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Active ingredients
Perindopril
Release form
Pills
Composition
Perindopril erbumin, semi-finished granules 76.78 mg, which corresponds to the content of perindopril erbumine 4 mg, ancillary substances of the semi-finished product: granules: calcium chloride hexahydrate, lactose monohydrate, crosspovidon. Adjuvants: microcrystalline cellulose, silicon dioxide, microcrystalline cellulose, silicon dioxide, crosspovidon.
Indications
- arterial hypertension; - chronic heart failure; - prevention of recurrent stroke (as part of combination therapy with indapamide) in patients with a history of cerebrovascular diseases (stroke or transient cerebral ischemic attack); - stable ischemic heart disease: reducing the risk of cardiovascular complications in patients previously undergoing myocardial infarction and / or coronary revascularization.
Contraindications
- angioedema edema in history (hereditary, idiopathic or angioedema edema due to the use of ACE inhibitors); - age up to 18 years (efficacy and safety not established); perindopril or other components of the drug; - hypersensitivity to other ACE inhibitors. With caution should be used for renovascular hypertension in patients with bilateral stenosis m renal artery stenosis of the artery only kidney - risk of severe hypotension and renal failure; in chronic heart failure in the stage of decompensation, arterial hypotension, in chronic renal failure (CC less than 60 ml / min), with significant hypovolemia and hyponatremia (salt-free diet and / or prior diuretic therapy, dialysis, vomiting, diarrhea), cerebrovascular diseases (in including insufficiency of cerebral circulation, coronary artery disease, coronary insufficiency) - the risk of excessive blood pressure reduction; with aortic or mitral valve stenosis, hypertrophic obstructive cardiomyopathy, hemodialysis using high-flow polyacrylonitrile membranes - the risk of anaphylactoid reactions; in patients after kidney transplantation - there is no experience of clinical use; before the procedureapheresis of LDL, simultaneously with the conduct of desensitizing therapy with allergens (for example, hymenoptera), the risk of anaphylactoid reactions; in diseases of the connective tissue (including SLE, scleroderma), inhibition of bone marrow hematopoiesis in patients receiving immunosuppressants, allopurinol or procainamide - the risk of agranulocytosis and neutropenia; with congenital deficiency of glucose-6-phosphate dehydrogenase - isolated cases of hemolytic anemia; representatives of the Negroid race - the risk of anaphylactoid reactions; with surgical intervention (the need for general anesthesia) - the risk of an excessive reduction in blood pressure; in diabetes mellitus (control of blood glucose concentration is necessary); with hyperkalemia; 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 administered orally 1 time / day, before meals, preferably in the morning. The dose is selected individually for each patient, depending on the severity of the disease and the individual response to treatment. Arterial hypertension The Perineva drug can be used as monotherapy or in combination with other antihypertensive drugs. The recommended initial dose is 4 mg / day in the morning. For patients with pronounced activation RAAS (for example, in case of renovascular hypertension, hypovolemia and / or hyponatremia, chronic heart failure in the stage of decompensation or severe arterial hypertension pertensia) the recommended initial dose is 2 mg / day in a single dose.With the ineffectiveness of therapy during the month, the dose can be increased to 8 mg 1 time / day with good tolerability of the previous dose. The addition of ACE inhibitors to patients taking diuretics may cause arterial hypotension. In this regard, it is recommended to carry out therapy with caution, stop taking diuretics 2-3 days before starting treatment with Perineva or start treatment with Perineva with an initial dose of 2 mg / day in one dose. The control of blood pressure, kidney function and the concentration of potassium ions in the serum. In the future, the dose of the drug may be increased depending on the dynamics of blood pressure levels. 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, up to a maximum of 8 mg / day, provided that the lower 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 may 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-blockers and / or digoxin. In patients with chronic heart failure, with renal failure and with a tendency to electrolyte disturbances (hyponatremia), as well as in patients taking diuretics and / or vasodilators, drug treatment is started under strict medical supervision. In patients with a high risk of developing clinically severe arterial hypotension If possible, prior to taking the drug Perineva, it is necessary to eliminate hypovolemia and electrolyte disturbances. Before starting therapy and during it, it is recommended to carefully monitor the level of blood pressure, the state of kidney function and the concentration of potassium ions in serum. Prevention of recurrent stroke in patients with cerebrovascular diseases in history The therapy with Perineva should be started with 2 mg during the first 2 weeks before taking indapamide.Treatment should begin at any time (from 2 weeks to several years) after a stroke. Stable IBSU patients with stable ischemic heart disease The recommended initial dose of Perineva is 4 mg / day. After 2 weeks, the dose is increased to 8 mg / day, provided that the dose of 4 mg / day is well tolerated and the kidney function is monitored. Treatment of elderly patients should be started with a dose of 2 mg, which can be increased to 4 mg / day in a week. In the future, if necessary, a week later, the dose can be increased to 8 mg / day with the obligatory preliminary control of renal function. In elderly patients, the dose of the drug can be increased only with good tolerability of the previous, lower dose.
Side effects
Determination of the frequency of adverse reactions: very often (more than 1/10), often (more than 1/100, less than 1/10), sometimes (more than 1/1000, less than 1/100), rarely (more than 1/10 000, less than 1/1000), very rarely ( less than 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 disorders; 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; very rarely - arrhythmias, stenocardia, 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, dyspepsia, diarrhea, constipation; sometimes dryness of the oral mucosa; rarely - pancreatitis; very rarely - cytolytic or cholestatic hepatitis. For the urogenital system: sometimes - renal failure, impotence; very rarely - acute renal failure. From the hematopoietic system and lymphatic system: very rarely, with prolonged use in high doses, hemoglobin and hematocrit may decrease, thrombocytopenia, leukopenia / neutropenia, agranulocytosis, pancytopenia; very rarely - hemolytic anemia (in patients with congenital glucose-6-phosphate dehydrogenase deficiency). Laboratory findings: an increase in serum urea and plasma creatinine, hyperkalemia, reversible after discontinuation of the drug (especially in patients with renal failure,severe chronic heart failure and renovascular hypertension); rarely - increased activity of liver enzymes and serum bilirubin; hypoglycemia. From the side of the skin: often - skin rash, itching; sometimes - increased sweating, angioedema of the face, extremities, urticaria; very rarely - erythema multiforme. Others: often - asthenia, muscle cramps.