Perineva side effects. Perineva - effect on the body, indications and contraindications, side effects and reviews. When reception is prohibited

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.

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.

Perineva (form - tablets) corresponds to the group of drugs that affect the renin-angiotensin system. Important features of the drug from the instructions for use:

• Sold by prescription only
• During pregnancy: contraindicated
• When breastfeeding: contraindicated
• In childhood: contraindicated
• In case of impaired renal function: with caution

Package

Compound

Perinev's medicine includes the following components:

• perindopril erbumine;
• lactose monohydrate, calcium chloride hexahydrate, crospovidone;
• colloidal silicon dioxide, MCC, magnesium stearate.

Release form

The drug is available in the form of round white biconvex tablets with a score on one side of 8, 4 or 2 mg. The blister contains 10, 14 or 30 tablets.

pharmachologic effect

Perineva has a hypotensive, vasodilating and cardioprotective effect.

Pharmacodynamics and pharmacokinetics

Perindopril has a therapeutic effect due to perindoprilat (active metabolite). It reduces systolic and diastolic pressure, OPSS, resulting in a decrease in blood pressure. At the same time, the peripheral blood flow accelerates, but the pulse does not increase.

The maximum effect appears after taking an average of 4-6 hours and lasts for a day.

Blood pressure drops pretty quickly. Pressure stabilization is observed after about a month of therapy. After discontinuation of treatment, withdrawal syndrome does not develop.

Increases the elasticity of arteries, helps to eliminate their structural changes. Normalizes the work of the heart muscle, reduces preload and afterload.

The maximum concentration of perindopril in the blood after taking is observed after an hour. It is rapidly absorbed from the gastrointestinal tract. Bioavailability - 65-70%.

Simultaneous eating with the drug reduces the conversion of perindopril to perindoprilat, which, accordingly, reduces its bioavailability. Excreted through the kidneys, does not accumulate.

Indications for use

What are Perinev's tablets from? Perineva is prescribed in the following cases:

• prevention of recurrent stroke (complex therapy together with Indapamide);
• chronic heart failure;
• arterial hypertension;
• stable ischemia of the heart.

Contraindications

The drug should not be taken when:

• sensitivity to any component of the drug;
• glucose/galactose malabsorption syndrome;
• age up to 18 years;
• lactase deficiency;
• history of angioedema (angioneurotic, idiopathic or hereditary edema as a result of taking ACE inhibitors);
• galactose intolerance.

With caution, the drug is used for:

• bilateral stenosis of the arteries of the kidneys;
• chronic renal failure;
• renovascular hypertension;
• stenosis of the artery of a single kidney;
• stages of decompensation of heart failure;
• hyponatremia, hypovolemia;
• hyperkalemia;
• cerebrovascular diseases;
• hypertrophic obstructive cardiomyopathy;
• after kidney transplant;
• connective tissue diseases;
• general anesthesia;
• diabetes mellitus;
• in old age.

Side effects

As a result of taking Perinev, the following side effects may occur:

• paresthesia, dizziness, headaches;
• noise in ears;
• visual impairment;
• a significant decrease in blood pressure, angina pectoris, arrhythmias, stroke, myocardial infarction, vasculitis;
• shortness of breath, bronchospasm, cough, rhinitis, eosinophilic pneumonia;
• abdominal pain, nausea, dysgeusia, vomiting, constipation, diarrhea, dyspepsia, dry mouth, pancreatitis, cholestatic or cytolytic hepatitis;
• itching, swelling of the limbs, face, rash, urticaria, erythema multiforme;
• muscle cramps;
• impotence, renal failure;
• increased sweating, asthenia;
• decrease in hemoglobin and hematocrit, neutropenia, leukopenia, thrombocytopenia, pancytopenia, agranulocytosis (manifested when used at high doses for a long period of time), hemolytic anemia (rarely seen in patients with glucose-6-phosphate dehydrogenase deficiency);
• increased concentration of urea and creatinine, hyperkalemia (reversible after discontinuation of the drug), hypoglycemia, increased activity of liver enzymes.

Application instruction of Perineva (Way and dosage)

The drug should be taken 1 time, in the morning, inside, before meals.

The instructions for the tablets note that the dose is selected for each patient individually, depending on the severity of the disease and the response to therapy.

With arterial hypertension, Perinev's medicine can be used both in monotherapy and simultaneously with other drugs that reduce pressure. The initial daily dose should not exceed 4 mg. If within a month the therapy does not bring results, the dose can be increased to 8 mg (with normal transfer of the previous dose).

Before you start taking this drug, you must stop taking diuretics at least 3 days in advance, since the combined use of these drugs can lead to arterial hypotension.

In chronic heart failure, the drug should be taken only under medical supervision, it should start with a minimum dose (2 mg). You can increase the dose to 4 mg no earlier than a week later.

As a prophylactic against recurrent stroke, the dose of the drug to start is 2 mg. You can start taking the drug as early as two weeks after the stroke.

In kidney disease, the dose of the drug is prescribed individually, based on the diagnosis and the degree of impairment. It is necessary to constantly monitor the patient's condition, in particular, the level of creatinine and potassium ions in the blood.

There is no need to adjust the dose for liver diseases.

Overdose

In case of overdose, the patient may experience the following symptoms: shock, renal failure, bradycardia, a sharp decrease in blood pressure, hyponatremia, dizziness, cough, hyperkalemia, tachycardia, anxiety, hyperventilation, palpitations.

With a sharp decrease in blood pressure, the patient should take a prone position, slightly raise his legs, and it is also necessary to take measures to replenish the BCC. In case of bradycardia, which is not amenable to therapy (in particular, with anthropin), it is necessary to install a pacemaker (artificial pacemaker). Perindopril can be removed from the bloodstream by hemodialysis.

Interaction

The simultaneous use of Perineva with diuretics can lead to arterial hypotension. You can reduce the risk of its occurrence by stopping the intake of diuretics or taking the drug in lower doses. In the future, increasing the dose of Perineva should be administered with caution.

The combination of perindopril with potassium-sparing diuretics, foods and supplements, as well as potassium preparations can lead to the development of hyperkalemia. They should be prescribed exclusively for hypokalemia with the utmost care, while controlling the level of ions.

Perindopril together with lithium preparations can cause lithium toxicity and increase the level of lithium in the blood, so it is not recommended to prescribe them simultaneously. If necessary, such a combination should monitor the concentration of lithium in the blood.

A decrease in the antihypertensive effect may occur as a result of the combination of Perineva with NSAIDs. Also, such therapy can lead to a deterioration in the condition of the kidneys. In some cases, this can lead to acute renal failure.

The antihypertensive effect of perindopril may be enhanced by the simultaneous use of other blood pressure lowering agents or vasodilators.

Hypoglycemic agents (including insulin) and Perinev in combination can cause an increase in the hypoglycemic effect, up to glycemia.

Sympathomimetics glorify the therapeutic effect of perindopril, when they are prescribed, it is necessary to control the effectiveness of Perineva.

Antidepressants, antipsychotics and general anesthetics can enhance the hypotensive effect.

A combination of Perineva with nitrates, acetylsalicylic acid, beta-blockers and thrombolytic agents is possible.

Terms of sale

On prescription.

Storage conditions

In a dark place at a temperature of 25 ° C.

Best before date

special instructions

In patients with diabetes, the first 3 months of taking Perineva in patients should control the level of glucose in the blood.

When driving, you should take into account the risk of side effects such as dizziness and a sharp decrease in pressure.

Perineva's analogs

The following drugs are considered analogues of this drug: arentopres, hypernick, coverex, parnavel, perinpress, perindopril.

Reviews about Perinev

Among patients, reviews about this drug are rather contradictory. On the one hand, many note its effectiveness, on the other hand, the effect of taking the medicine is spoiled by side effects, in particular cough and dizziness.

Price Perineva

The cost of tablets in Russia, depending on the packaging, is 220 rubles (4 mg), 330 rubles (8 mg). In Ukraine, the price of 8 mg is UAH 180, 4 mg is UAH 130.

Europharm* 4% discount with promo code medside11

Pharmacy IFK

Reviews

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Pressure medications for the elderly

Live healthy! Pressure medications. What should not be taken by the elderly? (05.10.2017)

Hypertension and the complications that this cardiovascular disease entails can be called a negative (from a medical point of view) sign of the times. And all because this disease occurs in at least one in five adults. If we add here the unexamined, those who have been sick for years, but avoid doctors, the statistics will be even more depressing.

But hypertension (arterial hypertension) is not a sentence, not a reason to fall into despair. Achievements of modern pharmacology allow to control the disease, while maintaining the optimal quality of life. Of course, this is possible if you see a doctor on time, and not at the stage when the target organs are already significantly affected - the heart, kidneys, brain, blood vessels, eyes. Among the drugs that can correct the state of hypertension, ACE inhibitors stand apart. They include the latest generation of medicines, developed by specialists so that their patients are well tolerated, and side effects are rare.

ACE inhibitors: how it works

The general scheme is as follows - from plasma beta-globulins, from angiotensinogen among them, angiotensin I is formed under the influence of renin. It does not affect vascular tone, it remains neutral. This component is amenable to the action of ACE (that is, angiotensin converting enzyme). Thus, the vasoactive peptide angiotensin II is formed: it has an inherent effect on vascular tone precisely due to irritation of receptors that are sensitive to angiotensin. So the blood vessels constrict.

Under the action of such an active angiotensin, norepinephrine and aldosterone, as well as antidiuretic hormone, are released. And now, if the entire process described above takes place with high intensity, a person develops hypertension. And the pressure can increase to a critical level, provoke a hypertensive crisis and vascular accidents.

Therefore, doctors have developed medicinal products that control the process of producing angiotensin II, subsequent hormonal surges. In particular, this goal was achieved with Perinev's pressure pills.

Perineva: farm dossier

This medicinal product is classified as an ACE inhibitor, it is available only in tablet form. Pills of white color (or with slightly dark impurities). Those in doses of 2 and 8 mg are roundish, but those in 4 mg are oval. There are 10 pieces in a cell package, and from 3 to 9 such packages in a box.

In the formula of the drug:

• Perindopril erbumine, semi-finished granules;
• Additional components are chloride and calcium hexahydrate, crospovidone and lactose monohydrate (this is an addition to granules), but for pills - silicon dioxide, magnesium stearate and cellulose.

Thus, the main component is . The drug belongs to pharmaceutical products that have a hypotensive, cardioprotective, and vasodilatory effect.

Pharmacodynamic characteristics

Perindopril (or kinase II) is an ACE inhibitor related to exopeptidases. It is considered a prodrug, and then an active metabolite called perindopril at is released from it. Transforms angiotensin I into a vasoconstructor, allows you to destroy bradykinin with the formation of an inactive hectapeptide.

Due to the fact that ACE activity decreases, plasma renin is activated, and aldosterone production decreases. And since ACE destroys bradykinin, inhibition of this enzyme leads to increased activation of the kallikrein-kinin system. The prostaglandin system is immediately activated.

Perindopril :

• Lowers blood pressure, and SBP, and DBP;
• Regardless of whether the patient is standing or lying down, blood pressure falls;
• Corrects downward OPSS;
• Accelerates peripheral blood flow;
• Does not increase heart rate;
• Accelerates, as noted in the instructions, and blood flow in the kidneys, without affecting the glomerular filtration rate.

To develop a peak hypotensive effect, you need to wait about 4-6 hours after ingestion. This action will be extended for 24 hours. But, as doctors say, even after a day the effect will remain at 87-100%. We can say that blood pressure drops quickly, but at the same time smoothly - and this is the most comfortable scheme for hypertensive patients.

As for the stabilization of the hypotensive state, it can be expected in a month of the regular schedule. And it keeps for a long time. When you stop drinking Perineva, there will be no withdrawal syndrome.

It has been proven that the active ingredient also reduces hypertrophic transformations of the left ventricular myocardium. It also increases the concentration of high-density lipoproteins. Individuals with hyperuricemia report a decrease in uric acid levels. With long-term use, the isoenzyme myosin profile stabilizes. The clinical significance of the interstitial type of fibrosis also decreases.

The drug tends to remove some of the transformations in the arteries of a small order, to optimize the elasticity of the large arteries. Reduced pre- and afterload on the heart. With CHF, OPSS decreases, as well as ventricular filling pressure. The cardiac output increases, as well as the cardiac index.

Pharmacokinetic characteristic

The medicinal composition is rapidly absorbed from the digestive tract, it takes an hour for the peak plasma content to be reached. Biological availability - within 65-70%.

Approximately 20% of the absorbed component becomes the active metabolite perindoprilat. Its plasma limiting concentration is fixed after 3.5 hours, and the half-life is one hour. With blood proteins (from the plasma part), the substance has a slight connection, while the connection with ACE does not reach 30%, but it depends on the content of the ingredient.

Evacuation is carried out through the kidneys. Food, as scientists have proven, slightly reduces the transformation of perindopril to perindoprilat, which reduces drug bioavailability.

Who is shown

In the detailed instructions for the use of the described Perineva, two main indications for admission are indicated - this is, in fact, arterial hypertension, as well as CHF. Often, this particular medication is applicable in combination therapy with indapamide - this is done to prevent a recurrent stroke in people who now or previously have cerebrovascular diseases in the active phase.

In addition, the ACE inhibitor in question can be prescribed for stable cardiac ischemia in order to reduce the risk of cardiovascular events in people who have experienced acute MI or coronary revascularization.

Who can't drink

Perineva, as well as its analogues, has absolute and relative contraindications for taking. So, for example, a categorical ban applies to children - this medication is not prescribed to persons under the age of majority in principle.

Among the absolute contraindications:

• Galactose intolerance and lactase deficiency, as well as glucose-galactose malabsorption syndrome;
• High individual sensitivity to formula ingredients or other representatives of this pharmaceutical group;
• Idiopathic nature angioedema earlier.

With such diagnoses or features, the patient, together with the doctor, needs to look for other therapeutic regimens. If we talk about relative contraindications, then in this case the doctor will evaluate all the risks that a particular patient has. And based on his forecast, he will decide whether he can drink Perineva or should he look for another remedy with less threat.

Relative limitations in use

This, above all, concerns CHF in the decompensated stage. You should not drink medicine for patients with arterial hypotension, only certain calculations on the part of the doctor can allow Perineva to be taken.

Relative contraindications include:

• Stenosis of the aortic / mitral valves;
• Renovascular type hypertension;
• Obstructive cardiomyopathy (hypertrophic type);
• Cerebrovascular diseases, which include ischemia of the heart muscle, insufficiency of cerebral blood flow, as well as coronary insufficiency;
• CRF (creatinine clearance is taken into account);
• Bilateral stenosis of the nephroarteries or arterial stenosis of the only available kidney, as well as post-transplantation status;
• Hemodialysis using special membranes;
• Hyperkalemia, hyponatremia and hypovolemia;
• Condition after surgery;
• Connective tissue diseases - for example, systemic lupus erythematosus, scleroderma;
• Diabetes mellitus of any type;
• Inhibition of hematopoiesis in the bone marrow, associated with the use of immunosuppressants;
• Belonging of the patient to the Negroid race;
• Age over 65;
• Parallel therapy with allergens (desensitizing).

If the doctor who prescribes the medicine for you, for some reason, does not know about some of your diseases, current or past, be sure to tell him about them. This happens if the patient comes to the appointment not with a medical card, but with a leaflet. He may forget to mention this or that disease, the doctor will not take this into account, and the therapy may be incorrect (and therefore dangerous).

How to use for hypertension

The medicine can be used both in monotherapy and as one of the complex components - your doctor is responsible for this choice. The recommended starting dosage of Perineva is 4 mg. For those individuals who have a significant activation of the RAAS (and this is typical for patients with severe hypertension, with renovascular type hypertension and decompensatory CHF), the initial dosage will not exceed 2 mg. If the effectiveness of treatment is insufficient, the daily dosage may eventually be raised to 8 mg.

If Perinev is drunk by a patient who simultaneously drinks a diuretic, then in order to avoid the development of hypotension, the inhibitor should be started three days after the diuretic is discontinued. Or (the doctor is also considering this option), he will prescribe Perinev at a dose of 2 mg, the minimum possible for this medication. In such a situation, monitoring of the content of potassium ions in the serum component of the blood, blood pressure and kidney functionality is indicated. Looking at the dynamics of these indicators, the doctor will adjust the dosage. Diuretic therapy may be resumed if requested.

Elderly hypertensive patients are also prescribed the minimum starting dosage - 2 mg.

Use in other cardiovascular diseases

In order to prevent a stroke (repeated), people with cerebrovascular diseases are recommended to drink a medicine of 2 mg 1/24 two weeks before the appointment. The start of preventive therapy is indicated by the doctor no earlier than 2 weeks after the stroke.

For patients with CHF, the drug is prescribed in the same starting dose - 2 mg. After two weeks, with positive dynamics, it is raised to 4 mg. With clinical manifestations of the disease, beta-blockers, digoxin and certain diuretics may be additionally prescribed.

If a specialist predicts a high probability of developing hypertension, for example, due to large doses of a diuretic, before prescribing Perineva, electrolyte disruptions, hypovolemia (as far as this is realistic) should be corrected. Before / during therapy, it is imperative to monitor blood pressure, the level of potassium ions in the serum part of the biofluid, as well as the state of nephrofunction.

Treatment for stable cardiac ischemia

Starting dosage - 4 mg 1/24. Two weeks later, under the strictest control of renal function, this dosage can be doubled. Elderly patients and with this diagnosis try to start treating with the lowest dose of 2 mg. If the dose is ineffective, after a preliminary control of renal function (this item is required), after a week the dosage is raised to 4 mg, and after another 7 days it is adjusted to 8 mg.

During therapy, physicians monitor the content of creatinine, as well as potassium ions in the serum component of the blood.

About negative reactions

Side effects of Perineva are detailed in the instructions. It should be noted that they often occur against the background of incorrect medication, suboptimal combined therapy, as well as the patient's wrong lifestyle.

The frequency of fixation of negative reactions is as follows - more than and equal to 1 case per 10 receptions is interpreted as "very often", more than or equal to 1 in 100, but less than 1 in 10 - "often". “Uncommon” is one or more cases in a thousand, but not less than 1 in 100. “Rare” is a ratio of more than one case per 10,000 appointments, but not less than 1 in 1,000. “Very / extremely rare” is more than 1 to 10000 with the inclusion of individual messages.

Negative reactions:

1. Heart and blood vessels. A significant decrease in blood pressure is often recorded. Very rarely, the reception turns into angina pectoris, arrhythmia, stroke and acute MI cannot be ruled out. Vasculitis occurs with an undetermined frequency.
2. The digestive system. Reception is often manifested by digestive disorders, constipation and nausea, possibly vomiting. Dyspepsia and abdominal pain are not excluded with the same frequency. Infrequently, the patient complains of unusual dry mouth. Pancreatitis will rarely be a negative scenario. Hepatitis (different types) is very rare.
3. Respiratory system. Often patients complain of cough and shortness of breath, infrequently they have bronchospasm, very rarely the reception turns into a runny nose and eosinophilic pneumonia.
4. CNS and PNS. Often there are complaints of headaches, paresthesia, dizziness. Infrequently, there are mood changes, as well as sleep disorders. Very rarely there are pathologies of consciousness associated with spatial disorientation, gaps in memory, difficulties in concentrating and performing automatic simple actions.
5. Sensors. Patients often complain about unusual tinnitus, often there are complaints about visual defects.
6. OH YEAH. Often fixed muscle convulsive syndrome.
7. Urogenital profile. Rarely occurs as a negative scenario for the treatment of erectile dysfunction, renal failure. It is extremely rare for ARF to occur.
8. Lymphatic system and hematopoiesis. In certain individuals with a predisposition to this, hemolytic anemia very rarely occurs. With long-term therapy at maximum doses, thrombocytopenia and agranulocytosis are possible, as well as neutropenia, reduced hemotocrit and hemoglobin.
9. Leather. The largest organ of our body can often respond to Perineva's therapy with a skin rash, itching. Urticaria appears less often, as well as angioedema of the face and arms / legs. Very rarely, erythema multiforme is noted.
10. Laboratory diagnostics can fix hyperkalemia, an increase in markers of blood plasma creatinine and serum urea. Especially in people with severe CHF. Rarely, hypoglycemia, elevated serum bilirubin, and activation of hepatic fermentation occur.

Among other reactions, asthenic syndrome is often noted, infrequently - hyperhidrosis.

In case of overdose

The main signs of an overdose are a significant decrease in blood pressure, palpitations and bradycardia, tachycardia, as well as disruptions in water and electrolyte balance. Hyperventilation of the lungs, anxiety, coughing and considerable dizziness are possible. A shock reaction and renal failure cannot be ruled out.

If the pressure has decreased significantly, it is recommended to lay the victim down, raise his lower limbs. The patient's blood volume is replenished, angiotensin II is administered intravenously, and also (possibly - at choice) a catecholamine solution. With developed bradycardia, which is not amenable to drug treatment, the pacemaker is increased. Therapy for overdose is routinely carried out with monitoring of vital signs, creatinine and electrolytes in the serum part of the biofluid.

Removal of the substance from the systemic circulation is acceptable by hemodialysis, but, importantly, the use of high-flow polyacrylonitrile membranes in this procedure should be avoided.

Remarks

The combined therapy of Perineva with lithium, potassium, potassium-sparing diuretics, as well as potassium-containing products and / or dietary supplements is not considered optimal.

As well as other ACE inhibitors, Perineva can provoke a sharp drop in blood pressure. But in people with uncomplicated hypertension, this effect of the “first dose” is recorded infrequently. But a pathological decrease in blood pressure can manifest itself in patients with reduced BCC due to a serious salt-free diet, diuretic therapy, and hemodialysis.

Also, it is worth noting that often a significant drop in blood pressure in people with CHF (severe) is recorded with the parallel intake of loop diuretics, and also with AN. These patients should be closely monitored throughout the entire period of treatment, the correct, accurate dosage of the medication is very important for them. This remark is also true for patients with ischemia of the heart, cerebrovascular diseases. In them, an excessive decrease in pressure is dangerous for acute myocardial infarction and complications of the cerebrovascular type.

It is important:

1. Transient (that is, passing) arterial hypertension cannot be considered an indication for interruption of therapy, after the restoration of BCC and stabilization of blood pressure, treatment continues.
2. If clinical symptoms are inherent in hypotension, the dosage of the pharmacological agent is adjusted (sometimes it is canceled altogether).
3. In situations with the development of an episode of unstable angina pectoris (even if it is insignificant) in patients with cardiac ischemia, the benefit / risk ratio is assessed in the first weeks.
4. If an angioedema occurs in a person being treated, Perinev is canceled urgently - with swelling of the face or lips, only standard antihistamines are needed, but with swelling of the tongue and larynx, as well as the glottis, the situation can get out of control. Help must be urgent.
5. If, during treatment, the patient develops jaundice, the medication is canceled, an examination is carried out, since Perineva can lead to a serious chain of pathologies that start with cholestatic jaundice.
6. In some situations, in patients with hypertension and previously undefined PN (in particular, when taking diuretics), there may be a temporary and insignificant increase in creatinine and urea in the serum part of the biological fluid.

In persons diagnosed with diabetes mellitus, who receive insulin or drink hypoglycemic agents, at the start of Perineva's therapy, the glucose indicator is clearly monitored.

Those patients who expect surgery in the near future, as a rule, cancel the medicine a day. This is due to the fact that anesthesia during surgery lowers blood pressure. If it is not possible to stop the ACE inhibitor, hypotension is corrected by an increase in BCC.

If, during therapy, the patient develops an unproductive, incessant cough, this is usually a reaction to the medication. It terminates upon its cancellation.

Gestation and lactation

Perineva is not prescribed during pregnancy. If during the course of treatment the patient becomes pregnant, the medicine is urgently canceled. If it is used by a pregnant woman in late gestation, the treatment may result in fetotoxic effects. Among them, oligohydramnios and a decrease in nephrofunctionality, as well as delayed ossification of the bones of the skull in a baby. Able to provoke the drug and neonatal toxic effects - hypotension, renal failure.

If, for one reason or another, the medication was used in the second and third trimesters, it is important to do an ultrasound of the fetus - to monitor the condition of the cranial bones and kidneys.

There is no data on whether perindopril passes into breast milk, so the drug should be discarded during lactation. Or, on the contrary, the course of treatment requires the rejection of lactation, its temporary suspension. These issues should be discussed with your doctor and gynecologist.

Can it be combined with NSAIDs

NSAIDs are a category of drugs with a particular frequency of use. These include anti-inflammatory and analgesic medications, which are used relatively often by people with different indicators of somatic health. For example, people drink Nimesulide or Diclofenac for joint pain, osteochondrosis, post-traumatic pain, etc. These compounds are also used for the so-called colds.

But not all patients think about whether it is possible to combine NSAIDs with other medications, often used courses. So, if you combine them with Perineva's treatment, a weakening of the hypotensive effect cannot be ruled out. The level of K ions in the blood may increase, causing deterioration in renal functionality. In some cases, the case turns into the development of acute renal failure. If a patient has diseased kidneys, and he drinks Aspirin along with Perineva, acute renal failure has a high probability of developing.

Therefore, before drinking an anesthetic or anti-inflammatory pill, remember that you are taking Perineva, which does not go well with them. And what can be taken in case of a cold or joint pain, check with your doctor.

What can be combined with if necessary

If there is such a request, then Perinev can be prescribed in combination with pharmaceuticals such as nitrates, beta-blockers, thrombolytics, as well as acetylsalicylic acid in doses with antiplatelet action.

In pharmacies, the medicinal product is dispensed by prescription. The price of Perinev tablets is from 210 rubles for 30 pills / 4 mg to 1000 rubles for 90 pills of 8 mg.

Driving

The medicine is associated with certain risks from the nervous system, therefore, all persons taking Perinev are not recommended to drive and work with complex mechanisms during the treatment process. It is impossible to exclude headaches, dizziness, confusion of consciousness, deconcentration. All this can lead to an emergency.

If you experience any severity of a negative reaction, hurry to contact your doctor.

Composition and form of release of the drug

Tablets white or almost white, oval, slightly biconvex, with a chamfer and a risk on one side.

Auxiliary substances of the semi-finished product-granules: hexahydrate, lactose monohydrate, crospovidone.

Excipients: microcrystalline cellulose, colloidal silicon dioxide, magnesium stearate.

10 pieces. - cellular contour packings (3) - packs of cardboard.
10 pieces. - blister packs contour (9) - packs of cardboard

pharmachologic effect

ACE inhibitor. It is a prodrug from which the active metabolite perindoprilat is formed in the body. It is believed that the mechanism of antihypertensive action is associated with competitive inhibition of ACE activity, which leads to a decrease in the rate of conversion of angiotensin I to angiotensin II, which is a powerful vasoconstrictor. As a result of a decrease in the concentration of angiotensin II, a secondary increase in renin activity occurs due to the elimination of negative feedback on renin release and a direct decrease in aldosterone secretion. Due to the vasodilating effect, it reduces OPSS (afterload), wedge pressure in the pulmonary capillaries (preload) and resistance in the pulmonary vessels; increases cardiac output and exercise tolerance.

The hypotensive effect develops within the first hour after taking perindopril, reaches a maximum after 4-8 hours and lasts for 24 hours.

In clinical studies, the use of perindopril (monotherapy or in combination with a diuretic) has shown a significant reduction in the risk of recurrent stroke (both ischemic and hemorrhagic), as well as the risk of fatal or disabling strokes; major cardiovascular complications, including myocardial infarction, incl. fatal; stroke-related dementia; severe cognitive impairment. These therapeutic benefits have been noted in both hypertensive and normal BP patients, regardless of age, gender, presence or absence of diabetes mellitus, and type of stroke.

It has been shown that against the background of the use of perindopril tertbutylamine at a dose of 8 mg/day (equivalent to 10 mg of perindopril arginine) in patients with stable coronary artery disease, there is a significant reduction in the absolute risk of complications provided by the main criterion of effectiveness (mortality from cardiovascular diseases, the incidence of non-fatal myocardial infarction and/or cardiac arrest followed by successful resuscitation) by 1.9%. In patients with a previous myocardial infarction or a coronary revascularization procedure, the absolute risk reduction was 2.2% compared with the placebo group.

Perindopril is used both in the form of monotherapy and in the form of fixed combinations with, with amlodipine.

Pharmacokinetics

After oral administration, perindopril is rapidly absorbed from the gastrointestinal tract. Cmax is achieved after 1 hour. Bioavailability is 65-70%.

In the process of metabolism, perindopril is biotransformed with the formation of an active metabolite - perindoprilat (about 20%) and 5 inactive compounds. C max perindoprilat in plasma is achieved between 3 and 5 hours after administration. The binding of perindoprilat to plasma proteins is insignificant (less than 30%) and depends on the concentration of the active substance. Vd of free perindoprilat is close to 0.2 l/kg.

Does not accumulate. Repeated reception does not lead to cumulation and T 1/2 corresponds to the period of its activity.

When taken with food, the metabolism of perindopril slows down.

T 1/2 perindopril is 1 hour.

Perindoprilat is excreted from the body by the kidneys; T 1/2 of its free fraction is 3-5 hours.

In elderly patients, as well as in renal and heart failure, the excretion of perindoprilat slows down.

Indications

Arterial hypertension.

Chronic insufficiency.

Prevention of recurrent stroke (combination therapy with indapamide) in patients who have had a stroke or transient ischemic cerebrovascular accident.

Stable coronary artery disease: reduced risk of cardiovascular complications in patients with stable coronary artery disease.

Contraindications

History of angioedema, concomitant use with aliskiren and aliskiren-containing drugs in patients with diabetes mellitus or impaired renal function (GFR<60 мл/мин/1.73 м 2), беременность, лактация, детский и подростковый возраст до 18 лет, повышенная чувствительность к периндоприлу, повышенная чувствительность к другим ингибиторам АПФ.

Dosage

The initial dose is 1-2 mg / day in 1 dose. Maintenance doses - 2-4 mg / day for congestive heart failure, 4 mg (less often - 8 mg) - for arterial hypertension in 1 dose.

Side effects

From the hematopoietic system: eosinophilia, decreased hemoglobin and hematocrit, thrombocytopenia, leukopenia/neutropenia, agranulocytosis, pancytopenia, hemolytic anemia in patients with congenital glucose-6-phosphate dehydrogenase deficiency.

From the side of metabolism: hypoglycemia, hyperkalemia, reversible after discontinuation of the drug, hyponatremia.

From the nervous system: paresthesia, headache, dizziness, vertigo, sleep disturbances, mood lability, drowsiness, fainting, confusion.

From the sense organs: visual disturbances, tinnitus.

From the side of the cardiovascular system: excessive decrease in blood pressure and associated symptoms, vasculitis, tachycardia, palpitations, cardiac arrhythmias, angina pectoris, myocardial infarction and stroke, possibly due to excessive reduction in blood pressure in patients at high risk.

From the respiratory system: cough, shortness of breath, bronchospasm, eosinophilic pneumonia, rhinitis.

From the digestive system: constipation, nausea, vomiting, abdominal pain, taste disturbance, dyspepsia, diarrhea, dryness of the oral mucosa, pancreatitis, hepatitis (cholestatic or cytolytic).

From the skin and subcutaneous fat: pruritus, rash, photosensitivity, pemphigus, increased sweating.

Allergic reactions: angioedema, urticaria, erythema multiforme.

From the musculoskeletal system: muscle spasms, arthralgia, myalgia.

From the urinary system: renal failure, acute renal failure.

From the reproductive system: erectile dysfunction.

General reactions: asthenia, chest pain, peripheral edema, weakness, fever, falls.

From the side of laboratory indicators: increased activity of hepatic transaminases and bilirubin in the blood serum, an increase in the concentration of urea and creatinine in the blood plasma.

drug interaction

The risk of developing hyperkalemia increases with the simultaneous use of perindopril with other drugs that can cause hyperkalemia: aliskiren and aliskiren-containing drugs, potassium salts, potassium-sparing diuretics, ACE inhibitors, angiotensin II receptor antagonists, NSAIDs, heparin, immunosuppressants such as cyclosporine or tacrolimus, trimethoprim.

When used concomitantly with aliskiren in patients with diabetes mellitus or impaired renal function (GFR<60 мл/мин) возрастает риск гиперкалиемии, ухудшения функции почек и повышения частоты сердечно-сосудистой заболеваемости и смертности (у пациентов этих групп данная комбинация противопоказана).

Simultaneous use with aliskiren is not recommended in patients who do not have diabetes mellitus or impaired renal function, because. possible increased risk of hyperkalemia, deterioration of renal function and increased incidence of cardiovascular morbidity and mortality.

It has been reported in the literature that in patients with established atherosclerotic disease, heart failure, or diabetes mellitus with end organ damage, concomitant therapy with an ACE inhibitor and an angiotensin II receptor antagonist is associated with a higher incidence of hypotension, syncope, hyperkalemia, and deterioration of renal function (including acute renal failure) compared with the use of only one drug that affects the RAAS. Double blockade (for example, when an ACE inhibitor is combined with an angiotensin II receptor antagonist) should be limited to individual cases with careful monitoring of renal function, potassium and blood pressure.

Simultaneous use with estramustine may lead to an increased risk of side effects such as angioedema.

With the simultaneous use of lithium preparations and perindopril, a reversible increase in the concentration of lithium in the blood serum and associated toxic effects are possible (this combination is not recommended).

Simultaneous use with hypoglycemic drugs (insulin, oral hypoglycemic agents) requires special care, because. ACE inhibitors, incl. perindopril, may enhance the hypoglycemic effect of these drugs up to the development of hypoglycemia. As a rule, this is observed in the first weeks of simultaneous therapy and in patients with impaired renal function.

Baclofen enhances the antihypertensive effect of perindopril, while the use of baclofen may require dose adjustment of the latter.

In patients receiving diuretics, especially those that remove fluid and / or salts, an excessive decrease in blood pressure may be observed at the beginning of perindopril therapy, the risk of which can be reduced by discontinuing the diuretic, replenishing the loss of fluid or salts before starting perindopril therapy, and using perindopril in low initial dose followed by a gradual increase.

In chronic heart failure in the case of the use of diuretics, perindopril should be used at a low dose, possibly after reducing the dose of the simultaneously used potassium-sparing diuretic. In all cases, renal function (creatinine concentration) should be monitored during the first weeks of ACE inhibitor use.

The use of eplerenone or spironolactone in doses from 12.5 mg to 50 mg / day and ACE inhibitors (including perindopril) in low doses: in the treatment of heart failure II-IV functional class according to the NYHA classification with left ventricular ejection fraction<40% и ранее применявшимися ингибиторами АПФ и "петлевыми" диуретиками, существует риск развития гиперкалиемии (с возможным летальным исходом), особенно в случае несоблюдения рекомендаций относительно этой комбинации. Перед применением данной комбинации необходимо убедиться в отсутствии гиперкалиемии и нарушений функции почек. Рекомендуется регулярно контролировать концентрацию креатинина и калия в крови - еженедельно в первый месяц лечения и ежемесячно в последующем.

The simultaneous use of perindopril with NSAIDs (at a dose that has an anti-inflammatory effect, COX-2 inhibitors and non-selective NSAIDs) can lead to a decrease in the antihypertensive effect of ACE inhibitors. The simultaneous use of ACE inhibitors and NSAIDs can lead to deterioration of renal function, including the development of acute renal failure, and an increase in serum potassium, especially in patients with reduced renal function. Use this combination with caution in elderly patients. Patients should receive adequate fluids; it is recommended to carefully monitor renal function, both at the beginning and during treatment.

The hypotensive effect of perindopril may be enhanced when used simultaneously with other vasodilators, including short-acting and long-acting nitrates.

Simultaneous use of gliptins (linagliptin, saxagliptin, sitagliptin, vitagliptin) with ACE inhibitors (including perindopril) may increase the risk of angioedema due to suppression of dipeptidyl peptidase IV activity by gliptin.

Simultaneous use of perindopril with tricyclic antidepressants, antipsychotics and general anesthesia agents may lead to an increase in the antihypertensive effect.

Sympathomimetics can weaken the antihypertensive effect of perindopril.

When using ACE inhibitors, incl. perindopril, in patients receiving an intravenous gold preparation (sodium aurothiomalate), a symptom complex was described, in which facial skin hyperemia, nausea, vomiting, arterial hypotension were observed.

special instructions

Carefully perindopril should be used for bilateral renal artery stenosis or renal artery stenosis of a single kidney; renal failure; systemic connective tissue diseases; therapy with immunosuppressants, allopurinol, procainamide (risk of developing neutropenia, agranulocytosis); reduced BCC (diuretics, salt-restricted diet, vomiting, diarrhea); angina; cerebrovascular diseases; renovascular hypertension; diabetes mellitus; chronic heart failure IV functional class according to the NYHA classification; simultaneously with potassium-sparing diuretics, potassium preparations, potassium-containing table salt substitutes, with lithium preparations; with hyperkalemia; surgery/general anesthesia; hemodialysis using high-flow membranes; desensitizing therapy; LDL apheresis; condition after kidney transplantation; aortic stenosis/mitral stenosis/hypertrophic obstructive cardiomyopathy; in black patients.

Cases of arterial hypotension, syncope, stroke, hyperkalemia and impaired renal function (including acute renal failure) have been reported in predisposed patients, especially when used simultaneously with drugs that affect the RAAS. Therefore, dual blockade of the RAAS by combining an ACE inhibitor with an angiotensin II receptor antagonist or aliskiren is not recommended.

Before starting treatment with perindopril, all patients are recommended to study kidney function.

During treatment with perindopril, kidney function, the activity of liver enzymes in the blood, and peripheral blood tests should be regularly monitored (especially in patients with diffuse connective tissue diseases, in patients who receive immunosuppressive drugs, allopurinol). Patients with sodium and fluid deficiency should be corrected for fluid and electrolyte disturbances before starting treatment.

Pregnancy and lactation

Perindopril is contraindicated for use during pregnancy and lactation (breastfeeding).

Application in childhood

Contraindicated in childhood.

For impaired renal function

In case of impaired renal function, a correction of the dosing regimen is required, depending on the CC values.