Perindopril, 4 mg 30 pcs

Perindopril is an ACE inhibitor (it interacts with the zinc ions in the ACE molecule and causes its inactivation). Perindopril acts through its active metabolite perindoprilat. Eliminates the vasoconstrictor effect of angiotensin II, increases the concentration of bradykinin and vasodilator prostaglandins (ACE converts inactive angiotensin I into angiotensin II, which has a vasoconstrictor effect, and causes degradation of bradykinin and prostaglandins that have vasodilator activity); reduces the production and release

aldosterone, inhibits the release of noradrenaline from sympathetic nerve fiber endings and the formation of endothelin in the vascular wall. Reduction of angiotensin II formation is accompanied by an increase in plasma renin activity (due to inhibition of negative feedback). ACE suppression is accompanied by increased activity of both circulating and tissue kallikrein-kinin system as well as prostaglandin system.

It promotes restoration of elasticity of large arterial vessels (decrease of formation of excessive amount of subendothelial collagen), reduces pressure in pulmonary capillaries, with long-term prescription it reduces expression of left ventricular myocardial hypertrophy and interstitial fibrosis, normalizes myosin isoenzyme profile; normalizes heart function.

Limits preload and postload (reduces systolic and diastolic blood pressure (BP) in “lying” and “standing” position), filling pressure of the left and right ventricles, total peripheral vascular resistance (TPR); increases minute blood volume (MOB) and cardiac index, does not increase heart rate (HR) (in patients with chronic heart failure (CHF) moderately reduces HR), increases regional blood flow in the muscles. Increases the concentration of high-density lipoproteins, in patients with hyperuricemia reduces the concentration of uric acid. Increases renal blood flow, does not change glomerular filtration rate.

Indications

Arterial hypertension.
Chronic heart failure.

Pharmacological effect

Perindopril is an ACE inhibitor (interacts with zinc ions in the ACE molecule and causes its inactivation). Perindopril acts through its active metabolite perindoprilate. Eliminates the vasoconstrictor effect of angiotensin II, increases the concentration of bradykinin and vasodilatory prostaglandins (ACE converts inactive angiotensin I into angiotensin II, which has a vasoconstrictor effect, and also causes degradation of bradykinin and prostaglandins with vasodilating activity); reduces production and release

aldosterone, suppresses the release of norepinephrine from the endings of sympathetic nerve fibers and the formation of endothelin in the vascular wall. A decrease in the formation of angiotensin II is accompanied by an increase in plasma renin activity (due to inhibition of negative feedback). Suppression of ACE is accompanied by an increase in the activity of both the circulating and tissue kallikrein-kinin system, as well as the prostaglandin system.

Helps restore the elasticity of large arterial vessels (reducing the formation of excess subendothelial collagen), reduces pressure in the pulmonary capillaries, with long-term administration reduces the severity of left ventricular myocardial hypertrophy and interstitial fibrosis, normalizes the myosin isoenzyme profile; normalizes heart function.

Reduces preload and afterload (reduces systolic and diastolic blood pressure (BP) in the “lying” and “standing” positions), filling pressure of the left and right ventricles, total peripheral vascular resistance (TPVR); increases minute blood volume (MBV) and cardiac index, does not increase heart rate (HR) (in patients with chronic heart failure (CHF) moderately reduces heart rate), increases regional blood flow in the muscles. Increases the concentration of high-density lipoproteins; in patients with hyperuricemia, reduces the concentration of uric acid. Increases renal blood flow, does not change glomerular filtration rate.

Special instructions

The risk of developing arterial hypotension and/or renal failure while taking the drug increases with significant loss of sodium and water (strict salt-free diet, and/or taking diuretics, diarrhea, vomiting) or renal artery stenosis (blockade in these situations of the renin-angiotensin system can lead, especially when first taking the drug and during the first 2 weeks of treatment, to a sudden decrease in blood pressure and the development of chronic renal failure). Before starting and during therapy, it is recommended to determine the concentration of creatinine, electrolytes and urea (within 1 month).

In patients with arterial hypertension already receiving diuretic therapy, it is necessary to stop taking them (3 days before starting Perindopril) and, if necessary, add them to treatment again in the future.

In patients with chronic heart failure receiving diuretic therapy, if possible, their dose should also be reduced several days before starting treatment.

In patients at risk, especially with chronic heart failure in the stage of decompensation, elderly patients, as well as patients with initially low blood pressure, impaired renal function or receiving large doses of diuretics, the initiation of use of the drug should be carried out under the supervision of medical personnel.

In patients undergoing hemodialysis, the use of polyacrylonitrile membranes should be avoided (the development of anaphylactoid reactions is possible). It is necessary to stop taking it 12 hours before the upcoming surgical treatment and notify the anesthesiologist about taking the drug.

Active ingredient

Perindopril

Composition

1 tablet contains perindopril erbumine – 4 mg.

Contraindications

Hypersensitivity to perindopril and other components of Perindopril or other ACE inhibitors, a history of angioedema during therapy with ACE inhibitors, hereditary or idiopathic angioedema, pregnancy, lactation, age under 18 years (efficacy and safety have not been established).

With caution:

Aortic valve stenosis, hypertrophic obstructive cardiomyopathy, cerebro- and cardiovascular diseases (including cerebrovascular insufficiency, coronary heart disease, coronary insufficiency – the risk of developing an excessive decrease in blood pressure and concomitant ischemia).

Severe autoimmune systemic connective tissue diseases (including systemic lupus erythematosus, scleroderma), suppression of bone marrow hematopoiesis while taking immunosuppressants (increased likelihood of developing neutropenia).

Renovascular hypertension, bilateral renal artery stenosis, stenosis of the artery of a single kidney, condition after kidney transplantation (risk of developing renal dysfunction and agranulocytosis), chronic renal failure (especially accompanied by hyperkalemia), hyperkalemia, sodium-restricted diet, conditions accompanied by a decrease in circulating blood volume (including diarrhea, vomiting, diuretics), diabetes mellitus, advanced age, surgery (general anesthesia).

Side Effects

The frequency of side effects is estimated based on: often – 1-10%; rarely – 0.1-1%; extremely rare, including individual reports – less than 0.1%.

From the cardiovascular system: often – excessive decrease in blood pressure and associated symptoms, rarely – arrhythmia, angina pectoris, myocardial infarction and stroke.

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

From the respiratory system: often – “dry” cough, difficulty breathing; rarely – bronchospasm, rhinorrhea.

From the digestive system: often – nausea, vomiting, abdominal pain, change in taste, diarrhea or constipation, dry mouth, loss of appetite, cholestatic jaundice, pancreatitis, intestinal edema.

From the central nervous system: often – headache, asthenia, fatigue, dizziness, ringing in the ears, visual disturbances, muscle cramps, paresthesia; rarely – decreased mood, insomnia; extremely rarely – confusion.

Allergic reactions: often – skin rash, itching; rarely – urticaria, angioedema; extremely rarely – exudative erythema multiforme.

Laboratory indicators: often – hypercreatininemia, proteinuria, hyperkalemia; hyperuricemia; rarely (with long-term use in high doses) – neutropenia, leukopenia, hypohemoglobinemia, thrombocytopenia, decreased hematocrit; extremely rarely – agranulocytosis, pancytopenia, increased activity of liver enzymes, hyperbilirubinemia, hemolytic anemia (due to glucose-6-phosphate dehydrogenase deficiency).

Other: increased sweating, impaired sexual function.

Interaction

Increases the severity of the hypoglycemic effect of insulin and sulfonylurea derivatives.
Baclofen, tricyclic antidepressants, antipsychotic drugs (neuroleptics), saluretics enhance the hypotensive effect and increase the risk of developing orthostatic hypotension (additive effect).

Antacids reduce the bioavailability of ACE inhibitors.

Glucocorticosteroids and non-steroidal anti-inflammatory drugs reduce the severity of the hypotensive effect (fluid and electrolyte retention).

Potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium supplements increase the risk of hyperkalemia. The simultaneous use of drugs that can cause hyperkalemia and ACE inhibitors is not recommended, except in cases of severe hypokalemia (monitoring serum potassium levels).

When used simultaneously with lithium preparations, it is possible to slow down its elimination from the body (regular monitoring of lithium levels in the blood is necessary).

Diuretics, drugs for general anesthesia and muscle relaxants, ethanol increase the risk of developing an excessive decrease in blood pressure. The risk of developing clinically significant hypotension can be reduced by stopping diuretics several days before starting treatment with perindopril.

Myelotoxic drugs – increased myelotoxic effect.

Overdose

Symptoms: decreased blood pressure, shock, stupor, bradycardia, electrolyte disturbances, renal failure.

Treatment: gastric lavage, use of enterosorbents, restoration of water-electrolyte balance, intravenous administration of 0.9% sodium chloride solution. In case of a pronounced decrease in blood pressure, the patient should be placed in a horizontal position with his legs elevated.

Hemodialysis is effective (do not use highly permeable polyacrylonitrile membranes). With the development of bradycardia – atropine. In severe cases, temporary implantation of a cardiac pacemaker is indicated. It is necessary to monitor and correct the vital functions of the body.

Storage conditions

Store in a dry place, out of reach of children, protected from light at a temperature not exceeding 25 °C.

Shelf life

2 years.

Manufacturer

Izvarino Pharma, Russia