Perineva - effect on the body, indications and contraindications, side effects and reviews. Use in children

Arterial hypertension - serious illness, which forces people suffering from it to take antihypertensive drugs. Currently, a medicinal substance for hypertension is Perinev's tablets.

The main active ingredient of this drug is perindopril, belonging to the class (angiotensin-converting enzyme).

Indications and contraindications, the features of taking the drug are described by the instructions for use that come with Perinev's tablets. At what pressure to drink them, you can ask your doctor. Reception of funds should be started only after consulting a specialist and the necessary examination.

Composition, manufacturer and form of release

Perineva tablets are produced by KRKA-RUS. The instructions for use indicate that the composition of the product includes the following components:

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

Tablets called Perineva, white on both sides, convex with a little line of two, eight and 4 mg. The blister consists of ten, fourteen or thirty tablets. The package usually contains thirty and ninety pieces.

What is Perinev's medicine for?

Doctors often prescribe a pill called Perineva. What this drug is from - a question arises for many users.

According to the instructions for use, they should be taken with elevated blood pressure, since they tend to normalize pressure both during systole and during diastole, as well as peripheral vascular resistance in general. In this case, the peripheral movement of blood increases, but the pulse remains at the same level.

The maximum amount of the active substance of tablets called Perinev according to the instructions for use in the blood is observed after sixty minutes. Absorbed in the stomach as soon as possible. Greatest effect, lasting 24 hours, occurs four to six hours after ingestion.

According to the instructions for use, blood pressure stabilizes after about thirty days from the start of use. This normalizes the condition of the heart muscle. There is no withdrawal syndrome. Excretion of the drug occurs through the kidneys.

At what pressure is it taken?

Tablets called Perineva according to the instructions for use are prescribed at a pressure above normal: from 140/90. Previously, the concept of "working pressure" was widely used in medicine. Now it is not used, as therapists believe that in order to avoid possible complications hypertension and reduce the likelihood lethal outcome from pathologies of the heart and blood vessels, one should strive for target indicators. With very high blood pressure and poor tolerance for a sharp decrease, it is lowered in stages.

From two to four weeks, the pressure according to the instructions is reduced by ten to fifteen percent of the original figures, after which the patient is given a month to get used to this level. In the future, the rate of decline is selected in individually. It is not recommended to reduce blood pressure too low, this can provoke a stroke and myocardial infarction.

Indications

What diseases are Perinev's tablets recommended for? Indications for use are as follows:

• with an increase in blood pressure;
• in order to prevent repeated circulatory disorders in the brain;
• at chronic course severe cardiac pathologies;
• with stable .

Instructions for use

Perinev, the manufacturer of which has created a very convenient package with instructions for use, is taken once a day, inside before meals. Perinev tablets, the release form of which exists in 2 mg, 4 mg and 8 mg, have their own application features. According to the instructions, they are:

• individual selection of dosage;
• both monotherapy and use with other drugs are possible;
• stop the use of diuretics before treatment with Perineva;
• do not take earlier than two weeks after circulatory disorders of the brain;
• take into account the condition of the heart and kidneys before the appointment.

The instructions for use of Perineva indicate that the dosages are individual for each patient. It depends on the severity of the course of the disease and the response to the reception. medicinal substance.

With hypertension, according to the instructions for the use of Perineva, only this medicine can be used or in combination with other medicines that lower blood pressure. The initial appointment of Perinev is 4 mg per day. If, after a month of use, the treatment is unsuccessful, it is permissible to increase the daily dose of Perineva to 8 mg or more (if the initial dose is transferred normally).

Before using the remedy, you need to stop using diuretics at least a few days in advance. Their joint use according to the instructions for use can dramatically reduce blood pressure. Often a completely correct question arises for those who are treated with Perinev's tablets: how to take this medicine.

For a patient diagnosed according to the instructions for use, the first dose of Perineva is preferably carried out under the supervision of a cardiologist or therapist. Perinev's medicine is started with 2 mg. It is permissible to increase to 4 mg no earlier than after seven days.

To prevent the recurrence of circulatory disorders in the brain, the drug is indicated for use in two mg. Start taking medication after a stroke no earlier than 14 days later.

When taking Perinev, the dosages of which are selected individually, starting from 4 mg. The dose is doubled only after 2 weeks (8 mg) under the control of the kidneys.

In case of kidney disease, according to the instructions, the amount of the drug taken is prescribed individually, taking into account the degree of damage and the diagnosis. The patient's condition must be constantly monitored.

Complications arterial hypertension

Dosages

Depending on the diagnosis, dosages for Perinev's tablets for use are selected as follows:

• - initial amount - 4 mg;
• elderly patients - from 2 mg;
• severe disorders of cardiac activity occurring chronically - from 2 mg;
• preventive measures to help avoid recurrent stroke - from two milligrams;
• kidney disease - 2-4 milligrams per day.

Many users are interested in what is the duration of Perinev's tablets. The duration of the use of any medicinal substance, including Perinev's tablets, according to the instructions for use, is prescribed only by a doctor after serious examinations and monitoring of the patient, the reaction of his body to these tablets. As antihypertensive drug can be used for a long time: its action lasts 24 hours, which is very convenient. According to the instructions for use, the drug is taken under regular monitoring of kidney function, the patient's health and well-being.

Side effects

What will happen if you independently, not according to the instructions for use, increase the dose of Perinev tablets recommended by the doctor? The composition of the drug is such that it rarely causes side effects, but they do happen. Overdose according to the instructions for use causes:

• a sharp decrease in pressure, up to collapse;
• development of renal failure;
• violation of lung ventilation.

Both bradycardia and tachycardia are possible, cough, anxiety, dizziness are not excluded.

If for some reason an overdose has occurred, according to the instructions for use, the patient is placed with raised legs. Next, the volume of circulating blood (VCC) is replenished with the help of solutions injected into the vein. Angiotensin II is also administered intravenously, if it is not available, catecholamines.

If the patient takes these pills, he should know what side effects Perinev has:

• dry cough, ;
• soreness in the head, dizziness;
• noise in ears;
• asthenia;
• drop in blood pressure;
• dyspeptic disorders;
• skin rashes;
• convulsions.

How safe is the use of Perinev's medicine? Side effects occur infrequently and do not always require discontinuation of the drug. But in case of their occurrence, it is necessary to consult a specialist.

Alcohol and pressure pills: compatibility

Patients are often interested in whether it is possible to combine the use of Perinev's tablets and alcohol. The compatibility of alcohol and blood pressure lowering agents has long been a subject of controversy. The instructions for use of the substance say that alcohol can lead to a more intense decrease in pressure. Therefore, it can cause overdose symptoms in a person:

• a sharp drop in blood pressure, collapse;
• failure of the kidneys;
• slow heart rate;
• decrease in the amount of sodium in the blood;
• dizziness;
• cough;
• increased potassium levels;
• cardiopalmus;
• anxiety;
• increased ventilation of the lungs.

And, conversely, if you take Perinev's tablets and alcohol at the same time, this will lead to more severe intoxication.

At the same time, the body of a patient who consumes alcohol has become accustomed to its vasodilating effect, which could lead to a sharp decrease in pressure. Therefore, the combination of Perineva and alcohol according to the instructions for use will not have such an effect on him as is possible in a non-drinking patient.

Reviews of patients taking the drug

Doctors often prescribe medication Perineva. Reviews of patients taking the drug are varied. But it is indispensable when you need a mild remedy that rarely causes side effects. If you believe the instructions for use, then Perineva is just that.

For example, one user writes that she has been taking Perineva for three months. One month after the start of the use, her blood pressure leveled off within 24 hours and did not rise above 130/80. Prior to that, it increased every evening.

In this case, the patient successfully picked up the medicine. But it should be noted that Perineva's treatment will not eliminate the causes of the disease, but will only dull the signs. Hypertension often occurs with an unhealthy lifestyle. You need to reconsider your diet, daily routine, stop smoking.

If you look further at what patients think about Perinev's tablets, the reviews confirm that not everyone is happy with the drug. Most often this comes from ignorance of the features of the tool. So, a patient with hypertension wrote that Perineva was being treated for the fourth month. Previously, the level of blood pressure did not rise above 130/85. But recently, with weather changes, the pressure began to rise and reach 170/110, headaches and other signs of hypertension appeared. These pills, in his opinion, do not significantly lower blood pressure. He wants to switch to another remedy, stronger.

In this case, it is necessary to seriously examine, go to the doctor for a consultation and follow his recommendations. important healthy lifestyle life. This will be the main treatment for hypertension. And medicines only supplement it. If you continue to move a little and eat at random, then after a couple of years the pressure can get out of control and no drugs will help.

And here's what another user is talking about. She turned to her local physician with complaints of high blood pressure, persistent headaches, shortness of breath during physical activity. The doctor prescribed treatment for Perineva. In Latin, she provided a prescription to a pharmacy, where she was sold Perinev 8 mg tablets. She took Perineva for hypertension for six months according to the instructions for use. The pressure at that time kept well, never rose above 145/95. But tormented persistent cough. The doctor said to switch to another remedy and add a diuretic. She has now started treatment with another drug. How this will affect her health is still unknown.

How effective this or that drug is cannot be predicted in advance. Currently, drugs for pressure are selected, taking into account the instructions for use, trial and error, but, unfortunately, they have not yet come up with another approach. Each person's body reacts differently to a particular drug.

Drug analogues

What can replace Perinev's tablets? Analogues of the remedy can be found in almost any pharmacy. The most popular among them are: Prestarium, Lorista, Enalapril, Perindopril, Ko-perineva.

Prestarium is a well-known analogue of Perinev's tablets. Patients often have a question: Perineva or Prestarium, which is better? This question cannot be answered unambiguously.

Prestarium is produced by the French company Servier. This well-known remedy to reduce pressure, having one active ingredient with Perineva. But the second drug is somewhat cheaper. What is more suitable for a particular patient, only a doctor can decide.

Lorista

Many hypertensive patients are interested in Perineva and Lorista, which is better, and what to choose. It is quite possible to replace Perineva with Lorista, as well as vice versa. So is there an answer to the question: Perineva or Lorista, which is better? For each hypertensive patient, the most suitable is what stabilizes pressure more effectively and for a long time. And it depends on individual characteristics organism.

Enalapril is a drug that lowers blood pressure, which is quite often used. There is no exact answer to the question, Perinev's tablet or Enalapril - which is better. It depends on many reasons, that is, to whom what suits. Perineva has a higher cost and acts more gently. Enalapril is cheaper.

Perineva and Perindopril, which is better? It is not easy to choose a drug for long-term use in order to normalize blood pressure. Perineva and Perindopril have the same active ingredient. In this case, we can also say that Perindopril can replace Perineva, and what will work better depends on the individual characteristics of the organism.

Thanks to the monotherapeutic use of Perineva, it is possible to achieve normalization of blood pressure in patients with the first and second stages of hypertension in almost half of the cases. Perindopril and Indapamide (thiazide diuretic) are combined very effectively. To make it most convenient for the patient, the combination of Koperineva is released in one tablet.

Useful video

For more information on the symptoms and treatment of hypertension, see this video:

Conclusion

1. Tablets from the pressure of Perinev according to the instructions for use are used to reduce blood pressure. They quickly normalize the pressure. Therapeutic effect continues for days.
2. Alcohol and other drugs can increase its effect. As a result, the risk of developing overdose symptoms increases.
3. Any drug must be prescribed by a doctor. Therefore, if you adhere to the recommended doses, the drug is well tolerated, quickly reduces blood pressure, rarely causes side effects.

At present, rather wide sections of the population of different social foundations, wealth, and level of education suffer from arterial hypertension. Nor can it be said that this disease affects only the elderly, as it was, say, in the last century. Modern life rapidly, global tasks, high technologies, the desire to do as much as possible today in order to do even more tomorrow do not allow the body to fully relax. In conditions of constant stress and work at the limit physical abilities and develops Who of pays attention to the fact that the head often hurts? It hurts for a day, two, a week, a month, and when, finally, a person goes to the doctor, then it becomes clear that arterial hypertension is already taking place.

Modern medicine is ready to offer hypertensive patients a lot of drugs to stabilize blood pressure, one of which is Ko-Perineva. Instructions for use contains full information about the possibilities, contraindications and side effects.

Composition and form of release

The main active ingredients of the drug are indapamide and perindopril erbumine. In addition, tablets additionally contain semi-finished granules (in the form of crospovidone, lactose monohydrate and calcium chloride hexahydrate) and a number of excipients.

Release form medicinal product- round biconvex white tablets. Offered in multiple dosages. The buyer can purchase a medicine in pharmacies with a dose of active substances of 0.625 + 2 mg, respectively, 1.25 + 4 or 2.5 + 8 mg.

In general, it must be said that French doctors have developed and successfully use the drug "Noliprel A", and its Russian analogue- "Ko-Perineva".

Pharmacodynamics

Perindopril is it promotes vasodilation, as a result of which blood pressure decreases and, accordingly, the load on the heart decreases. 4-6 hours after taking the medication, the maximum effect develops, which can be maintained throughout the day. Indapamide belongs to the group of thiazide-like diuretics. In addition, this substance can improve the elasticity of the vascular walls, which also helps to lower blood pressure.

Like not any of its analogues, "Ko-Perineva" does not affect the processes of fat and carbohydrate metabolism. In addition, the presence of indapamide does not cause great harm water-salt balance body, which cannot be said about other diuretic drugs. Treatment with this combined remedy("Ko-Perineva") does not contribute to the development of tachycardia, the state of the heart muscle stabilizes, and its ability to endure stress improves.

Who should refrain from applying?

The drug is very effective for the treatment of arterial hypertension, however, it also has a list of contraindications. "Ko-Perineva", analogues containing the same active ingredients, should not be taken by people with hypersensitivity to any components of the drug. Also, the drug is not prescribed for those who suffer from lactose intolerance or deficiency, glucose-galactose malabsorption, stenosis renal arteries, hepatic or kidney failure. A contraindication for the use of "Co-Perinev" is the patient's refractory hyperkalemia (excess potassium in the body), a predisposition to development (the body's reaction to the effects of chemical and biological factors, very often has an allergic nature).

Do not prescribe "Ko-Perinev" and those patients who suffer from azotemia (the blood contains nitrogenous products of metabolism above the permissible limits, which must be excreted by the kidneys) and anuria (urine does not enter bladder). The effectiveness and safety of Ko-Perinev has not been established ( similar preparations can be used if results are available clinical research) for patients under 18 years of age, pregnant and lactating women. Therefore, for these groups of people, the medication is prohibited.

Possible side effects

Most often, as negative effects that the medication itself can provoke or cheap analogue"Ko-Perineva" - tablets "Perindopril plus Indapamide" - you can name certain side effects from the side various organs and body systems. The most common reactions from the side of the central nervous system are headaches, dizziness, weakness, and sensory disturbances. From the side of the senses, you can hear about tinnitus, impaired visual perception. Pronounced decrease in blood pressure - possible reaction of cardio-vascular system.

A dry, irritating, non-productive cough signals a reaction in the respiratory system. Enough big list deviations can be observed from the side gastrointestinal tract. Here, regarding the reaction to the Ko-Perinev remedy (analogues), patient reviews speak of nausea, vomiting, diarrhea, frequent constipation, pain in the abdomen and epigastric region, changes taste sensations, The musculoskeletal system can remind of itself with convulsions.

Various side effects are possible in the form skin rashes of varying intensity, itching, swelling of the face, mucous membranes of the mouth, uvula of the upper palate or larynx.

Dosing regimen

Dosage of the drug (any analogue of "Ko-Perinev" can be taken according to a different scheme) - 1 tablet during the day. It is best to do this in the morning, before breakfast, with water. Most often, the scheme is developed based on the ratio "indapamide / perindopril". First, the patient is prescribed tablets with a dosage of 0.625 / 2 mg. If after a month it was not possible to achieve control over blood pressure, the dose is increased to one tablet at a dose of 1.25/4 mg. To achieve an effective result, the dosage can be increased to a maximum daily dose of 2.5/8 mg.

Elderly patients begin treatment with one tablet at a dosage of 0.625/2 mg. Therapy begins and is carried out under the constant control of blood pressure and kidney function.

If the patient suffers from renal insufficiency moderate degree, therapy also begins with a dosage of 0.625 / 2 mg, however, the maximum allowable dose during the day should not exceed 1.25 / 4 mg.

Exceeding the permissible dose: symptoms, treatment

Symptoms of an overdose of medication that have occurred are the presence of nausea, vomiting, development muscle cramps. Drowsiness, dizziness, confusion, oliguria (a decrease in the volume of urine excreted by the kidneys), a decrease in water and electrolyte balance, and a drop in blood pressure are possible. Any analogue of "Ko-Perinev" may have other symptoms in case of an overdose.

To eliminate the consequences, it is recommended to wash the stomach and take absorbent drugs. It is also necessary to restore. If there is a strong drop in blood pressure, the patient needs to lie on his back and raise his legs. The attending physician may deem it necessary to administer a 0.9% sodium chloride solution. There is information about the effectiveness of hemodialysis.

Pregnant and lactating women

"Ko-Perineva" instructions for use prohibits pregnant women and nursing mothers from taking. The use of this medication during the period of bearing a child can provoke the development of fetoplacental ischemia, and, as a result, increase the risk of slowing down the development of the fetus. If we are talking about a nursing mother, it must be borne in mind that indapamide is excreted from breast milk. If, nevertheless, the use of "Ko-Perinev" during lactation is an urgent need, you will have to give up breastfeeding.

Special Instructions

The use of "Ko-Perinev" in parallel with any is unacceptable. In case of violations in the functioning of the kidneys, the medication should also not be taken. If a patient with a diagnosis of arterial hypertension against the background of the use of Ko-Perinev has symptoms of renal failure, treatment should be stopped immediately. A little later, you can try to resume taking the medication in minimal doses or switch to monotherapy with indapamide and perindopril. In such patients, every 2 weeks it is necessary to control the level of potassium and creatine in the blood.

In patients with diabetes or renal failure "Co-Perinev" (including analogues) can provoke the development of hypokalemia. Therefore, such people require constant monitoring of the level of potassium in the blood.

Interaction with other substances

Do not use perindopril in conjunction with potassium-sparing diuretics and potassium preparations. Also, with great care, the medication itself (and any analogue of the drug "Co-Perinev") is prescribed together with insulin and other hypoglycemic agents. Joint reception medication with cytostatic immunosuppressants can cause the development of leukopenia. When using the drug and medicines for general anesthesia there is a possibility of an increase in the hypotensive effect.

Application contrast agents with a high content of iodine can be an impetus for the development of renal failure.

Medicines-analogues

The most commonly used and known to a wide range of consumers analogue of "Ko-Perinev" is "Noliprel A". Dosage (ratio "perindopril / indapamide" from original manufacturer"Servier" France) can be 2.5 / 0.625 mg, 10 / 2.5 mg, 5 / 1.25 mg. Also, this drug is produced in the Russian Federation ("Serdics") in the same dosage as the original.

Another famous similar medication- "Perindopril plus Indapamide" from a Russian manufacturer. For the above ratio, dosages of 1.25/4 mg, 2.5/0.008 mg, 0.625/0.002 mg, 8/2.5 mg are possible.

Price range

The dosage and number of tablets in a package are the main factors affecting the price of the drug "Ko-Perinev". The instruction (analogues may differ slightly in dosage) describes the possible ratios of the two main components - perindopril and indapamide. For example, 30 tablets with a ratio of 0.625 / 2 mg will cost the buyer 350 rubles. A medicine with a dosage of 1.25 / 4 mg will cost 390-440 rubles. The largest ratio of 2.5 / 8 mg is from 470 to 510 rubles for 30 tablets. Naturally, packs of 90 tablets will cost customers much more.

The French original "Noliprel A" will cost consumers much more.

Consumer opinion

Medication "Ko-Perinev" instructions for use, patient reviews in most cases are characterized as modern and very effective drug to normalize blood pressure. The drug is convenient to use: I took one tablet in the morning, and is free until next day. In addition, at a cost, Ko-Perinev is available to a wide range of consumers with different financial capabilities, which cannot be said about Noliprel A from a French manufacturer.

However, they are not uncommon and negative feedback, which are most often associated with the manifestation side effects in the form of headaches, swelling of the face and limbs, reactions from the gastrointestinal tract. In such cases, it is necessary to stop treatment and seek medical advice. After examining and assessing the situation, the specialist will decide whether to resume taking the drug "Co-Perineva" with a reduced dosage, or it is better to pay attention to other medicines with similar characteristics and expected treatment results.

Perineva is a drug intended for the treatment of high blood pressure. Perineva's active ingredient, perindopril, belongs to the class of angiotensin-converting enzyme (ACE) inhibitors. The drug is produced by the Slovenian company KRKKA, which has a production branch in Russia.

Regulation of blood pressure in the body

To understand exactly how the remedy works, you need to know how blood pressure is regulated in the body. Regulation mechanisms are systemic and local. Local act at the level vascular wall and "correct" the result of the work of systemic mechanisms, based on the momentary needs of a particular body.

Systemic mechanisms regulate blood pressure at the level of the body as a whole. According to the mechanism of action, they are divided into nervous and humoral. As the name suggests, neural mechanisms regulated by the peripheral nervous system. Humoral mechanisms regulate systemic blood flow with the help of active substances dissolved in the blood.

One of the main mechanisms that controls systemic blood flow and, as a result, regulates blood pressure is the Renin-Angiotensin-Aldosterone system.

Renin is a hormone-like substance that is produced in the cells of the arterioles of the vascular glomeruli of the kidneys. It is also synthesized by the endothelium inner shell vessels of the brain, myocardium, glomerular zone of the adrenal cortex. Renin production is regulated by:

• The pressure in the blood-bearing vessel, namely, the degree of its stretching;
• The content of sodium in the distal tubules of the kidneys - the more it is, the more active is the secretion of renin;
• Sympathetic nervous system;
• By the principle of negative feedback, reacting to the content of angiotensin and aldosterone in the blood.

Renin transforms the angiotensinogen protein synthesized by the liver into the inactive hormone angiotensinogen I. With the blood flow, it enters the lungs, where, under the action of angiotensin-converting enzyme (ACE), it is converted into active angiotensin II.

Functions of angiotensin II:

• Narrows arteries, including coronary;
• Causes myocardial hypertrophy;
• Stimulates the release of vasopressin (aka antidiuretic hormone) in the pituitary gland, which retains water in the body, reducing its excretion by the kidneys;
• Stimulates the production of aldosterone in the adrenal glands

Aldosterone, which is produced under the action of angiotensin II, is the most important regulator of extracellular fluid volume in the body. It increases readsorption ( reverse suction) sodium and water in the kidneys. The volume of circulating blood increases, which, in turn, further increases the pressure.

Perineva: how it works

Perineva blocks ACE, thus reducing the amount of angiotensin II in the body and eliminating it vasoconstrictive effects. In parallel, the secretion of aldosterone decreases, the retention of sodium and fluid in the body decreases. This reduces the volume of circulating blood and, as a result, reduces the pressure in the arterial system.

In general, the effects of the drug can be divided into the following groups:

Changes in the cardiovascular system:

Effects from the kidneys:

• Normalization of intraglomerular hemodynamics;
• Reducing proteinuria.

From the endocrine system:

• Decreased tissue resistance to insulin (important for patients with metabolic syndrome and type 2 diabetes)
• prevention of angiopathy and nephropathy caused by diabetes.

From other metabolic processes:

• Increased excretion by the kidneys uric acid(important for gout patients);
• Anti-atherosclerotic action: reduces cell permeability inner wall(endothelium) of blood vessels and reduces the amount of lipoproteins in them.

With prolonged regular use, Perineva exhibits the so-called chronic antihypertensive effect. Decreased proliferation and growth of smooth muscle cells middle wall arteries, which increases their lumen and restores elasticity.

A decrease in arterial wall hypertrophy, together with the already mentioned decrease in myocardial hypertrophy, reduces hemodynamic resistance in peripheral vessels, and therefore blood pressure also decreases.

How to use Perineva

• arterial hypertension,
• For cardioprotection in chronic heart failure,
• For cardioprotection after myocardial infarction or surgery coronary arteries subject to the stability of the ischemic process,
• To prevent recurrence of stroke in patients who once had it.

When to start using Perineva

The main indication for this is arterial hypertension. It is understood as an increase in systolic, “upper” blood pressure > 140 mm Hg. st and / or diastolic, “lower” blood pressure> 90 mm. rt. Art. An increase in pressure can be secondary, caused by diseases of other organs (glomerulonephritis, adrenal tumors, etc.) and primary, when it is impossible to identify and eliminate the cause of the disease.

Primary (essential) hypertension accounts for 90% of all cases of high blood pressure and is referred to as hypertension. Ministry of Health of the Russian Federation in clinical guidelines from 2013 offers the following criteria for its diagnosis:

Thus, the indication for the use of perindopril (Perineva) is a regular isolated increase in systolic blood pressure to 140 mm or more. rt. Art., or diastolic up to 90 mm. rt. Art. and more.

Reception regimen and principles of dose selection

Recommended figures for target blood pressure are less than 140/90 (for patients with diabetes mellitus - less than 140/85). The previously used concept of “working pressure” was recognized as incorrect - to prevent complications and reduce the likelihood cardiovascular death targets must be achieved. If the pressure is excessively high and its abrupt normalization is poorly tolerated, the correction is carried out in several stages.

In the first 2-4 weeks, blood pressure drops by 10-15% of entry level, then the patient is given a month to get used to such pressure values. Further, the rate of decline is selected individually. The lower limit of the decrease in SBP is 115-110 mm Hg, DBP is 75-70 mm Hg, with excessive low levels again increases the risk of myocardial infarction and stroke.

The medicine is taken once a day, in the morning. The initial dosage is 4 mg, for pensioners - 2 mg, gradually increasing to 4 mg. Patients taking diuretics should stop using them 2-3 days before the start of the course of Perineva, or start treatment with a dosage of 2 mg, also gradually increasing to 4 mg. According to the same principle, doses are selected for patients suffering from chronic heart failure.

After a month of regular intake, the effectiveness of the drug is evaluated. If the target blood pressure is not achieved, it is necessary to switch to a dosage of 8 mg.

For patients with stable coronary artery disease, Perineva is prescribed at a starting dosage of 4 mg, after 2 weeks they switch to 8 mg.

Contraindications:

special instructions

Perineva can provoke an excessive decrease in blood pressure when:

• cerebrovascular pathologies,
• Simultaneous use of diuretics,
• Loss of electrolytes: after a salt-free diet, vomiting or diarrhea,
• After hemodialysis,
• Stenosis of the mitral or aortic valves - since cardiac output in these conditions cannot increase, it is not able to compensate for the decrease in peripheral vascular resistance,
• renovascular hypertension,
• Chronic cardiovascular insufficiency in the stage of decompensation.

May exacerbate renal failure in patients with bilateral renal artery stenosis or stenosis of the artery to a single kidney.

May provoke anaphylactoid reactions in patients undergoing desensitization therapy with allergens, patients on hemodialysis using high-flow membranes, patients of the black race.

Perinev should be used with extreme caution in women of childbearing age. Planned pregnancy is an indication for changing the antihypertensive drug.

Overdose and side effects

In case of an overdose, blood pressure drops excessively, up to shock, kidney failure develops, respiratory intensity decreases (hypoventilation), heart rate can change both in the direction of tachycardia and bradycardia, dizziness, anxiety, and coughing are possible.

In case of an overdose, it is necessary to lay the patient down, raising his legs, replenish the BCC, intravenous administration solutions. Angiotensin II is also administered intravenously, in its absence - catecholamines.

Side effects:

Perineva's analogs

To date, more than 19 registered medicines based on perindopril. Here are some of them:

• Prestarium. The drug, manufactured by the French company Servier, was the first drug based on perindopril that appeared at the disposal of doctors. It was on this drug that all studies were conducted on the effectiveness of perindopril, reducing cardiovascular risk (a decrease of 20% was proven), positive impact on the condition of the walls of blood vessels. The cost is from 433 rubles.
• Perindopril-Richter. Production of the Hungarian company "Gedeon-Richter". Price from 245 rubles.
• Parnavel. Production Russian company Ozone. Price from 308 rubles.

Choosing from options optimal in terms of price and quality, it must be remembered that today, of all manufacturers of generic drugs, the bioequivalence (compliance with the original medicine) of its product has been proven only by KRKKA.

The cost of Perineva in pharmacies is from 244 rubles.

Ko-Perineva

Monotherapy with perindopril (Perineva) allows achieving the target values ​​of blood pressure in patients with 1-2 stages of hypertension in 50% of cases. In addition, often the therapy of arterial hypertension should immediately begin with a combination of two active substances.

The combination of perindopril and indapamide (thiazide diuretic) has proven to be one of the most effective. For the convenience of patients, this combination is available as a single tablet.

Co-perinev is produced in 3 dosages:

1. Perindopril 2 mg + indapamide 0.625 mg;
2. Perindopril 4 mg + indapamide 1.25 mg;
3. Perindopril 8 mg + indapamide 2.5 mg.

The cost in pharmacies - from 269 rubles.

Used to treat arterial hypertension. Dosage selection is carried out individually, according to the same principles as in monotherapy.

Contraindications

In addition to those already indicated for perindopril, for Ko-perineva:

• Azotemia, anuria;
• Liver failure.

Side effects

In addition to the adverse events characteristic of perindopril, Ko-perinev can cause:

• hemolytic anemia, hemorrhagic vasculitis- rarely;
• Photosensitivity, erythema multiforme - very rare;

Perinev tablets have a cardioprotective and vasodilating effect, and also show a hypotensive effect.

The basis of the drug includes components: perindopril, lactose, calcium salt of hydrochloric acid, povidone (enterosorbent), pyrogenic silicon dioxide, microcrystalline cellulose, magnesium stearate.

Stabilization of blood pressure is observed after a month of treatment. Regular intake of the drug helps to reduce hypertrophic changes in the heart muscle. The appointment of long treatment courses can reduce the severity of interstitial pulmonary fibrosis, while normalizing the isoenzymes of fibrillar proteins, which are the main components of contractile muscles.

Clinical and pharmacological group

Perineva has a hypotensive, vasodilating and cardioprotective effect.

Terms of dispensing from pharmacies

Released by prescription.

Prices

How much does Perineva cost in pharmacies? The average price is at the level of 250 rubles.

Release form and composition

Perineva is produced by KRKA (Slovenia) in the form of tablets that are taken orally. Each tablet, regardless of dosage active substance painted in White color, round shape. Packs of 30 or 90 tablets, plus official instruction by application.

Perindopril ( international name Perindopril) is an active ingredient that has everything pharmacological actions medicines. Included in the preparation Perineva (in Latin INN - Perineva) in the amount of 2, 4, 8 mg. Combined forms of Co-Perinev are produced, containing Perindopril in the indicated doses and Indapamide (diuretic) in the amount of 0.625; 1.25 or 2.5 mg.

Other Ingredients:

• silicon oxides;
• lactose;
• cellulose;
• magnesium stearates;
• povidone;
• calcium chloride.

Ko-Perineva

It should be noted that Perineva's therapy is effective only in 50% clinical cases. To achieve a more stable result, the treatment of hypertension stages 1 and 2 is carried out in two active ingredients. The most effective combination is perindopril and indapaid. It is this combination of active ingredients that is presented in Ko-Perinev tablets.

The drug is presented in three dosages:

• Perindopril 2 mg, indapamide 0.625 mg;
• Perindopril 4 mg, indapamide 1.25 mg;
• Perindopril 8 mg, indapamide 2.5 mg.

Ko-Perinev is prescribed as the main medication for the treatment of hypertension.

Pharmacological effect

Perineva's active substance, perindopril, belongs to oxopeptidases, is an ACE inhibitor or kininase inhibitor. He can convert angiotensin to a vasoconstrictor and destroy the vasodilator bradykinin to an inactive hectapeptide substance. This effect leads to a decrease in the level of angiotensin, aldosterone secretion and an increase in the activity of renin in the blood plasma, the prostaglandin system.

Perindopril reduces systolic and diastolic pressure, accelerates peripheral blood flow without increasing heart rate. The maximum effect after taking the tablets occurs after five hours and persists throughout the day. Stabilization of health is observed after a month of therapy, the termination of which is not accompanied by a withdrawal syndrome. Perindopril reduces left ventricular myocardial hypertrophy, the severity of interstitial fibrosis, the concentration of uric acid in hyperuricemia.

Indications for use

Among the main indications for the use of the drug are the following:

• for the prevention of relapse;
• with stable coronary artery disease;
• to prevent recurrent stroke, while the drug can be used exclusively in combination therapy together with indapamide drugs.

With monotherapy and complex treatment may be appointed various dosages medication according to the patient's condition. In some cases, despite a suitable diagnosis, the doctor may prohibit taking Perineva. This risk is especially high in the elderly.

Contraindications

The following conditions are considered complete contraindications to the use of the drug: lactation;

• children under 18 years of age;
• galactose intolerance;
• allergies;
• pregnancy;
• syndromes of malabsorption of galactose and glucose;
• lactase deficiency;
• angioedema when using other drugs in this group.

Relative contraindications (taken with caution) are the following conditions: cardiomyopathy;

• anesthesia;
• diseases affecting connective tissues;
• persons over 60;
• diabetes;
• failure of the kidneys;
• reduced sodium levels;
• reduced volume of circulating blood;
• increased levels of potassium in the blood;
• heart failure in the stage of decompensation;
• cerebrovascular disease;
• kidney transplants.

Use during pregnancy and lactation

According to the instructions, Perineva is contraindicated during pregnancy. If pregnancy occurs, the drug should be discontinued immediately. The use of perindopril in the second and third trimesters of pregnancy can lead to the development of fetotoxic (oligohydramnios, impaired renal function, slowing down the process of ossification of the fetal skull) and neonatal toxic (hyperkalemia, arterial hypotension, renal failure) effects.

Dosage and method of application

The instructions for use indicate that Perinev tablets should be taken in morning time before breakfast, without chewing or grinding, drinking plenty of water. The drug is taken 1 time per day, starting with a minimum dose of 2 mg, gradually increasing if necessary. Maximum daily dose should not exceed 8 mg.

1. 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, it is necessary to stop taking diuretics at least 3 days in advance, since joint application these drugs can lead to arterial hypotension. Elderly patients are not recommended to take a dose higher than 2 mg per day at the beginning of the course. If necessary, with normal tolerance, you can increase to 4 mg, and then up to 8 mg.
2. 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.
3. 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.
4. The recommended dose for coronary artery disease is 4 mg. When monitoring kidney function, after two weeks, the dose can be doubled (8 mg).

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.

Side effects

In general, the drug is normally tolerated by patients, however, adverse reactions may occur during therapy:

1. On the part of the respiratory system - cough, shortness of breath, bronchial obstruction and bronchospasm;
2. From the nervous system - dizziness and headaches, drowsiness, lethargy, emotional instability, seizures may develop;
3. From the organs genitourinary system- violation of potency in men and libido in women, the development of nephritis, renal failure, an increase in the level of creatinine in the blood;
4. From the side digestive system- pain in the epigastric region, nausea, heaviness in the stomach, dry mouth, sometimes vomiting, diarrhea or constipation, abnormal liver function;
5. Allergic reactions - the development of urticaria, Quincke's edema, skin rash, skin itching.

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.

special instructions

Before you start using the drug, read the special instructions:

1. 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.
2. In patients who are to surgery using general anesthesia, the drug should be canceled the day before the upcoming surgery.
3. Against the background of treatment with Perinev, the development of persistent, unproductive cough, which ceases after discontinuation of therapy. This fact must be taken into account when diagnosing cough.
4. In patients with diabetes mellitus taking oral hypoglycemic drugs or insulin, during the first months of therapy with Perineva, it is necessary to control the level of glucose in the blood.

During treatment with the drug, dizziness or an excessive decrease in blood pressure may develop, which may affect the patient's ability to drive vehicles and work with other technical means.

drug interaction

The drug can interact with other drugs, enhancing or weakening them or their own effect. This effect is also important to consider when simultaneous reception multiple drugs at once.

Here are some examples of interaction:

1. With immunosuppressants: the risk of developing leukopenia increases.
2. When used with neuroleptics: the hypotensive effect is enhanced.
3. When used with drugs for general anesthesia: the general hypotensive effect is enhanced.
4. When used with diuretics: hypovolemia may occur, or blood pressure may decrease.
5. When used with potassium-sparing diuretics: the potassium content in the blood may increase - and this is very dangerous.
6. With insulin: increased glucose tolerance may increase, as well as a decrease in insulin requirements.
7. With baclofen: the latter has an increased hypotensive effect, as a result of which blood pressure may change significantly;
8. With metformin: functional type renal failure may occur. A similar effect occurs with the use of iodine-containing contrast agents.
9. 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.
10. When used simultaneously 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.

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.

pharmachologic effect

Antihypertensive drug. Perindopril is an ACE inhibitor, or kininase II, belongs to oxopeptidases. It converts angiotensin I into the vasoconstrictor angiotensin II and destroys the vasodilator bradykinin to an inactive hectapeptide. Suppression of ACE activity leads to a decrease in the level of angiotensin II and an increase in plasma renin activity (suppressing the negative feedback 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 prostaglandin system is activated.

Perindopril renders 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 dose of the drug. The hypotensive effect persists for 24 hours, and after 24 hours the drug still provides from 87% to 100% 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.

At long-term use 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 elasticity large arteries, eliminates structural changes in small arteries.

Perindopril normalizes the work of the heart, reducing pre- and afterload. In patients with chronic heart failure during perindopril therapy, the following was noted: a decrease in filling pressure in the left and right ventricles; decrease in OPSS; increase cardiac output and heart index.

Initial dose of perindopril 2 mg in patients with chronic heart failure I-II functional class according to the NYHA classification was not accompanied statistically significant decrease BP compared with placebo.

Pharmacokinetics

Suction

After oral administration, perindopril is rapidly absorbed from the gastrointestinal tract and reaches Cmax in plasma within 1 hour. Bioavailability is 65-70%. 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.

20% of the total amount of absorbed perindopril is converted to perindoprilat (active metabolite). Cmax of perindoprilat is reached in 3-4 hours.

Distribution

Vd of unbound perindoprilat is 0.2 l/kg. Plasma protein binding is negligible. The binding of perindoprilat to ACE is less than 30%, but depends on its concentration.

Does not accumulate.

breeding

T 1/2 of perindopril from blood plasma is 1 hour. Perindoprilat is excreted by the kidneys. T 1/2 of the unbound fraction is about 3-5 hours.

Pharmacokinetics in special clinical situations

In elderly patients, in patients with renal and chronic heart failure, the excretion of perindoprilat is slowed down.

Perindoprilat is removed by hemodialysis (speed 70 ml/min, 1.17 ml/sec) 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 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.

Dosing regimen

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.

Addendum ACE inhibitors patients taking diuretics may cause arterial hypotension. In this regard, it is recommended to carry out therapy with caution, stop taking diuretics 2-3 days before 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 chronic heart failure with clinical manifestations 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 at high risk of developing clinically significant arterial hypotension (for example, when taking high doses diuretics), if possible, it is necessary to eliminate hypovolemia and electrolyte disturbances 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.

The dose of Perinev ® 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.

dose adjustment is not required.

Side effect

Frequency detection 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.

Contraindications for use

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

- age up to 18 years (efficacy and safety have not been 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.

WITH 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.

Use during pregnancy and lactation

During pregnancy, the use of the drug is contraindicated. When pregnancy is confirmed, Perineva ® should be discontinued as soon as possible. Use in the II and III trimesters of pregnancy can cause fetotoxic effects (decrease in kidney function, oligohydramnios, slow ossification of the bones of the fetal skull) and neonatal toxic effects (renal failure, arterial hypotension, hyperkalemia). In the case of using the drug in the II and III trimesters of pregnancy, it is necessary to conduct an ultrasound examination 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 penetration of perindopril into breast milk. If necessary, the use of the drug during lactation, breastfeeding should be discontinued.

Use in children

Contraindicated: under 18 years of age (efficacy and safety not established).

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 - intravenous administration of angiotensin II and / or intravenous administration 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 control vital functions and the content 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.

drug 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, intravenous administration 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.

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 supplements 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 serum lithium concentrations and lithium toxicity may develop. With the simultaneous use of ACE inhibitors with thiazide diuretics, it is possible to 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 impaired renal function, such as in elderly patients or against the background of dehydration.

Other antihypertensive drugs and vasodilators

With the simultaneous use of perindopril with other antihypertensive agents, it is possible to increase 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

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

Terms of dispensing from pharmacies

The drug is dispensed by prescription.

Terms and conditions of storage

The drug should be stored out of the reach of children at a temperature not exceeding 30 ° C. Shelf life - 3 years. Do not use the drug after the expiration date.

Application for violations of liver function

Patients with liver disease dose adjustment is not required. 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.

Application for violations of kidney function

At patients with kidney disease the dose of Perinev's drug 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. Perinev's drug must be taken after a dialysis session.

Use in elderly patients

special instructions

Stable coronary artery disease

In patients with coronary artery disease with the development of an episode of unstable angina (significant or not) during the first month of therapy with Perineva ®, it is necessary to evaluate the benefit / risk ratio for therapy with this drug.

Arterial hypotension

In the treatment of arterial hypertension, ACE inhibitors can cause a sharp decrease 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 arterial hypertension. Severe arterial hypotension was observed in patients with severe chronic heart failure, both in the presence of concomitant renal failure, and in its absence. Most often, severe arterial hypotension can develop in patients with more severe chronic heart failure, taking high doses of "loop" diuretics, as well as against the background of hyponatremia or renal failure. Such 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 which an excessive decrease in blood pressure can lead to myocardial infarction or cerebrovascular complications.

In case of development 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 chronic heart failure and normal or low blood pressure during therapy with Perineva ®, an additional decrease in blood pressure may occur. 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. 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 (CC less than 60 ml / min), the initial dose of the drug Perinev should be selected in accordance with the CC and then depending on the therapeutic response. For such patients, regular monitoring of the concentration of potassium ions and creatinine in the blood serum is necessary.

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/angioneurotic edema

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) subcutaneously and ensure airway patency.

Patients with a history of angioedema unrelated to the use of ACE inhibitors have a higher risk of developing angioedema while taking an ACE inhibitor.

Anaphylactoid reactions during LDL apheresis procedure

In patients on the appointment of ACE inhibitors during the procedure of LDL apheresis using dextran sulfate absorption, in rare cases, an anaphylactic reaction may develop. 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. Perineva® should be used with great caution in patients with systemic connective tissue diseases (eg, 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. During therapy with Perineva ® 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 in 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 should be carefully monitored in the first few months of therapy with ACE inhibitors.

Potassium-sparing diuretics, potassium-containing drugs, potassium-containing foods, and dietary supplements

Lactose

Perinev ® tablets contain lactose. Therefore, patients with hereditary galactose intolerance, lapp lactase deficiency or glucose-galactose malabsorption syndrome should not take this drug.

Influence on the ability to drive vehicles and control mechanisms

It is necessary to take into account the possibility of developing arterial hypotension or dizziness, which can affect driving and working with technical equipment.