ways to use it - wash it down with water or put it under the tongue for emergency action.
Telmista
The imported analogue of Telmista contains a different substance - telmisartan. It is used to reduce and stabilize blood pressure. Additionally, it is produced with a diuretic component under the trade name Telmista N.
Amprilan
The analogue Amprilan is based on the substance ramipril, which belongs to the group of ACE inhibitors. Like Perineva, it reduces and normalizes high blood pressure, reduces the load on the myocardium, improves the condition of patients after a heart attack and stroke.
Which is better - Ramipril or Perineva, is determined individually. Both drugs maintain blood pressure for 24 hours. The difference is that the maximum effect after taking Amprilan or Ramipril is observed after 3-6 hours, Perinevs - 4-8 hours.
A cheap analogue of Enalapril is a drug for high blood pressure from the group of ACE inhibitors. It is taken twice a day. Produced by domestic and foreign pharmaceutical companies.
The price of the medication is 10–20 times lower, so the question is which is better - Enalapril or Perineva. The first drug maintains pressure for only 12 hours and is drunk twice, the second acts for 24 hours. Both drugs are cumulative and can cause coughing to varying degrees. Which is better, more effective and safer individually.
The drug Amlodipine is used to reduce pressure and reduce the load on the myocardium, oxygen starvation during ischemia. In some cases, it can cause swelling.
Which is better - Perineva or Amlodipine, it is difficult to determine. They belong to different groups of antihypertensive drugs, are often prescribed together or the components are included in complex drugs (for example, Dalneva).
Prestarium or Perineva - which is better
Prestarium A is an original drug based on perindopril. It is produced in two dosages - 5 and 10 mg and two forms - regular tablets and soluble in the mouth. The dispersible form is convenient for people who are uncomfortable with drinking water (for example, there is no opportunity at work) and have difficulty swallowing. The price for 30 tablets is more expensive than Perineva.
When choosing between Prestarium and Perineva, with financial resources, the first medicine is recommended. It is original, which means that it was clinically studied in patients with arterial hypertension, stable angina pectoris, myocardial infarction and stroke.
When taking Prestarium, according to the reviews of doctors and patients, cough and bronchospasm occur less often as a side effect.
Which is better - Perineva or Perindopril
Perindopril is a cheap Russian analogue of Perineva, available in dosages of 4 and 8 mg. Produced by the following domestic companies: Biochemist, Pranafarm, Izvarino, North Star. The price is lower than that of Prestarium and Perinevs. Side effects are more common.
Available in pharmacies Perindopril of foreign manufacturers: Richter (analogue of Perineva 4 mg and 8 mg) and Teva (dosages as in Prestarium - 5 and 10 mg).
In terms of properties and composition, Perineva and the analogue Perindopril are identical: perindopril is included, which turns into an active metabolite of perindoprilat.
The drugs are cumulative, stabilize blood pressure, improve the quality of life and reduce the risk of complications in coronary artery disease, heart attack and stroke. When choosing between analogues, it is advisable to give preference to proven manufacturing companies, to consult with a cardiologist.
Perineva or Lozap
Lozap is an analogue of Perineva based on losartan. Reduces and stabilizes pressure, is used in cases where there is an individual intolerance to perindopril or side effects (bronchospasm, cough) have appeared.
Both drugs - analogs of Lozap and Perineva are modern remedies for hypertension, are well tolerated and act for 24 hours.
Lisinopril or Perineva - which is better
Lisinopril is a cheap analogue of Perineva with the active ingredient of the same name. Refers to the same group - ACE inhibitors. Accepted once.
Which is better - Perineva or Lisinopril, depends on individual characteristics, the presence of other pathologies.
Perineva or Lorista - which is better after stenting
Lorista is an analogue of Perineva, containing losartan. Does not cause cough and other undesirable effects of ACE inhibitors. It is applied once. There are combinations of losartan and hydrochlorothiazide (diuretic) in the assortment of pharmacies under the trade name Lorista N and ND.
Which is better - Losartan or Perineva, it is better to decide with a cardiologist in each individual case.
It is better to coordinate the choice of Perineva's substitutes with a specialist. Analogues are sold by prescription. It can be independently replaced only by structural analogs with the chemical name Perindopril.
Frequently Asked Questions
The answers to the topical questions of buyers are given.
- What is the difference between Perineva or Perindopril?
The two medicines have the same active ingredient - perindopril. They differ in the manufacturer, auxiliary components, bioavailability (efficiency), quality. When replacing, proven analogs should be chosen.
- Is Perineva a diuretic or not?
The drug contains perindopril and belongs to the group of antihypertensive drugs (ACE inhibitors). Does not have a diuretic effect.
ACE inhibitors are effective drugs prescribed by cardiologists to treat heart disease. They allow you to quickly lower blood pressure and improve the patient's well-being. In this article, we will consider a domestic drug called Perineva, which allows you to stop the symptoms of hypertension and has practically no negative consequences.
Perineva is a drug belonging to the group of ACE inhibitors. It has a cardioprotective effect on the body, and also has a hypotensive effect due to the inhibitory effect on the inactive hormone angiotensin I, which, converting into angiotensin II, constricts blood vessels and coronary arteries. INN funds - perindopril.
Release form and cost
The product is made in the form of white or beige round tablets. For the convenience of dividing into parts, there is a risk on one of the sides. The active substance weight of each tablet is 2, 4 or 8 mg. The medicine is packed in blisters of 10, 14 or 30 pieces. After a period of 2 years, it is prohibited to use the drug. Storage is carried out in a cool place, out of the reach of children.
The price of tablets in pharmacies depends on the number of blisters in the package and ranges from 280 to 950 rubles. The tool belongs to list B, so you need to get a prescription from a doctor to purchase.
Composition and mechanism of action
The main active ingredient in the drug is perindopril erbumin. Its name determines the INN and the name according to the WHO classification. The components contain the following additional substances:
The use of the drug leads to an increase in the activity of renin, which promotes vasodilation, improving blood flow. At the same time, the concentration of bradykinin also increases, which contributes to an increase in the circulating capacity of capillaries and arteries. The resistance of the vessels to conduction decreases, which helps to reduce the load on the myocardium and stabilizes blood pressure.
Properties
Perineva is prescribed in order to get rid of the pressure, which reaches 140 (systolic) to 90 (diastolic) mm Hg. Art. The effect is felt 1-3 hours after taking the product, and lasts from 18 to 24 hours. In patients with increased heart rate, it decreases.
With a course admission, left ventricular hypertrophy decreases and the number of dead myocardial cells decreases. The main active ingredient normalizes blood pressure and increases the elasticity of arteries and blood vessels. Long-term use provides a decrease in pre- and afterload on the heart muscle.
The drug is quickly excreted from the body - the half-life is 1 hour. There is no accumulation effect. In patients with a history of renal failure, as well as in the elderly, the elimination time is increased.
Indications and contraindications
The main purpose of the drug is to lower blood pressure. Other indications for use:
- chronic heart failure;
- prevention of the recurrence and development of stroke;
- reducing the risk of cardiovascular diseases associated with ischemic diseases.
Indications for prescribing the drug
It is forbidden to use tablets if the following factors are present:
- hypersensitivity to the constituents of the drug or allergy to them;
- angioneurotic edema, which developed against the background of the use of ACE inhibitors;
- hereditary or acquired lactose intolerance.
The medicine must be used carefully and under the supervision of a physician in the presence of the following pathologies:
- bilateral narrowing of the lumen of the renal arteries (stenosis);
- coronary insufficiency;
- decreased hematopoiesis in the bone marrow;
- diabetes.
Pregnancy and the period of breastfeeding are absolute contraindications to taking pills due to the risk to the fetus.
Elderly patients should use Perineva after tests and under the supervision of a cardiologist.
Instructions for use
The medicine is taken orally, once a day, preferably in the morning before meals. Instructions for use recommend starting treatment with 1 tablet weighing 4 mg of active ingredient. In the presence of decompensated heart failure and prevention of recurrent stroke, the dosage is reduced to 2 mg. In the absence of a pronounced clinical effect, it is possible to increase the dose to 8 mg per day.
Decompensated heart failure
An increase in the hypotensive effect is observed when combining the drug with the following medicines:
- diuretics;
- antipsychotics;
- anesthetics;
- tricyclic antidepressants;
- nitrates;
- vasodilators.
The use of lithium-containing tablets can lead to toxicity. If necessary, such therapy is carried out under the strict supervision of a specialist. The combination with a group of NSAID drugs weakens the hypotensive effect of Perineva.
Negroid patients are at a higher risk of developing angioedema. This group of patients has a reduced antihypertensive effect of the drug.
Possible side effects
Side effects of the drug are rare, but some patients note the following negative reactions of the body:
In isolated cases, the development of renal failure occurs in patients with a history of renal impairment, hyperkalemia in the absence of refusal to take diuretics when using Perineva, confusion and sleep disturbances.
Overdose is accompanied by the following conditions:
- tachycardia;
- cough;
- bradycardia;
- dizziness;
- cardiogenic shock;
- hyperventilation;
- increased anxiety.
To combat the consequences of an overdose, hemodialysis is used and measures are taken to restore the volume of circulating blood.
Compatibility with alcohol in tablets is negative: it is possible to develop symptoms that resemble the manifestations of an overdose. Also, the level of blood pressure may sharply drop to critical indicators, which will lead to loss of consciousness.
Analogs
Means that can replace the medication are prescribed only by the attending physician. Among the drugs, absolute analogs can be distinguished, in which the main substance and the mechanism of action coincide:
- (300-720 rubles).
- (130-270 rubles).
- (350-400 rubles).
Due to the difference in the clinical picture, patients cannot independently replace the drug. Only a cardiologist is able to assess the risks and prescribe an alternative medication.
INSTRUCTIONS
on the medical use of the drug
Registration number:
LSR-008961 / 09-061109
Tradename: Perineva
International (non-proprietary) name: perindopril
Dosage form:
pills Composition
Composition for 1 tablet:
Microcrystalline cellulose, colloidal silicon dioxide, magnesium stearate.
Description
Tablets 2 mg. Round, slightly biconvex tablets, white or almost white, with a beveled edge.
Tablets 4 mg. Oval, slightly biconvex tablets, white or off-white, with a bevel and a notch on one side.
Tablets 8 mg. Round, slightly biconvex tablets, white or off-white, with a chamfer and a notch on one side.
Pharmacotherapeutic group:
angiotensin-converting enzyme (ACE) inhibitor
ATX code: S09AA04
Pharmacological properties
Pharmacodynamics
Perindopril is an ACE inhibitor, or kininase II, belongs to oxopeptidases. Converts angiotensin I to a vasoconstrictor angiotensin II and destroys the vasodilator bradykinin to an inactive hectapeptide. Suppression of ACE activity leads to a decrease in angiotensin II levels and an increase in plasma renin activity (suppressing the negative feedback of renin release) and a decrease in aldosterone secretion. Since ACE also destroys bradykinin, suppression of ACE also leads to an increase in the activity of the circulating and tissue kallikrein-kinin system, while the prostaglandin system is activated.
Perindopril has a therapeutic effect due to its active metabolite, perindoprilat.
Perindopril reduces both systolic and diastolic blood pressure (BP) in the lying and standing positions. Perindopril reduces total peripheral vascular resistance (OPSR), which leads to a decrease in blood pressure. In this case, peripheral blood flow is accelerated. However, the heart rate (HR) does not increase. Renal blood flow is usually increased while the glomerular filtration rate does not change. The maximum antihypertensive effect is achieved within 4-6 hours after a single oral administration of perindopril; the hypotensive effect persists for 24 hours, and after 24 hours the drug still provides 87% to 100% of the maximum effect. The decrease in blood pressure develops rapidly. Stabilization of the antihypertensive effect is observed after 1 month of therapy and persists for a long time. Discontinuation of therapy is not accompanied by a "withdrawal" syndrome. Perindopril reduces left ventricular myocardial hypertrophy. With long-term administration, it reduces the severity of interstitial fibrosis, normalizes the isozyme profile of myosin. Increases the concentration of high density lipoprotein (HDL), in patients with hyperuricemia, reduces the concentration of uric acid.
Perindopril improves the elasticity of large arteries, eliminates structural changes in small arteries.
Perindopril normalizes heart function by reducing pre- and post-load.
In patients with chronic heart failure (CHF) during therapy with perindopril, it was noted:
Taking an initial dose of perindopril 2 mg in patients with CHF I-II functional class according to the NYHA classification was not accompanied by a statistically significant decrease in blood pressure compared with placebo. Pharmacokinetics
After oral administration, perindopril is rapidly absorbed from the gastrointestinal tract and reaches maximum plasma concentrations within 1 hour. Bioavailability is 65 -70%.
20% of the total amount of absorbed perindopril is converted into perindoprilat (active metabolite). The half-life (T1 / 2) of perindopril from blood plasma is 1 hour. The maximum plasma concentrations of perindoprilat are reached after 3-4 hours.
Taking the drug during a meal is accompanied by a decrease in the conversion of perindopril to perindoprilat, respectively, the bioavailability of the drug decreases. The volume of distribution of unbound perindoprilat is 0.2 l / kg. The connection with blood plasma proteins is insignificant, the connection of perindoprilat with ACE is less than 30%, but depends on its concentration.
Perindoprilat is excreted by the kidneys. T1 / 2 of the unbound fraction is about 3-5 hours. Does not cumulate. In elderly patients, in patients with renal and chronic heart failure, the excretion of perindoprilat is slowed down. Perindoprilat is removed by hemodialysis (speed 70 ml / min., 1.17 ml / sec.) And peritoneal dialysis.
In patients with liver cirrhosis, the "hepatic" clearance of perindopril changes, while the total amount of perindoprilat formed does not change and no dosage regimen correction is required. Indications for use
During pregnancy, the use of the drug is contraindicated. It should not be used in the first trimester of pregnancy, therefore, when confirming pregnancy, the drug Perineva should be canceled as soon as possible. The drug is contraindicated in the II-III trimesters of pregnancy, since the use in the II-III trimesters of pregnancy can cause fetotoxic effects (decreased renal function, oligohydramnios, slowing of ossification of the fetal skull bones) and neonatal toxic effects (renal failure, arterial hypotension, hyperkalemia). If, nevertheless, the drug was used in the II-III trimesters of pregnancy, then it is necessary to conduct an ultrasound examination of the kidneys and bones of the fetal skull.
The use of the drug Perineva during lactation is not recommended, due to the lack of data on the possibility of its penetration into breast milk. If it is necessary to use the drug during lactation, stop breastfeeding. Method of administration and dosage
Inside, it is recommended to take once a day, before meals, preferably in the morning. The dose of the drug is selected individually for each patient, depending on the severity of the disease and the individual response to treatment.
Arterial hypertension
The drug Perineva can be used in monotherapy and in combination with other antihypertensive drugs.
The recommended starting dose is 4 mg once daily in the morning. For patients with pronounced activation of the renin-angiotensin-aldosterone system (for example, with renovascular hypertension, hypovolemia and / or hyponatremia, CHF in the stage of decompensation or severe arterial hypertension), the recommended initial dose is 2 mg per day in one dose. If therapy is ineffective within a month, the dose can be increased to 8 mg 1 time / day and if the previous dose is well tolerated.
Adding ACE inhibitors patients taking diuretics, can cause the development of arterial hypotension. In this regard, it is recommended to carry out therapy with caution, to stop taking diuretics 2 - 3 days before starting treatment with Perinev's drug or to start treatment with Perineva's drug with an initial dose of 2 mg per day, in one dose. Control is required: blood pressure, renal function and serum potassium ion concentration. In the future, the dose of the drug may be increased, depending on the dynamics of the blood pressure level. If necessary, diuretic therapy can be resumed.
In elderly patients the recommended initial daily dose is 2 mg, in one dose. In the future, the dose can be gradually increased to 4 mg and, if necessary, to a maximum of 8 mg once a day, provided the lower dose is well tolerated.
Chronic heart failure The recommended starting dose is 2 mg in the morning, under medical supervision. After 2 weeks, the dose can be increased to 4 mg per day in one dose, under the control of blood pressure. Treatment of CHF with clinical manifestations is usually combined with potassium-sparing diuretics, beta-blockers and / or digoxin.
Have patients with CHF, with renal failure and with a tendency to electrolyte disturbances (hyponatremia), as well as in patients taking diuretics and / or vasodilators at the same time, drug treatment is started under strict medical supervision.
In patients at high risk of developing clinically significant arterial hypotension (for example, when taking high doses of diuretics), if possible, before taking the drug Perineva, it is necessary to eliminate hypovolemia and electrolyte disturbances. It is recommended to carefully monitor the blood pressure level, the state of renal function and the concentration of potassium ions in the blood serum before and during therapy.
Prevention of recurrent stroke in patients with a history of cerebrovascular disease
Therapy with Perineva should be started with 2 mg during the first 2 weeks before taking indapamide. Treatment should be started at any time (from 2 weeks to several years) after a stroke.
In patients with stable coronary artery disease, the recommended initial dose of Perinev is 4 mg per day. After 2 weeks, the dose is increased to 8 mg per day, provided that the dose of 4 mg per day is well tolerated and renal function is monitored. Treatment of elderly patients should begin with a dose of 2 mg, which can be increased to 4 mg per day after a week. In the future, if necessary, after another week, you can increase the dose to 8 mg per day with mandatory preliminary monitoring of renal function. In elderly patients, the dose of the drug can be increased only if the previous, lower dose is well tolerated. In case of renal failure: in patients with kidney disease, the dose of Perineva is set depending on the degree of impairment of renal function. Monitoring the patient's condition usually includes regularly determining the concentration of potassium and creatinine ions in the blood serum.
Recommended doses:
* - Dialysis clearance of perindoprilat is 70 ml / min. Perinev's drug must be taken after a dialysis session. For liver diseases: dose adjustment is not required.
Side effectvery often:\u003e 1/10,
often:\u003e 1/100,<1/10,
sometimes:\u003e 1/1000,<1/100,
rarely:\u003e 1/10000,<1/1000,
very rarely:<1/10000, включая отдельные сообщения.
From the central and peripheral nervous system: often - headache, dizziness, paresthesia; sometimes - sleep or mood disorders; very rarely - confusion of consciousness.
On the part of the organ of vision: often - visual impairment.
On the part of the organ of hearing: often - tinnitus.
On the part of the cardiovascular system: often - a pronounced decrease in blood pressure; very rarely - arrhythmias, angina pectoris, myocardial infarction or stroke, possibly secondary, due to severe arterial hypotension in high-risk patients; vasculitis (frequency unknown).
From the respiratory system: often - cough, shortness of breath; sometimes bronchospasm; very rarely - eosinophilic pneumonia, rhinitis.
From the digestive tract: often - nausea, vomiting, abdominal pain, dysgeusia, dyspepsia, diarrhea, constipation; sometimes - dryness of the oral mucosa; rarely - pancreatitis; very rarely - cytolytic or cholestatic hepatitis (see the section "Special instructions").
From the side of the skin: often - skin rash, itching; sometimes - angioedema of the face, extremities, urticaria; very rarely - erythema multiforme.
From the side of the musculoskeletal system: often - muscle cramps.
From the genitourinary system: sometimes - renal failure, impotence; very rarely - acute renal failure.
General violations: often - asthenia; sometimes - increased sweating.
On the part of the hematopoietic and lymphatic system: very rarely - with prolonged use in high doses, it is possible to reduce the concentration of hemoglobin and hematocrit, thrombocytopenia, leukopenia / neutropenia, agranulocytosis, pancytopenia; very rarely - hemolytic anemia (in patients with congenital glucose-6-phosphate dehydrogenase deficiency).
Laboratory indicators: an increase in the concentration of urea in blood serum and plasma creatinine, and hyperkalemia, reversible after discontinuation of the drug (especially in patients with renal failure, severe CHF and renovascular hypertension); rarely - an increase in the activity of "liver" enzymes and bilirubin in the blood serum; hypoglycemia. Overdose
Symptoms: marked decrease in blood pressure, shock, disturbances in water and electrolyte balance (hyperkalemia, hyponatremia), renal failure, hyperventilation, tachycardia, palpitations, bradycardia, dizziness, anxiety, cough.
Treatment: with a pronounced decrease in blood pressure, give the patient a horizontal position with raised legs and take measures to replenish the circulating blood volume (BCC), if possible - intravenous administration of angiotensin II and / or an intravenous solution of catecholamines. With the development of severe bradycardia, not amenable to drug therapy (including atropine), the installation of an artificial pacemaker (pacemaker) is indicated. It is necessary to monitor vital functions and serum creatinine and electrolyte concentrations. Perindopril can be removed from the systemic circulation by hemodialysis. The use of high flow polyacrylonitrile membranes should be avoided. Interaction with other medicinal products
Diuretics
In patients taking diuretics, especially with excessive excretion of fluid and / or sodium, excessive arterial hypotension may develop at the beginning of therapy with ACE inhibitors. The risk of developing excessive arterial hypotension can be reduced by discontinuation of the diuretic, intravenous administration of 0.9% sodium chloride solution, and by prescribing an ACE inhibitor in lower doses. Further increase in the dose of perindopril should be carried out with caution.
Potassium-sparing diuretics, potassium supplements, potassium-containing foods, and dietary supplements
Usually, during therapy with ACE inhibitors, the concentration of potassium in the serum remains within the normal range, but in some patients hyperkalemia may develop. The combined use of ACE inhibitors and potassium-sparing diuretics (eg, spironolactone, triamterene, or amiloride), potassium or potassium-containing foods, and food supplements may cause hyperkalemia.
Therefore, it is not recommended to combine perindopril with these drugs. These combinations should be prescribed only in case of hypokalemia, taking precautions and regularly monitoring the concentration of potassium ions in the blood serum.
Lithium
With the simultaneous use of lithium preparations and ACE inhibitors, it is possible to develop a reversible increase in the concentration of lithium in the blood serum and lithium toxicity. The simultaneous use of ACE inhibitors with thiazide diuretics can further increase the concentration of lithium in the blood serum and increase the risk of developing its toxic effects. The simultaneous use of perindopril and lithium is not recommended.
If necessary, such a combination therapy is carried out under regular monitoring of the concentration of lithium in the blood serum.
Non-steroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid in doses of 3 g / day and above
NSAID therapy can weaken the antihypertensive effect of ACE inhibitors. In addition, NSAIDs and ACE inhibitors have an additive effect in increasing the concentration of potassium ions in the blood serum, which can provoke a deterioration in renal function. This effect is usually reversible. In rare cases, acute renal failure can develop, especially in patients with pre-existing renal impairment, for example, in elderly patients or with dehydration.
Other antihypertensive drugs and vasodilators
The simultaneous use of perindopril with other antihypertensive drugs may enhance the antihypertensive effect of perindopril. The simultaneous use of nitroglycerin, other nitrates or vasodilators can lead to an additional hypotensive effect.
Hypoglycemic agents
The simultaneous use of ACE inhibitors and hypoglycemic agents (insulin or hypoglycemic agents for oral administration) can enhance the hypoglycemic effect, up to the development of hypoglycemia. Typically, this phenomenon occurs in the first weeks of combination therapy in patients with renal insufficiency.
Acetylsalicylic acid, thrombolytic agents, beta-blockers and nitrates
Perindopril can be combined with acetylsalicylic acid (as an antiplatelet agent), thrombolytic agents, and beta-blockers and / or nitrates.
Tricyclic antidepressants / antipsychotics (neuroleptics) / general anesthetics (general anesthetics)
Concomitant use with ACE inhibitors can lead to an increase in the hypotensive effect.
Sympathomimetics
Sympathomimetics can weaken the antihypertensive effect of ACE inhibitors. When prescribing such a combination, the effectiveness of ACE inhibitors should be regularly evaluated. special instructions
Stable coronary artery disease (CHD)
With the development of an episode of unstable angina pectoris (significant or not) during the first month of therapy with Perinev, it is necessary to assess the benefit / risk ratio during therapy with this drug.
Arterial hypotension
ACE inhibitors can cause a sharp drop in blood pressure. In patients with uncomplicated arterial hypertension, symptomatic arterial hypotension rarely occurs after taking the first dose. The risk of an excessive decrease in blood pressure is increased in patients with reduced BCC during diuretic therapy, with a strict salt-free diet, hemodialysis, as well as with diarrhea or vomiting, or in those suffering from 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. Most often, severe arterial hypotension can develop in patients with more severe CHF, taking loop diuretics in high doses, as well as in the presence of hyponatremia or renal failure. These patients are advised to be closely monitored at the beginning of therapy and during dose 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.
In the case of arterial hypotension, it is necessary to give the patient a horizontal position with raised legs, and, if necessary, inject sodium chloride solution intravenously to increase the BCC. Transient arterial hypotension is not a contraindication for further therapy. After the restoration of the BCC and blood pressure, treatment can be continued, provided that the dose of the drug is carefully selected.
In some patients with CHF and normal or low blood pressure during therapy with Perineva, an additional decrease in blood pressure may occur. 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 the drug Perineva.
Aortic or mitral valve stenosis / hypertrophic cardiomyopathy
ACE inhibitors, incl. and perindopril should be used with caution in patients with mitral stenosis and left ventricular outflow tract obstruction (aortic valve stenosis and hypertrophic cardiomyopathy).
Impaired renal function
In patients with renal insufficiency (CC less than 60 ml / min), the initial dose of the drug Perinev should be selected in accordance with the CC (see section "Dosage and Administration") and then - depending on the therapeutic response. For such patients, regular monitoring of the concentration of potassium ions and creatinine in the blood serum 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. These patients sometimes have cases of acute renal failure, usually reversible.
In some patients with bilateral renal artery stenosis or renal artery stenosis of a solitary kidney (especially in the presence of renal failure) during therapy with ACE inhibitors, there was an increase in serum concentrations of urea and creatinine, reversible after discontinuation of therapy. Patients with renovascular hypertension during therapy with ACE inhibitors have an increased risk of severe arterial hypotension and renal failure. Treatment of such patients should begin under close medical supervision, with low doses of the drug and with further adequate dose selection. During the first weeks of therapy with Perineva, it is necessary to discontinue diuretics and regularly monitor renal function. 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 the concentration of urea and creatinine in the blood serum. In this case, it is recommended to reduce the dose of the drug Perinev and / or to cancel the diuretic.
Patients on hemodialysis
Several cases of persistent, life-threatening anaphylactic reactions have been reported in patients on dialysis with high-flow membranes and concomitantly taking ACE inhibitors. If hemodialysis is required, a different type of membrane must be used.
Kidney transplant
There is no experience with the use of perindopril in patients with recent kidney transplantation.
Hypersensitivity / angioedema
Rarely in patients taking ACE inhibitors, incl. perindopril, angioedema of the face, extremities, lips, mucous membranes, tongue, glottis and / or larynx developed. This condition can develop at any time during treatment. With the development of angioedema, treatment should be stopped immediately, the patient should be under medical supervision until the symptoms disappear completely. Angioedema of the lips and face usually does not require treatment; antihistamines can be used to relieve symptoms. Angioedema of the tongue, glottis, or larynx can be fatal. With the development of angioedema, it is necessary to immediately inject epinephrine (adrenaline) subcutaneously and ensure airway patency. ACE inhibitors are more likely to cause angioedema in black patients.
Patients with a history of angioedema not associated with the use of an ACE inhibitor may be at high risk of developing angioedema when taking an ACE inhibitor.
Anaphylactoid reactions during low-density lipoprotein apheresis (LDL-apheresis)
In patients with the appointment of ACE inhibitors against the background of low-density lipoprotein (LDL) apheresis procedure using dextran-sulfate absorption, in rare cases, an anaphylactic reaction may develop. Temporary withdrawal of the ACE inhibitor prior to each apheresis procedure is recommended.
Anaphylactic reactions during desensitization
In patients receiving ACE inhibitors during a course of desensitization (for example, Hymenoptera venom (Hymenoptera venom)), in very rare cases, life-threatening anaphylactic reactions may develop. It is recommended that the ACE inhibitor be temporarily discontinued prior to each desensitization procedure.
Liver failure
During therapy with ACE inhibitors, it is sometimes possible to develop a syndrome that begins with cholestatic jaundice and then progresses to fulminant necrosis of the liver, sometimes with a fatal outcome. The mechanism for the development of this syndrome is unclear. If jaundice appears while taking an ACE inhibitor or an increase in the activity of "liver" enzymes is observed, the ACE inhibitor should be immediately canceled and the patient should be closely monitored. It is also necessary to conduct an appropriate examination.
Peutropenia / agranulocytosis / thrombocytopenia / anemia
Cases of neutropenia / agranulocytosis, thrombocytopenia and anemia have been observed in patients on the background of therapy with ACE inhibitors. With normal renal function in the absence of other complications, neutropenia is rare. The drug Perinev must be used with great caution in patients with systemic connective tissue diseases (for example, SLE, scleroderma), who are simultaneously receiving immunosuppressive therapy, allopurinol or procainamide, as well as when all of these factors are combined, especially with existing renal dysfunction. Such patients may develop severe infections that do not respond to intensive antibiotic therapy. When conducting therapy with Perineva 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 glucose-6-phosphate dehydrogenase deficiency, isolated cases of hemolytic anemia have been reported.
Negroid race
The risk of developing angioedema in patients of the Negroid race is higher. Like other ACE inhibitors, perindopril is less effective in lowering blood pressure in black patients, possibly due to the greater prevalence of low-root conditions in the population of this group of patients with arterial hypertension.
Cough
During therapy with ACE inhibitors, a persistent, unproductive cough may develop, which stops after discontinuation of the drug. This should be taken into account in the differential diagnosis of cough.
Surgery / general anesthesia
In patients whose condition requires extensive surgery or anesthesia with drugs that cause arterial hypotension, ACE inhibitors, including perindopril, can block the formation of angiotensin II during compensatory renin release. The day before surgery, therapy with ACE inhibitors must be canceled. If it is impossible to cancel an ACE inhibitor, then arterial hypotension, which develops according to the described mechanism, can be corrected by an increase in the BCC.
Hyperkalemia
During therapy with ACE inhibitors, including perindopril, in some patients, the concentration of potassium ions in the blood may increase. The risk of hyperkalemia is increased in patients with renal and / or heart failure, decompensated diabetes mellitus, and in patients using potassium-sparing diuretics, potassium supplements, or other drugs that cause hyperkalemia (eg, heparin). If it is necessary to simultaneously prescribe these drugs, it is recommended to regularly monitor the serum potassium content.
Diabetes
In patients with diabetes mellitus taking oral hypoglycemic agents or insulin, in the first few months of therapy with ACE inhibitors, it is necessary to carefully monitor the concentration of glucose in the blood.
Lithium
It is not recommended to take lithium and perindopril together.
Potassium-sparing diuretics, potassium preparations, potassium-containing foods, and dietary supplements
Combined use with ACE inhibitors is not recommended.
Lactose
Perinev tablets contain lactose. Therefore, patients with hereditary galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption syndrome should not take this drug. Influence on the ability to drive vehicles and other mechanical means:
it is necessary to take into account the possibility of developing arterial hypotension or dizziness, which can affect the management of vehicles and work with technical equipment. Release form
Tablets of 2 mg, 4 mg and 8 mg. 10, 14 or 30 tablets in a blister strip packaging. 3.6 or 9 blister packs of 10 tablets or 1, 2, 4, 7 blister packs of 14 tablets or 1, 2, 3 blister packs of 30 tablets each, together with instructions for use, are placed in a cardboard box. Storage conditions
List B.
Store at a temperature not exceeding 30 ° C. Keep out of the reach of children. Shelf life
2 years.
Do not use the drug after the expiration date. Terms of dispensing from pharmacies
On prescription.
Manufacturer:
LLC "KRKA-RUS", 143500, Russia, Moscow region, Istra, st. Moscow, 50. in cooperation with KRKA, dd, Novo mesto, Šmarješka cesta 6, 8501 Novo mesto, Slovenia For all questions, please contact the Representative Office in the Russian Federation:
123022, Moscow, 2nd Zvenigorodskaya street, 13, building 41.
The drug Perineva is an antihypertensive agent belonging to the group of ACE inhibitors. It can be used as a therapeutic agent for the treatment of arterial hypertension, stable form of coronary heart disease and chronic heart failure, as well as for the prevention of recurrent stroke. Perinev's remedy is contraindicated in pregnancy, hepatitis B, hypersensitivity, lactose intolerance, edema, as well as in children under 18 years of age.
Dosage form
Perineva is available in pill form. The product is packed in blisters of 10 units. Regardless of the dosage of the active ingredient, the drug is packaged in cardboard boxes of 30 tablets.
Description and composition
If pregnancy is confirmed during the period of therapy, you should immediately stop taking the medication and seek the advice of your doctor.
It is forbidden to take Perinev's drug with potassium-sparing diuretics, lithium preparations, medicines and products containing potassium.
While taking Perinev's remedy, such effects may occur, such as a sharp decrease in blood pressure and dizziness, which can negatively affect the ability to drive vehicles or carry out activities that require concentration of attention, reaction speed and a high level of mental activity.
Overdose
In case of an overdose with Perinev, the patient may experience symptoms such as:
- bradycardia;
- hyponatremia;
- tachycardia;
- renal failure;
- palpitations;
- a sharp decrease in blood pressure;
- hyperkalemia;
- anxiety;
- dry cough.
- in case of a sharp decrease in blood pressure, it is necessary to lay the patient on a flat surface, raise his legs and take measures to increase the volume of circulating blood;
- in the event of bradycardia that does not respond to therapy (for example,), an artificial heart rate driver should be installed. It is necessary to remove from the systemic circulation by the hemodialysis procedure.
Storage conditions
The Perinev product should be stored in a dark place, out of the reach of children, at temperatures up to 25˚C. The drug is dispensed with a prescription from a doctor.
The shelf life is 3 years.
Analogs
In case of individual intolerance to certain components of the Perinev drug or an urgent need for an urgent replacement of the drug, the most effective direct or indirect analogue should be selected. These drugs are:
Selective angiotensin II receptor antagonist. The composition contains potassium. The drug can be used to treat arterial hypertension, chronic heart failure, as well as for the prevention of strokes and kidney protection in type II, accompanied by proteinuria. The agent is contraindicated in dehydration, hyperkalemia, pregnancy, hepatitis B, hypersensitivity, hypotension and under the age of 18 years.
Price
Perinev's cost is on average 510 rubles. Prices range from 209 to 1059 rubles.
Perineva - pills used for high blood pressure. The active ingredient is (a substance from the group of ACE inhibitors). The drug is a product of the Slovenian brand KRKKA, which has a branch in Russia.
Medicinal form, composition
Perineva is presented in the form of tablets, packaged in blisters and cardboard boxes.
The assortment includes a medication in three dosages:
- 2 mg - the amount of the active ingredient - 0.02 g;
- 4 mg - contains 0.04 g of perindopril;
- 8 mg - the amount of active ingredient - 0.08 g.
Auxiliary ingredients: calcium chloride hexahydrate, cellulose, crospovilon, magnesium stearate, milk sugar.
Perineva's principle of action
The main mechanism that regulates the blood flow system and the level of pressure is the Renin-Angiotensin-Aldosterone system. The main component of the system is renin, a substance close to hormones that is synthesized by:
- Kidney cells;
- Cerebral vessels;
- Myocardium.
Through renin, the protein is transformed into the low activity hormone angiotensinogen I, which, under the influence of the enzyme, is converted into the high activity hormone angiotensin II.
This hormone has several important functions:
- Activates the synthesis of the hormone that retains water, respectively, the kidneys secrete a smaller volume of fluid;
- Narrows the arteries
- Activates the synthesis of the hormone aldosterone;
- It provokes myocardial hypertrophy.
Aldosterone is an essential tool for regulating the amount of fluid in the body. With an increase in the amount of the hormone, the volume of blood flow increases, this increases the pressure.
The drug reduces the amount of the hormone angiotensin II, as a result:
- Its vasoconstrictor effect is neutralized;
- The synthesis of aldosterone decreases;
- The body's sodium levels decrease and fluid volume decreases.
Such a complex action helps to reduce blood flow, respectively, the pressure level is normalized.
Drug action
The cardiovascular system:
- Pressure is normalized;
- A long course of therapy (1.5-2 years) reduces myocardial hypertrophy;
- Blood vessels expand;
- With the constant use of medication, the likelihood of developing a heart attack decreases by 8% annually.
- Intra-glomerular hemodynamics is restored;
- The amount of protein that is excreted in the urine decreases.
Endocrine system:
- The body's sensitivity to insulin is restored (this is especially true for patients with a history of diabetes mellitus);
- Prevention of complications provoked by diabetes mellitus.
Metabolic processes:
- The kidneys are more active and in a greater volume remove uric acid (this is especially true for patients with a diagnosis of gout);
- The content of lipoproteins in blood vessels is reduced, thereby, the drug reduces the likelihood of developing atherosclerosis.
With constant use (exclusively under the supervision of a specialist) Perineva has a chronic antihypertensive effect. Thus, the elasticity and strength of the blood vessels is restored. The tablets reduce the likelihood of myocardium, blood pressure normalizes.
Application mechanism
Indications for use:
- Arterial hypertension;
- Prevention of stroke (the doctor determines the complex therapy);
- Myocardial insufficiency;
- Treatment of complications caused by previous operations on the heart, heart attack.
When to start therapy
The main indication is arterial hypertension. The disease is diagnosed when:
- The upper systolic reading is greater than 140 mm. rt. Art .;
- The lower diastolic reading is greater than 90 mm. rt. Art.
Pathological changes can be triggered by concomitant diseases (cancer of the adrenal glands, glomerulonephritis). Also, pills are prescribed when high blood pressure is the primary symptom, but it is impossible to establish the cause of the pathology.
In 90% of cases, hypertension is the cause of high blood pressure.
Perineva's reception rules
The Ministry of Health adopted the new indicators as working pressure. The recommended rate is no more than 140/90. In the presence of diabetes mellitus in history, the indicators are 140/85. In most patients, a sharp normalization of pressure is poorly tolerated by the body. That is why the correction of indicators is carried out in stages.
- Over the course of a month, the pressure decreases by 15%, then for another month the patient gets used to the new indicators;
- After that, the therapy regimen is selected individually.
The upper figure is reduced to 115 mm. rt. Art., and the bottom - up to 75 mm. rt. Art. If the decline is too fast, the likelihood of heart attack or stroke increases.
Perineva is the medication that doctors usually choose first. The following scheme is considered optimal: 1 tablet daily. The patient chooses a convenient time - in the morning or in the evening. The optimal dosage for starting therapy is 4 mg (pensioners are prescribed 2 mg, gradually increasing the dosage to 4 mg).
Patients who take, 2-3 days before the start of Perineva's treatment, need to be abandoned. If it is impossible to stop therapy with diuretic medicines, Perineva is prescribed in a minimum dosage of 2 mg, you can gradually increase the dosage to 4 mg. According to a similar principle, a therapy regimen is selected for patients with a diagnosis of chronic heart failure.
After 30 days of taking the pills, the specialist evaluates the effectiveness of the prescribed therapy, if the dynamics are unsatisfactory, the doctor prescribes the drug in a dosage of 8 mg.
Contraindications
- Individual intolerance;
- Age up to 18 years - laboratory and clinical studies have not been carried out for this group of patients;
- Pregnancy - the active ingredient can provoke abnormal disorders in the development of the fetus;
- Lactation - no clinical trials have been conducted for women during breastfeeding;
- Lactose intolerance, lactose deficiency, maladsorption syndrome;
- Previously transferred angioedema.
Under constant supervision, the medication is taken when:
- Renovascular hypertension;
- Artery stenosis against the background of a removed kidney;
- Renal artery stenosis;
- Arterial hypotension;
- Hemodialysis;
- Hypovolemia;
- Renal failure;
- Heart valve stenosis;
- After kidney transplant (for certain indications);
- Deficiency of sodium ions in the circulatory system;
- Immunosuppressive therapy;
- Coronary insufficiency;
- Pathological processes of the cerebrovascular system, connective tissue;
- Treatment with allopurinol and procainamide;
- Diabetes;
- Certain indications for gerontological pathologies;
- Excessive potassium.
The drug during pregnancy
If you suspect pregnancy or while carrying a child, Perineva's reception is contraindicated. The active ingredient can provoke pathological changes in the kidneys associated with their functioning. In some cases, oligohydramnios develops, possibly early ossification of the bone tissue of the child's skull.
During therapy in the last months of pregnancy, the fetus developed renal failure, blood pressure dropped sharply, symptoms of excess potassium developed.
If the health condition of the expectant mother required Perineva's therapy, it is imperative to conduct an ultrasound scan to check the condition of the kidneys and bones of the fetal skull.
special instructions
Tablets can provoke a sharp drop in pressure if the patient has a history of:
- Cerebrovascular pathological processes;
- Taking diuretic medications with Perineva;
- Hemodialysis;
- Heart valve stenosis;
- Renovascular hypertension;
- Heart failure in the chronic stage.
Also, blood pressure may decrease after a diet that eliminates salt.
In some cases, Perineva:
- Increases the symptoms of renal failure if the patient has a history of renal artery stenosis;
- Anaphylactoid reactions are possible in patients undergoing therapy with allergens, representatives of the Negroid race and in patients on hemodialysis.
Pills are prescribed with caution to women of fertile age.
Overdose, side effects
With uncontrolled intake of the drug and non-compliance with the dosage, the pressure drops sharply, and the following may develop:
- Shock state;
- Renal failure;
- Hypoventilation (insufficient breathing intensity);
- Feeling anxious and coughing.
The pulse may increase sharply or vice versa - slow down.
If signs of drug overdose appear, the patient should be put on his back, raised his legs, and replenished the volume of blood circulation by introducing special solutions. The hormone angiotensin II is administered intravenously; if it is not available, catecholamines are used.
Side effects:
- Shortness of breath, perspiration, and dry cough;
- Pain in the head, abdomen;
- Extraneous sounds in the ears;
- Stool disorders;
- Rashes;
- Seizures;
- Asthenia.
Storage and shelf life
Regardless of the dosage, the tablets are stored in a dry and dark place at a temperature not exceeding +30 degrees. It is strictly forbidden to store the medication in high humidity; direct sunlight should be avoided. The storage space must be out of reach of children, people with mental illness and animals.
The shelf life of the tablets is 2 years.
Price
Depending on the city, the number of tablets in the package, the cost varies from 250 to 1050 rubles.
Analogs
In pharmacies, there are almost two dozen drugs based on perindopril. The most popular ones are:
- Prestarium is a French-made product, the first drug based on perindopril, all studies were carried out on this drug, the price was about 450 rubles;
- Perindopril-Richter - Hungarian drug, cost about 250 rubles;
- Parnavel is a Russian product, the price is about 350 rubles;
- Noliprel is a French product worth 700 rubles;
- Perindopril Plus is a complex drug of domestic production, the price is about 570 rubles.
Of all the drugs on the pharmaceutical market, only Perineva fully corresponds to the original drug.
It should be noted that Perineva's therapy is effective only in 50% of clinical cases. To achieve a more lasting result, treatment of stage 1 and 2 hypertension is carried out with two active ingredients. The most effective combination is perindopril and indapaid. It is this combination of active ingredients that is presented in Ko-Perinev tablets.
The drug is presented in three dosages:
- Perindopril 2 mg, indapamide 0.625 mg;
- Perindopril 4 mg, indapamide 1.25 mg;
- Perindopril 8 mg, indapamide 2.5 mg.
Ko-Perineva is prescribed as the main medication for the treatment of hypertension.
The average cost in pharmacies is 270 rubles.
Contraindications are the same as for the drug Perinev, in addition, anuria, azotemia and renal failure should be taken into account. Side effects of Ko-Perineva do not differ from the side effects of Perineva.
