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 forms 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, puffiness, and also 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 carton packs 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
Perinev's agent 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 drug is contraindicated in dehydration, hyperkalemia, pregnancy, hepatitis B, hypersensitivity, hypotension and under 18 years of age.
Price
Perinev's cost is 510 rubles on average. Prices range from 209 to 1059 rubles.
The drug Perinev belongs to the group of ACE inhibitors. The instruction for use explains at what pressure it is better to take tablets of 2 mg, 4 mg and 8 mg, Ku-Tab dispersible to reduce it. Reviews of cardiologists confirm that the drug helps in the treatment of hypertension and the prevention of complications after strokes.
Release form and composition
The drug Perineva is available in the form of tablets for oral use. The tablets are packed in blisters of 10 pieces, 3 blisters per pack, detailed instructions with a description are attached to the drug.
Each tablet contains the main active ingredient - Perindopril ebumin 4 mg or 8 mg, as well as a number of auxiliary components,
Also produce:
- Tablets 2 mg + 625 μg, 4 mg + 1.25 mg, 8 mg + 2.5 mg (Co-Perineva).
- Tablets dispersed in the oral cavity 4 mg and 8 mg (Perineva Ku-Tab).
Indications for use
What helps Perineva? Tablets are prescribed if diagnosed:
- Arterial hypertension.
- Cardiac ischemia.
- Chronic heart failure.
This medication is also prescribed to patients as a prophylactic agent after suffering strokes and heart attacks, in order to avoid re-injury.
At what pressure to take?
Perineva can be prescribed at a pressure of 130 to 90 RT. Art. and higher. In the later stages of arterial hypertension, the drug is ineffective.
Instructions for use
The initial dose is 1-2 mg per day in 1 dose. Maintenance doses - 2-4 mg per day for congestive heart failure, 4 mg (less often - 8 mg) - for arterial hypertension in 1 dose. In case of impaired renal function, correction of the dosage regimen is required depending on the CC values.
Ko-Perineva - instruction
The drug is taken orally once a day, preferably in the morning before breakfast, with a sufficient amount of liquid. If possible, the use of the drug should begin with the selection of doses of perindopril and indapamide separately. In case of clinical need, it is possible to prescribe a combination therapy with Ko-Perinev immediately after monotherapy.
Doses are given for the ratio of perindopril / indapamide. The initial dose of the drug Co-Perinev is 2 mg / 0.625 mg (1 tablet) once a day. If after 1 month of using the drug it is not possible to achieve adequate blood pressure control, then the dose of the drug should be increased to 4 mg / 1.25 mg (1 tablet) once a day.
If necessary, in order to achieve a more pronounced hypotensive effect, it is possible to increase to the maximum daily dose of the drug Co-Perineva - 1 tablet (8 mg / 2.5 mg) 1 time per day. For elderly patients, the initial dose of Ko-Perinev is 2 mg / 0.625 mg (1 tablet) once a day. Drug treatment should be prescribed after monitoring renal function and blood pressure.
The drug Ko-Perinev is contraindicated in patients with severe renal insufficiency (CC less than 30 ml / min). Patients with moderately severe renal failure (CC 30-60 ml / min) are recommended to start therapy with the necessary doses of drugs (in monotherapy) that are part of the drug Co-Perinev; the maximum daily dose of the drug Ko-Perinev is 4 mg / 1.25 mg.
No dose adjustment is required for patients with CC more than 60 ml / min. During therapy, it is necessary to regularly monitor the concentration of creatinine and the content of potassium in the blood serum. The drug is contraindicated in patients with severe hepatic impairment. With moderate hepatic impairment, dose adjustment is not required.
pharmachologic effect
Perindopril has a therapeutic effect due to perindoprilat (active metabolite). It reduces systolic and diastolic pressure, OPSS, resulting in a decrease in blood pressure. At the same time, peripheral blood flow is accelerated, but the pulse does not increase.
The maximum effect appears after taking an average of 4-6 hours and lasts for a day.
Blood pressure drops quite quickly. Pressure stabilization is observed after about a month of therapy. After stopping treatment, withdrawal symptoms do not develop. Increases the elasticity of arteries, helps to eliminate their structural changes. Normalizes the work of the heart muscle, reduces preload and afterload.
Contraindications
Absolute contraindications (conditions / diseases for which the drug is prohibited from taking):
- increased individual sensitivity to any component of the drug or other ACE inhibitors;
- age up to 18 years;
- idiopathic, hereditary, or developed as a result of taking ACE inhibitors, angioedema in history;
- lapp lactase deficiency, hereditary galactose intolerance, glucose-galactose malabsorption syndrome.
Relative contraindications (conditions / diseases in which the use of the drug is possible, but only after assessing the benefits and risks, with extreme caution and under special medical supervision):
- simultaneous desensitizing therapy with allergens (for example, hymenoptera venom);
- cerebrovascular diseases (including ischemic heart disease, cerebrovascular insufficiency, coronary insufficiency);
- congenital deficiency of glucose-6-phosphate dehydrogenase;
- hyperkalemia;
- renovascular hypertension;
- diabetes;
- bilateral stenosis of the renal arteries or stenosis of an artery of a solitary kidney;
- stenosis of the aortic or mitral valve;
- severe hypovolemia and hyponatremia (eg, due to vomiting, diarrhea, salt-free diet, dialysis, prior diuretic therapy);
- connective tissue diseases such as systemic lupus erythematosus or scleroderma;
- belonging to the Negroid race;
- inhibition of bone marrow hematopoiesis while taking immunosuppressants, procainamide, allopurinol;
- chronic renal failure (creatinine clearance less than 60 ml / min);
- hemodialysis using high-flow polyacrylonitrile membranes;
- the period before the procedure for apheresis of low density lipoprotein (LDL);
- condition after kidney transplantation;
- hypertrophic obstructive cardiomyopathy;
- arterial hypotension;
- surgical intervention;
- elderly age;
- CHF in the stage of decompensation.
Side effects
As a result of taking the drug Perineva, the following side effects may occur: 
- significant decrease in blood pressure, angina pectoris, arrhythmias, stroke, myocardial infarction, vasculitis;
- increased sweating, asthenia;
- increased concentration of urea and creatinine, hyperkalemia (reversible after discontinuation of the drug), hypoglycemia, increased activity of liver enzymes;
- decreased hemoglobin and hematocrit, neutropenia, leukopenia, thrombocytopenia, pancytopenia, agranulocytosis (manifested when used in high doses for a long period of time), hemolytic anemia (rarely manifested in patients with glucose-6-phosphate dehydrogenase deficiency);
- shortness of breath, bronchospasm, cough, rhinitis, eosinophilic pneumonia;
- visual impairment;
- noise in ears;
- itching, edema of the limbs, face, rash, urticaria, erythema multiforme;
- muscle cramps;
- abdominal pain, nausea, dysgeusia, vomiting, constipation, diarrhea, dyspepsia, dry mouth, pancreatitis, cholestatic or cytolytic hepatitis;
- impotence, renal failure;
- paresthesia, dizziness, headaches.
Children, during pregnancy and breastfeeding
The drug Perineva is contraindicated for use during pregnancy and lactation (breastfeeding).
Contraindicated in children and adolescents under the age of 18 (efficacy and safety have not been established).
special instructions
The tablets contain lactose, therefore, this drug should not be prescribed to patients with individual intolerance to this component or malabsorption syndrome.
Since during treatment with the drug, the patient may experience dizziness and lethargy, you should avoid driving vehicles and complex equipment that requires increased attention.
While using this drug, patients often have a dry cough that stops immediately after the drug is discontinued. With the development of cough, it should be differentiated from ARVI or lung cancer.
With prolonged use of tablets, patients should regularly take blood tests to assess platelet and hemoglobin counts, since thrombocytopenia and anemia may develop during therapy.
Drug interactions
Hypoclycemic agents (including insulin) and Perineva in combination can cause an increase in the hypoglycemic effect, up to glycemia.
A combination of Perineva with nitrates, acetylsalicylic acid, beta-blockers and thrombolytic agents is possible.
Antidepressants, antipsychotics and general anesthetics can enhance the hypotensive effect.
The combination of perindopril with potassium-sparing diuretics, foods and supplements, as well as potassium preparations can lead to the development of hyperkalemia. They should be prescribed exclusively for hypokalemia with maximum caution, while controlling the level of ions.
A decrease in the antihypertensive effect can occur as a result of the combination of Perineva with NSAIDs. Also, such therapy can lead to deterioration of the kidneys. In some cases, this can lead to acute renal failure.
The simultaneous use of Perineva with diuretics can lead to arterial hypotension. You can reduce the risk of its occurrence by discontinuing diuretics or taking the drug in lower doses. In the future, increasing the dose of Perineva should be prescribed with caution.
Sympathomimetics glorify the therapeutic effect of perindopril, when they are prescribed, it is necessary to monitor the effectiveness of Perineva.
Perindopril together with lithium preparations can cause lithium toxicity and an increase in the level of lithium in the blood, therefore it is not recommended to prescribe them simultaneously. If necessary, such a combination should control the concentration of lithium in the blood.
The antihypertensive effect of perindopril can be enhanced by the simultaneous use of other drugs that lower blood pressure or vasodilators.
Analogues of the drug Perinev
Analogs are determined by structure:
- Arentopres.
- Perineva Ku-Tab.
- Perindide.
- Parnavel.
- Co-preness.
- Perindopril arginine.
- Perindopril erbumine.
- Noliprel A.
- Hypernik.
- Perindopril plus Indapamide.
- Noliprel A Bi-Forte.
- Prestarium A.
- Perindopril.
- Stoppress.
- Perinpress.
- Pyristar.
- Noliprel forte.
- Coverex.
- Perindopril-Indapamide Richter.
- Perindopril + Indapamide Sandoz.
Vacation conditions and price
The average cost of Perinev (4 mg tablets No. 30) in Moscow is 279 rubles. The drug can be purchased from pharmacies with a prescription only.
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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 breastfeeding 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 with good tolerance to the previous dose.
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.
pills
Owner / Registrar
KRKA-RUS, LLC
International Classification of Diseases (ICD-10)
G45 Transient transient cerebral ischemic attacks [attacks] and related syndromes I10 Essential [primary] hypertension I20 Angina pectoris [angina pectoris] I50.0 Congestive heart failure I63 Brain infarction I69 Sequelae of cerebrovascular diseasesPharmacological group
ACE inhibitor
Arterial hypertension;
Chronic heart failure;
Prevention of recurrent stroke (as part of complex therapy with indapamide) in patients with a history of cerebrovascular diseases (stroke or transient cerebral ischemic attack);
Stable coronary artery disease: reducing the risk of developing cardiovascular complications in patients with previous myocardial infarction and / or coronary revascularization.
A history of angioedema (hereditary, idiopathic or angioedema due to the use of ACE inhibitors);
Age up to 18 years (efficacy and safety have not been established);
Hereditary galactose intolerance, lapp lactase deficiency or glucose-galactose malabsorption syndrome;
Hypersensitivity to perindopril or other components of the drug;
Hypersensitivity to other ACE inhibitors.
FROM caution should be used for renovascular hypertension, in patients with bilateral renal artery stenosis, stenosis of the artery of a single kidney - the risk of severe arterial hypotension and renal failure; with chronic heart failure in the stage of decompensation, arterial hypotension, with chronic renal failure (CC less than 60 ml / min), with significant hypovolemia and hyponatremia (salt-free diet and / or previous diuretic therapy, dialysis, vomiting, diarrhea), cerebrovascular diseases (in including cerebral circulation failure, coronary artery disease, coronary insufficiency) - the risk of developing an excessive decrease in blood pressure; with stenosis of the aortic or mitral valve, hypertrophic obstructive cardiomyopathy, hemodialysis using high-flow polyacrylonitrile membranes - the risk of developing anaphylactoid reactions; in patients after kidney transplantation, there is no clinical experience; before the LDL apheresis procedure, simultaneously with desensitizing therapy with allergens (for example, hymenoptera venom) - the risk of developing anaphylactoid reactions; in diseases of the connective tissue (including SLE, scleroderma), inhibition of bone marrow hematopoiesis while taking immunosuppressants, allopurinol or procainamide - the risk of agranulocytosis and neutropenia; with congenital deficiency of glucose-6-phosphate dehydrogenase - isolated cases of hemolytic anemia; in representatives of the black race - the risk of developing anaphylactoid reactions; with surgical intervention (the need for general anesthesia) - the risk of developing an excessive decrease in blood pressure; with diabetes mellitus (control of blood glucose concentration is necessary); with hyperkalemia; in elderly patients.
Determination of the frequency of adverse reactions: very often (\u003e 1/10), often (\u003e 1/100,<1/10), иногда (>1/1000, <1/100), редко (>1/10 000, <1/1000), очень редко (<1/10 000, включая отдельные сообщения).
From the side of the central nervous system and peripheral nervous system:often - headache, dizziness, paresthesia; sometimes - sleep or mood disorders; very rarely - confusion.
From the senses:often - visual impairment, 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 system:often - nausea, vomiting, abdominal pain, dysgeusia, dyspepsia, diarrhea, constipation; sometimes - dryness of the oral mucosa; rarely - pancreatitis; very rarely - cytolytic or cholestatic hepatitis.
From the genitourinary system:sometimes - renal failure, impotence; very rarely - acute renal failure.
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: increased serum urea and plasma creatinine, hyperkalemia, reversible after drug withdrawal (especially in patients with renal failure, severe chronic heart failure and renovascular hypertension); rarely - increased activity of hepatic enzymes and serum bilirubin; hypoglycemia.
From the side of the skin:often - skin rash, itching; sometimes - increased sweating, angioedema of the face, extremities, urticaria; very rarely - erythema multiforme.
Others:often - asthenia, muscle cramps.
The drug is administered orally 1 time / day, before meals, preferably in the morning. The dose 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 as monotherapy or in combination with other antihypertensive drugs.
For patients with severe activation of the RAAS (for example, with renovascular hypertension, hypovolemia and / or hyponatremia, chronic heart failure in the stage of decompensation or severe arterial hypertension), the recommended initial dose is 2 mg / day in one dose. If therapy is ineffective within a month, the dose can be increased to 8 mg 1 time / day with good tolerance to the previous dose.
The addition of ACE inhibitors to patients taking diuretics can cause hypotension. In this regard, it is recommended to carry out therapy with caution, to stop taking diuretics 2-3 days before starting treatment with Perineva® or start treatment with Perineva® with an initial dose of 2 mg / day at a time. It is necessary to control blood pressure, renal function and the concentration of potassium ions in the blood serum. 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.
Have elderly patientsthe recommended starting dose is 2 mg / day in one dose. In the future, the dose can be gradually increased to 4 mg and, if necessary, to a maximum of 8 mg / day, provided that the lower dose is well tolerated.
Chronic heart failure
The recommended starting dose is 2 mg / day in the morning, under medical supervision. After 2 weeks, the dose can be increased to 4 mg / day in 1 dose, under the control of blood pressure. Treatment of symptomatic chronic heart failure is usually combined with potassium-sparing diuretics, beta-blockers and / or digoxin.
In patients with chronic heart failure, 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 with a high risk of developing clinically pronounced 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.
Stable ischemic heart disease
Treatment elderly patients should start with a dose of 2 mg, which can be increased to 4 mg / day after a week. In the future, if necessary, after another week, the dose can be increased to 8 mg / 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.
Have patients with kidney diseasethe dose of Perineva ® is set depending on the degree of renal dysfunction. During treatment, the content of potassium and creatinine ions in the blood serum should be regularly monitored. Recommended doses are presented in the table.
* - Dialysis clearance of perindoprilat is 70 ml / min. Perineva ® must be taken after dialysis.
Patients with liver diseasedose adjustment is not required.
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 forms 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, puffiness, and also 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 carton packs 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
Perinev's agent 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 drug is contraindicated in dehydration, hyperkalemia, pregnancy, hepatitis B, hypersensitivity, hypotension and under 18 years of age.
Price
Perinev's cost is 510 rubles on average. Prices range from 209 to 1059 rubles.
