Perindopril tablets are effective ACE inhibitors. What does the medicine help with? The instructions for use of the drug Perindopril suggest taking it when coronary disease, heart failure and hypertension.
Composition and release form
Perindopril tablets are produced, for which the medicine is indicated in the instructions, white or close to white in color, flat cylindrical in shape with a characteristic chamfer on one of the sides. The drug is supplied in blisters made of aluminum foil or PVC, designed for 10 pieces, or in a polymer jar with 10 or 30 tablets.
IN cardboard box Packed in 1 or 3 contour cell plates or one polymer jar with detailed instructions for use. Perindopril in tablet form contains: perindopril erbumine (acts as the main active substance) in a volume of 4 mg and excipients.
Pharmacological properties
The medicine Perindopril, which helps with heart problems, is an 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 1 to angiotensin 2, which is a powerful vasoconstrictor.
As a result of a decrease in the concentration of angiotensin 2, a secondary increase in plasma renin activity occurs due to the elimination of negative feedback with the release of renin and a direct decrease in aldosterone secretion.
Thanks to its vasodilating effect, it reduces roundabout percentage (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 at 4-8 hours and continues for 24 hours.
Perindopril tablets: what does the medicine help with?
Indications for use are narrow-profile for a therapeutic hospital due to its specificity therapeutic effect medicine:
- stable coronary heart disease;
- arterial hypertension;
- hypertension of renovascular etiology;
- prevention of recurrent stroke or stroke after transient ischemic attack;
- chronic heart failure.
Contraindications
Instructions for use prohibit taking the drug Perindopril when:
- breastfeeding;
- hypersensitivity to ACE inhibitors and components of the drug Perindopril, from which the tablets can cause side effects;
- pregnancy;
- children.
Not contraindications - diabetes mellitus, renal failure, elderly age. Patients who fall into these groups can be treated with perindopril. In this case, you need to regularly take blood and urine tests to monitor kidney function. If your test results get worse, tell your doctor and he will decide what to do.
The drug Perindopril: instructions for use and dosage regimen
The pharmaceutical drug is used orally in one dose (1 time per day). Treatment usually begins with a starting dosage of 1-2 mg per day. Further, depending on the indications for therapy, the instructions for using Perindopril vary slightly:
- therapy for stable coronary heart disease begins with a starting dose of 4 mg per day for 2 weeks, and then the amount of the drug taken increases to 8 mg per day;
- in case of congestive heart failure, conservative rehabilitation is continued with the optimal dosage of 2-4 mg per day;
- renovascular hypertension is treatable at 2 mg daily;
- Stroke prevention is carried out according to a special scheme: first, 2 mg every day for 2 weeks, and then 4 mg per day for the same length of time;
- arterial hypertension can be treated with higher amounts of medication taken; for this pathology, 4-8 mg per day is used, the dosage should be increased gradually, over 3-4 weeks.
Side effect
The drug Perindopril, instructions and patient reviews confirm this, can cause negative reactions in the body. Side effects include:
- taste disturbances;
- decreased hemoglobin levels (especially at the beginning of treatment);
- dyspeptic symptoms;
- skin rash;
- dry cough;
- angioedema;
- sexual disorders;
- dry mouth;
- erythema;
- sleep or mood disturbances;
- dizziness;
- decreased number of red blood cells and/or platelets;
- headache;
- convulsions;
- reversible increase in creatinine levels and uric acid.
Use during breastfeeding and pregnancy
Perindopril, like other ACE inhibitors, is contraindicated during pregnancy and breastfeeding. If you are planning a pregnancy or find out that you are pregnant, stop taking this medicine immediately.
Because it can disrupt the development of the fetus. If a patient accidentally took the wrong pill during pregnancy, she should not panic, but do an ultrasound of the fetus, assess the condition of its skull bones and kidney function.
special instructions
Before starting treatment with perindopril, a renal function test is recommended for all patients.
During treatment with perindopril, renal function, the activity of liver enzymes in the blood, and peripheral blood tests should be regularly monitored (especially in patients with diffuse diseases connective tissue, in patients receiving immunosuppressive drugs, allopurinol).
Patients with sodium and fluid deficiency must undergo correction of water and electrolyte disturbances before starting treatment.
Interaction
Some medications, if taken together with perindopril, may increase potassium levels in the blood excessively. This is called hyperkalemia, and can be deadly. Risky medications include angiotensin II receptor antagonists, non-steroidal anti-inflammatory drugs, heparin, potassium-sparing diuretics. Do not take medications that contain potassium.
Don't eat salt substitutes that contain potassium. Tell your doctor about all the medications, herbs, and dietary supplements you take. Detailed description drug interactions perindopril - read the instructions for use, which are in the box with the medicine.
Analogues of the drug Perindopril
Identical active substance contain analogues:
- Perindopril arginine.
- Prestarium A.
- Perinpress.
- Perindopril Richter.
- Hypernik.
- Coverex.
- Perindopril erbumine.
- Parnavel.
- Arentopres.
- Noliprel forte.
- Piristar.
- Perindopril plus Indapamide.
- Ko Perineva.
- Perindid.
- Prestarium.
- Dalneva.
- Perindopril Pfizer.
- Noliprel A.
- Perindopril Indapamide Richter.
- Prestance.
- Noliprel.
- Stoppress.
- Perineva.
Price
You can buy Perindopril tablets in Moscow for 136 rubles. The price of the drug in Kyiv and Ukrainian cities reaches 75 hryvnia. In Minsk, pharmacies offer to buy the product for 2.7-15 bel. rubles In Kazakhstan, pharmacies offer analogues of Perindopril.
Perindopril blood pressure tablets have proven themselves well in the pharmaceutical market due to good tolerability, infrequent occurrence of unwanted manifestations and a small list of contraindications for use.
What are Perindopril tablets? Instructions for use provide a comprehensive description of the features of this medicine.
The first thing we see when opening the annotation for the medication Perindopril is tradename. Further, the instructions for use of the medicine describe the composition of the drug. It is represented by the main active ingredient - perindopril erbumine, and several additional ingredients, including croscarmellose sodium, lactose and others.
For the convenience of long-term use and correct dosing of the medication, the release form is limited to tablet form in the dosage of perindopril 2 mg, 4 mg, 8 mg. Some of foreign analogues The drug is available in tablets of 5 mg and 10 mg containing perindopril.
What are Perindopril tablets for?
Knowing that the drug group Perindopril is (ACEI), we can say what effect the medicine has on the human body:
- antihypertensive;
- by reducing vascular tone (arterioles and veins), it facilitates the work of the heart;
- increases tolerance to physical activity in cardiac patients.
What Perindopril tablets help with is described in the instructions for use in the paragraph - indications for use.
Mechanism of action
We can say that it is the pharmacological group of the drug that determines the main mechanism of action of the drug. Entering the body, under the influence of hepatic esterases, it is converted into an active metabolite - perindoprilat, which has the following effects:
- causes expansion of peripheral (mainly resistive) vessels and a moderate drop in blood pressure;
- reduces pre- and afterload on the heart muscle;
- corrects blood circulation in the pulmonary circulation and respiratory function;
- reduces vascular resistance renal arteries, improving blood flow in them.
At what pressure should I take it?
The question - at what pressure and how to take Perindopril - is only partially addressed in the instructions for use. That is, it is limited to instructions for prescribing the medication - in case of an increase blood pressure. The abstract does not specify specific pressure figures for using the medication.
Hypertension therapy suggests that Perindopril should be taken continuously, regardless of the current values on the tonometer.
Indications for use
For a medicine such as Perindopril, indications for use are limited to the following conditions:
- high blood pressure;
- chronic cardiac failure.
Taking into account the pharmacodynamics of the drug, the indications for use can be expanded by using it for prophylactic purposes in patients:
- after a stroke or transient (transient) ischemic cerebrovascular accident;
- with stable ischemic (coronary) heart disease;
- when hypertension is renovascular in nature.
Instructions for use
A prescription for Perindopril is written on Latin. All the necessary information about the features of the drug is contained in the instructions for use. The components of Perindopril tablets, their mechanism of action and indications for use were described in the previous sections. Contraindications for use, dosages, side effects and some other issues remained unexamined.
Contraindications to the use of Perindopril are standard factors:
- individual intolerance to perindopril and other components of the medication or ACE inhibitors in general;
- a history of predisposition to angioedema during therapy with ACE blockers, angioedema of hereditary or idiopathic origin;
- periods of childbearing and breastfeeding;
- adolescence (up to 18 years of age) (no studies to establish effectiveness and safety).
Causes of hypertension
Dosage
If your doctor has prescribed you the medicine Perindopril, the instructions for use recommend that you follow following conditions according to its use:
- take regularly;
- in the morning;
- before breakfast;
- 1 per day.
For the drug Perindopril, the dosage is selected individually, taking into account data on:
- availability concomitant pathology, especially if there were changes in the functioning of the urinary system;
- concomitant use of other drugs;
- age of the patient.
Therapy begins with minimal doses of 1–2 mg of perindopril and, if necessary, is gradually increased at intervals of several weeks. The maximum daily dose of the drug is 8 mg. Patients with pathology of the hepatobiliary system do not need dosage adjustment.
Side effects
Taking the medication in question, like any other drug, does not exclude the possibility of developing unwanted reactions.
For Perindopril tablets side effects The frequency of occurrence can be represented as follows:
- often - up to 10% of cases: excessive drop in blood pressure; asthenoneurotic syndrome, dry hacking cough, difficulty breathing; tinnitus and blurred vision; dyspepsia, stool disorders, changes in taste; allergic manifestations; convulsive muscle twitching;
- rarely - up to 1%: sleep disturbance, mood swings; bronchospasm; dry mucous membranes; Quincke's edema, deterioration of kidney function, increased sweating, impotence;
- extremely rare - less than 0.1%: violations from of cardio-vascular system in the form of rhythm disturbances, chest pain similar to angina pectoris, acute; pneumonia with eosinophilic infiltration; rhinitis; change in blood test; disruption of the liver and pancreas; confusion, exudative erythema.
We can say that this medication is better tolerated than some other representatives of the ACE inhibitor group. For the drug Perindopril, side effects can be minimized by prescribing minimal doses.
Effect on potency
Starting therapy antihypertensive drug, many men are often worried about one of the side effects of medications of this kind - the effect on potency. Perindopril, like other ACE inhibitors, does not impair erectile function and does not reduce libido. Moreover, studies have shown that antihypertensive therapy with ACE inhibitors stimulates the production of androgens, which, on the contrary, improves potency.
Medicine and alcohol
For Perindopril tablets, the instructions for use state the fact that you must refrain from drinking alcohol for the entire course of therapy. Taking them together can cause the following reactions:
- sudden loss of consciousness;
- acute cerebral circulatory failure;
- coronary (heart) failure;
- erectile dysfunction.
Do not neglect the information provided by the instructions for use for Perindopril tablets regarding alcohol.
Reviews from patients who took the drug
It cannot be said that reviews of the drug Perindopril are purely negative or positive. Tolerability of the drug is sufficient individual characteristics medicine. And reviews of patients who took the drug can be presented as follows:
- some patients note the onset of a rapid and stable decrease in pressure in the absence of any unwanted effects from taking medication;
- others reveal such side effects as dry cough, sore throat, weakness with moderate therapeutic effect.
However, the appearance of certain adverse reactions depends on many factors, for example:
- drug dose;
- patient's age;
- degree of hypertension and presence of concomitant pathology;
- company and country of origin.
But, reviews are reviews, and before you start taking it, you need to consult your doctor.
To enhance therapeutic effect Some drugs with perindopril as an active substance are available in combination with other antihypertensive substances. For example, Perindopril Indapamide Richter, produced well-known company in Poland, contains perindopril and indapamide (diuretic).
Thanks to the combination of such components, this drug has a wider list of indications for use, which is discussed in detail in the annotation for the combined Perindopril - instructions for use. At what pressure you should pay attention to this particular medication, it is better to decide with your doctor.
Another medicine based on perindopril is an analogue of the above drug, but Russian production- Perindopril PLUS Indapamide. Despite the almost 100% identity of the composition with the Polish synonym Perindopril with a diuretic, some distinctive factors are still present in it.
For example, as part of auxiliary ingredients Russian tablets Perindopril PLUS Indapamide instructions for use do not indicate lactose monohydrate. This circumstance can be considered an advantage for patients with rare intolerance to this disaccharide.
The composition of a calcium channel blocker - amlodipine besilate - and an angiotensin-converting enzyme blocker - perindopril erbumine - is the basis of several drugs that are often used as analogues and replacements for Perindopril, although they are not its complete synonyms. A calcium antagonist ensures the release of “slow” calcium channels from excesses of this macroelement (Ca), the excess of which indirectly contributes to vasoconstriction (narrowing of blood vessels). Thus, there is a double antihypertensive effect on the vascular system.
Analogues, synonyms, replacements
In some cases, when purchasing the original medicine is impossible for a number of reasons, patients are interested in what can replace Perindopril.
The search for an absolute analogue (that is, a drug with an identical composition) for the treatment of hypertension is not always justified, because medicines with other active ingredients of similar pharmacological action, they are usually no less effective. The main thing is to select an analogue together with your doctor.
Experts know exactly (from practice) which is better - Perindopril or Ramipril, Perindopril or Lisinopril and so on.
Antihypertensive drug French manufacturer Servier Laboratories Prestarium is a one-component analogue of Perindopril. The excipients contain lactose monohydrate; the medicine is available in the form of tablets for oral administration and for resorption under the tongue.
The question of which is better, Perindopril or Prestarium, can only be answered after the practical use of these medications. One thing is certain - a medicine from a French manufacturer will be several times more expensive than, say, Russian drug Perindopril SZ.
The active ingredient lisinopril in the drug of the same name, produced by a large number of European, Russian and Indian companies, is an ACE inhibitor. That is pharmachologic effect the drug is similar to Perindopril and its analogues and can be used in the treatment of hypertension instead of these drugs.
The auxiliary components do not contain lactose, and the drug itself is excreted unchanged from the body through the kidneys. There are no conditions for which Perindopril tablets would be powerless, but Lisinopril would cope with incredible efficiency. Therefore, discussions about the advantages of a particular remedy should be based on individual approach for every occasion.
You should not try to find out which is better - Perindopril or Enalapril - at the pharmacy. Of course, the pharmacy worker will describe the benefits of the medicine that is available at the pharmacy outlet. If you have to choose between these two drugs, it is better to consult a doctor.
Let's compare another pair of drugs - Monopril and Perindopril. It is still difficult to answer which drug is better. Active ingredient Monopril is fosinopril - ACE blocker; The composition contains lactose in anhydrous form. The list of side effects presented in the instructions for use is similar to the list under consideration for Perindopril. Most likely, it will be possible to talk about preference only after careful selection of doses and practical use of the medicine.
The antihypertensive drug Perineva, produced by the Russian branch of the KRKA company, can confidently be called synonymous with the drug in question.
According to the instructions for use, the composition of the drug, with the exception of minor differences in excipients, is the same, respectively, pharmacological properties and efficiency are the same. Which is better - Perindopril or Perineva, as in most cases, should be shown by practical experience in the use of these drugs.
The active ingredient of Ramipril tablets and their direct analogues is ramipril, a precursor to the active metabolite ramiprilat, an angiotensin-converting enzyme blocker. According to the instructions for use, the composition of the excipients of Ramipril does not differ significantly from the composition of Perindopril, but the list of indications for use is much more extensive, in particular, due to its use in nephropathy (diabetic and non-diabetic), severe proteinuria, especially accompanied by hypertension.
The question of replacing Perindopril with Ramipril should be considered after carefully studying the instructions for use of both medications and comparing them with the characteristics of the course of hypertension in the patient.
What to replace when coughing?
One of the side effects of the drug, like other representatives of the ACE inhibitor group, is nonproductive cough. Often this undesirable manifestation becomes persistent, long-lasting and complicates further therapy.
If during treatment a person notices the occurrence of this and other side effects, it is recommended to seek help.
Only a doctor can tell you how to replace Perindopril for a cough. Perhaps the drug from the Israeli concern Perindopril TEVA will be offered, or the patient will be advised to completely abandon the ACE inhibitor group and treat hypertension with calcium channel blockers, beta-blockers or other medications. You should not self-medicate and change the drug following the advice of a pharmacist, neighbors or relatives.
Useful video
You can learn about common side effects of blood pressure medications from this video:
Conclusion
- According to the instructions for use, Perindopril tablets belong to the group of angiotensin-converting enzyme (ACE) and are intended for the treatment arterial hypertension and heart failure.
- According to the instructions for use, Perindopril does not exhibit an inhibitory effect on erectile function, however, when consumed in parallel with alcohol, it may have such an effect. by-effect in an enhanced form.
- The active ingredient perindopril is included in many antihypertensive drugs, both as the sole active ingredient and in combination with others. antihypertensive drugs.
- You can replace this drug with any medications with a similar composition (specified in the instructions for use) or similar active ingredients. However, this issue can only be resolved with the attending physician.
Structural formula
Russian name
Latin name of the substance Perindopril
Perindoprilum ( genus. Perindoprili)Chemical name
2alpha,3a beta,7a beta]]-1-amino]-1-oxopropyl]-octahydro-1H-indole-2-carboxylic acid (as tert-butylamine and arginine salt)
Gross formula
C19H32N2O5Pharmacological group of the substance Perindopril
Nosological classification (ICD-10)
CAS code
82834-16-0Characteristics of the substance Perindopril
ACE inhibitor. Perindopril erbumine (tert-butylamine) is a white crystalline powder. Easily soluble in water (60% wt.), alcohol and chloroform. Molecular weight 368.47 (free acid); 441.61 (tert-butylamine salt); 542.680 (arginine salt).
Pharmacology
pharmachologic effect- hypotensive, vasodilating, natriuretic, cardioprotective.In the body it turns into an active metabolite - perindoprilat (contains a carboxyalkyl group), which interacts with the zinc atom in the ACE molecule. Inactivates ACE in plasma, endothelium of the vascular wall, possibly in the cells of the renal glomeruli and tubules, lung tissue, heart, adrenal glands and brain. Reduces the level of angiotensin II in the blood and tissues, reduces the production and release of aldosterone from the adrenal glands, suppresses the liberation of norepinephrine from the endings of sympathetic nerve fibers and the formation of endothelin in the vascular wall. Reduces peripheral vascular resistance, blood pressure (without the development of tachycardia), left ventricular filling pressure (improves its diastolic relaxation). Arterial and venous vasodilation is accompanied by a weakening of post- and preload on the myocardium, a decrease in end-diastolic pressure in the ventricles of the heart, a moderate decrease in heart rate, an increase cardiac output. Improves regional (coronary, cerebral, renal, muscular) blood circulation, reduces myocardial oxygen demand in coronary artery disease. By inhibiting tissue renin-angiotensin systems, it is cardioprotective (prevents or promotes regression by 19% of hypertrophy and dilatation of the left ventricle) and angioprotective (prevents hyperplasia and proliferation of vascular smooth muscle cells, induces the reverse development of hypertrophy of the vascular wall, restores the elasticity of large vessels and endothelial function, including including the ability to release nitric oxide, endothelial relaxing factor). Reduces excess collagen deposition in the subendocardial layers of the myocardium, normalizes the myosin isoenzyme profile, and reduces the incidence of ventricular and reperfusion arrhythmias. Increases the activity of the kallikrein-kinin system, stabilizes the level of bradykinin, vasodilator PGI 2 and PGE 2, atrial natriuretic peptide, endothelin-dependent relaxing factor. Minimizes pressor pressure, incl. adrenergic, effects on blood vessels, prevents sodium retention in the body, increases natriuresis and diuresis. Against the background of daily intake acetylsalicylic acid has an effect on hemostasis parameters (the increase in fibrinogen levels and the activity of factors VII and X is compensated by increased fibrinolysis against the background of increased consumption of AT III). Sensitizes peripheral tissues to the action of insulin and improves glucose metabolism. Shows antioxidant properties. Inhibits the development of tolerance to nitrates and enhances their vasodilating effect.
After a single dose of 4-8 mg, blood pressure decreases after 4-6 hours. It has a prolonged hypotensive effect, continuing with repeated daily doses for 24 hours. The antihypertensive effect depends on the dose (in the range of 2-8 mg). At a dose of 2 mg, it inhibits ACE by 80% at the peak of action and by 60% after 24 hours; when the dose is increased to 8 mg, its inhibitory activity increases to 95% and 75%, respectively. In patients with a positive response to treatment, blood pressure normalizes within 1 month and remains within normal limits during treatment. Discontinuation of therapy is not accompanied by the development of withdrawal syndrome. In patients with chronic heart failure, it statistically significantly reduces the severity of clinical symptoms and increases exercise tolerance. Does not cause fluctuations in blood pressure after the first dose and during long-term therapy. When taken for six months in patients with chronic heart failure, it improves the patency of large, medium and small bronchi (the increase in patency in the small bronchi is more pronounced in smoking patients). Against the background of portal gastropathy, it reduces the vulnerability and bleeding of the gastric mucosa with the disappearance of erosions and ulcers. Long-term therapy is not accompanied by changes in renal function. Increases HDL level, lowers uric acid (in patients with hyperuricemia).
When researching in vitro And in vivo There were no signs of mutagenicity, with long-term use in mice and rats - carcinogenic properties, as well as signs of embryotoxicity and teratogenic effects in rats, mice, rabbits and monkeys. In high doses, it has a toxic effect on the maternal and fetal organisms in rodents and rabbits, penetrates into breast milk rats
When taken orally, it is quickly absorbed from the gastrointestinal tract. Bioavailability is 65-95%, decreased by 35% with simultaneous food intake. The concentration reaches its maximum in plasma after 1 hour (perindoprilate - after 3-4 hours) and decreases by the end of the day to 33-34% Cmax. Penetrates through the BBB. 17-20% is converted in the liver into perindoprilat, the rest - into 5 inactive metabolites. Communication with plasma proteins is less than 30% and depends on the concentration, volume of distribution - 0.2 l/kg, T1/2 - 1.5-3 hours. Slowly dissociates from connection with ACE ("effective" T1/2 - 25-30 hours), does not accumulate, is excreted by the kidneys (70%). With repeated use, equilibrium concentrations are achieved after 4 days. Against the background of impaired renal function, chronic cardiac and renal failure, in elderly patients, the excretion of all metabolites decreases (correction of the dosage regimen is necessary).
Use of the substance Perindopril
Arterial hypertension, incl. renovascular, chronic heart failure; prevention of recurrent stroke in patients who have suffered a stroke or transient ischemic attack (ministroke) ( combination therapy with indapamide); stable CAD: reducing the risk of cardiovascular complications in patients with stable CAD.
Contraindications
Hypersensitivity, history of angioedema, pregnancy, breastfeeding, childhood(safety and effectiveness have not been determined).
Restrictions on use
An assessment of the risk-benefit ratio is necessary in following cases: heavy autoimmune diseases, aortic or mitral stenosis, constrictive pericarditis, hypertrophic cardiomyopathy with hemodynamic disturbances, the presence of obstructive changes that impede the outflow of blood from the heart, bilateral renal artery stenosis or stenosis of the artery of a single kidney, the presence of a transplanted kidney; atherosclerosis obliterating: arteries lower limbs, common with damage to coronary and carotid arteries; moderate renal failure, hyperkalemia (5 to 5.5 mmol/l), hyponatremia or sodium restriction in the diet, dehydration, leukopenia, thrombocytopenia, conduction general anesthesia And surgical interventions.
Use during pregnancy and breastfeeding
Contraindicated during pregnancy.
Breastfeeding should be stopped during treatment.
Side effects of the substance Perindopril
From the cardiovascular system and blood (hematopoiesis, hemostasis): arterial hypotension, chest pain, anemia, increased hemoglobin levels (at the beginning of treatment), leukemia/neutropenia, thrombocytopenia.
From the outside nervous system and sense organs: weakness, asthenia, headache, dizziness, mood and/or sleep disturbances, paresthesia, convulsions.
From the gastrointestinal tract: dry mouth, taste disturbance, stomatitis, dyspepsia.
From the outside skin: rash, alopecia.
Others: dry cough, allergic reactions, angioedema, impaired renal function, increased levels of potassium, creatinine, urea in the blood, impotence.
Interaction
Hypotension is enhanced (additive effect) by other antihypertensive drugs, incl. beta-blockers with significant systemic absorption from ophthalmic dosage forms, diuretics, imipramine antidepressants, antipsychotics, alcohol; weaken - estrogens, NSAIDs, sympathomimetics. Cyclosporine, potassium-sparing diuretics, potassium-containing drugs, potassium supplements, and salt substitutes increase the risk of hyperkalemia. Potentiates the hypoglycemic effect of oral antidiabetic drugs (dose adjustment of the latter is necessary), the hypotensive effect of some general anesthetics and muscle relaxants; reduces hypokalemia and hyperaldosteronism induced by diuretics; increases the concentration of lithium and the toxic effect of lithium. When used simultaneously with NSAIDs, the risk of renal dysfunction increases, with myelosuppressants, interferon - neutropenia and/or agranulocytosis with fatal. Antacids and tetracyclines reduce the speed and completeness of absorption from the gastrointestinal tract.
Overdose
Symptoms: acute arterial hypotension, Quincke's edema.
Treatment: dose reduction or complete withdrawal of the drug; gastric lavage, measures to increase blood volume (introduction of saline and other blood-substituting fluids), symptomatic therapy: epinephrine (s.c. or i.v.), antihistamines, hydrocortisone (iv); carrying out dialysis procedures.
Routes of administration
Inside.
Precautions for the substance Perindopril
Treatment is carried out with regular medical supervision. In patients receiving diuretics, they should be discontinued 3 days before starting treatment with perindopril, and in case of chronic heart failure, the dose should be reduced (to reduce the risk of developing symptomatic hypotension). During therapy, it is necessary to monitor blood pressure, constant monitoring of the peripheral blood picture (before starting treatment, in the first 3-6 months of treatment and subsequently at periodic intervals for 1 year, especially in patients with increased risk neutropenia), plasma protein levels, potassium, urea nitrogen, creatinine, renal function, body weight, diet. During treatment, hemodialysis using high-performance membranes made of polyacrylonitrile metaallyl sulfate (for example AN69), hemofiltration or LDL apheresis should be avoided (the development of anaphylaxis or anaphylactoid reactions is possible). It should be borne in mind that in patients with renal artery stenosis, as well as with hyponatremia, the first dose may be accompanied by severe hypotension and the development of acute renal failure. Use with caution when working for drivers Vehicle and people whose profession is associated with increased concentration. During treatment, it is recommended to avoid the consumption of alcoholic beverages and use adequate contraceptive measures. Caution is required when carrying out any therapy during therapy. surgical interventions(including dental). If a dose is missed, the subsequent dose is not doubled.
Interactions with other active ingredients
Trade names
| Name | The value of the Vyshkowski Index ® |
Prohibited during pregnancy
Prohibited during breastfeeding
Not suitable for children
Has restrictions for older people
Has limitations for liver problems
Has limitations for kidney problems
Among the angiotensin-converting enzyme inhibitors, the most studied is Perindopril. Patients with the second stage of chronic heart failure taking the drug experience improvement general condition, and the number of attacks decreases. Today it is one of the most common and frequently prescribed ACE inhibitors.
To take Perindopril in mandatory it is necessary to study all the rules of therapy set out in the instructions for use.
Perindopril is a class II drug and has a long-lasting effect. It copes well with reduction high blood pressure, improves the condition of patients with heart failure and is well tolerated by patients.
Drug group, INN, scope of application
The drug is part of the carbonyl group of ACE. Angiotensin-converting enzyme inhibitors belong to a large class of antihypertensive drugs, which, in turn, form large group drugs that affect the function of the cardiovascular system. The active ingredient is perindopril erbumine. INN – Perindopril.
Release forms and prices, average in Russia
Perindoril tablets are available for sale in almost all pharmacies. Available under various names. These are tablet forms that differ in the amount of active substance in 1 tablet (4.8 and 10 ml), as well as the number of tablets per package (30, 90). Prices for it vary from 82 to 394 rubles. The table shows the most popular pharmacies where you can purchase a package of 30 tablets of 4 ml:
Composition and pharmacological properties
Each tablet of the drug Perindopril contains 4 mg of perindopril erbumine (active ingredient) and excipients. These include lactose, cellulose, silicon dioxide and magnesium stearate.
Perindopril is an ACE inhibitor. The importance of the two types of angiotensin is very great. Angiotensin I is metabolized by the angiotensin-converting enzyme into an octapeptide, angiotensin II. Angiotensin II is one of the most active endogenous vasoconstrictors. It stimulates the excretion of aldosterone by the adrenal glands, retains sodium and water in the body, and increases potassium secretion.
Blockade of angiotensin II formation, facilitated by Perindopril, leads to a decrease in the release of aldosterone, which, in turn, reduces total peripheral vascular resistance. Additionally, this blockade stimulates the synthesis of nitric oxide and promotes the release of prostaglandin E2 and prostaglandin.
The result of such complex reactions is a decrease in blood pressure. But Perindopril is not the final active substance; it is first metabolized, turning into the active substance - perindoprilat. It not only weakens vascular wall and myocardium, but also the amount of subendocardial glycogen in the heart.
After oral administration, approximately 20% of the drug is absorbed regardless of food intake, thus the bioavailability is 20%. In the blood, the drug reaches its maximum concentration after 3 hours, it is 90 mg/ml, the drug binds to proteins relatively poorly (30%). It penetrates poorly through the blood-brain barrier, is excreted by the kidneys without being metabolized in the liver, and can accumulate in renal failure.
The drug penetrates the placenta and breast milk. The half-life is achieved within 12 hours. The onset of the hypotensive effect is observed a couple of hours after administration, the maximum effect lasts 36 hours and occurs after 7-9. Stabilization of the effect of the drug is achieved a week after systematic treatment.
Instructions for use
Safe use of the drug depends on complete compliance with the instructions of the specialist and the instructions for using the product.
Indications and contraindications
Perindopril has the following indications for use:
- various forms of arterial hypertension;
- chronic forms of heart failure.
Perindopril is recommended for patients suffering from hypertension, with high activity of the renin-angiotensin system or additionally taking diuretics that increase renin synthesis and the activity of the renin-angiotensin system, as well as for:
The drug is contraindicated in patients with allergic reactions on the active or excipients, pregnant women, as well as children and adolescents under 18 years of age.
Dosage
Perindopril is intended for parenteral use, preferably in the morning, before breakfast. When treating hypertension, dosage always starts with 4 ml per day. If a person has increased activity of the renin system, in order to avoid the opposite effect, start with a dose 2 times less, then gradually increase to 8 mg over the course of a month.
Important! Do not forget about the risk of sudden hypotension at the beginning of treatment.
When treating heart failure, they begin with the same small dose (2 mg), gradually increasing to 4 mg. Elderly patients begin to be treated with ½ tablet.
Drug interactions
You should not use Perindopril simultaneously with diuretics to avoid a sharp decrease in blood pressure. It is better to reduce or discontinue one of the drugs. Perindopril increases the side effects of lithium preparations, so this combination is used extremely rarely, constantly measuring the level of lithium in the blood serum.
Nonsteroidal anti-inflammatory drugs (Ibuprofen, Indomethacin) reduce the hypotensive effect of the drug. In addition, both NSAIDs and ACE inhibitors increase the level of K+ ions in the blood, which together can lead to kidney damage.
Also, you should not use Perindopril together with antidiabetic drugs and sympathimetic drugs. Anesthetics, antipsychotics and antidepressants can further enhance the hypotensive effect of Perindopril. You can take ACE inhibitors, thrombolytics and beta blockers at the same time; they do not affect each other's effects in any way.
Possible side effects and overdose
Some side effects from taking Perindopril occur frequently, while others occur much less frequently. In this regard, it is rational to classify them according to their frequency of occurrence. Side effects which are relatively common:
Side effects that are relatively rare:
If the dose is incorrectly selected or if the drug is used uncontrolled, symptoms of overdose occur. These include:
- Bradycardia.
- Cough.
- High blood pressure.
- Heartbeat.
- Anxiety.
- Electrolyte imbalance.
Necessary medical measures in case of overdose:
Analogs
Perindopril analogues are included in the same group of antihypertensive drugs. There is a certain order in which such groups are used. The most effective are the first five groups:
- ACE inhibitors (,
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Perindopril is a prodrug that is the gold standard in the treatment of hypertension and heart failure. It is relevant for use in elderly people, since it has many pharmacological effects that have a positive effect on the diseases associated with hypertension.
The effect of perindopril has been very well studied, and it has a wide evidence base. Medicinal substance passed such large-scale studies as PROGRESS and EUROPA. Perindopril is included in many drugs - Perindopril-Richter, Perindopril Pfizer, Perindopril C3, etc.
About the drug, composition and release form
Perindopril is available as oral tablets in 2 mg, 4 mg or 8 mg strengths. The tablets have a round shape, white with a notch and a chamfer in the middle. They are usually sold in blisters of 30 pieces in a cardboard package. The active ingredient of the drug is a metabolite that is formed after biochemical transformations in the liver from perindopril - perindoprilat.
This metabolite competitively inhibits angiotensin-converting enzyme (ACE). Inhibition of the enzyme stops the conversion of angiotensin I to the active vasoconstrictor angiotensin II. Thus, there is interference in the renin-angiotensin-aldosterone system chain.
These processes increase the secretion of aldosterone, which leads to a decrease in the reabsorption of sodium ions and an increase in fluid loss, and as a result, a decrease in circulating blood volume. The drug prevents the decomposition of bradykinin, an endogenous vasodilator, its increase in the blood helps improve endothelial functions. All this leads to vasodilation and a decrease in blood pressure.
In addition, perindopril has the following antihypertensive effects:
- inhibits the synthesis of vasopressin;
- increases the production of prostaglandins with vasodilating properties;
- prevents atrial natriuretic peptide from being inactivated;
- stimulates the release of nitric oxide from the endothelium;
- inhibits the activity of the vasoconstrictor sympathoadrenal system;
- promotes the retention of potassium and magnesium in the body.
The drug prevents smooth muscle hypertrophy in the arteries and thereby prevents left ventricular hypertrophy. Due to reduced resistance peripheral vessels and an increase in coronary blood flow, the myocardial oxygen demand decreases and has a cardioprotective effect. An increase in potassium and magnesium in the blood leads to normalization of heart rate.
For older people, it is very important that perindopril increases the content of high-density lipoproteins and increases the ability of cells to absorb glucose.
What does Perindopril help with?
All clinical researches indicate the advisability of prescribing Perindopril for the following pathologies:
- arterial hypertension of various origins;
- heart failure;
- stable coronary heart disease;
- prevention of recurrent stroke;
- prevention of stroke after transient ischemic attack.
Perindopril helps with all types of hypertension: both mild and severe. Experts note a decrease in diastolic and systolic pressure in any body position.
It should be noted that a persistent decrease in pressure occurs quite quickly - within a month after starting to take the pills. In this case, tachyphylaxis does not occur.
Perindopril - instructions for use
The instructions for use of Perindopril indicate that in order to avoid a sharp decrease in blood pressure, the drug should be started at a dosage of 1-2 mg per day. The tablet is taken once a day with a glass of water. It is better to take the medicine at the same time.
Over 3-4 weeks, the minimum dosage is increased to 4-8 mg, depending on therapeutic effect and dynamics of treatment. If a patient is diagnosed with renovascular hypertension, the recommended dosage for treatment is 2 mg per day. If you have the original low blood pressure in elderly people, the drug is taken in a minimum dosage throughout therapy.
Stroke prevention is carried out by taking 2 mg of the drug daily for 14 days, and then 4 mg according to the same regimen. Treatment of stable coronary artery disease begins with 4 mg and increases to 8 mg after 2 weeks.
Sometimes the drug is prescribed in combination with other antihypertensive drugs, for example, diuretics. There is even a drug on the pharmaceutical market that is a combination of perindopril and a diuretic - Perindopril PLUS Indapamide.
special instructions
Taking Perindopril with certain drugs must be strictly monitored, as they may interact pharmacologically. Sleeping pills and narcotic drugs, as well as means to reduce pressure during joint use with the drug enhance the antihypertensive effect.
Taking potassium supplements can cause hyperkalemia. Leukopenia can develop due to the use of allopurinol and various cytostatics against this background ACE inhibitor. Failure to comply with a salt-free diet, some NSAIDs, estrogens and antacids may reduce the effectiveness of Perindopril therapy.
In the presence of diabetes mellitus Regular monitoring of blood glucose is necessary, since the drug enhances the hypoglycemic effect of antidiabetic drugs.
Side effects, contraindications and overdose
Unfortunately, in addition to the positive properties, Perindopril has a considerable number of side effects:
- hypersensitivity reactions: itching, redness, urticaria, photosensitivity, angioedema (the latter is a reason for immediate discontinuation of the drug);
- from the digestive system: nausea, vomiting, stool disorders, rashes in the mouth, loss of appetite, liver function disorders;
- from the respiratory organs: dry persistent cough (as a consequence of the accumulation of bradykinin, disappears after discontinuation of the drug), loss of voice, hoarseness, wheezing when breathing;
- from the cardiovascular system: hyperkalemia, paradoxical increase in blood pressure, orthostatic hypertension;
- from the hematopoietic system: thrombocytopenia, leukopenia, anemia;
- from the kidneys: proteinuria, impaired renal function.
A drug it is forbidden apply in the following cases:
- low blood pressure;
- the presence of angioedema;
- pregnancy;
- lactation;
- childhood;
- stenosis of the aorta and mitral valve;
- renal artery stenosis;
- end-stage renal failure;
- period after kidney transplantation;
- primary aldosteronism;
- hypertrophic cardiomyopathy;
- hemodialysis.
An overdose of Perindopril leads to sharp decline blood pressure. Treatment methods include symptomatic (increased blood pressure) and detoxification (induction of vomiting, gastric lavage) therapy.
Analogues of Perindopril, list of medications
The original drug containing perindopril is Prestarium. All other medicines containing this substance are generics:
- Perindopril-Richter,
- Perindopril Pfizer,
- Perindopril Sandoz,
- Parnavel,
- Coverex,
- Hypernik,
- Arentopres,
- Perineva,
- Piristar, etc.
Due to their high effectiveness, Perindopril analogues are very common and are produced by many pharmaceutical companies.
Remember that consultation with a doctor is required, but if you are going to use an analogue of the already prescribed Perindopril, the instructions for use, price and reviews do not apply to analogues and cannot be used as a guide for treatment. When replacing Perindopril with an analogue, dosage or treatment regimen adjustments may be required; do not self-medicate!
This drug is in the first line of treatment for heart failure. This is a thoroughly studied substance with proven effectiveness. This has been successfully used to treat high blood pressure of various origins in different age groups and with various concomitant diseases.
