Perindopril

When ATH:
C09AA04

Characteristic.

ACE inhibitor. Perindopril erbumine (tert-butylamine) - A white crystalline powder. Easily soluble in water (60% wt.), alcohol and chloroform. Molecular weight 368,47 (free acid); 441,61 (third-butilaminovaя solь); 542,680 (arginine salt).

Pharmacological action.
Gipotenzivnoe, vazodilatirtee, kardioprotektivnoe, natriuretic.

Application.

Arterial hypertension, incl. renovascular, congestive heart failure; prevention of recurrent stroke in patients, stroke or transient ischemic attack (mykroynsult) (Combination therapy with indapamide); stable coronary artery disease: reducing the risk of cardiovascular complications in patients with stable coronary artery disease.

Contraindications.

Hypersensitivity, angioedema in history, pregnancy, lactation, childhood (Safety and efficacy have not determined).

Restrictions apply.

Assessment of the risk-benefit ratio in the following cases: severe autoimmune diseases, aortalnыy or stenosis mytralnыy, constrictive pericarditis, hypertrophic cardiomyopathy with impaired hemodynamics, the presence of obstructive changes, impede the outflow of blood from the heart, bilateral renal artery stenosis or stenosis of the artery to a solitary kidney, the transplanted kidney; arteriosclerosis obliterans: lower limb arteries, common with coronary and carotid arteries; moderate renal insufficiency, hyperkalemia (from 5 to 5,5 mmol / l), hyponatremia or restriction of sodium in the diet, degidratatsiya, leukopenia, thrombocytopenia, general anesthesia and surgical procedures.

Pregnancy and breast-feeding.

Contraindicated in pregnancy.

Category actions result in FDA - D. (There is evidence of the risk of adverse effects of drugs on the human fetus, obtained in research or practice, However, the potential benefits, associated with drugs in pregnant, may justify its use, in spite of the possible risk, if the drug is needed in life-threatening situations or severe disease, when safer agents should not be used or are ineffective.)

At the time of treatment should stop breastfeeding.

Side effects.

Cardio-vascular system and blood (hematopoiesis, hemostasis): hypotension, chest pain, anemia, increase the level of hemoglobin (at the beginning of treatment), Lake / neutropenia, thrombocytopenia.

From the nervous system and sensory organs: weakness, asthenia, headache, dizziness, mood disorders and / or sleep, paraesthesia, convulsions.

From the digestive tract: dry mouth, taste disturbance, stomatitis, dyspepsia.

For the skin: rash, alopecia.

Other: dry cough, allergic reactions, angioedema, impairment of renal function, increase the level of potassium, creatinine, blood urea, impotence.

Cooperation.

Hypotension increase (additive effect) other antihypertensives, incl. beta-blockers with significant systemic absorption of ophthalmic dosage forms, diuretics, antidepressants imipraminovogo series, neuroleptics, alcohol; weaken - estrogens, NSAIDs, sympathomimetic. Cyclosporine, potassium-sparing diuretics, kalisodergaszczye drugs, kalievыe supplements, salt substitutes increase the risk of hyperkalemia. Potentiates the hypoglycemic effect of oral antidiabetic drugs (a correction of the last dose), hypotensive effect of some general anesthetics and muscle relaxants; hypokalemia, and reduces the effects of hyperaldosteronism, induced by diuretics; increases the concentration of the toxic effects of lithium and lithium. In an application with NSAIDs increases the risk of renal dysfunction, with mielodepressantami, Interferon - neutropenia and / or fatal agranulocytosis. Antacids and tetracyclines reduce the speed and completeness of absorption from the gastrointestinal tract.

Overdose.

Symptoms: severe hypotension, angioedema.

Treatment: dose reduction or complete removal of the drug; gastric lavage, introduce measures to increase BCC (administration of saline, etc.. blood liquids), simptomaticheskaya therapy: epinephrine (n / a or I /), antihistamines, gidrokortizon (I /); carrying out dialysis treatments.

Dosing and Administration.

Inside, before meals, 1 once a day, at the same time. When hypertension - Starting dose is 4 mg, if necessary increase the dose to the maximum daily - 8 mg every 3-4 weeks, if renovascular hypertension - 2 mg; patients, at risk (IV heart failure NYHA class, advanced age, initially low blood pressure, impairment of renal function, combination with diuretikami, a high risk of side effects) - 1 mg, Heart failure - 2-4 mg 1 once a day; for the prevention of recurrent stroke (Combination therapy with indapamide) - Starting dose is 2 mg during the first 2 Sun, then, increasing the dose to 4 mg during subsequent 2 Weeks prior to the introduction of indapamide; with stable coronary artery disease - Starting dose is 4 mg for 2 Sun, then the daily dose should be increased to 8 mg (depending on renal function).

In patients with renal insufficiency dosage is determined by the Cl creatinine: the Cl creatinine more 60 ml / min - 4 mg / day, 30-60 Ml / min - 2 mg / day, 15-30 Ml / min - 2 mg a day, below 15 ml / min - 2 mg daily dialysis (диализный Cl периндоприлата — 70 ml / min). The maintenance dose is adjusted individually, depending on tolerability, therapeutic effect and the condition of the patient.

Precautions.

Treatment is carried out under regular medical supervision. Patients, treated with diuretics, they should be abolished for 3 days before the start of treatment with perindopril, and on the background of chronic heart failure - reduced dose (to reduce the risk of symptomatic hypotension). During therapy, blood pressure monitoring should be carried out, continuous monitoring of peripheral blood (before treatment, in the first 3-6 months of treatment, and thereafter at periodic intervals during 1 year, especially in patients with an increased risk of neutropenia), protein levels, Plasma potassium, BUN, creatinine, renal function, body weight, diet. During treatment to avoid hemodialysis using high-performance membranes poliakrilonitritmetallilsulfata (например АN69), gemofilytratsii or LDL apheresis (may develop anaphylaxis or anaphylactoid reactions). It will be appreciated, In patients with renal artery stenosis, and also at the first reception of hyponatremia may be accompanied by sudden hypotension and the development of acute renal failure. Be wary of during the drivers of vehicles and people, skills relate to the high concentration of attention. During treatment, it is recommended the use of alcohol and use of adequate contraceptive measures. Care should be taken during the period of treatment in any surgical intervention (including dental). When you miss a dose do not receive follow-doubles.

Cooperation