Index of drugs

Hypertension. Heart failure.

1 tabl contains 4 mg of Perindopril tert-butylamine salt.

Angiotensin converting enzyme inhibitor angiotensin II. Suppression of ACE activity results in a decrease in plasma angiotensin II, which leads to an increase in plasma renin activity (by inhibition of negative feedback regulating renin secretion) and a reduction in aldosterone secretion. Because the angiotensin-converting enzyme inactivates bradykinin, inhibition of this enzyme also increases the activity of circulating and local kallikrein-kinin systems (and thus also the activation of the prostaglandin system). It is possible that this mechanism is responsible for lowering blood pressure and is partly responsible for specific side effects (eg cough). Perindopril works through the active metabolite - perindopril. Other metabolites do not showin vitro ACE-inhibitory activity. Perindopril is effective in all degrees of hypertension, reduces both systolic and diastolic pressure in the standing and lying position. Perindopril reduces peripheral resistance, which causes a decrease in blood pressure, consequently an increase in peripheral flow, without affecting the heart rate. There is an increase in renal blood flow, while glomerular filtration usually remains unchanged. The maximum antihypertensive effect occurs after 4-6 h after a single dose and persists for 24 hours. Perindopril reduces hypertrophy of the left ventricle. It improves the flexibility of large vessels and reduces the ratio of the thickness of the musculature to the diameter of light in small vessels. In heart failure, perindopril reduces heart rate by reducing afterload and preload. Studies in patients with heart failure have shown: reduced left and right ventricular filling pressure, decreased total peripheral resistance, increased cardiac output and improved cardiac index. After oral administration, perindopril is rapidly absorbed from the gastrointestinal tract, reaching a maximum blood concentration after 1 hour. It is converted to the active metabolite - perindoprilat. The maximum concentration of perindoprilat in the blood occurs within 3-4 h. Food reduces the conversion of perindopril into perindoprilat, which affects its bioavailability. Perindoprilat weakly binds to plasma proteins. Perindoprilat is mainly excreted in the urine, T_0,5 in the elimination phase of its free fraction is 3-5 h, the equilibrium is reached within 4 days_0,5 Perindopril is 1 hour. Elimination of perindoprilat is slower in the elderly, in patients with heart failure or renal failure. Perindoprilat is removed during dialysis.

Hypersensitivity to the components of the preparation or other ACE inhibitors. History of angioneurotic edema associated with previous treatment with ACE inhibitors. Congenital or idiopathic angioedema. Pregnancy and breastfeeding. Do not use in children.

Particularly cautiously use in patients with mitral valve, aortic valve, hypertrophic cardiomyopathy, with renal dysfunction (especially associated with vascular collagenosis or the use of immunosuppressive drugs). The risk of hypotension is higher in patients with water-electrolyte imbalance associated with the use of diuretics, low-sodium diet, dialysis, diarrhea or vomiting, and in patients with severe renin-dependent hypertension; this applies mainly to patients with severe heart failure, with or without renal failure. In patients with an increased risk of symptomatic hypotension, initiation of therapy and dose adjustment should be under close medical supervision.These remarks also apply to patients with ischemic heart disease or cerebrovascular disease, in whom a sudden reduction in blood pressure may result in a heart attack or cerebrovascular accident. Use with caution in patients with bilateral renal artery stenosis or renal artery stenosis of the sole kidney. In patients with concomitant renovascular hypertension, there is an increased risk of severe hypotension and renal failure - the treatment should be started under close medical supervision, from small doses, gently increasing them. Caution in patients with severe heart failure (Class IV), in patients with insulin-dependent diabetes (treatment should be started with low doses under strict medical supervision), in patients with renal insufficiency. Treatment with the preparation should be discontinued 2 days before the planned surgery. Do not use in patients on dialysis using high-passive filtration membranes or during LDL-apheresis with dextran sulphate. In patients requiring desensitisation of hymenoptera venom it is recommended to temporarily discontinue administration due to the risk of life-threatening anaphylactoid reactions. It should not be used in patients with rare, hereditary galactose intolerance, Lapp lactase deficiency or malabsorption of glucose-galactose.

The preparation is contraindicated in pregnancy and breast-feeding. Administration of the preparation in the second and third trimester of pregnancy results in renal dysfunction, oligohydramnios and delayed bone ossification of the skull; in the newborn, renal failure, hypotension and hyperkalemia may occur.

The following may occur: hypotension, nausea, abdominal pain, anorexia, headache and dizziness, fatigue, sleep disturbances, mood disorders, muscle cramps, taste disturbances, cough, rash, pruritus, urticaria, erythema multiforme, angioneurotic edema. Rare: increased urea and creatinine in the blood (especially with coexisting renal failure, severe heart failure and renovascular hypertension). In isolated cases: pancreatitis, decrease in hemoglobin and hematocrit values, anemia, and thrombocytopenia.

Orally.HypertensionThe recommended dose is 4 mg once a day in the morning. If necessary, after 3-4 weeks of treatment, the dose should be increased to 8 mg administered once a day in the morning. In patients treated with diuretics, patients with renovascular hypertension and in elderly patients, the recommended starting dose is 2 mg once a day in the morning (the dose should be adjusted to the patient's treatment effectiveness). If possible, treatment with diuretics should be discontinued before starting treatment with perindopril.Congestive heart failureThe recommended starting dose is 2 mg once a day in the morning. The dose can be increased to 4 mg a day (if you do not notice an excessive reduction in blood pressure). Perindopril can be used in combination with potassium and / or digoxin-free diuretic medicines, under strict medical supervision. To reduce the low risk of symptomatic hypotension, patients receiving diuretic therapy should reduce the dose of diuretics before perindopril use and / or reduce the starting dose of perindopril (eg up to 1 mg / day).
In patients with renal insufficiency, the dose should be adjusted based on the creatinine clearance value: creatinine clearance ≥ 60 ml / min- recommended dose of 4 mg per day; clearance 30-60 ml / min - 2 mg per day; clearance 15-30 ml / min - 2 mg every other day, clearance <15 ml / min - 2 mg on the day of dialysis.