Ko-Perinev pills 0.625 mg + 2 mg 30 pcs
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Active ingredients
Indapamide + Perindopril
Release form
Pills
Composition
Perindopril erbumine to a semi-finished product of granules 37.515 mg, which corresponds to the content of perindopril erbumine 2 mg indapamide 0.625 mg, ancillary substances of the semi-finished product granules: calcium chloride hexahydrate - 0.6 mg, lactose monohydrate - 30.915 mg, crospovidone - 4 mg. hydrocarbonate - 0.25 mg, colloidal silicon dioxide - 0.135 mg, magnesium stearate - 0.225 mg.
Indications
- essential hypertension.
Contraindications
- angioedema in history (hereditary / idiopathic or angioedema in the background of taking other ACE inhibitors in history); - hypokalemia; - severe renal insufficiency (CC less than 30 ml / min); refractory hyperkalemia; - severe liver failure (including with encephalopathy); - lactose intolerance, lactase deficiency or glucose-galactose malabsorption; - simultaneous use of drugs that extend the QT interval on the ECG; Primary use with antiarrhythmic drugs that can cause ventricular tachycardia such as pirouette; - pregnancy; - breastfeeding period; - age up to 18 years (efficacy and safety have not been established); auxiliary components of the drug. Considering the lack of sufficient clinical experience, the drug Ko-Perinev should not be used in patients on dialysis, and in patients with untreated oh decompensated heart nedostatochnostyu.S care use in patients with systemic connective tissue diseases (including systemic lupus erythematosus, scleroderma); during therapy with immunosuppressants (risk of developing neutropenia, agranulocytosis); in the suppression of bone marrow hematopoiesis; lower bcc (diuretic intake, salt-free diet, vomiting, diarrhea); angina pectoris; cerebrovascular diseases; renovascular hypertension; diabetes; chronic heart failure (NYHA functional class IV); with hyperuricemia (especially accompanied by gout and urate nephrolithiasis); lability of blood pressure; during hemodialysis using high-flow polyacrylonitrile membranes; before the procedure for apheresis of LDL; simultaneously with the conduct of desensitizing therapy with allergens (for example,Hymenoptera venom); in condition after kidney transplantation; stenosis of the aortic and / or mitral valve; hypertrophic obstructive cardiomyopathy; in elderly patients.
Precautionary measures
During treatment, psoriasis may worsen. During pheochromocytoma, propranolol can only be used after taking an alpha blocker. After a long course of treatment, propranolol should be discontinued gradually, under the supervision of a physician. during anesthesia, you must stop taking propranolol or find a remedy for anesthesia with minimal negative inotropic effects. The impact on the ability to drive vehicles and control mechanisms of patients whose activities require increased attention, the question of the use of propranolol on an outpatient basis should be addressed only after evaluating the individual response of the patient.
Dosage and administration
The drug is taken orally 1 time / day, preferably in the morning before breakfast, with a sufficient amount of liquid. If possible, the drug should be started by selecting the doses of perindopril and indapamide separately. In case of clinical necessity, it is possible to prescribe a combination therapy with Ko-Perinev immediately after monotherapy. Doses are given for the perindopril / indapamide ratio. The initial dose of Co-Perineva is 2 mg / 0.625 mg (1 tab.) 1 time / day. If after 1 month of use of 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. If necessary, to achieve a more pronounced hypotensive effect, it is possible to increase to the maximum daily dose of Co -Perineva - 1 tab. (8 mg / 2.5 mg) 1 time / day. For elderly patients, the initial dose of Co-Perineva is 2 mg / 0.625 mg (1 tab.) 1 time / day. It should be prescribed drug treatment after monitoring kidney function and blood pressure. The Ko-Perinev drug is contraindicated in patients with severe renal failure (CC less than 30 ml / min). Patients with moderate renal insufficiency (CC 30-60 ml / min) are recommended to begin therapy with the necessary doses of drugs (in monotherapy), which are part of the preparation Ko-Perinev; the maximum daily dose of the drug Ko-Perinev 4 mg / 1.25 mg. Patients with CC ≥60 ml / min dose adjustment is not required.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 liver failure. In moderately severe hepatic impairment, dose adjustment is not required. The preparation of Co-Perineva should not be used in children and adolescents under the age of 18, as Insufficient performance and safety data.
Side effects
Perindopril has an inhibitory effect on the RAAS and reduces the excretion of potassium ions by the kidneys while taking indapamide. The risk of hypokalemia (serum potassium content less than 3.4 mmol / l) in patients against the background of the use of the drug Ko-Perinev in a daily dose of 2 mg / 0.625 mg is 2%, 4 mg / 1.25 mg - 4% and 8 mg / 2.5 mg - 6%. Classification of the incidence of side effects (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 — cannot be estimated based on the available data. In each group, unwanted effects are presented in order of decreasing severity. System side hematopoiesis: very rarely - thrombocytopenia, leukopenia / neutropenia, agranulocytosis, aplastic anemia, hemolytic anemia (there are messages when using ACE inhibitors). In certain clinical situations (conditions after kidney transplantation or patients on hemodialysis or peritoneal dialysis), ACE inhibitors can cause anemia. From the nervous system: often - paresthesia, headache, dizziness, vertigo; infrequently - mood lability, sleep disturbances; very rarely - confusion; frequency is unknown - fainting. On the part of the sense organs: often - visual disturbances, tinnitus. On the part of the cardiovascular system: often - pronounced decrease in blood pressure, incl. orthostatic hypotension; very rarely - arrhythmias, incl. bradycardia, ventricular tachycardia, atrial fibrillation, as well as angina, myocardial infarction, possibly secondary, due to a decrease in blood pressure in high-risk patients; frequency is unknown - ventricular tachycardia of the pirouette type (possibly fatal). On the respiratory system: often a dry cough that persists for a long time against the use of ACE inhibitors and disappears after their withdrawal,dyspnea; 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, disturbances in taste, vomiting, dyspepsia, diarrhea; very rarely - pancreatitis, angioedema, cholestatic jaundice; the frequency is unknown - in case of liver failure, there is a likelihood of hepatic encephalopathy. On the side of the skin and subcutaneous fat: often - itching, skin rash, maculo-papular rash; possible worsening of systemic lupus erythematosus; very rarely - erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome; in isolated cases - photosensitivity reactions. Allergic reactions: infrequently - angioedema of the face, extremities, lips, mucous membranes of the mouth, tongue, vocal folds and / or larynx, urticaria; in patients with allergic history - mainly dermatological hypersensitivity reactions. From the musculoskeletal system: often - muscle spasms. From the urinary system: rarely - renal failure; very rarely - acute renal failure. From the reproductive system: infrequently - impotence. Others: often - asthenia; infrequently - increased sweating. From laboratory indicators: rarely - hypercalcemia; unknown frequency - an increase in QT on the ECG, an increase in the concentration of uric acid and glucose in the blood serum while taking the drug, an increase in liver enzyme activity, a slight increase in plasma creatinine, reversible after cessation of therapy, which often develops against the background of renal artery stenosis or stenosis arteries of a single kidney, arterial hypertension during diuretic therapy, in renal failure; hypokalemia, especially significant for patients at risk; hypochloremia can lead to a compensatory metabolic alkalosis (the probability and severity of the effect is low); hyperkalemia often reversible; hyponatremia with hypovolemia, leading to a decrease in bcc and orthostatic hypotension. Side effects from clinical studies According to clinical studies, side effects correspond to the previously established safety profile of a combination of perindopril and indapamide.In rare cases, the following serious adverse reactions have developed: hyperkalemia, acute renal failure, arterial hypotension and cough, possibly the development of angioedema.