Ko-Perinev pills 1.25 mg + 4 mg 90 pcs
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Active ingredients
Indapamide + Perindopril
Release form
Pills
Composition
Active ingredient: Perindopril erbumin, Indapamide (Indapamide) Active ingredient concentration (mg): 5.25
Pharmacological effect
Vasodilator, diuretic, hypotensive.
Pharmacokinetics
Combined use of perindopril and indapamide does not change their pharmacokinetic parameters compared with the separate intake of these drugs. Perindopril after oral administration is rapidly absorbed from the gastrointestinal tract. Bioavailability is 65–70%. Eating reduces the conversion of perindopril to perindoprilat. T1 / 2 perindopril from blood plasma is 1 h. Cmax in the blood plasma is reached 3-4 hours after ingestion. Since food intake reduces the conversion of perindopril to perindopril and the bioavailability of the drug, perindopril should be taken 1 time per day in the morning before breakfast. Taking perindopril once a day, the equilibrium concentration is reached within 4 days. In the liver it is metabolized to form the active metabolite, perindoprilat. In addition to the active metabolite of perindoprilat, perindopril forms 5 more inactive metabolites. Plasma protein binding of perindoprilat is dose-dependent and is 20%. Perindoprilat easily passes through histohematogenous barriers, excluding BBB, a small amount penetrates through the placenta and into breast milk. Excreted by the kidneys, T1 / 2 perindoprilat is about 17 h. It does not accumulate. In elderly patients, in patients with renal and heart failure, excretion of perindoprilat is slow. Dialysis Cl of perindoprilat is 70 ml / min. The kinetics of perindopril is changed in patients with cirrhosis of the liver: the hepatic clearance is reduced by half. However, the amount of perindoprilat formed does not decrease, which does not require dose adjustment. Indapamide. Quickly and almost completely absorbed in the digestive tract. Food intake slows down the absorption somewhat, but does not significantly affect the amount of indapamide absorbed. Cmax in plasma is achieved 1 h after ingestion of a single dose.Associated with plasma proteins by 79%. T1 / 2 is from 14 to 24 hours (on average - 18 hours). Does not accumulate. Metabolized in the liver. Excreted by the kidneys (70%) mainly in the form of metabolites (the fraction of unchanged drug is about 5%) and the intestine with bile in the form of inactive metabolites (22%). In patients with renal failure, the pharmacokinetic parameters of indapamide do not change significantly.
Indications
Disease of the musculoskeletal system (rheumatoid arthritis, ankylosis spondyloarthritis, osteoarthritis, osteochondrosis with radicular syndrome, radiculitis, lumbago, sciatica) rheumatic diseases of soft tissues (tenosynovitis, bursitis, periarticular tissue damage); post-traumatic inflammation of soft tissues and joints, for example, due to sprains, overstresses and bruises; backache, lower back pain.
Contraindications
A history of angioedema edema (hereditary, idiopathic or angioedema due to the use of ACE inhibitors); severe renal failure (CC less than 30 ml / min); azotemia; anuria; bilateral renal artery stenosis, single kidney artery stenosis, chronic heart failure in the decompensation stage ; refractory hyperkalemia; hereditary galactosemia, lactase deficiency, glucose-galactose malabsorption; age up to 18 years (efficacy and safety not established); severe hepatic not sufficiency (including with encephalopathy); pregnancy; lactation period; hypersensitivity to components of Co-Perineva.
Use during pregnancy and lactation
Lithium preparations. The simultaneous use of the drug Ko-Perinev with lithium preparations is not recommended. Renal impairment. Ko-Perinev therapy is contraindicated in patients with severe renal insufficiency (Cl creatinine less than 30 ml / min). Some patients with arterial hypertension without a preceding renal dysfunction during therapy with Co-Perineva may experience signs of acute renal failure. In this case, treatment with Ko-Perinev should be discontinued. In the future, you can resume combination therapy using low doses of Ko-Perinev, or use perindopril and indapamide in monotherapy.Such patients require regular monitoring of serum potassium and creatinine every 2 weeks after initiation of therapy and every subsequent 2 months of therapy with Ko-Perinev. Acute renal failure often develops in patients with severe CHF or an initial renal failure, including . with bilateral stenosis of the renal arteries or stenosis of the artery of the only functioning kidney. Admission of the drug Ko-Perinev is not recommended for patients with bilateral renal artery stenosis or arterial stenosis of the only functioning kidney. Reduction of blood pressure and impaired water and electrolyte balance. Hyponatremia is associated with the risk of a sudden decrease in blood pressure (especially in patients with bilateral renal artery stenosis or arterial stenosis of the only functioning kidney). Therefore, in the dynamic monitoring of patients should pay attention to possible symptoms of dehydration and a decrease in the content of electrolytes in the blood plasma, for example, after prolonged diarrhea or vomiting. Such patients require regular monitoring of electrolytes in the blood plasma. With a marked decrease in blood pressure, it may be necessary to / in the introduction of a 0.9% solution of sodium chloride. Transient hypotension is not a contraindication for further continuation of therapy. After restoring the BCC and blood pressure, you can resume therapy with Ko-Perinev, using low doses of the drug or using perindopril and indapamide in monotherapy. Potassium content. The combined use of perindopril and indapamide does not prevent the development of hypokalemia, especially in patients with diabetes mellitus or renal failure. As in the case of the combined use of antihypertensive drugs and diuretic, regular monitoring of the potassium content in the blood plasma is necessary. Auxiliary substances. It should be borne in mind that lactose monohydrate is included in the excipients of Ko-Perinev, therefore the drug is contraindicated in patients with hereditary galactosemia, lactase deficiency, glucose-galactose malabsorption (see section "Contraindications") Perindopril Neutropenia / agranulocytosis. Patients taking ACE inhibitors may develop neutropenia / agranulocytosis, thrombocytopenia, and anemia.In patients with normal kidney function in the absence of other complications, neutropenia rarely develops and disappears independently after discontinuation of ACE inhibitors. Perindopril should be used with great caution in patients with connective tissue diseases and at the same time receiving immunosuppressive therapy, allopurinol or procainamide, especially in existing disorders of renal function. Such patients may develop severe infections that are not susceptible to intensive antibiotic therapy. In the case of perindopril, it is recommended to periodically monitor the number of leukocytes in the blood. The patient should be warned that in the event of any signs of an infectious disease (sore throat, fever), you should immediately consult a doctor. Increased sensitivity / angioedema (angioedema). When taking ACE inhibitors, incl. perindopril, in rare cases, angioedema of the face, lips, tongue, uvula of the upper palate and / or larynx may develop. If these symptoms appear, the drug should be immediately discontinued, the patient should be observed until the signs of edema disappear completely. If angioedema affects only the face and lips, then its manifestations usually disappear, or antihistamines can be used to treat its symptoms. . Angioedema, accompanied by swelling of the tongue or larynx, can lead to airway obstruction and death. If these symptoms appear, you should immediately enter the epinephrine (adrenaline) (at a dilution of 1: 1000 (0.3 or 0.5 ml) and / or provide airway patency. Patients with a history of Quincke edema not associated with taking ACE inhibitors may have an increased risk of developing it when taking drugs of this group. In rare cases, ACE inhibitors develop during therapy with ACE inhibitors. intestinal edema.At the same time, patients have abdominal pain as an isolated symptom or in combination with nausea and vomiting, in some cases without prior angioedema of the face and at a normal level of C1-esterase. The diagnosis is established using computed tomography of the abdominal cavity, ultrasound or moment of surgery.The symptoms disappear after discontinuation of the use of ACE inhibitors.In patients with abdominal pain, receiving ACE inhibitors, when conducting a differential diagnosis, it is necessary to take into account the possibility of developing angioedema of the intestine. Anaphylactoid reactions during desensitization procedures. There are separate reports on the development of long-term, life-threatening anaphylactoid reactions in patients receiving ACE inhibitors during desensitizing therapy with hymenoptera venom (bees, wasps). The use of an ACE inhibitor in patients receiving immunotherapy with hymenoptera poison should be avoided. The development of anaphylactoid reactions can be avoided by temporarily canceling the ACE inhibitor no less than 24 hours before the start of the desensitization procedure. Anaphylactoid reactions during LDL apheresis. In rare cases, patients receiving ACE inhibitors may experience life-threatening anaphylactoid reactions when performing an apheresis of LDL using dextran sulfate. To prevent an anaphylactoid reaction, discontinue therapy with an ACE inhibitor before each LDL apheresis procedure using high-flow membranes. Hemodialysis. Anaphylactoid reactions have been noted in patients receiving ACE inhibitors when performing hemodialysis using high-flow membranes (for example, AN69). Therefore, it is desirable to use a different type of membrane or use a hypotensive drug of another pharmacotherapeutic group (see section “With caution”). Potassium-sparing diuretics and potassium preparations. The combined use of perindopril and potassium-saving diuretics, as well as preparations of potassium and potassium-containing substitutes for table salt is not recommended. Cough. During therapy with an ACE inhibitor, a dry cough may occur, which disappears after discontinuation of drugs of this group. With the appearance of dry cough, you should remember about the possible connection of this symptom with taking an ACE inhibitor. If the doctor believes that the therapy with an ACE inhibitor is necessary for the patient, the use of Ko-Perinev can be continued. Children and adolescents under 18 years of age. Ko-Perinev is contraindicated in children and adolescents younger than 18 years of age due to the lack of data on efficacy and safety of use. The risk of arterial hypotension and / or renal failure (in patients with CHF, impaired water and electrolyte balance, etc.).With cirrhosis of the liver, accompanied by edema and ascites, arterial hypotension, CHF, a significant activation of the renin-angiotensin-aldosterone system (RAAS) can be observed, especially with severe hypovolemia and a decrease in plasma electrolytes (on the background of a salt-free diet or long-term diuretic administration). an ACE inhibitor causes a blockage of the RAAS, therefore, a sharp decrease in blood pressure and / or an increase in plasma creatinine levels is possible, indicating the development of acute renal failure, which It is more observed when taking the first dose of Ko-Perinev or during the first 2 weeks of therapy. Elderly patients. Before you start taking the drug Ko-Perinev should assess the renal function and the content of potassium in the blood plasma. The initial dose of the drug Ko-Perinev is selected depending on the degree of reduction in blood pressure, especially with a decrease in BCC and CHF (IV functional class according to the NYHA classification). Such measures help to avoid a sharp decrease in blood pressure. Atherosclerosis. The risk of arterial hypotension exists in all patients, however, special care should be taken when using the drug Co-Perineva in patients with coronary heart disease and cerebrovascular insufficiency. In such patients, treatment should begin with a dose of 0.625 / 2 mg of the drug Ko-Perinev (initial dose). Patients with renovascular hypertension. Treatment of Ko-Perinev with patients with diagnosed or suspected renal artery stenosis should be started in a hospital setting with a dose of Ko-Perinev 0.625 / 2 mg, controlling kidney function and plasma potassium. Some patients may develop acute renal failure, which is reversible after discontinuation of the drug. Other risk groups. In patients with CHF (class IVHA functional class IV) and patients with type 1 diabetes mellitus (risk of spontaneous increase in potassium), treatment should be started with an initial dose of 0.625 / 2 mg of Co-Perineva and under medical supervision. Patients with diabetes mellitus. When administering Ko-Perinev to patients with diabetes mellitus receiving hypoglycemic oral or insulin, the concentration of glucose in the blood must be regularly monitored during the first month of therapy. Ethnic features. Perindopril (as well as other ACE inhibitors), has a less pronounced hypotensive effect in patients of the Negroid race compared with other races. Surgical interventions / General anesthesia.The use of ACE inhibitors in patients undergoing surgery using general anesthesia can lead to a pronounced decrease in blood pressure, especially when using agents for general anesthesia that have a hypotensive effect. It is recommended to stop taking ACE inhibitors, including perindopril, 12 hours before surgery, warning the anesthesiologist about the use of ACE inhibitors. Aortic stenosis / Mitral stenosis / Hypertrophic obstructive cardiomyopathy. ACE inhibitors should be used with caution in patients with obstruction of the left ventricular outflow tract and with aortic and / or mitral stenosis. Hepatic insufficiency. In rare cases, in patients receiving ACE inhibitors, cholestatic jaundice occurs, with the progression of which fulminant necrosis of the liver develops, sometimes with a fatal outcome. With the appearance of jaundice or a significant increase in the activity of hepatic transaminases in patients receiving ACE inhibitors, the use of the drug Co-Perineva should be discontinued. Anemia. May develop in patients after kidney transplantation or in patients on hemodialysis. Hyperkalemia. May develop during treatment with ACE inhibitors, incl. and perindopril. Risk factors for hyperkalemia are renal failure, advanced age, diabetes mellitus, some concomitant conditions (reduced BCC, acute heart failure in the decompensation stage, metabolic acidosis), simultaneous use of potassium-sparing diuretics (such as spironolactone, eplerenone, triamterene, amyloride), and also drugs potassium or potassium-containing substitutes for edible salt and the use of other drugs that increase the content of potassium in the blood plasma (for example, heparin). Hyperkalemia can lead to serious heart rhythm disturbances, sometimes fatal. The combined use of the above preparations should be carried out with caution. Indapamide photosensitivity. There are reports of cases of increased photosensitivity in patients receiving thiazide and thiazide-like diuretics. With the development of photosensitivity reaction in the background of taking the drug Ko-Perinevalechenie must be stopped.If there is a need to resume the use of the drug Ko-Perinev, you should protect exposed skin from direct exposure to solar and artificial UV rays. An electrolyte balance. Sodium content in blood plasma. Prior to the start of treatment with Ko-Perinev, it is necessary to determine the sodium content in the blood plasma and, while taking the drug, conduct regular monitoring of electrolytes in the blood plasma. All diuretics can cause hyponatremia, leading to serious complications. The content of potassium in the blood plasma. Therapy with thiazide and thiazide-like diuretics is associated with the risk of hypokalemia (less than 3.4 mmol / l) in the following patients: elderly, exhausted patients, patients with cirrhosis of the liver, patients with peripheral edema, ascites, coronary heart disease, CHF. Hypokalemia in these patients increases the toxic effect of cardiac glycosides and increases the risk of arrhythmia. Patients with an increased QT interval on an ECG are considered to be at increased risk. Hypokalemia, like bradycardia, contributes to the development of severe cardiac arrhythmias, especially pirouette-type arrhythmias, which can be fatal. In all the cases described, regular monitoring of potassium in the blood plasma is necessary. The first determination of the potassium content in the blood plasma must be carried out within the first week of the start of therapy with the drug Ko-Perinev. The calcium content in the blood plasma. Thiazide and thiazide-like diuretics reduce the excretion of calcium by the kidneys, leading to a slight and temporary increase in plasma calcium levels. Severe hypercalcemia may be due to latent hyperparathyroidism. Before studying the function of the parathyroid glands, you should stop taking the drug Ko-Perinev. The concentration of glucose in the blood plasma. The concentration of glucose in patients with diabetes mellitus should be monitored. Uric acid. In patients with an increased concentration of uric acid in the blood plasma during therapy with Co-Perineva, the frequency of exacerbation of gout may increase. Diuretics and kidney function. Hypovolemia as a result of a decrease in bcc or hyponatremia caused by taking diuretics, at the beginning of treatment with Ko-Perinev, can lead to a decrease in glomerular filtration rate and be accompanied by an increase in the concentration of creatinine and urea in the blood plasma.Indapamide can give a false positive reaction during doping control. Effects on the ability to drive a car or perform work that requires an increased rate of physical and mental reactions. Care must be taken when driving vehicles and working with technical devices that require increased attention and speed of psychomotor reactions.
Dosage and administration
Assign inside 1 time / day, preferably in the morning before breakfast, drinking plenty of fluids. Doses are given for the ratio of perindopril / indapamide. The initial dose of the drug Ko-Perinev - 2 mg / 625 mg (1 tab.) 1 time / day. If after 1 month of taking 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 tab.) 1 time / day. For elderly patients, the initial dose of Ko-Perinev is 2 mg / 625 mg (1 tab.) 1 time / day. Patients with renal insufficiency (CC 60 ml / min or more) do not require dose adjustment. For patients with CC 30-60 ml / min, the maximum dose of Ko-Perinev is 2 mg / 625 mg (1 tab.) 1 time / day. When QA is less than 30 ml / min, the drug Ko-Perinev is contraindicated. Patients with moderate hepatic impairment do not require dose adjustment.
Side effects
Simultaneous use is not recommended. Lithium preparations. With the simultaneous use of lithium preparations and ACE inhibitors, there have been cases of a reversible increase in serum lithium concentration. Simultaneous administration of thiazide diuretics may increase the plasma concentration of lithium and the risk of its toxic effect in the presence of an ACE inhibitor. Simultaneous use of Co-Perineva with lithium is not recommended. If necessary, the simultaneous use should be carefully monitored serum concentrations of lithium. Simultaneous use requiring special cautionBaclofen - potentiation of the hypotensive effect. It is necessary to control blood pressure, kidney function and, if necessary, dose adjustment of antihypertensive drugs. NSAIDs, incl. high doses of acetylsalicylic acid (more than 3 g / day). The simultaneous use of ACE inhibitors with NSAIDs (including acetylsalicylic acid in doses that have anti-inflammatory effects,COX-2 inhibitors and non-selective NSAIDs) reduces the hypotensive effect of ACE inhibitors, increases the risk of developing renal dysfunction, up to the development of acute renal failure, increases serum potassium, especially in patients with already existing renal dysfunction. caution, especially in elderly patients. Before treatment, patients need to compensate for fluid loss, as well as regularly monitor kidney function, both at the beginning of therapy and during treatment. Simultaneous use requiring cautionTricyclic antidepressants, antipsychotics (neuroleptics). Enhance the hypotensive effect and increase the risk of orthostatic hypotension (additive effect). GCS, tetracosactide. Reduction of the hypotensive effect (fluid and sodium ion retention as a result of GCS). Other antihypertensive drugs: the hypotensive effect of Co-Perineva may be enhanced. Perindopril Simultaneous use is not recommended. potassium by the kidneys caused by diuretic. When combined with their use of ACE inhibitors, it is possible to increase the content of potassium in the blood serum up to a lethal outcome. If simultaneous use of an ACE inhibitor and the above drugs (in the case of confirmed hypokalemia) is necessary, caution should be exercised and regular monitoring of potassium in the blood plasma and ECG parameters should be made. Simultaneous use requiring special caution ACE inhibitors (described for captopril and enalapril) in very rare cases may enhance the hypoglycemic effect of sulfonylureas and insulin in diabetic patients; with their simultaneous use may increase glucose tolerance and reduce the need for insulin, which may require correction doses of hypoglycemic agents for oral administration and insulin. Simultaneous use requiring caution Allopurinol, cytostatic immunosuppressants,GCS (with systemic use) and procainamide: the simultaneous use of these drugs with ACE inhibitors may increase the risk of developing leukopenia. Means for general anesthesia: ACE inhibitors can enhance the hypotensive effect of some agents for general anesthesia. Diuretics (thiazide and loop): the use of diuretics in high doses can lead to hypovolemia (due to a decrease in the BCC), and the addition to perindopril to therapy can lead to a pronounced decrease in blood pressure. Indapamide Simultaneous use requiring special caution. capable of causing ventricular polymorphic tachycardia such as "pirouette": there is a risk of hypokalemia, indapamide should be used with caution simultaneously with drugs that can cause ventricular tachycardia of the "pirouette" type, such as: antiarrhythmic drugs (quinidine, hydroquinidine, disopyramide, amiodarone, dofetilide, ibutilide, bretily tosilate, sotalol); some neuroleptics (chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoperazine), benzamides (amisulpride, sulpiride, sultopride, tiaprid), butyrophenones (droperidol, haloperidol), and other neuroleptics (pimoside), other drugs such as bepridil, cisapride, diphemanyl methyl sulfate, erythromycin for i / w, halofantrine, mizolastine, moxifloxacin, pentamidine, sparfloxacin, vincamine for i / o, methadone, astemizole, terfenadine. It is necessary to avoid simultaneous use with the above preparations. It is necessary to control the content of potassium in the blood serum in order to avoid hypokalemia, during the development of which it is necessary to carry out its correction, to monitor the QT interval on the ECG. Drugs that can cause hypokalemia: amphotericin B in a / in the introduction, gluco-and mineralocorticoid (for systemic use), laxatives that stimulate intestinal motility (laxatives should be used that do not stimulate intestinal motility), tetracosactide - an increased risk of hypokalemia (additive effect). It is necessary to control the content of potassium in the blood plasma, if necessary, its correction. Particular attention should be paid to patients simultaneously receiving cardiac glycosides. Cardiac glycosides: hypokalemia enhances the toxic effect of cardiac glycosides.With simultaneous use of indapamide and cardiac glycosides should be monitored potassium in the blood plasma, ECG indicators and, if necessary, adjust the dose of cardiac glycosides. Simultaneous use requiring cautionMetformin: functional renal failure while taking diuretics, especially loopback, while using metformin increases risk of developing lactic acidosis. Metformin should not be used if the concentration of creatinine in the blood plasma exceeds 15 mg / l (135 μmol / l) in men and 12 mg / l (110 μmol / l) in women. Iodine-containing contrast media: in patients with hypovolemia on the background use of diuretics there is an increased risk of developing acute renal failure, especially when using contrast agents containing high doses of iodine. Before using iodine-containing contrast agents, you should replenish the BCC. Preparations containing calcium salts: with simultaneous use, hypercalcemia may develop due to a decrease in calcium excretion by the kidneys. Cyclosporine: an increase in plasma creatinine may occur without changing the concentration of cyclosporine in the blood plasma, even in the absence of pronounced loss of ions sodium and dehydration.
Overdose
Classification of the incidence of side effects: very often -> 1/10; often from> 1/100 to 1/1000 to 1 / 10,000 to. From the side of the hematopoietic system and the lymphatic system: very rarely - hemorrhagic vasculitis, hemolytic anemia; with long-term use in high doses - thrombocytopenia, leukopenia / neutropenia, agranulocytosis, aplastic anemia, which was recorded while taking ACE inhibitors (patients on hemodialysis or peritoneal dialysis). From the central and peripheral nervous system: often - paresthesia, headache dizziness, vertigo, asthenia; infrequently - mood lability, sleep disturbances, increased sweating; very rarely - confusion of consciousness. From the sense organs: often - visual disturbances, tinnitus. From the side of the cardiovascular system: often - pronounced decrease in blood pressure, orthostatic hypotension; very rarely - arrhythmias, incl. and bradycardia, ventricular tachycardia, atrial flutter, angina pectoris, myocardial infarction or stroke,possibly secondary, due to severe arterial hypotension in patients at high risk. From the respiratory system: often - dry, irritating, persistent nature of coughing, which passes after discontinuation of the drug, shortness of breath; infrequently - bronchospasm; very rarely - eosinophilic pneumonia, rhinitis. From the digestive system: often - constipation, dryness of the oral mucosa, loss of appetite, nausea, epigastric pain, abdominal pain, change in taste, vomiting, dyspepsia, diarrhea; very rarely - pancreatitis, jaundice (cytolytic or cholestatic); frequency not established: in the case of liver failure, there is a likelihood of developing hepatic encephalopathy; intestinal edema. From the skin and subcutaneous fat: often - pruritus, maculopapular rash; infrequently - angioedema of the face, oral mucosa, tongue, uvula and / or larynx, urticaria; reactions of individual hypersensitivity, mainly dermatological, in patients with burdened allergological anamnesis; purpura; possible exacerbation of the course of SLE; very rarely - erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome; isolated cases of photosensitivity reaction. From the musculoskeletal system: often - muscle cramps. From the urinary system: infrequently - renal failure; very rarely - acute renal failure. From the reproductive system and the mammary glands: infrequently - impotence. Laboratory parameters: hypokalemia; hyponatremia with hypovolemia leading to reduced BCC and orthostatic hypotension; increasing the concentration of uric acid and glucose in the serum; a slight increase in plasma creatinine and urea concentrations, reversible after cessation of therapy, which often develops on the background of renal artery stenosis or arterial stenosis of a single kidney, on the background of arterial hypertension therapy with diuretics, in renal failure; a transient increase in sodium in the blood plasma; hypochloraemia; proteinuria; rarely - hypercalcemia.
Interaction with other drugs
Precautionary measures
special instructions
Symptoms: pronounced decrease in blood pressure, nausea, vomiting, muscle cramps, dizziness, drowsiness, confusion, oliguria up to anuria (due to a decrease in BCC); possible violations of water and electrolyte balance (low sodium and potassium in the blood plasma). Treatment: washing the stomach and / or the appointment of activated carbon, restoration of water and electrolyte balance in the hospital. With a pronounced decrease in blood pressure, it is necessary to transfer the patient to a supine position with their legs elevated; then it is necessary to carry out measures aimed at increasing the bcc (introduction of a 0.9% solution of sodium chloride in / in). Perindoprilat, the active metabolite of perindopril, can be eliminated from the body through dialysis.