Perineva perindopril instructions for use. Perineva is an assistant in the fight against high blood pressure. For impaired renal function


Ko-Perineva is an antihypertensive drug of the combined type. It contains two active substances at once: perindopril, which is an ACE inhibitor, and indapamide, a thiazide-like diuretic.

Together they have both diuretic, vasodilating and antihypertensive effects.

The antihypertensive effect is quite long, it lasts about a day. This effect directly depends on the volume of the drug taken.

After a month of use, the drug can achieve a stable decrease in blood pressure without an increase in heart rate. After termination, withdrawal syndrome does not develop.

The drug dilates the veins, reducing the load on the heart (both preload and afterload). The use of this drug is equally effective in arterial hypertension of any severity level - mild, moderate or severe.

The greatest effectiveness of the drug begins after 4-6 hours from the first moment of its administration - and it remains at the proper level during the day.

Instructions for use

The drug is taken orally, once a day. The preferred time of taking is in the morning hours before breakfast. It is necessary to take the tablets with a sufficient amount of water.

To begin with, you need to start with tablets with a minimum content of perindopril and indapamide (2 mg and 0.625 mg, respectively). If blood pressure control cannot be effectively established, you should switch to tablets with twice the amount of active substances.

It is unacceptable to increase the dose to more than one tablet with 8 mg of perindopril and 2.5 mg of indapamide per day. In case of renal insufficiency, the allowable daily dose is halved.

The drug is produced exclusively by prescription - and the current dose of its use must be prescribed by the attending physician.

Release form and composition

The main form of release of this drug are white or close to white tablets, biconvex, round, with a chamfer and an engraving in the form of a short line on one of the sides.

The main substances contained in these tablets are perindopril erbumine in the form of a semi-finished product and indapamide.

A number of excipients are also available:

  • calcium chloride hexahydrate;
  • lactose monohydrate;
  • crospovidone;
  • colloidal dioxide;
  • magnesium stearate;
  • sodium bicarbonate;
  • microcrystalline cellulose.

Tablets are placed in blister packs of 10 pieces, which, in turn, are packed in cardboard boxes. The amount of active substance may vary.

Beneficial features

The drug has a positive effect in the case of essential hypertension - this is its main purpose.

Side effects

There are a number of possible side effects that may occur with the use of this drug.

The likelihood of such effects is small, but still they should be taken into account when taking the drug in order to provide for all possibilities, both positive and negative.

These effects include:

  • muscle spasms;
  • impotence;
  • asthenia;
  • angioedema;
  • rash;
  • hives;
  • bronchospasm;
  • rhinitis;
  • eosinophilic pneumonia;
  • vomit;
  • dyspepsia;
  • diarrhea;
  • jaundice;
  • pancreatitis;
  • visual impairment;
  • noise in ears;
  • dry cough;
  • anemia of aplastic type;
  • vertigo;
  • dizziness;
  • paresthesia;
  • mood problems;
  • sleep problems;
  • confusion;
  • agranulocytosis;
  • thrombocytopenia and more.

Although the likelihood of these deviations is very insignificant, it is important to consider that it is still not worth the risk - at the first symptoms of these deviations, you should consult a doctor to adjust the doses of the drug taken, or consider alternative medicines.

Contraindications

There are a number of characteristic contraindications in which the use of the drug is unacceptable.

These include, among others:

  • individual sensitivity to one of the components of the drug;
  • refractory hyperkalemia;
  • lactose intolerance;
  • angioedema;
  • lactase deficiency;
  • bilateral renal artery stenosis;
  • liver failure;
  • pregnancy or lactation;
  • age up to eighteen years;
  • normal renal artery stenosis;
  • malabsorption of the glucose-galactose type and so on.

In these situations, you can take the drug, but this must be done with extreme caution:

  • diabetes;
  • hyperuricemia;
  • angina;
  • problems with hematopoiesis of the bone marrow;
  • hypertension of the renovascular type;
  • decrease in BCC;
  • cerebrovascular diseases;
  • therapy with immunosuppressants;
  • connective tissue diseases of various types.

Interaction with other drugs

The drug can interact with other drugs, enhancing or weakening them or their own effect.

This effect is also important to consider when several drugs are taken simultaneously.

Here are some examples of interaction:

  • When taken with lithium preparations: the concentration of lithium in the blood plasma may increase, and therefore you should not combine Ko-Perinev with these drugs.
  • With baclofen: the latter has an increased hypotensive effect, as a result of which blood pressure can change significantly;
  • With simultaneous use with acetylsalicylic acid and other NSAIDs: the hypotensive effect of the drug may decrease, but the risk of kidney problems increases, up to the manifestation of acute renal failure. In the presence of existing problems with the kidneys, the one-time use of drugs is strictly contraindicated.
  • When used with neuroleptics: The hypotensive effect is enhanced.
  • When used with potassium-sparing diuretics: the content of potassium in the blood may increase - and this is very dangerous.
  • With insulin: may increase increased glucose tolerance, as well as lowering the need for insulin.
  • With immunosuppressants: the claim of development of a leukopenia increases.
  • When used with drugs for general anesthesia: increased overall hypotensive effect.
  • When used with diuretics: hypovolemia may occur, or blood pressure may decrease.
  • with metformin: functional type renal failure may occur. A similar effect occurs with the use of iodine-containing contrast agents.

And this is only a part of the possible interactions that can occur with the simultaneous use of various drugs. Therefore, be sure to consult with your doctor about what non-standard effects may occur if you use several different drugs at the same time.

Terms and conditions of storage

It is important to store the drug at a temperature that does not exceed 30 degrees Celsius. Keep children away from the drug. Shelf life - up to three years from the date of issue.

tablets

Owner/Registrar

KRKA-RUS, OOO

International Classification of Diseases (ICD-10)

G45 Transient transient cerebral ischemic attacks [attacks] and related syndromes I10 Essential [primary] hypertension I20 Angina pectoris [angina pectoris] I50.0 Congestive heart failure I63 Cerebral infarction I69 Consequences of cerebrovascular diseases

Pharmacological group

ACE inhibitor

Arterial hypertension;

Chronic heart failure;

Prevention of recurrent stroke (as part of complex therapy with indapamide) in patients with a history of cerebrovascular disease (stroke or transient cerebral ischemic attack);

Stable coronary artery disease: reduced risk of cardiovascular complications in patients with previous myocardial infarction and / or coronary revascularization.

Angioedema in history (hereditary, idiopathic or angioedema due to the use of ACE inhibitors);

Age up to 18 years (efficacy and safety not established);

Hereditary galactose intolerance, lapp lactase deficiency or glucose-galactose malabsorption syndrome;

Hypersensitivity to perindopril or other components of the drug;

Hypersensitivity to other ACE inhibitors.

FROM caution should be used for renovascular hypertension, in patients with bilateral renal artery stenosis, stenosis of the artery of a single kidney - the risk of developing severe arterial hypotension and renal failure; with chronic heart failure in the stage of decompensation, arterial hypotension, with 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 (in including cerebrovascular insufficiency, ischemic heart disease, coronary insufficiency) - the risk of developing an excessive decrease in blood pressure; 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 experience of clinical use; before the LDL apheresis procedure, simultaneously with desensitizing therapy with allergens (for example, hymenoptera venom) - the risk of developing anaphylactoid reactions; with connective tissue diseases (including SLE, scleroderma), inhibition of bone marrow hematopoiesis while taking immunosuppressants, allopurinol or procainamide - the risk of developing agranulocytosis and neutropenia; with congenital deficiency of glucose-6-phosphate dehydrogenase - isolated cases of the development 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 an excessive decrease in blood pressure; with diabetes (it is necessary to control the concentration of glucose in the blood); with hyperkalemia; in elderly patients.

Determining the frequency of adverse reactions: very often (> 1/10), often (> 1/100,<1/10), иногда (>1/1000, <1/100), редко (>1/10 000, <1/1000), очень редко (<1/10 000, включая отдельные сообщения).

From the side of the central nervous system and peripheral nervous system: often - headache, dizziness, paresthesia; sometimes - sleep or mood disorders; very rarely - confusion.

From the sense organs: often - visual impairment, tinnitus.

From the side of 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).

From the side 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.

From the genitourinary system: sometimes - renal failure, impotence; very rarely - acute renal failure.

From the hematopoietic and lymphatic systems: very rarely - with prolonged use in high doses, a decrease in 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 serum urea and plasma creatinine, hyperkalemia, reversible after discontinuation of the drug (especially in patients with renal insufficiency, severe chronic heart failure and renovascular hypertension); rarely - increased activity of liver enzymes and bilirubin in the blood serum; hypoglycemia.

From the side of the skin: often - skin rash, itching; sometimes - increased sweating, angioedema of the face, limbs, urticaria; very rarely - erythema multiforme.

Others: often - asthenia, muscle cramps.

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

Perineva ® can be used as monotherapy or in combination with other antihypertensive agents.

For patients with severe activation of the RAAS (for example, with renovascular hypertension, hypovolemia and / or hyponatremia, chronic heart failure in the stage of decompensation or severe arterial hypertension), the recommended initial dose is 2 mg / day in one dose. If therapy is ineffective within a month, the dose may 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 hypotension. In this regard, it is recommended to carry out therapy with caution, stop taking diuretics 2-3 days before the start of treatment with Perineva ® or start treatment with Perineva ® with an initial dose of 2 mg / day in one dose. It is necessary to control 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 the level of blood pressure. If necessary, diuretic therapy can be resumed.

At elderly patients The recommended starting dose is 2 mg/day in one 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 starting 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 symptomatic chronic heart failure is usually combined with non-potassium-sparing diuretics, beta-blockers, and/or digoxin.

In patients with chronic heart failure, with renal insufficiency and with a tendency to electrolyte disturbances (hyponatremia), as well as in patients taking diuretics and / or vasodilators at the same time, treatment with the drug is started under strict medical supervision.

In patients with a high risk of developing clinically pronounced arterial hypotension (for example, when taking high doses of diuretics), if possible, hypovolemia and electrolyte disturbances should be eliminated before starting the drug Perinev ®. It is recommended before and during therapy to carefully monitor the level of blood pressure, the state of kidney function and the concentration of potassium ions in the blood serum.

Prevention of recurrent stroke in patients with a history of cerebrovascular disease

Therapy with Perineva® should begin 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 coronary artery disease

Treatment 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 another week, the dose can be increased to 8 mg / day with mandatory preliminary monitoring of kidney function. In elderly patients, the dose of the drug can be increased only if the previous, lower dose is well tolerated.

At patients with kidney disease the dose of the drug Perineva ® is set depending on the degree of impaired renal function. During treatment, the content of potassium ions and creatinine in the blood serum should be regularly monitored. Recommended doses are presented in the table.

*- Dialysis clearance of perindoprilat is 70 ml/min. Perineva ® must be taken after a dialysis session.

Patients with liver disease dose adjustment is not required.

Active substance

Perindopril

Dosage form

tablets

Manufacturer

Krka, Slovenia

Compound

Active ingredients: perindopril erbumine 8 mg;

Excipients: calcium chloride hexahydrate; lactose monohydrate; crospovidone; MCC; silicon dioxide colloidal; magnesium stearate

pharmachologic effect

Perineva - cardioprotective, vasodilating, hypotensive.

Pharmacodynamics

Perindopril - an ACE inhibitor, or kininase II - refers to oxopeptidases. It converts angiotensin I into the vasoconstrictor angiotensin II and destroys the vasodilator bradykinin to an inactive hexapeptide. Suppression of ACE activity leads to a decrease in the level of angiotensin II, an increase in plasma renin activity (suppressing the negative feedback of renin release), and a decrease in aldosterone secretion. Since ACE also destroys bradykinin, ACE suppression also leads to an increase in the activity of the circulating and tissue kallikrein-kinin system, while the PG system is activated.

Perindopril has a therapeutic effect due to the active metabolite - perindoprilat.

Perindopril reduces both systolic and diastolic blood pressure in the supine and standing positions. Perindopril reduces OPSS, which leads to a decrease in blood pressure. At the same time, peripheral blood flow is accelerated. However, the heart rate does not increase. Renal blood flow usually increases while glomerular filtration rate does not change. The maximum antihypertensive effect is achieved 4-6 hours after a single oral administration of perindopril; the hypotensive effect persists for 24 hours, and after 24 hours the drug still provides from 87 to 100% of the maximum effect. The decrease in blood pressure develops rapidly. Stabilization of the antihypertensive effect is observed after 1 month of therapy and persists for a long time. Termination of therapy is not accompanied by a "withdrawal" syndrome. Perindopril reduces left ventricular myocardial hypertrophy. With long-term administration, it reduces the severity of interstitial fibrosis, normalizes the isoenzyme 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 work of the heart, reducing pre- and afterload.

In patients with CHF during perindopril therapy, the following was noted:

Decrease in filling pressure in the left and right ventricles;

Reducing OPSS;

Increased cardiac output and cardiac index.

Taking the initial dose of perindopril (2 mg) in patients with CHF I-II functional class according to the NYHA classification was not accompanied by a statistically significant decrease in blood pressure compared with placebo.

Pharmacokinetics

After oral administration, perindopril is rapidly absorbed from the gastrointestinal tract and reaches maximum plasma concentrations within 1 hour. Bioavailability is 65-70%, 20% of the total amount of absorbed perindopril is converted to perindoprilat (active metabolite). T1 / 2 from the blood plasma of perindopril is 1 hour. Cmax of perindoprilat in plasma is reached after 3-4 hours.

Taking the drug during a meal is accompanied by a decrease in the conversion of perindopril to perindoprilat, respectively, the bioavailability of the drug decreases. The volume of distribution of unbound perindoprilat is 0.2 l/kg. The binding to plasma proteins is negligible, the binding of perindoprilat to ACE is less than 30% and depends on its concentration.

Perindoprilat is excreted by the kidneys. T1 / 2 of the unbound fraction is about 3-5 hours. It does not accumulate. In elderly patients, in patients with renal and chronic heart failure (CHF), the excretion of perindoprilat is slowed down. Perindoprilat is removed during hemodialysis (speed - 70 ml / min, 1.17 ml / s) and peritoneal dialysis.

In patients with cirrhosis of the liver, the hepatic clearance of perindopril changes, while the total amount of perindoprilat formed does not change 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 a history of cerebrovascular disease (stroke or transient cerebral ischemic attack);
  • stable coronary artery disease: reduced risk of cardiovascular complications in patients with previous myocardial infarction and / or coronary revascularization.

Use during pregnancy and lactation

During pregnancy, the use of the drug is contraindicated. It should not be used in the first trimester of pregnancy, therefore, when pregnancy is confirmed, Perinev should be discontinued as soon as possible. The drug is contraindicated in the II-III trimesters of pregnancy, since the use during this period of pregnancy can cause fetotoxic effects (decrease in kidney function, oligohydramnios, slow ossification of the fetal skull bones) and neonatal toxic effects (renal failure, arterial hypotension, hyperkalemia). If, nevertheless, the drug was used in the II-III trimesters of pregnancy, then it is necessary to conduct an ultrasound scan of the kidneys and bones of the fetal skull.

The use of the drug Perineva during lactation is not recommended due to the lack of data on the possibility of its penetration into breast milk. If necessary, the use of the drug during lactation, breastfeeding should be discontinued.

Contraindications

  • hypersensitivity to perindopril or other components of the drug, as well as to other ACE inhibitors;
  • angioedema in history (hereditary, idiopathic or angioedema due to the use of ACE inhibitors);
  • age up to 18 years (efficacy and safety not established);
  • hereditary galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption syndrome.

With caution: renovascular hypertension, bilateral stenosis of the renal arteries, stenosis of the artery of a single kidney - the risk of developing severe arterial hypotension and renal failure; CHF in the stage of decompensation, arterial hypotension; chronic renal failure (Cl creatinine -

Side effects

From the side of the central and peripheral nervous system: often - headache, dizziness, paresthesia; sometimes - sleep or mood disorders; very rarely - confusion.

On the part of the organ of vision: often - visual impairment.

On the part of the organ of hearing: often - tinnitus.

From the side of 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 tract: often - nausea, vomiting, abdominal pain, dysgeusia, dyspepsia, diarrhea, constipation; sometimes - dryness of the oral mucosa; rarely - pancreatitis; very rarely - cytolytic or cholestatic hepatitis (see section "Special Instructions").

From the side of the skin: often - skin rash, itching; sometimes - angioedema of the face, limbs, urticaria; very rarely - erythema multiforme.

From the musculoskeletal system: often - muscle cramps.

From the genitourinary system: sometimes - renal failure, impotence; very rarely - acute renal failure.

General disorders: often - asthenia; sometimes - increased sweating.

On the part of the hematopoietic organs and the lymphatic system: very rarely - with prolonged use in high doses, a decrease in 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: an increase in the concentration of urea in the blood serum and plasma creatinine and hyperkalemia, reversible after discontinuation of the drug (especially in patients with renal insufficiency, severe CHF and renovascular hypertension); rarely - increased activity of liver enzymes and bilirubin in the blood serum; hypoglycemia.

Interaction

Diuretics. In patients taking diuretics, especially with excessive fluid and / or sodium excretion, excessive arterial hypotension may develop at the beginning of therapy with ACE inhibitors. The risk of developing excessive arterial hypotension can be reduced by discontinuing the diuretic, in / in the introduction of 0.9% sodium chloride solution, and also by prescribing an ACE inhibitor at lower doses. Further increase in the dose of perindopril should be carried out with caution.

Potassium-sparing diuretics, potassium preparations, potassium-containing foods and nutritional supplements. Usually, during therapy with ACE inhibitors, the concentration of potassium in the blood serum remains within normal values, but hyperkalemia may develop in some patients. The combined use of ACE inhibitors and potassium-sparing diuretics (eg spironolactone, triamterene, or amiloride), potassium preparations or potassium-containing foods, and dietary supplements may cause hyperkalemia.

Therefore, it is not recommended to combine perindopril with these drugs. These combinations should be prescribed only in case of hypokalemia, taking precautions and regularly monitoring the concentration of potassium ions in the blood serum.

Lithium. With the simultaneous use of lithium preparations and ACE inhibitors, a reversible increase in the concentration of lithium in the blood serum and lithium toxicity may develop. The simultaneous use of ACE inhibitors with thiazide diuretics can further increase the concentration of lithium in the blood serum and increase the risk of developing its toxic effects. The simultaneous use of perindopril and lithium is not recommended.

If necessary, such a combination therapy is carried out under regular monitoring of the concentration of lithium in the blood serum.

NSAIDs, incl. acetylsalicylic acid in doses of 3 g / day and above. Therapy with NSAIDs may weaken the antihypertensive effect of ACE inhibitors. In addition, NSAIDs and ACE inhibitors have an additive effect on increasing the concentration of potassium ions in the blood serum, which can provoke a deterioration in kidney function. This effect is usually reversible. In rare cases, acute renal failure may develop, especially in patients with pre-existing renal impairment, such as elderly patients or against the background of dehydration.

Other antihypertensive agents and vasodilators. The simultaneous use of perindopril with other antihypertensive agents may enhance the antihypertensive effect of perindopril. The simultaneous use of nitroglycerin, other nitrates or vasodilators may lead to an additional hypotensive effect.

Hypoglycemic agents. The simultaneous use of ACE inhibitors and hypoglycemic agents (insulin or oral hypoglycemic agents) can enhance the hypoglycemic effect, up to 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 can be combined with acetylsalicylic acid (as an antiplatelet agent), thrombolytic agents and beta-blockers and / or nitrates.

Tricyclic antidepressants, antipsychotics (neuroleptics), general anesthetics (general anesthetics). Combined use with ACE inhibitors may lead to an increase in the hypotensive effect.

Sympathomimetics. May weaken the antihypertensive effect of ACE inhibitors. When prescribing such a combination, the effectiveness of ACE inhibitors should be regularly evaluated.

How to take, course of administration and dosage

The dose of the drug is selected individually for each patient, depending on the severity of the disease and the individual response to treatment.

Arterial hypertension. Perinev can be used as monotherapy and in combination with other antihypertensive agents.

The recommended starting dose is 4 mg once a day, in the morning. For patients with severe activation of the renin-angiotensin-aldosterone system (for example, with renovascular hypertension, hypovolemia and / or hyponatremia, chronic heart failure in the stage of decompensation or severe arterial hypertension), the recommended initial dose is 2 mg / day in one dose. If therapy is ineffective within a month, the dose can be increased to 8 mg 1 time per day and if the previous dose is well tolerated.

The addition of ACE inhibitors to patients taking diuretics may cause hypotension. In this regard, it is recommended to carry out therapy with caution, stop taking diuretics 2-3 days before the start of treatment with Perinev, or start treatment with Perinev with an initial dose of 2 mg / day, in one dose. It is necessary to control 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 the level of blood pressure. If necessary, diuretic therapy can be resumed.

In elderly patients, the recommended initial daily dose is 2 mg at a time. In the future, the dose can be gradually increased to 4 mg and, if necessary, up to a maximum of 8 mg 1 time per day, provided that the lower dose is well tolerated.

CHF. The recommended starting dose is 2 mg in the morning, under medical supervision. After 2 weeks, the dose can be increased to 4 mg / day in one dose, under the control of blood pressure. Treatment of symptomatic CHF is usually combined with potassium-sparing diuretics, beta-blockers, and/or digoxin.

In patients with CHF, with renal insufficiency and with a tendency to electrolyte disturbances (hyponatremia), as well as in patients taking diuretics and / or vasodilators at the same time, treatment with the drug is started under strict medical supervision.

In patients with a high risk of developing clinically pronounced arterial hypotension (for example, when taking high doses of diuretics), if possible, hypovolemia and electrolyte disturbances should be eliminated before starting the drug Perinev. It is recommended before and during therapy to carefully monitor the level of blood pressure, the state of kidney function and the concentration of potassium ions in the blood serum.

Prevention of recurrent stroke in patients with a history of cerebrovascular disease. Therapy with Perinev should be started at 2 mg for the first 2 weeks before taking indapamide. Treatment should begin at any time (from 2 weeks to several years) after a stroke.

stable ischemic heart disease. In patients with stable CAD, the recommended starting dose of Perinev 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 renal function is monitored. Treatment of elderly patients should begin with a dose of 2 mg, which after a week can be increased to 4 mg / day. In the future, if necessary, after another week, you can increase the dose to 8 mg / day with mandatory preliminary monitoring of kidney function. In elderly patients, the dose of the drug can be increased only if the previous, lower dose is well tolerated.

Overdose

Symptoms: pronounced decrease in blood pressure, shock, water and electrolyte imbalance (hyperkalemia, hyponatremia), renal failure, hyperventilation, tachycardia, palpitations, bradycardia, dizziness, anxiety, cough.

Treatment: with a pronounced decrease in blood pressure - give the patient a horizontal position with raised legs and take measures to replenish the BCC, if possible - in / in the introduction of angiotensin II and / or in / in the solution of catecholamines. With the development of severe bradycardia, not amenable to drug therapy (including atropine), the installation of an artificial pacemaker (pacemaker) is indicated. It is necessary to monitor vital functions and the concentration of creatinine and electrolytes in the blood serum. Perindopril can be removed from the systemic circulation by hemodialysis. The use of high flow polyacrylonitrile membranes should be avoided.

Special Instructions

stable ischemic heart disease. With the development of an episode of unstable angina (significant or minor) during the first month of therapy with Perinev, it is necessary to evaluate the benefit / risk ratio of therapy with this drug.

Arterial hypotension. ACE inhibitors can cause a sharp drop in blood pressure. In patients with uncomplicated hypertension, symptomatic hypotension rarely occurs after the first dose. The risk of an excessive decrease in blood pressure is increased in patients with reduced BCC during diuretic therapy, with a strict salt-free diet, hemodialysis, as well as with diarrhea or vomiting, or in those suffering from severe renin-dependent hypertension. Severe arterial hypotension was observed in patients with severe CHF, both in the presence of concomitant renal insufficiency and in its absence. Most often, severe arterial hypotension can develop in patients with more severe CHF, taking high doses of loop diuretics, as well as against the background of hyponatremia or renal failure. These patients are recommended careful medical supervision at the beginning of therapy and when titrating doses of the drug. The same applies to patients with coronary artery disease or cerebrovascular disease, in whom an excessive decrease in blood pressure can lead to myocardial infarction or cerebrovascular complications.

In the event of arterial hypotension, it is necessary to give the patient a horizontal position with raised legs and, if necessary, inject intravenous sodium chloride solution to increase BCC. Transient arterial hypotension is not a contraindication for further therapy. After the restoration of BCC and blood pressure, treatment can be continued subject to careful selection of the dose of the drug.

In some patients with CHF and normal or low blood pressure, an additional decrease in blood pressure may occur during therapy with Perinev. This effect is expected and is usually not a reason to stop the drug. If arterial hypotension is accompanied by clinical manifestations, it may be necessary to reduce the dose or discontinue the drug Perinev.

Aortic or mitral valve stenosis/hypertrophic cardiomyopathy. ACE inhibitors, incl. and perindopril should be used with caution in patients with mitral valve stenosis and left ventricular outflow tract obstruction (aortic valve stenosis and hypertrophic cardiomyopathy).

Impaired kidney function. In patients with renal insufficiency (Cl creatinine

In patients with symptomatic heart failure, arterial hypotension that develops during the initial period of therapy with ACE inhibitors can lead to a deterioration in renal function. These patients have occasionally experienced acute renal failure, which is usually reversible.

In some patients with bilateral renal artery stenosis or renal artery stenosis of a single kidney (especially in the presence of renal failure), during therapy with ACE inhibitors, an increase in serum urea and creatinine concentrations was observed, which is reversible after discontinuation of therapy. In patients with renovascular hypertension during therapy with ACE inhibitors, there is an increased risk of developing severe arterial hypotension and renal failure. Treatment of such patients should begin under close medical supervision, with small doses of the drug and with further adequate dose selection. During the first weeks of therapy with Perinev, it is necessary to cancel diuretics and regularly monitor kidney function. In some patients with arterial hypertension, in the presence of previously undiagnosed renal failure, especially with concomitant diuretic therapy, there was a slight and temporary increase in the concentration of urea and creatinine in the blood serum. In this case, it is recommended to reduce the dose of Perinev and / or cancel the diuretic.

Patients on hemodialysis. In patients on dialysis using high-flow membranes and taking concomitant ACE inhibitors, there have been several cases of persistent, life-threatening anaphylactic reactions. If hemodialysis is required, a different type of membrane must be used.

Kidney transplant. There is no experience with the use of perindopril in patients with recent kidney transplantation.

Hypersensitivity/angioedema. Rarely in patients taking ACE inhibitors, incl. perindopril, angioedema of the face, extremities, lips, mucous membranes, tongue, glottis and / or larynx developed. This condition can develop at any time during treatment. With the development of angioedema, treatment should be stopped immediately, the patient should be under medical supervision until the symptoms disappear completely. Angioedema of the lips and face usually does not require treatment; Antihistamines may be used to reduce symptoms. Angioedema of the tongue, glottis, or larynx can be fatal. With the development of angioedema, it is necessary to immediately inject epinephrine (adrenaline) s / c and ensure airway patency. ACE inhibitors are more likely to cause angioedema in black patients.

Patients with a history of angioedema not associated with the use of ACE inhibitors may be at high risk of developing angioedema while taking an ACE inhibitor.

Anaphylactoid reactions during LDL apheresis (LDL apheresis). In rare cases, patients receiving ACE inhibitors while undergoing LDL apheresis using dextran sulfate absorption may develop an anaphylactic reaction. Temporary withdrawal of the ACE inhibitor before each apheresis procedure is recommended.

Anaphylactic reactions during desensitization. In patients receiving ACE inhibitors during a course of desensitization (for example, hymenoptera venom), in very rare cases, life-threatening anaphylactic reactions may develop. Temporary withdrawal of the ACE inhibitor is recommended prior to each desensitization procedure.

Liver failure. During therapy with ACE inhibitors, it is sometimes possible to develop a syndrome that begins with cholestatic jaundice and then progresses to fulminant hepatic necrosis, sometimes with a fatal outcome. The mechanism by which this syndrome develops is unclear. If jaundice occurs or an increase in liver enzymes occurs while taking an ACE inhibitor, the ACE inhibitor should be discontinued immediately and the patient should be closely monitored. It is also necessary to conduct an appropriate examination.

Neutropenia/agranulocytosis/thrombocytopenia/anemia. In patients treated with ACE inhibitors, there have been cases of neutropenia / agranulocytosis, thrombocytopenia and anemia. With normal renal function in the absence of other complications, neutropenia rarely develops. Perinev should be used with great caution in patients with systemic connective tissue diseases (e.g. SLE, scleroderma) who are simultaneously receiving immunosuppressive therapy, allopurinol or procainamide, as well as when all of these factors are combined, especially with existing impaired renal function. These patients may develop severe infections that are not amenable to intensive antibiotic therapy. When conducting therapy with Perinev in patients with the above factors, it is recommended to periodically monitor the number of leukocytes in the blood and warn the patient about the need to inform the doctor about the appearance of any symptoms of infection.

In patients with congenital deficiency of glucose-6-phosphate dehydrogenase, isolated cases of hemolytic anemia have been noted.

Negroid race. The risk of developing angioedema in patients of the Negroid race is higher. Like other ACE inhibitors, perindopril is less effective in lowering blood pressure in black patients, possibly due to the greater prevalence of low-renin conditions in the population of this group of patients with arterial hypertension.

Cough. Against the background of therapy with ACE inhibitors, a persistent, unproductive cough may develop, which stops after discontinuation of the drug. This should be considered in the differential diagnosis of cough.

Surgery/general anesthesia. In patients whose condition requires extensive surgery or anesthesia with drugs that cause arterial hypotension, ACE inhibitors, including perindopril, can block the formation of angiotensin II with compensatory renin release. The day before surgery, ACE inhibitor therapy should be discontinued. If the ACE inhibitor cannot be canceled, then arterial hypotension, which develops according to the described mechanism, can be corrected by an increase in BCC.

Hyperkalemia. During therapy with ACE inhibitors, including perindopril, the concentration of potassium ions in the blood may increase in some patients. The risk of hyperkalemia is increased in patients with renal and / or heart failure, decompensated diabetes mellitus and patients using potassium-sparing diuretics, potassium supplements or other drugs that cause hyperkalemia (eg heparin). If necessary, the simultaneous appointment of these drugs, it is recommended to regularly monitor the content of potassium in the blood serum.

Diabetes. In patients with diabetes mellitus taking oral hypoglycemic agents or insulin, blood glucose concentrations must be carefully monitored in the first few months of therapy with ACE inhibitors.

Potassium-sparing diuretics, potassium-containing drugs, potassium-containing foods, and nutritional supplements. Co-administration with ACE inhibitors is not recommended.

Lactose. Perinev's tablets contain lactose. Therefore, patients with hereditary galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this drug.

Influence on the ability to drive a car or perform work that requires an increased speed of physical and mental reactions. It is necessary to take into account the possibility of developing arterial hypotension or dizziness, which can affect driving and working with technical equipment.

Release form

tablets

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The drug Perinev is an antihypertensive drug belonging to the group of ACE inhibitors. It can be used as a therapeutic agent for the treatment of arterial hypertension, stable coronary heart disease and chronic heart failure, as well as for the prevention of recurrent stroke. Perinev's remedy is contraindicated in pregnancy, HB, hypersensitivity, lactose intolerance, puffiness, as well as in children under 18 years of age.

Dosage form

Perineva is available in the form of tablets. The product is packed in blisters of 10 units. Regardless of the dosage of the active ingredient, the drug is packaged in cardboard packs of 30 tablets.

Description and composition

If pregnancy is confirmed during therapy, you should immediately stop taking the medication and seek advice from your doctor.

It is forbidden to take the drug Perinev with potassium-sparing diuretics, lithium preparations, medicines and products containing potassium.

Against the background of taking Perinev, such effects may occur, such as a sharp decrease in blood pressure and dizziness, which may adversely affect the ability to drive vehicles or carry out activities that require concentration, reaction speed and a high level of mental activity.

Overdose

In the event of an overdose of Perinev, the patient may experience symptoms such as:

  • bradycardia;
  • hyponatremia;
  • tachycardia;
  • kidney failure;
  • feeling of heartbeat;
  • a sharp decrease in blood pressure;
  • hyperkalemia;
  • anxiety state;
  • dry cough.
  • in case of a sharp decrease in blood pressure, it is necessary to lay the patient on a flat surface, raise the legs and take measures to increase the volume of circulating blood;
  • if bradycardia occurs that is not amenable to therapy (for example,), an artificial pacemaker should be installed. Remove from the systemic circulation by hemodialysis.

Storage conditions

Perinev's remedy should be stored in a dark place, out of reach of children, at temperatures up to 25˚C. The drug is dispensed by prescription from a doctor.

Shelf life - 3 years.

Analogues

In case of individual intolerance to certain components of the drug Perinev or the urgent need for an emergency replacement of the drug, the most effective direct or indirect analogue should be selected. These drugs are:

Selective angiotensin II receptor antagonist. Contains potassium. The drug can be used for the treatment of arterial hypertension, chronic heart failure, as well as for the prevention of strokes and kidney protection in type II, accompanied by proteinuria. The drug is contraindicated in dehydration, hyperkalemia, pregnancy, HB, hypersensitivity, hypotension and under 18 years of age.

Price

The cost of Perinev averages 510 rubles. Prices range from 209 to 1059 rubles.

Perineva: instructions for use and reviews

Perineva is an ACE inhibitor (angiotensin-converting enzyme).

Release form and composition

Dosage form - tablets: almost white or white, slightly biconvex, with a chamfer: round in a dosage of 2 and 8 mg or oval in a dosage of 4 mg, on one side of the tablets 4 and 8 mg there is a separating risk (in blisters 10 pcs., in a carton box 3, 6 or 9 packs; in blister packs of 14 pcs., in a carton box 1, 2, 4 or 7 packs; in blister packs of 30 pcs., in a carton box 1, 2 or 3 packs).

Composition of 1 tablet:

  • perindopril erbumine, semi-finished granules - 38.39 / 76.78 / 153.56 mg;
  • active substance semi-finished granules - perindopril erbumine - 2/4/8 mg;
  • auxiliary components of semi-finished granules: calcium chloride hexahydrate, lactose monohydrate, crospovidone;
  • Tablet excipients: colloidal silicon dioxide, microcrystalline cellulose, magnesium stearate.

Pharmacological properties

Pharmacodynamics

Perindopril or kinase II, an angiotensin-converting enzyme (ACE) inhibitor, belongs to exopeptidases and is a prodrug from which the active metabolite perindoprilat is formed. It converts angiotensin I to angiotensin II (vasoconstrictor) and destroys the vasodilator bradykinin to an inactive hectapeptide. Due to the suppression of ACE activity, the level of angiotensin II decreases, plasma renin activity increases (the negative feedback of renin release is inhibited), and aldosterone secretion decreases. ACE destroys bradykinin, so the suppression of this enzyme also leads to an increase in the activity of the circulating and tissue kallikrein-kinin system, while activating the prostaglandin system.

The therapeutic effect of the drug is due to the effect of the active metabolite - perindoprilat.

Perindopril lowers blood pressure (both diastolic and systolic) in the supine and standing positions. It reduces the total peripheral vascular resistance (OPSS), resulting in a decrease in blood pressure (BP). This accelerates peripheral blood flow, but the heart rate (HR) does not increase. As a rule, renal blood flow is also accelerated, but the glomerular filtration rate does not change. The development of the maximum hypotensive effect after a single oral tablet intake requires 4-6 hours, the effect persists for 24 hours, but even after a day, 87-100% of the maximum effect is still provided. BP drops rapidly. Stabilization of the hypotensive effect is observed after 1 month of regular use of Perineva and persists for a long time. Termination of therapy does not cause the development of a withdrawal syndrome.

The active substance reduces left ventricular myocardial hypertrophy. Increases the concentration of high density lipoproteins (HDL), in patients with hyperuricemia reduces the concentration of uric acid. With prolonged use, it normalizes the isoenzyme profile of myosin, reduces the severity of interstitial fibrosis.

The drug eliminates structural changes in small arteries and improves the elasticity of large arteries. Reducing pre- and post-load, normalizes the work of the heart. In chronic heart failure (CHF), it reduces OPSS, filling pressure in the right and left ventricles, increases cardiac output and cardiac index. When taking the drug at an initial daily dose of 2 mg in patients with CHF I and II functional classes according to the NYHA classification, there is no statistically significant decrease in blood pressure compared with placebo.

Pharmacokinetics

Perindopril in the form of tablets is rapidly absorbed from the gastrointestinal tract, it takes 1 hour to reach the maximum plasma concentration. Bioavailability is about 65-70%.

About 20% of the absorbed substance is converted into the active metabolite perindoprilat. The maximum content in plasma is observed after 3-4 hours. The half-life (T 1/2) - 1 hour. The volume of distribution of unbound perindoprilat is 0.2 l/kg. Communication with blood plasma proteins is insignificant, communication with ACE is less than 30%, but depends on its concentration. Excreted by the kidneys. Does not accumulate. T 1/2 of the unbound fraction is 3-5 hours, in patients with chronic heart and kidney failure and the elderly, excretion is slowed down.

In patients with cirrhosis of the liver, the hepatic clearance of perindopril changes, but the total amount of the resulting metabolite remains unchanged, so dose adjustment of Perineva is not required.

Food reduces the conversion of perindopril to perindoprilat, which reduces the bioavailability of the drug.

Perindoprilat is removed by peritoneal dialysis and hemodialysis (rate 70 ml/min., 1.17 ml/sec.).

Indications for use

According to the instructions, Perineva is intended for the treatment of arterial hypertension and chronic heart failure.

The drug is used (as part of complex therapy with indapamide) for the prevention of recurrent stroke in patients with cerebrovascular diseases in the history of the disease.

Also, an ACE inhibitor is prescribed for stable coronary heart disease (CHD) to reduce the risk of cardiovascular complications in patients after coronary revascularization and / or myocardial infarction.

Contraindications

Absolute contraindications (conditions/diseases in which the drug is prohibited from taking):

  • age up to 18 years;
  • Lapp lactase deficiency, hereditary galactose intolerance, glucose-galactose malabsorption syndrome;
  • idiopathic, hereditary or developed as a result of taking ACE inhibitors angioedema in history;
  • increased individual sensitivity to any component of the drug or other ACE inhibitors.

Relative contraindications (conditions / diseases in which the use of the drug is possible, but only after assessing the benefits and risks, with extreme caution and under special medical supervision):

  • CHF in the stage of decompensation;
  • arterial hypotension;
  • hypertrophic obstructive cardiomyopathy;
  • stenosis of the aortic or mitral valve;
  • renovascular hypertension;
  • cerebrovascular diseases (including ischemic heart disease, cerebrovascular insufficiency, coronary insufficiency);
  • chronic renal failure (creatinine clearance less than 60 ml / min);
  • bilateral stenosis of the renal arteries or stenosis of the artery of a single kidney;
  • condition after kidney transplantation;
  • hemodialysis using high-flow polyacrylonitrile membranes;
  • the period before the procedure of low-density lipoprotein (LDL) apheresis;
  • severe hypovolemia and hyponatremia (for example, due to vomiting, diarrhea, salt-free diet, dialysis, previous diuretic therapy);
  • hyperkalemia;
  • congenital deficiency of glucose-6-phosphate dehydrogenase;
  • connective tissue diseases such as systemic lupus erythematosus or scleroderma;
  • diabetes;
  • oppression of bone marrow hematopoiesis while taking immunosuppressants, procainamide, allopurinol;
  • surgical intervention;
  • elderly age;
  • belonging to the Negroid race;
  • simultaneous desensitizing therapy with allergens (for example, hymenoptera venom).

Instructions for use Perineva: method and dosage

It is advisable to take Perinev tablets before meals, once a day - in the morning.

The doctor selects the dose for patients personally, based on indications and individual effectiveness of treatment.

Regardless of the indications, it is possible to increase the dosage only if the drug is well tolerated in the previous dose used.

Arterial hypertension

The drug is used either as monotherapy or as part of a combination treatment, in combination with other antihypertensive drugs.

The recommended initial dose of Perineva is 4 mg. For patients with severe activation of the RAAS (renin-angiotensin-aldosterone system), for example, with severe arterial hypertension, renovascular hypertension, chronic heart failure in the stage of decompensation, hyponatremia, hypovolemia, - 2 mg. In case of insufficient effect after a month of treatment, the daily dose may be increased to 8 mg.

If Perineva is prescribed to patients receiving diuretics, in order to avoid the development of arterial hypotension, it is recommended to start taking perindopril 2-3 days after discontinuation of the diuretic, or to prescribe it at a minimum dose of 2 mg. In this case, the concentration of potassium ions in the blood serum, blood pressure and kidney function should be monitored. Depending on the dynamics of the blood pressure indicator, the dose can be increased. Diuretic therapy is resumed if necessary.

Elderly patients at the beginning of therapy are prescribed perindopril at a dose of 2 mg. Further, according to indications, it is increased to 4 mg and, if the effect is still not enough, up to 8 mg.

Prevention of recurrent stroke in patients with a history of cerebrovascular disease

Perinev's drug is taken at a dose of 2 mg 2 weeks before the appointment of indapamide.

You can start preventive therapy after a stroke at any time, even after several years, but not earlier than after 2 weeks.

Chronic heart failure

The optimal starting dose is 2 mg. After 2 weeks, if necessary, under the control of blood pressure, it is increased to 4 mg. If the disease is accompanied by clinical manifestations, β-blockers, potassium-sparing diuretics and / or digoxin are additionally prescribed.

With CHF, renal failure, a tendency to electrolyte disturbances (hyponatremia), or the simultaneous use of diuretics and / or vasodilators, treatment should be started under the strict supervision of a physician.

If there is a high risk of developing clinically pronounced arterial hypotension (for example, with concomitant use of a diuretic in high doses), it is recommended to eliminate electrolyte disturbances and hypovolemia before prescribing Perineva, if possible. Before and during therapy, blood pressure, the concentration of potassium ions in the blood serum and the state of renal function should be constantly monitored.

Stable coronary artery disease

Elderly patients are started on a dose of 2 mg. If the effect is insufficient, after a mandatory preliminary monitoring of renal function, after a week it can be increased to 4 mg, after another week - up to 8 mg.

In renal failure, the dose is determined on the basis of the results of a study of kidney function, namely the creatinine clearance (CC):

  • CC> 60 ml / min - 4 mg / day;
  • CC 30-60 ml / min - 2 mg / day;
  • CC 15-30 ml / min - 2 mg every other day;
  • QC< 15 мл/мин (гемодиализ) – 2 мг в день диализа.

During treatment, it is required to control the concentration of creatinine and potassium ions in the blood serum.

Side effects

The division of side effects by prevalence: very often -> 1/10, often - from > 1/100 to< 1/10, нечасто – от >1/1000 to< 1/100, редко – от >1/10000 to< 1/1000, очень редко – < 1/10000, включая отдельные сообщения.

Side effects that may occur during therapy with perindopril:

  • on the part of the organ of hearing: often - tinnitus;
  • on the part of the organ of vision: often - visual impairment;
  • from the side of the central and peripheral nervous system: often - paresthesia, headache, dizziness; infrequently - mood changes, sleep disturbances; very rarely - confusion;
  • on the part of the respiratory system: often - shortness of breath, cough; infrequently - bronchospasm; very rarely - rhinitis, eosinophilic pneumonia;
  • from the musculoskeletal system: often - muscle cramps;
  • from the genitourinary system: infrequently - impotence, renal failure; very rarely - acute renal failure;
  • from the digestive tract: often - diarrhea, constipation, dyspepsia, abdominal pain, nausea, vomiting, dysgeusia; infrequently - dryness of the oral mucosa; rarely - pancreatitis; very rarely - hepatitis (cholestatic or cytolytic);
  • from the side of the cardiovascular system: often - a pronounced decrease in blood pressure; very rarely - angina pectoris, arrhythmias, as well as stroke and myocardial infarction (in patients at high risk, possibly secondary, due to severe arterial hypotension); frequency unknown - vasculitis;
  • on the part of the hematopoietic organs and the lymphatic system: very rarely in patients with congenital deficiency of glucose-6-phosphate dehydrogenase - hemolytic anemia; very rarely with prolonged use of the drug in high doses - agranulocytosis, thrombocytopenia, pancytopenia, leukopenia / neutropenia, a decrease in the concentration of hemoglobin and hematocrit;
  • on the part of the skin: often - skin rashes, itching; infrequently - urticaria, angioedema of the face and extremities; very rarely - erythema multiforme;
  • laboratory studies: hyperkalemia, increased plasma creatinine and serum urea, especially in patients with severe CHF, renovascular hypertension and renal failure (reversible after discontinuation of the drug); rarely - hypoglycemia, increased serum bilirubin and liver enzyme activity;
  • other reactions: often - asthenia; infrequently - increased sweating.

Overdose

Signs of overdose: pronounced decrease in blood pressure, bradycardia, palpitations, tachycardia, water and electrolyte imbalance (hyperkalemia, hyponatremia), hyperventilation, cough, anxiety, dizziness, renal failure, shock.

With a pronounced decrease in blood pressure, it is necessary to put the patient down and raise his legs, replenish the volume of circulating blood (BCC), if possible, inject intravenous angiotensin II and / or catecholamine solution. If bradycardia develops, not amenable to drug therapy (including atropine), a pacemaker (artificial pacemaker) is installed. Treatment of an overdose should be carried out under the control of vital functions of the body, the concentration of creatinine and electrolytes in the blood serum. The drug can be removed from the systemic circulation by hemodialysis, but the use of high-flow polyacrylonitrile membranes should be avoided.

special instructions

Like other ACE inhibitors, perindopril can cause a sharp decrease in blood pressure. Symptomatic arterial hypotension after taking the first dose in patients with uncomplicated arterial hypertension rarely occurs. An excessive decrease in blood pressure is likely in individuals with reduced BCC on the background of a strict salt-free diet, hemodialysis, diuretic therapy, vomiting and diarrhea, as well as renin-dependent hypertension, severe CHF, including with concomitant renal failure. A more pronounced decrease in blood pressure is observed in patients with severe CHF receiving high doses of loop diuretics, as well as in renal failure and hyponatremia. These categories of patients are shown careful observation at the beginning of treatment and during the selection of the optimal dose. The same applies to patients with coronary heart disease and cerebrovascular diseases, since excessive reduction in blood pressure in them is fraught with myocardial infarction and cerebrovascular complications.

If the patient has arterial hypotension, it is necessary to give him a horizontal position and raise his legs, if necessary, intravenously inject a solution of sodium chloride to increase the BCC. Transient (passing) arterial hypotension is not a contraindication for continuing treatment. After the restoration of blood pressure and BCC, therapy can be resumed, it is only necessary to choose the right dose of Perineva.

In some patients with CHF, including those with low blood pressure, the drug may cause an additional decrease in blood pressure. This effect is expected and is often not a reason to stop therapy. In cases where arterial hypotension is accompanied by clinical symptoms, reduce the dose of the drug or cancel it completely.

In the event of an episode (even a minor one) of unstable angina in patients with stable coronary heart disease during the first month of using Perineva, the benefit-risk ratio in further treatment should be assessed.

Patients with a history of angioedema unrelated to ACE inhibitors are at high risk of angioedema as a reaction to perindopril.

In case of development of angioedema, Perinev should be immediately canceled. With swelling of the lips and face, special treatment is not required, it is enough to take antihistamines to reduce the severity of symptoms. Swelling of the tongue, larynx, or glottis can lead to death. If such a reaction occurs, it is necessary to inject epinephrine (epinephrine) subcutaneously and ensure airway patency. More often, angioedema during therapy with ACE inhibitors occurs in patients of the Negroid race.

In rare cases, anaphylactic reactions develop in patients who undergo LDL apheresis using dextran sulfate absorption during treatment with Perineva, because of this, it is recommended to cancel the ACE inhibitor before each procedure. The same applies to patients who are prescribed a course of desensitization - before each procedure, the drug should be temporarily canceled.

If during treatment there is an increase in the activity of liver enzymes or jaundice appears, the drug should be discontinued and an appropriate examination should be carried out, since Perineva can cause the development of a syndrome that begins with cholestatic jaundice and progresses to a fulminant course of hepatitis with extensive liver necrosis, up to death.

ACE inhibitors can contribute to the development of renal failure and severe arterial hypotension in patients with renovascular hypertension, so treatment should be started with small doses, under close medical supervision and with further adequate titration of the dose of the drug. During the first weeks of taking Perineva, it is necessary to cancel diuretics and constantly monitor renal function.

In some cases, in patients with arterial hypertension and previously undiagnosed renal failure, especially with concomitant use of diuretics, a slight and temporary increase in creatinine and serum urea concentration is possible, which requires a reduction in the dose of the drug and / or discontinuation of the diuretic.

Patients on hemodialysis should not use high-strength membranes for a session, otherwise persistent, life-threatening anaphylactic reactions may develop.

In diabetic patients receiving insulin or taking oral hypoglycemic agents, at the beginning of Perineva's therapy, it is necessary to control the level of glucose in the blood.

Patients in anticipation of a planned surgical intervention or other measures with the use of anesthesia with agents that can cause arterial hypotension should stop the ACE inhibitor the day before. If this is not possible, arterial hypotension can be corrected by an increase in BCC.

Perindopril may increase the concentration of potassium ions in the blood. The likelihood of developing hyperkalemia increases with renal and / or heart failure, decompensated diabetes mellitus, in the case of simultaneous use of potassium-sparing diuretics, potassium preparations or other agents that can cause hyperkalemia (for example, heparin). If the combined use of these drugs is justified, the level of potassium in the blood serum should be constantly monitored.

When conducting a differential diagnosis of cough in a patient, it should be borne in mind that perindopril can cause a persistent, unproductive cough - it stops after the drug is discontinued.

Influence on the ability to drive vehicles and complex mechanisms

The drug can cause dizziness and arterial hypotension, which can affect the reaction rate and concentration, which should be taken into account by drivers and people employed in potentially hazardous industries.

Use during pregnancy and lactation

Perineva is contraindicated during pregnancy. If pregnancy occurs during treatment, the drug should be discontinued immediately. When used in the later stages, perindopril can cause fetotoxic (oligohydramnios, decreased kidney function, slowing of the ossification of the skull bones) and neonatal toxic (renal failure, hyperkalemia, arterial hypotension) effects. If the drug for some reason was used in the II-III trimesters, it is necessary to conduct an ultrasound examination of the kidneys and bones of the fetal skull.

There are no data on the penetration of perindopril into breast milk, therefore, if it is necessary to use Perineva, women are advised to stop breastfeeding.

Application in childhood

The safety and efficacy of the drug in children and adolescents under 18 years of age have not been confirmed, therefore Perineva is not used in pediatric practice.

For impaired renal function

In patients with kidney disease, the drug is used with caution, the dose is determined individually, depending on the degree of impaired renal function and the therapeutic response. Treatment should be carried out under regular monitoring of creatinine and potassium ions in the blood serum.

For impaired liver function

In diseases and impaired liver function, dose adjustment of Perineva is not required.

Use in the elderly

Perineva is used with caution. Treatment should be initiated in the elderly with a dose of 2 mg/day. If the effect is insufficient, but only if the drug is well tolerated, after a week it can be increased to 4 mg, after another week - up to 8 mg.

drug interaction

  • sympathomimetics: possible decrease in the effectiveness of perindopril. If the use of such a combination is necessary, the effectiveness of Perineva should be regularly evaluated;
  • diuretics: possible development of excessive arterial hypotension. The risk can be reduced by intravenous administration of sodium chloride solution 0.9%, the use of perindopril at lower doses, or the withdrawal of the diuretic;
  • potassium preparations, potassium-sparing diuretics, potassium-containing foods and nutritional supplements: the risk of developing hyperkalemia increases. Such combinations are undesirable except in cases of hypokalemia;
  • lithium preparations: a reversible increase in the concentration of lithium in the blood serum and the development of toxicity are possible. This combination is not recommended. If concomitant administration of drugs is necessary, the content of lithium in the blood serum should be monitored;
  • hypoglycemic agents: their effect may be enhanced and hypoglycemia may develop, the risk is especially high in patients with renal insufficiency in the first weeks of combination therapy;
  • tricyclic antidepressants, antipsychotics (neuroleptics), agents for general anesthesia (general anesthetics): it is possible to increase the hypotensive effect of the drug;
  • non-steroidal anti-inflammatory drugs, including acetylsalicylic acid in a daily dose of 3000 mg: a weakening of the effect of perindopril is possible, the risk of an increase in the level of potassium ions in the blood serum increases, as a result of which kidney function may worsen (reversible effect), in rare cases up to the development of acute renal failure, especially in patients with concomitant impaired renal function, for example, with dehydration and in the elderly;
  • other antihypertensive agents and vasodilators: may increase the antihypertensive effect.

If necessary, Perinev can be prescribed in combination with drugs such as nitrates, β-blockers, thrombolytic drugs, acetylsalicylic acid in doses that have an antiplatelet effect.

Analogues

Perineva's analogues are: Coverex, Arentopres, Perindopril, Perindopril-Teva, Perindopril-Richter, Perindopril-TAD, Perindopril-C3, Parnavel, Hypernik, Prestarium, Perinpress, Perineva, Perineva Ku-tab, Piristar, Prenessa, Stopress.

Terms and conditions of storage

Keep away from children.

Storage conditions - temperature not higher than 30 °C.

Shelf life - 3 years.
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