Composition, form of production and packaging
The tablets covered with a film membrane from gray-green to green with a grayish shade of color, round, biconcave; on the cross section - the core is white or almost white.
1 tab.
indapamide 0.625 mg
perindopril erbumine 2 mg
Excipients: microcrystalline cellulose - 70.375 mg, corn pregelatinized corn starch - 15 mg, crospovidone - 10 mg, magnesium stearate - 1 mg, silicon dioxide colloid - 1 mg.
The composition of the film shell: opedrai II green (85F21738), including polyvinyl alcohol - 40%, titanium dioxide - 24.345%, macrogol-3350 - 20.2%, talcum - 14.8%, indigocarmine aluminum varnish - 0.54%, quinoline yellow - 0.115%.
10 pieces. - Cellular outline packaging (aluminum / PVC) (1) - cardboard packs.
10 pieces. - Cellular outline packaging (aluminum / PVC) (3) - cardboard packs.
10 pieces. - Cellular outline packaging (aluminum / PVC) (6) - cardboard packs.
10 pieces. - Cellular outline packaging (aluminum / PVC) (9) - cardboard packs.
The tablets covered with a film membrane from light yellow with a pinkish shade to yellow with a pinkish shade of color, round, biconcave; on the cross section - the core is white or almost white.
1 tab.
indapamide 1.25 mg
perindopril erbumine 4 mg
Excipients: microcrystalline cellulose - 67.75 mg, corn pregelatinized corn starch - 15 mg, crospovidone - 10 mg, magnesium stearate - 1 mg, silicon dioxide colloid - 1 mg.
The composition of the film shell: opadrai II yellow (85F38201), including polyvinyl alcohol - 40%, titanium dioxide - 24.48%, macrogol-3350 - 20.2%, talc - 14.8%, iron oxide yellow 0.5%, iron oxide red 0.02 %.
10 pieces. - Cellular outline packaging (aluminum / PVC) (1) - cardboard packs.
10 pieces. - Cellular outline packaging (aluminum / PVC) (3) - cardboard packs.
10 pieces. - Cellular outline packaging (aluminum / PVC) (6) - cardboard packs.
10 pieces. - Cellular outline packaging (aluminum / PVC) (9) - cardboard packs.
The tablets covered with a film membrane of white or almost white color, round, biconcave; on the cross section - the core is white or almost white.
1 tab.
indapamide 2.5 mg
perindopril erbumine 8 mg
Excipients: microcrystalline cellulose - 62.5 mg, corn pregelatinized corn starch - 15 mg, crospovidone - 10 mg, magnesium stearate - 1 mg, silicon dioxide colloid - 1 mg.
The composition of the film shell: opadrai II white (85F48105), including polyvinyl alcohol - 46.9%, macrogol-3350 - 23.6%, talc - 17.4%, titanium dioxide - 12.1%.
10 pieces. - Cellular outline packaging (aluminum / PVC) (1) - cardboard packs.
10 pieces. - Cellular outline packaging (aluminum / PVC) (3) - cardboard packs.
10 pieces. - Cellular outline packaging (aluminum / PVC) (6) - cardboard packs.
10 pieces. - Cellular outline packaging (aluminum / PVC) (9) - cardboard packs.
INSTRUCTION FOR THE SPECIALIST.
Description of the drug approved by the manufacturer for the printed edition of 2015.
PHARMACHOLOGIC EFFECT
Combined antihypertensive drug containing inhibitor of apyotensin-converting enzyme (ACE) - perindopril and thiazide-like diuretic - indapamide. The drug has antihypertensive, diuretic and vasodilating effect.
Perindopril plus Indapamide has a pronounced dose-dependent antihypertensive effect, independent of the age and position of the patient's body and not accompanied by reflex tachycardia. Does not affect the metabolism of lipids (total cholesterol, low density lipoproteins (LDL), very low density lipoproteins (VLDL), high density lipoproteins (HDL), triglycerides (TG) and carbohydrates), incl. in patients with diabetes mellitus. Reduces the risk of hypokalemia due to monotherapy with a diuretic. The hypotensive effect persists for 24 hours.
A stable decrease in blood pressure (BP) is achieved within 1 month against the background of the use of the drug Perindopril plus Indapamide without increasing the heart rate (heart rate). Termination of treatment does not lead to the development of the "withdrawal" syndrome.
Perindopril is an ACE inhibitor. the mechanism of its action is associated with the inhibition of ACE activity, leading to a decrease in the formation of angiotensin II, eliminates the vasoconstrictive effect of angiotensin II, reduces the secretion of aldosterone. The use of perindopril does not lead to the retention of sodium and liquid, does not cause reflex tachycardia in long-term treatment. The hypotensive effect of perindopril is developed in patients with low or normal renin activity of blood plasma. Perindopril acts through its main active metabolite - perindoprilata. Its other metabolites are inactive.
The action of perindopril leads to widening of the veins (decrease in preload on the heart), caused by a change in the metabolism of prostaglandins; reduction of total peripheral resistance of blood vessels (OPSS) (decrease in postload on the heart). In patients with heart failure, perindopril helps to decrease the filling pressure of the left and right ventricles; increased cardiac output and cardiac index; increase in regional blood flow in muscles. Perindopril is effective in arterial hypertension of any severity: mild, moderate and severe.
The maximum hypotensive effect develops 4-6 hours after a single oral intake and persists for 24 hours.
Termination of therapy does not lead to the development of the "withdrawal" syndrome.
Has vasodilating properties and restores the elasticity of large arteries. The addition of a thiazide-like diuretic enhances the hypotensive (additive) effect of perindopril.
Indapamide refers to sulfonamide derivatives. is a diuretic. Inhibits the reabsorption of sodium in the cortical segment of the renal tubules, increasing the excretion of sodium and chlorine by the kidneys, thus leading to increased diuresis. To a lesser extent increases the excretion of potassium and magnesium. Possessing the ability to selectively block slow calcium channels, indapamide increases the elasticity of the walls of the arteries and reduces the OPSS. Has antihypertensive effect in doses that do not have a pronounced diuretic effect. An increase in the dose of indapamide does not entail an increase in the hypotensive effect, but increases the risk of developing undesirable phenomena. Indapamide in patients with hypertension has no effect on the metabolism of lipids - TG, LDL and HDL; on the metabolism of carbohydrates, even in patients with diabetes mellitus and hypertension.
PHARMACOKINETICS
The combined use of perindopril and indapamide does not alter their pharmacokinetic parameters, as compared to the separate administration of these drugs.
Perindopril
Suction
After oral administration, perindopril is rapidly absorbed from the digestive tract. Bioavailability is 65 - 70%. C max in the blood plasma is achieved 3-4 hours after ingestion.
Eating a meal reduces the conversion of perindopril to perindoprilat and the bioavailability of perindopril. so it should be taken 1 time / day in the morning, before breakfast. When taking perindopril 1 time / day. The equilibrium concentration (C ss ) is reached within 4 days.
Distribution
Binding to blood plasma proteins perindoprilata has a dose-dependent character and is 20%. Perindoprilat easily passes through the histohematological barriers, excluding the blood-brain barrier (BBB). Do not cumulate.
Metabolism
In the liver is metabolized with the formation of an active metabolite perindoprilata. In addition, 5 more inactive metabolites are formed.
Excretion
T 1/2 perindopril from blood plasma is 1 h. T 1/2 perindoprilata is about 17h. It is excreted by the kidneys.
Pharmacokinetics in specific patient groups
In patients of advanced age, in patients with renal and cardiac failure, excretion of perindoprilate is slowed.
The dialytic clearance of perindoprilat is 70 ml / min.
The kinetics of perindopril has been altered in patients with cirrhosis: the liver clearance is reduced by half. Nevertheless, the amount of perindoprilate formed does not decrease, which does not require correction of the dose.
Indapamide
Suction
After oral administration, it is quickly and almost completely absorbed from the digestive tract. Eating somewhat slows down absorption, but does not significantly affect the amount of absorbed indapamide. After ingestion in a single dose of C max , the blood plasma is reached after 1 hour.
Distribution
Binding to plasma proteins is 79%. Do not cumulate.
Metabolism
Metabolised in the liver.
Excretion
T 1/2 is from 14 to 24 hours (an average of 18 hours). It is excreted by the kidneys (70%) mainly in the form of metabolites (the fraction of the unchanged drug is about 5%) and the intestine with bile in the form of inactive metabolites (22%).
Pharmacokinetics in special clinical cases
In patients with renal insufficiency, the pharmacokinetic parameters of indapamide do not change significantly.
INDICATIONS
- arterial hypertension.
DOSING MODE
Assign inside 1 time / day. preferably in the morning before breakfast, with plenty of liquid.
Doses are given for the ratio of perindopril / indapamide.
The initial dose of the drug Perindopril plus Indapamide - 0.625 mg / 2 mg (1 tablet) 1 time / day. If after 1 month of taking the drug, you can not achieve adequate blood pressure control. then the dose of the drug should be increased to 1.25 mg / 4 mg (1 tablet) 1 time / day.
Patients with renal insufficiency (CC 60 ml / min or more) dose adjustment is not required. For patients with KK 30-60 ml / min the maximum dose of Perindopril plus Indapamide is 0,625 mg / 2 mg (1 tablet) 1 time / day, treatment should be started with the selection of doses of perindopril and indapamide in monotherapy. With QC less than 30 ml / min, the use of the drug Perindopril plus Indapamide is contraindicated (see section "Contraindications").
Patients with moderate dysfunction of the liver dosage adjustment is not required. Patients with severe violations of the liver function of the drug Perindopril plus Indapamide is contraindicated.
For elderly patients, the initial dose of Perindopril plus Indapamide is 0.625 mg / 2 mg (1 tablet) 1 time / day.
In elderly patients, the function of the kidneys and the content of potassium in the blood plasma should be evaluated before starting the drug Perindopril plus Indapamide. The initial dose of the drug Perindopril plus Indapamide is selected depending on the degree of BP reduction, especially with a decrease in BCC and in chronic heart failure (IV functional class according to the NYHA classification). Such measures allow to avoid a sharp decrease in blood pressure.
The risk of arterial hypotension exists in all patients, but special care should be taken when using the drug Perindopril plus Indapamide in patients with ischemic heart disease and cerebral circulatory insufficiency. In such patients, treatment with the drug should begin with a dose of 0.625 mg / 2 mg (initial dose). In patients with diagnosed or suspected renal artery stenosis, treatment with Perindopril plus Indapamide should be started in a hospital setting at a dose of 0.625 mg / 2 mg under the control of kidney function and potassium levels in the blood plasma. Some patients may develop acute renal failure, which is reversible after discontinuation of the drug.
In patients with chronic heart failure (NYHA functional class IV), treatment with Perindopril plus Indapamide should begin with an initial dose of 0.625 mg / 2 mg under medical supervision.
SIDE EFFECT
Classification of the incidence of adverse events (WHO): very often (> 1/10). often (from> 1/100 to <1/10), infrequently (from> 1/1000 to <1/100), rarely (from> 1/10 000 to <1/1000). Very rarely (from <1/10 000), the frequency is unknown (the frequency can not be calculated from the available data).
On the part of the hematopoiesis system: infrequently - eosinophilia, hyponatremia, very rarely - thrombocytopenia, leukopoeia / neutropenia, agranulocytosis, aplastic anemia, hemolytic anemia. In certain clinical situations (patients after kidney transplantation, patients on hemodialysis) ACE inhibitors can cause anemia.
From the side of the central nervous system: often - paresthesia, headache, dizziness, vertigo; infrequently - sleep disturbance, mood lability; very rarely, confusion;frequency unknown - faint.
From the side of the organ of vision: often - impaired vision.
From the side of the organ of hearing: often - noise in the ears.
From the side of the cardiovascular system: infrequent - a pronounced decrease in blood pressure (including orthostatic hypotension), a feeling of palpitations; very rarely - heart rhythm disturbances (including bradycardia, ventricular tachycardia, atrial fibrillation), angina pectoris and myocardial infarction, possibly due to excess BP reduction in patients at high risk; the frequency is unknown - arrhythmias of the "pirouette" type (possibly with a lethal outcome), an increase in the QT interval on the ECG.
On the part of the respiratory system: often - against the background of the use of ACE inhibitors may occur a dry cough that persists long during the intake of drugs of this group and disappears after their withdrawal, dyspnea; infrequently bronchospasm; very rarely - eosionophilic pneumonia, rhinitis.
On the part of the digestive system: often - dryness of the oral mucosa, nausea, vomiting, abdominal pain, epigastric pain, impaired taste, decreased appetite, indigestion, constipation, diarrhea: very rarely - pancreatitis, angioedema, cholestatic jaundice; frequency unknown - hepatic encephalopathy in patients with hepatic insufficiency, increased activity of "liver" transaminases.
From the skin: often - skin rash, itching, maculopapular rash; infrequently, angioedema, swelling of the face, lips, extremities, mucous membrane of the tongue, vocal folds and / or larynx, urticaria, hypersensitivity reactions in patients predisposed to bronchial obstructive and allergic reactions, hemorrhagic vasculitis. In patients with acute form of systemic lupus erythematosus, the course of the disease may worsen; very rarely - erythema multiforme, toxic epidermal necrolysis. Stevens-Johnson syndrome. Cases of photosensitivity reaction are noted.
From the musculoskeletal system: often - muscle spasms.
From the side of the urinary system: infrequently - kidney failure; very rarely - acute renal failure, the frequency is unknown - hepatitis.
From the side of the reproductive system: infrequently - erectile dysfunction.
Laboratory indicators: rarely - hypercalcemia; frequency unknown - hypokatieia, especially significant for patients at risk; hyponatremia and gynovolemia, leading to dehydration and orthostatic hypotension; increase in the concentration of uric acid and glucose in the blood during the administration of the drug: a slight increase in the concentration of creatinine in the urine and in blood plasma, which occurs after the abolition of therapy, more often in patients with renal artery stenosis, in the treatment of arterial hypertension with diuretics and in the case of kidney failure; hyperkalaemia, often transient.
Other: often - asthenia; infrequently - increased sweating.
With the use of ACE inhibitors, there was rarely a syndrome of impaired secretion of anitidiuretic hormone.
CONTRAINDICATIONS
Perindopril
- hypersensitivity to perindopril and other ACE inhibitors;
- angioedema (angioedema) in history, associated with the taking of an ACE inhibitor;
- hereditary / idiopathic angioedema;
- bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney;
- simultaneous administration of ACE inhibitors with aliskiren and aliskiren-containing drugs in patients with diabetes mellitus and renal failure (creatinine clearance less than 60 ml / min);
- Pregnancy;
- the period of breastfeeding;
- age under 18 years (efficiency and safety not established).
Indapamide
- hypersensitivity to indapamide and other sulfonamide derivatives;
- severe hepatic insufficiency (including with encephalopathy);
- hypokalemia;
- simultaneous use with drugs capable of causing arrhythmia of the "pirouette" type;
- Pregnancy and the period of breastfeeding;
- age under 18 years (efficiency and safety not established).
Perindopril plus Indapamide
- hypersensitivity to the excipients included in the preparation;
- severe renal failure (CK <30 ml / min);
- simultaneous reception with potassium-sparing diuretics, potassium and lithium preparations, and in patients with hyperkalemia;
- simultaneous reception of drugs that extend the QT interval;
- Due to a lack of sufficient clinical experience, the drug Perindopril plus Indapamide should not be used in patients on hemodialysis, as well as in patients with untreated heart failure in the stage of decompensation;
- age under 18 years (efficiency and safety not established).
With caution: the drug should be used for systemic diseases of connective tissue (including systemic lupus erythematosus, scleroderma); on the background of immunosuppressant therapy (risk of neutropenia, agranulocytosis); when oppression of bone marrow hematopoiesis; decrease in the volume of circulating blood (BCC) (due to taking diuretics, diets with restriction of table salt, vomiting, diarrhea); with ischemic heart disease (IHD); cerebrovascular diseases; Renovascular hypertension; chronic heart failure (NYHA functional class IV); with hyperuricemia (especially accompanied by gout and urate nsphrolithiasis); lability of blood pressure; when hemodialysis using high-flow polyacrylonitrile membranes (risk of anaphylactoid reactions); before the procedure for apheresis of LDL with dextrin sulfate; simultaneously with the conduct of desensitizing therapy with allergens (for example, the poison of Hymenoptera insects); after the kidney transplantation;stenosis of the aortic and / or mitral valve, hypertrophic obstructive cardiomyopathy; in elderly patients. Patients with a history of Quincke edema who are not associated with the administration of ACE inhibitors may be at increased risk of developing it with this group of drugs. In patients of the Negroid race angioneurotic edema develops more often than in patients of other races.
PREGNANCY AND LACTATION
Perindopril plus Indapamide is contraindicated in pregnancy.
When planning pregnancy or when it comes on the background of taking the drug should immediately stop taking the drug and prescribe another antihypertensive therapy. Appropriate controlled trials of ACE inhibitors in pregnant women have not been conducted. The available limited data on the effect of the drug in the first trimester of pregnancy indicate that the drug did not lead to malformations associated with fetotoxicity.
It is not recommended to use the drug Perindopril plus Indapamide in the I trimester of pregnancy. Perindopril plus Indapamide is contraindicated in the second and third trimesters of pregnancy.
It is known that prolonged exposure to ACE inhibitors in the fruit during II and III trimester of gestation may lead to disruption of its development (reduction of renal function, oligohydramnios, slowing ossification of bones of the skull) and the development of complications in the newborn (such as renal failure, hypotension, hyperkalaemia).
Prolonged use of thiazide diuretics in the III trimester of pregnancy may cause maternal hypovolemia and decreased uteroplacental blood flow that leads to ischemia placental and fetal growth retardation. In rare cases in patients receiving diuretics just before birth in the newborn develops hypoglycemia and thrombocytopenia.
If a patient receiving perindopril plus indapamide in II and III trimesters of pregnancy, it is recommended to fetal ultrasound for the evaluation of bone status of the skull and renal function.
Neonates whose mothers were treated with ACE inhibitors, there may be hypotension, and therefore, the newborn should be under close medical supervision.
Perindopril plus indapamide is contraindicated during breast-feeding. It is not known whether perindopril into breast milk is released.
Indapamide is excreted in breast milk. Acceptance of thiazide diuretics causes a decrease in the amount of breast milk or suppression of lactation. A newborn in this case may develop hypersensitivity to sulfonamide derivatives, hypokalemia, and "nuclear" jaundice.
If necessary, use Perindopril plus indapamide lactation should stop breastfeeding.
APPLICATION FOR FUNCTIONS OF THE LIVER
Patients with renal failure (creatinine clearance of 60 ml / min or more) dose adjustment is required. For patients with CC 30-60 ml / min maximum dose plus Indapamide Perindopril is 0,625mg / 2 mg (1 tablet) 1 time / day, treatment should begin with the selection of doses of perindopril and indapamide in monotherapy.When CC less than 30 ml / min, use of the drug plus Perindopril Indapamide contraindicated (cm. "Contraindications").
APPLICATION FOR VIOLATIONS OF THE FUNCTION OF KIDNEYS
Patients with moderate hepatic impairment dose adjustment is required. Patients with severe hepatic impairment drug application Perindopril plus Indapamide contraindicated.
APPLICATION FOR CHILDREN
The drug Perindopril plus indapamide is contraindicated in children and adolescents under the age of 18 years due to a lack of data on efficacy and safety of its use.
APPLICATION IN ELDERLY PATIENTS
For elderly initial dose Perindopril plus Indapamide is 0.625 mg / 2 mg (1 tablet) 1 time / day.
Elderly patients before taking the drug Perindopril plus indapamide should assess kidney function and the content of potassium in the blood plasma. The initial dose Perindopril plus Indapamide selected depending on the degree of decrease in blood pressure, particularly when reducing the bcc and chronic heart failure (IV NYHA functional class classification). Such measures make it possible to avoid a sharp decrease in blood pressure.
SPECIAL INSTRUCTIONS
Perindopril plus Indapamide
Not recommended simultaneous application of the drug plus Perindopril Indapamide with lithium therapy.
Perindopril drug therapy plus Indapamide is contraindicated in patients with severe renal impairment (creatinine clearance less than 30 mL / min). Some patients with arterial ginertenziey without prior renal dysfunction on the background of therapy with Perindopril plus indapamide may cause symptoms of acute renal failure. In this case, treatment with Perindopril plus indapamide should be discontinued. In the future, you can resume a combination therapy using low doses of the drug Perindopril plus indapamide or use drugs perindopril and indapamide monotherapy. Such patients need regular monitoring of potassium and serum concentration kreatiiina every 2 weeks after initiation of therapy and every 2 months following therapy with Perindopril plus indapamide.Acute renal failure often develops in patients with severe congestive heart failure or renal dysfunction source, including with bilateral renal artery stenosis or stenosis of the artery only functioning kidney. The drug Perindopril plus indapamide is not recommended in patients with bilateral renal artery stenosis or stenosis of the artery only functioning kidney.
Hyponatremia associated with the risk of a sudden drop in blood pressure (especially in patients with bilateral renal artery stenosis or stenosis of the artery only functioning kidney). Therefore, in the follow-up of patients should pay attention to possible symptoms of dehydration and reduction of electrolytes in the blood plasma, for example, after prolonged diarrhea or vomiting. Such patients requires regular monitoring of electrolytes in the blood plasma.
In marked decrease in blood pressure may be required in / in a 0.9% sodium chloride solution.
Transient hypotension is not a contraindication to further continuation of therapy. After the restoration of the bcc and blood pressure can resume therapy with Perindopril plus indapamide, using low doses of the drug, or using drugs perindopril and indapamide monotherapy.
Combined use of perindopril and indapamide does not prevent the development of hypokalemia, especially in patients with diabetes or renal failure. As in the case of combined use of antihypertensive and diuretic agents requires regular monitoring the potassium content in the blood plasma.
perindopril
Patients taking ACE inhibitors, there may be cases of neutropenia / agranulocytosis, thrombocytopenia and anemia. In patients with normal renal function, in the absence of other complications of neutropenia is rare and takes place spontaneously after discontinuation of ACE inhibitors.
Perindopril is necessary with extreme caution in patients with connective tissue diseases and at the same time receiving immunosuppressive therapy, allopurinol or procainamide, especially when existing renal impairment. These patients may develop severe infections refractory to intensive antibiotic therapy. In the case of perindopril recommended destination periodically monitor the number of leukocytes in blood. Patients should be warned that in case of any signs of infection (sore throat, fever), you should immediately consult a doctor.
When receiving ACE inhibitors, including perindopril, in rare cases, can be observed the development of facial angioedema, lips, tongue, uvula upper palate, and / or the larynx. When these symptoms the drug should be discontinued immediately. the patient should be monitored for as long as edema symptoms do not disappear completely.
If angioedema affects only the face and lips, his symptoms usually disappear on their own, or to treat the symptoms can be used antihistamines. Angioneurotic edema, accompanied by edema of the larynx or tongue may cause airway obstruction and death. When angioedema symptoms should immediately enter p / epinephrine (adrenaline), diluted 1: 1000 (0.3 or 0.5 ml) and / or to ensure airway patency.
Patients with a history of observed angioedema not associated with taking ACE inhibitors. the risk of its development may be increased when receiving drugs in this group. Patients blacks angioedema develops more frequently than patients of other races.
In rare cases during treatment with ACE inhibitors develop angioedema bowel edema. Thus, patients have a pain in the abdomen as an isolated symptom or in combination with nausea and vomiting in some cases without prior angioneurotic edema of the face and under the normal C-1 esterase. Diagnosis is established via CT abdominal ultrasound or during surgery. Symptoms disappear after discontinuation of ACE inhibitors. In patients with abdominal pain who receive ACE inhibitors in the differential diagnosis should consider the possibility of angioneurotic edema of the intestine. There are some reports about the development of long-term, life-threatening anaphylactoid reactions in patientsreceiving ACE inhibitors during desensitizing treatment with poison Hymenoptera (bees, wasps). ACE inhibitors should be used with caution in patients prone to allergic reactions, undergoing desensitization procedure. Avoid destination ACE inhibitor to patients receiving immunotherapy Hymenoptera venom. Nevertheless, development of anaphylactoid reactions can be avoided by temporary discontinuation of ACE inhibitor for at least 24 hours before initiated desensitization procedures.of anaphylactoid reactions can be avoided by temporary discontinuation of ACE inhibitor for at least 24 hours before initiated desensitization procedures.of anaphylactoid reactions can be avoided by temporary discontinuation of ACE inhibitor for at least 24 hours before initiated desensitization procedures.
In rare cases, patients receiving ACE inhibitors during apheresis line using dskstrana sulfate can develop life-threatening anaphylactoid reactions. To prevent apafnlaktoidnoy reaction should discontinue therapy with an ACE inhibitor before every LDL apheresis procedure using vysokoprotochnyh membranes.
Patients receiving ACE inhibitors during hemodialysis using vysokoprotochnyh membranes (e.g., AN69 В®), Anaphylactoid reactions have been observed. It is therefore desirable to use a diaphragm or other type use an antihypertensive drug other pharmacotherapeutic group. The therapy of ACE inhibitor, dry cough can occur which disappears after drug withdrawal in this group. When dry cough should be mindful of possible connection with this symptom receiving ACE inhibitor. If the doctor believes that ACE inhibitor therapy requires the patient receiving the drug Perindopril plus indapamide could be continued.
In liver cirrhosis, accompanied by edema and ascites, arterial hypotension. chronic heart failure can be a significant activation of the renin-angiotensin-aldosterone system (RAAS), particularly in severe hypovolemia and decreased content of electrolytes in the blood plasma (in the background the salt-free diet or prolonged use of diuretics).
The use of an ACE inhibitor causes a blockade of the RAAS, in connection with the possible sharp decline in blood pressure and / or elevated levels of serum creatinine, indicative of the development of acute renal failure that often occurs when taking the first dose of the drug Perindopril plus indapamide or within the first 2 weeks of therapy.
When administering the drug Perindopril plus Indapamide patients with diabetes receiving hypoglycemic agents for oral or insulin, for the first month of therapy is necessary to regularly monitor the concentration of glucose in the blood.
Perindopril (and other ACE inhibitors), has a less pronounced antihypertensive effect in blacks compared to patients with other races.
The use of ACE inhibitors in patients undergoing surgery with general anesthesia can lead to a marked decrease in blood pressure, particularly when applying means to sheathe anesthesia providing antihypertensive activity.
It is recommended to stop taking ACE inhibitors, including perindopril, for 12 hours before surgery, tell your doctor, anesthetist on the use of ACE inhibitors.
ACE inhibitors should be used with caution in patients with obstruction of the left ventricular outflow tract and the aortic and / or mitral stenosis and GOKMP (Hypertrophic Obstructive Cardiomyopathy).
In rare cases in patients receiving an ACE inhibitor arises cholestatic jaundice, which develops in the progression of fulminant hepatic necrosis, sometimes with fatal consequences. When jaundice or a significant increase in "liver" transaminases in patients receiving an ACE inhibitor drug reception Perindopril plus Indapamide should cease.
In patients following kidney transplantation or in patients on hemodialysis, may develop anemia.
During treatment with ACE inhibitors, including and perindopril may develop hyperkalemia. Risk factors for hyperkalemia are renal failure, advanced age, diabetes, some comorbid conditions (reduction BCC. Acute heart failure decompensation, metabolic acidosis), simultaneous reception of potassium-sparing diuretics (such as spironolactone, zplerenon. Triamterene, amiloride), as well as drugs potassium or potassium-containing salt and substitutes the use of other drugs that enhance the potassium content in the blood plasma (e.g., heparin). Hyperkalemia can cause serious heart rhythm abnormalities, sometimes with fatal consequences. Combined use of the above formulations is not recommended,if necessary, their use of therapy should be administered with extreme caution.
Indapamide
have been reported cases of increased photosensitivity in patients receiving thiazide and thiazide diuretics. With the development of photosensitivity reactions in patients receiving the drug Perindopril plus indapamide treatment should be stopped. If necessary, renew the application of the drug Perindopril plus indapamide, should protect exposed skin from direct exposure to the sun and artificial UV rays.
Before beginning treatment with Perindopril plus indapamide is necessary to determine the sodium content in the blood plasma and in patients receiving the drug to carry out regular monitoring of electrolytes in the blood plasma (especially in elderly patients). All diuretics can cause hyponatremia, leading to serious complications.
Treatment with thiazide diuretics and thiazide
