Composition, form of production and packaging
Tablets white or almost white, oval, slightly biconcave, with a facet and risk on one side.
1 tab.
perindopril erbumine, semifinished-granules 76.78 mg,
which corresponds to the content of perindopril erbumine 4 mg
Auxiliary substances of semifinished products-granules: calcium chloride hexahydrate, lactose monohydrate, crospovidone.
Excipients: microcrystalline cellulose, colloidal silicon dioxide, magnesium stearate.
10 pieces. - packings cellular planimetric (3) - packs cardboard.
10 pieces. - packings cellular planimetric (9) - packs cardboard.
Tablets are white or almost white, round, slightly biconcave, with a facet and a risk on one side.
1 tab.
Perindopril erbumine, semi-finished granules 153.56 mg,
which corresponds to the content of perindopril erbumine 8 mg
Auxiliary substances of semifinished products-granules: calcium chloride hexahydrate, lactose monohydrate, crospovidone.
Excipients: microcrystalline cellulose, colloidal silicon dioxide, magnesium stearate.
10 pieces. - packings cellular planimetric (3) - packs cardboard.
10 pieces. - packings cellular planimetric (9) - packs cardboard.
INSTRUCTION FOR THE SPECIALIST.
Description of the drug approved by the manufacturer for the printed edition of 2015.
PHARMACHOLOGIC EFFECT
Antihypertensive drug. Perindopril - an ACE inhibitor, or kininase II, refers to oxo-peptidases. It converts angiotensin I into an angiotensin II vasoconstrictor and destroys the bradykinin vasodilator to an inactive heptapeptide. The suppression of ACE activity leads to a decrease in the level of angiotensin II and an increase in renin activity in plasma (suppressing the negative feedback of renin release) and a decrease in aldosterone secretion. Since ACE also destroys bradykinin, suppression of ACE leads to an increase in the activity of the circulating and tissue kallikrein-kinin system, with the activation of the prostaglandin system.
Perindopril has a therapeutic effect due to the active metabolite - perindoprilat.
Perindopril reduces both systolic and diastolic blood pressure in a supine and standing position. Perindopril reduces OPSS, which leads to a decrease in blood pressure. In this case, the peripheral blood flow is accelerated. However, the heart rate does not increase. Renal blood flow, as a rule, increases, while the rate of glomerular filtration does not change.
The maximum antihypertensive effect is achieved 4-6 hours after a single dose. The hypotensive effect persists for 24 hours, and after 24 hours the drug still provides 87% to 100% of the maximum effect. Reduction of blood pressure develops rapidly. Stabilization of antihypertensive action is observed after 1 month of therapy and persists for a long time. Termination of therapy is not accompanied by withdrawal syndrome.
Perindopril reduces myocardial hypertrophy of the left ventricle.
With prolonged use reduces the severity of interstitial fibrosis, normalizes the isozyme profile of myosin. Increases the concentration of 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 the heart, reducing pre- and postnagruzku. In patients with chronic heart failure in the presence of perindopril therapy, a decrease in the filling pressure in the left and right ventricles was noted; reduction in OPSS; increased cardiac output and cardiac index.
Admission of an initial dose of perindopril 2 mg in patients with chronic cardiac insufficiency of I-II functional class according to the NYHA classification was not accompanied by a statistically significant decrease in blood pressure compared with placebo.
PHARMACOKINETICS
Suction
After oral administration, perindopril is rapidly absorbed from the gastrointestinal tract and reaches C max in blood plasma for 1 hour. Bioavailability is 65-70%.Admission of the drug during meals is accompanied by a decrease in the conversion of perindopril to perindoprilat, respectively, the bioavailability of the drug decreases.
20% of the total amount of absorbed perindopril is converted to perindoprilat (active metabolite). C max perindoprilata is reached after 3-4 hours.
Distribution
V d of unbound perindoprilata is 0.2 l / kg. Binding to blood plasma proteins is negligible. The binding of perindoprilata with ACE is less than 30%, but depends on its concentration.
Do not cumulate.
Excretion
T 1/2 perindopril from the blood plasma is 1 hour. Perindoprilat is excreted by the kidneys. T 1/2 of the unbound fraction is about 3-5 hours.
Pharmacokinetics in special clinical cases
In patients of advanced age, in patients with renal and chronic heart failure, excretion of perindoprilate is slowed.
Perindoprilat is removed during hemodialysis (rate 70 ml / min, 1.17 ml / sec) and peritoneal dialysis.
In patients with cirrhosis, the liver clearance of perindopril changes, with the total amount of perindoprilate formed not changing, and correction of the dosing regimen is not required.
INDICATIONS
- arterial hypertension;
- Chronic heart failure;
- prevention of recurrent stroke (as part of complex therapy with indapamide) in patients with cerebrovascular diseases in the anamnesis (stroke or transient cerebral ischemic attack);
- stable ischemic heart disease: reduced risk of cardiovascular complications in patients who have had previous myocardial infarction and / or coronary revascularization.
DOSING MODE
The drug is prescribed by mouth 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 В® can be used as a monotherapy or in combination with other antihypertensive agents.
The recommended initial dose is 4 mg / day, in the morning.
For patients with severe RAAS activation (eg, with renal vascular hypertension, hypovolemia and / or hyponatremia, chronic heart failure in decompensation or severe hypertension), the recommended initial dose is 2 mg / day in a single dose. If the therapy is ineffective for a month, the dose may be increased to 8 mg 1 time / day with good tolerability of the previous dose.
Adding ACE inhibitors to patients taking diuretics can cause arterial hypotension. In this regard, it is recommended to take care with caution, to cancel diuretics 2-3 days before the start of treatment with Perineva В®, or to start treatment with Perineva В® from the initial dose of 2 mg / day in one dose. It is necessary to monitor blood pressure, kidney 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 blood pressure. If necessary, diuretic therapy can be resumed.
In elderly patients, the recommended initial dose is 2 mg / day in a single 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 dose is well tolerated.
Chronic heart failure
The recommended initial 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 chronic heart failure with clinical manifestations is usually combined with potassium-sparing diuretics, beta-adrenoblockers and / or digoxin.
In patients with chronic heart failure, with renal insufficiency and with a tendency to electrolyte disorders (hyponatremia), as well as in patients taking both diuretics and / or vasodilators, treatment with the drug is started under strict medical supervision.
In patients with a high risk of developing clinically significant arterial hypotension (for example, taking high doses of diuretics), hypovolemia and electrolyte disturbances should be eliminated if possible before the start of the Perinev В® drug. It is recommended to carefully monitor the level of blood pressure, the state of kidney function and the concentration of potassium ions in the blood serum before and during therapy.
Prevention of recurrent stroke in patients with cerebrovascular disease in history
Therapy with Perineva В® 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
In patients with stable ischemic heart disease, the recommended initial dose of Perineva В® is 4 mg / day. After 2 weeks, the dose is increased to 8 mg / day, provided that the dose is well tolerated at 4 mg / day and the kidney function is monitored.
Treatment of elderly patients should start with a dose of 2 mg, which after a week can be increased to 4 mg / day. In the future, if necessary, after a week, the dose can be increased to 8 mg / day with mandatory pre-control of kidney function. In elderly patients, the dose of the drug can be increased only if the previous, lower dose is well tolerated.
In patients with kidney diseases, the dose of Perineva В® is set depending on the degree of renal dysfunction. During treatment should regularly monitor the content of potassium ions and creatinine in the blood serum. Recommended doses are presented in the table.
Creatinine clearance Recommended dose
from 60 ml / min and more than 4 mg / day
from 30 to 60 ml / min 2 mg / day
from 15 to 30 ml / min 2 mg every other day
Patients on hemodialysis * (CC less than 15 mL / min) 2 mg per day of dialysis
* - Dialyz clearance of perindoprilata is 70 ml / min. Preparation Perineva В® should be taken after a dialysis session.
Patients with liver disease dosage adjustment is not required.
SIDE EFFECT
Determination of the frequency of adverse reactions: very often (> 1/10), often (> 1/100, <1/10), sometimes (> 1/1000, <1/100), rarely (> 1/10 000, <1 / 1000), very rarely (<1/10 000, including individual messages).
From the side of the central nervous system and peripheral nervous system: often - headache, dizziness, paresthesia; sometimes - sleep or mood disturbances; very rarely confusion.
From the sense organs: often - visual disturbances, noise in the ears.
From 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).
On the part of 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, indigestion, diarrhea, constipation; sometimes - dryness of the oral mucosa; rarely - pancreatitis; very rarely - cytolytic or cholestatic hepatitis.
From the genitourinary system: sometimes - kidney failure, impotence; very rarely acute renal failure.
From the hemopoietic system 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 deficiency of glucose-6-phosphate dehydrogenase).
Laboratory indicators: increased urea levels in blood serum and plasma creatinine, hyperkalaemia, reversible after discontinuation of the drug (especially in patients with renal insufficiency, severe chronic heart failure and renovascular hypertension); rarely - increased activity of hepatic enzymes and bilirubin in the blood serum;hypoglycemia.
From the skin: often - skin rash, itching; sometimes - increased sweating, angioedema, swelling of the face, limbs, urticaria; very rarely erythema multiforme.
Other: often - asthenia, muscle cramps.
CONTRAINDICATIONS
- angioedema in the anamnesis (hereditary, idiopathic or angioedema due to the administration of ACE inhibitors);
- age under 18 years (effectiveness and safety not established);
- hereditary intolerance to galactose, lactase deficiency lapp or glucose-galactose malabsorption syndrome;
- hypersensitivity to perindopril or other components of the drug;
- Hypersensitivity to other ACE inhibitors.
It should be used with caution in renal vascular hypertension, in patients with bilateral stenosis of the renal arteries, 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, 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 including cerebral circulatory insufficiency, coronary heart disease, coronary insufficiency) - the risk of developing excessive blood pressure lowering; 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 procedure of apheresis of LDL, simultaneously with the conduct of desensitizing therapy with allergens (for example, Hymenoptera venom) - the risk of developing anaphylactoid reactions; with connective tissue diseases (including SLE, scleroderma), oppression of bone marrow hematopoiesis with immunosuppressant, allopurinol or procainamide - the risk of agranulocytosis and neutropenia; with congenital deficiency of glucose-6-phosphate dehydrogenase - single cases of hemolytic anemia; in representatives of the Negroid race - the risk of developing anaphylactoid reactions; with surgical intervention (the need for general anesthesia) - the risk of developing excessive blood pressure lowering; at a diabetes (the control of concentration of a glucose in a blood is necessary); with hyperkalemia; in elderly patients.
PREGNANCY AND LACTATION
In pregnancy, the use of the drug is contraindicated. With the confirmation of pregnancy, the drug Perineva В® must be canceled as soon as possible. Use in the II and III trimesters of pregnancy can cause fetotoxic effects (decreased kidney function, low blood pressure, slowing ossification of the fetal bones) and neonatal toxic effects (renal failure, arterial hypotension, hyperkalemia). In the case of the drug in the II and III trimesters of pregnancy, ultrasound examination of the kidneys and bones of the fetal skull is necessary.
The use of Perineva В® during lactation is not recommended, due to the lack of data on the possibility of penetration of perindopril into breast milk. If you need to use the drug during lactation, breastfeeding should be discontinued.
APPLICATION FOR FUNCTIONS OF THE LIVER
In patients with kidney disease, the dose of Perineva is set depending on the degree of renal dysfunction. During treatment should regularly monitor the content of potassium ions and creatinine in the blood serum. Recommended doses are presented in the table.
Creatinine clearance Recommended dose
from 60 ml / min and more than 4 mg / day
from 30 to 60 ml / min 2 mg / day
from 15 to 30 ml / min 2 mg every other day
Patients on hemodialysis * (CC less than 15 mL / min) 2 mg per day of dialysis
* - Dialyz clearance of perindoprilata is 70 ml / min. Perineva should be taken after a dialysis session.
APPLICATION FOR VIOLATIONS OF THE FUNCTION OF KIDNEYS
Patients with liver disease dosage adjustment is not required. In patients with cirrhosis, the liver clearance of perindopril changes, with the total amount of perindoprilate formed not changing, and correction of the dosing regimen is not required.
APPLICATION FOR CHILDREN
Contraindicated: age under 18 years (efficacy and safety not established).
APPLICATION IN ELDERLY PATIENTS
In elderly patients the recommended initial dose is 2 mg / day. 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 dose is well tolerated.
SPECIAL INSTRUCTIONS
Stable ischemic heart disease
In patients with coronary artery disease with the development of an episode of unstable angina (significant or not) during the first month of therapy with Perineva В®, it is necessary to evaluate the benefit / risk ratio for therapy with this drug.
Arterial hypotension
In the treatment of hypertension, ACE inhibitors can cause a sharp decrease in blood pressure. In patients with uncomplicated arterial hypertension, symptomatic arterial hypotension rarely occurs after taking the first dose. The risk of excessive reduction in blood pressure is increased in patients with reduced BCC in the presence of diuretic therapy, with strict salt-free diet, hemodialysis, as well as with diarrhea or vomiting, or in those with severe renin-dependent hypertension. The expressed arterial hypotension was observed in patients with severe chronic heart failure, both in the presence of concomitant renal failure and in its absence. The most common arterial hypotension can develop in patients with more severe chronic heart failure, taking "loop" diuretics in high doses, as well as against hyponatremia or kidney failure. Such patients are recommended careful medical supervision at the beginning of therapy and when titrating the doses of the drug. The same applies to patients with IHD or cerebrovascular disease, in which excessive reduction in blood pressure can lead to myocardial infarction or cerebrovascular complications.
In the case of arterial hypotension necessary to give a patient a horizontal position with the raised feet, and if necessary, to enter in / sodium chloride solution to increase BCC. Transient hypotension is not a contraindication to further treatment. After restoring the bcc and BP treatment may be continued with careful selection of the dose.
Some patients with chronic heart failure and normal or low blood pressure during therapy with Perineva В® may occur additional blood pressure reduction. This effect forward and usually not a reason for discontinuation. If hypotension accompanied by clinical manifestations, may require dose reduction or abolition of the drug Perineva В® .
Stenosis of the aortic or mitral valve / hypertrophic cardiomyopathy
ACE Inhibitors, including perindopril should be used with caution in patients with mitral stenosis and obstruction of the left ventricular outflow tract (aortic valve stenosis and hypertrophic cardiomyopathy).
Renal dysfunction
in patients with renal failure (creatinine clearance less than 60 mL / min), the initial dose of drug Perineva В® should be selected in accordance with QC and then - depending on the therapeutic response. For these patients requires regular monitoring of the concentration of potassium ions in serum creatinine.
In patients with symptomatic heart failure, hypotension, developing in the initial period of treatment with ACE inhibitors, may lead to a deterioration of renal function. In these patients, sometimes there were cases of acute renal failure, usually reversible.
In some patients with bilateral renal artery stenosis or stenosis of the renal artery to a solitary kidney (especially in the presence of renal failure) during therapy with ACE inhibitors was an increase in serum concentrations of urea and creatinine, reversible after discontinuation of therapy. Patients with renovascular hypertension during therapy with ACE inhibitors are at increased risk of severe hypotension and renal insufficiency. Treatment of such patients should start under close medical supervision with low doses and with further adequate dose selection. During the first weeks of therapy with Perineva В®to cancel diuretics and regular monitoring of renal function. Some patients with 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 serum. In this case, the recommended dose reduction Perineva В® and / or cancellation diuretic.
Patients on hemodialysis
in patients on dialysis using membranes vysokoprotochnyh and taking ACE inhibitors at the same time, it was noted several cases of persistent, life-threatening anaphylactic reactions. When the need for dialysis is necessary to use another type of membrane.
Kidney Transplantation
Experience with perindopril in patients with recently undergone kidney transplantation is not available.
Hypersensitivity / angioedema
Rarely, patients treated with ACE inhibitors, including perindopril, developed angioneurotic edema of the face, extremities, lips, mucous membranes, tongue, glottis and / or larynx. This condition can develop at any time of treatment. With the development of angioedema treatment should be discontinued immediately, the patient should be kept under medical supervision until complete disappearance of symptoms. Angioneurotic edema of the lips and face usually does not require treatment; you can use antihistamines to reduce the severity of symptoms. Angioneurotic edema, tongue, glottis or larynx may be fatal. With the development of angioedema should immediately enter subcutaneous epinephrine (adrenaline) and secure the airway.
In patients with a history of angioedema unrelated to ACE inhibitors, there is a higher risk of angioedema while receiving an ACE inhibitor.
Anaphylactoid reactions during LDL apheresis procedure
in patients at appointment of ACE inhibitors on the background of LDL apheresis procedure using dextran-sulfate absorption in rare cases may develop an anaphylactic reaction. Recommended temporary cancellation of the ACE inhibitor before each apheresis procedure.
Anaphylactic reactions during desensitizing
Patients receiving ACE inhibitors during the course of desensitization (eg, poison Hymenoptera), in very rare cases may develop life-threatening anaphylactic reactions. Recommended temporary cancellation ACE inhibitor prior to each desensitization procedures.
Liver failure
During therapy with ACE inhibitors sometimes syndrome may develop, which begins with cholestatic jaundice and then progresses to fulminant hepatic necrosis, sometimes with fatal consequences. The mechanism of this syndrome is unclear. When you are receiving an ACE inhibitor jaundice appears or there is an increase in liver enzymes, an ACE inhibitor should be lifted immediately and the patient should be monitored carefully. It is also necessary to conduct a survey.
Neutropenia, agranulocytosis, thrombocytopenia, and anemia
in patients on background therapy of ACE inhibitors cases of neutropenia / agranulocytosis, thrombocytopenia and anemia have been observed. With normal kidney function in the absence of other complications of neutropenia is rare. Preparation Perineva В®necessary to apply a very great caution in patients with systemic connective tissue diseases (e.g., lupus, scleroderma), simultaneously receiving immunosuppressive therapy, allopurinol or procainamide, and by combining all these factors, especially if the existing impaired renal function. These patients may develop severe infections that can not be intensive antibiotic therapy. In conducting therapy with Perineva В® in patients with the above factors, it is recommended to periodically monitor the white blood cell count, and warn the patient of the need to inform the doctor about any symptoms of infection.
In patients with a congenital deficiency of glucose-6-phosphate dehydrogenase observed isolated cases of hemolytic anemia.
Negroid
risk of angioedema in patients blacks is higher. Like other ACE inhibitors, perindopril less effective in reducing blood pressure in patients blacks possibly because of greater prevalence of low-renin states in a given population group of patients with arterial hypertension.
Cough
Against the background of ACE inhibitor therapy may develop a persistent, non-productive cough, which ceases after discontinuation of the drug. This should be considered in the differential diagnosis of cough.
Surgery / general anesthesia
Patients whose condition requires major surgery or anesthesia drugs that cause hypotension, ACE inhibitors, including perindopril, can block the formation of angiotensin II during compensatory renin release. One day before the surgery, therapy with ACE inhibitors should be abolished. If an ACE inhibitor can not be undone, then hypotension, developing according to the described mechanism can be adjusted to increase BCC.
hyperkalemia
The therapy of ACE inhibitors including perindopril, potassium ion concentration in blood may rise in some patients. Increased risk of hyperkalemia in patients with kidney and / or heart failure, decompensated diabetes and patients using potassium-sparing diuretics, potassium supplements or other drugs that cause hyperkalemia (e.g., heparin). If necessary, the simultaneous administration of said drugs, to regularly monitor the content of potassium in serum.
Diabetes mellitus
Patients with diabetes mellitus receiving hypoglycemic agents for oral or insulin, in the first few months of therapy with ACE inhibitors should be carefully monitored blood glucose concentrations.
Lithium
We do not recommend joint reception drugs lithium and perindopril.
Potassium-sparing diuretics, preparations containing potassium kalisodergaszczye products and food additives
is not recommended to be used in conjunction with ACE inhibitors.
Lactose
tablets Perineva В® contains lactose. Therefore, patients with hereditary galactose intolerance, lapp lactase deficiency syndrome or glucose-galactose malabsorption should not take this drug.
Impact on the ability to drive vehicles and manage mechanisms
It is necessary to consider the possibility of arterial hypotension or dizziness, which may affect the management of road and work with technical means.
OVERDOSE
Symptoms: marked reduction of blood pressure, shock, disorders of water and electrolyte balance (hyperkalemia, hyponatremia), renal failure, hyperventilation, tachycardia, palpitations, bradycardia, dizziness, anxiety, and cough.
Treatment:In marked decrease in blood pressure - to give the patient a horizontal position with legs elevated and arrange for the replenishing of bcc as possible - in / administration of angiotensin II and / or I / administration of catecholamines. If severe bradycardia refractory to drug therapy (including atropine) shows the installation of an artificial pacemaker (pacemaker). It is necessary to monitor vital signs and creatinine and electrolytes in the blood serum. Perindopril may be removed from the systemic circulation by hemodialysis. Avoid using vysokoprotochnyh polyacrylonitrile membranes.
DRUG INTERACTION
Diuretics
in patients receiving diuretics, especially when an excess of fluid excretion and / or sodium, early treatment with ACE inhibitors may develop excessive hypotension. The risk of excessive hypotension can be reduced by eliminating a diuretic, intravenous administration of 0.9% sodium chloride solution, and assigning an ACE inhibitor at lower doses. A further increase in the dose of perindopril should be administered with caution.
Potassium-sparing diuretics, preparations containing potassium kalisodergaszczye products and dietary supplements
Usually, the therapy with ACE inhibitors, the concentration of potassium in the blood serum is in the normal range, but some patients may develop hyperkalemia. The combined use of ACE inhibitors and potassium sparing diuretics (e.g., spironolactone, triamterene or amiloride), potassium or potassium-containing drugs and food additives can cause hyperkalemia. Therefore it is not recommended to be combined with perindopril with these drugs. Assign these combinations should only be in the event of hypokalaemia, observing precautions and regularly monitoring the concentration of potassium ions in the blood serum.
Lithium
With simultaneous use of drugs lithium and ACE inhibitors may develop reversible increase lithium concentrations in serum and lithium toxicity. With simultaneous use of ACE inhibitors with thiazide diuretics may further increase the concentration of lithium in blood serum and increase the risk of its toxic effects. The simultaneous use of perindopril and lithium is not recommended. If necessary, a combination therapy is carried out under the regular supervision of the concentration of lithium in blood serum.
NSAIDs, including acetylsalicylic acid at doses of 3 g / day and higher
NSAID therapy can attenuate the antihypertensive effect of the ACE inhibitors. In addition, NSAIDs and ACE inhibitors have an additive effect on the increase in the concentration of potassium ions in serum that can cause deterioration of kidney function. This effect is usually reversible. In rare cases, may develop acute renal failure, especially in patients with pre-existing renal impairment, eg, in the elderly or in the background of dehydration.
Other antihypertensive agents and vasodilators
With simultaneous use of perindopril with other antihypertensive agents may enhance the antihypertensive effect of perindopril. Simultaneous use of nitroglycerin, other nitrates or vasodilators may result in additional hypotensive effect.
Hypoglycemics
simultaneous use of ACE inhibitors and hypoglycemic agents (insulin or hypoglycemic agents for oral administration) can enhance the hypoglycemic effect until the development of hypoglycemia. As a rule, this phenomenon occurs in the first weeks of combination therapy in patients with renal insufficiency.
Acetylsalicylic acid, thrombolytic agents, beta-blockers and nitrates
Perindopril may be combined with acetylsalicylic acid (as an antiplatelet agent), thrombolytic agents and beta-blockers and / or nitrates.
Tricyclic antidepressant / antipsychotic agents (neuroleptics) / tools for general anesthesia (general anesthetics)
The combined use of ACE inhibitors may lead to increased hypotensive effect.
Sympathomimetics
Sympathomimetics may reduce antihypertensive effect of ACE inhibitors. When assigning such a combination should regularly evaluate the effectiveness of ACE inhibitors.
TERMS OF RELEASE FROM PHARMACY
The drug is released by prescription.
TERMS AND CONDITIONS OF STORAGE
The drug should be stored out of reach of children at a temperature of no higher than 30 В° C. Shelf life - 3 years. Do not use the drug after the expiration date.
