Perindopril: a medicine for hypertension in old age. Features of the use of Perindopril tablets: instructions, at what pressure to take, patient reviews and analogues How long can you take Perindopril

Perindopril is an ACE inhibitor. It is customary to include it in therapy aimed at treating patients who have been diagnosed with diseases such as heart failure and arterial hypertension. The action of the medication is aimed at significantly reducing the amount of angiotensin II. It is due to this that the dilation of blood vessels occurs. As a result, it decreases arterial pressure.

Analogues and substitutes

It is rightfully considered a powerful drug, which can help in the fight against heart and vascular diseases. However, like any other medicine, it has certain contraindications. The most common contraindication is increased sensitivity. Moreover, the human body can be especially sensitive not only to the action of the main substance. Allergies to additional components are also widespread. In addition, contraindications may include certain conditions or diagnosed diseases. This is why there is a need to replace the medicine. Let us consider in more detail not the drug Perindopril, but its analogues.

Today, replacing one product with another is not particularly difficult. Because the market medications every day is updated with new developments. If we talk specifically about analogues and substitutes for a medication such as Perindopril, then they may have a similar mechanism of action. However, there are also drugs whose mechanism of action is radically different. Their composition is often different. That is why it is possible to replace the drug with one to which the patient is not allergic.

The most popular and frequently used in medical practice analogues include the following drugs:

Prestarium;
Perineva;
Ramipril;
Valsartan.

Table comparing drug analogues by cost. Last update data was 03/30/2020 00:00.

Name

Price

Captopril

from 16.00 rub. up to 169.10 rub.

Amlodipine

from 18.00 rub. up to 237.00 rub.

Lisinopril

from 22.00 rub. up to 204.00 rub.

Indapamide

from 22.00 rub. up to 115.00 rub.

Ramipril

from 89.00 rub. up to 171.00 rub.

Diroton

from 186.00 rub. up to 797.00 rub.

Valsartan

from 191.00 rub. up to 240.00 rub.

Perineva

from 322.00 rub. up to 1111.00 rub.

Prestarium

from 388.00 rub. up to 629.00 rub.

The above-mentioned substitutes and analogues are in most cases used by doctors to treat patients who have problems with vascular system and heart. They are highly effective and can help normalize the patient’s condition. Perindopril, whose analogues are cheaper, in some cases can be used in combination with them.

Perindopril or Prestarium: which is better?

This analogue cannot be called cheap, since it costs an order of magnitude more than the original medicine. The active ingredient of these two drugs is the same. But its concentration in Prestarium is 1.7 mg.

The drug can not only normalize the functioning of the heart muscle and reduce vascular resistance. It may also have a preventive effect. That is why it is usually included in therapy aimed at preventing the development of stroke or ischemic attacks. The main contraindication to the use of the product is angioedema.

Perindopril or Perineva

The drug is available in the form of granules that contain 76 mg active substance. Active component is perindopril erbumine. Do not be afraid of such a large dosage, because it corresponds to the standard dosage of the drug Perindopril.

This drug also belongs to the category of ACE inhibitors. But it is prescribed exclusively to those patients who have been diagnosed with high blood pressure. The effect of lowering blood pressure is achieved due to the fact that vascular resistance decreases. Although patients experience an acceleration of blood flow while taking the medication, this does not have any effect negative influence on heart rate.

Perindopril or Indapamide: what to choose

Indapamide is a sulfonamide diuretic. A hypertensive effect can only be achieved if a small dosage has been prescribed. At this dose it is impossible to achieve a diuretic effect. The action of the medication is aimed at:

reduce the contractility of smooth muscles;
stimulate the synthesis of certain substances that promote vasodilation.

Please note that the drug can only be used to treat essential type hypertension. In addition, it should not be prescribed to patients who have kidney or liver disease or are being treated for hypokalemia.

Perindopril or Amlodipine

The active ingredients of these two drugs are different. Because y is a calcium antagonist. With its help, it is possible to completely block the entry of calcium ions into the myocardium and smooth muscles. It is due to this that the load on the heart is reduced and the pressure is lowered. Its effect on the body is similar to that of the original medicine.

This drug can also be used if the patient has been diagnosed with liver and kidney diseases. However, it is imperative to see a doctor. Only he can choose the correct and gentle dosage.

Perindopril or Ramipril: which is better?

The drug belongs to the category of ACE inhibitors. It is widely used in cardiology. With its help, you can reduce the risk of myocardial development and stabilize the patient's condition.

Moreover, with the help of the drug Ramipril, diabetic nephropathy is treated. The drug is not prescribed to girls during pregnancy and lactation. It is also contraindicated for children, as it has many side effects.

Perindopril or Valsartan

Valsartan is a good replacement for the drug Perindopril. It is included in therapy, which is aimed at normalizing the patient’s condition. This may be a post-infarction condition or an exacerbation of heart failure. It can also be used to treat arterial hypertension, of various types.

The main contraindication to the use of the medication is if the patient has problems with the functioning of an organ such as the liver. In addition, it should not be used not only by pregnant women, but also by women who are planning to become pregnant in the near future. The product has a very negative effect on the woman’s reproductive system.

Other substitutes

Listed above are the most frequently used substitutes. However, there are others that can also be prescribed in certain cases. We are talking about the following analogues:

Captopril;
Lisinopril;

The main advantage of these analogues is their price. All of them cost an order of magnitude cheaper than the original product. That is why in some cases doctors recommend their patients to use these substitutes.

Perindopril is a medicine for hypertension and heart failure. It is also prescribed for coronary heart disease. According to the classification, it belongs to ACE inhibitors. This drug is taken once a day in the dosage prescribed by the doctor. Perindopril is often prescribed to elderly patients with hypertension, as well as to people with type 2 diabetes. The original drug is called Prestarium, the analogue is Perineva. Indications for use, contraindications, dosage, side effects. Are given real reviews sick. Find out in detail about the combined tablets perindopril + indapamide (Noliprel, Co-Perineva), perindopril + amlodipine (Prestans, Dalneva).

Prestarium tablets - detailed article - here.

Perindopril: instructions for use

pharmachologic effect	Perindopril is part of the ACE inhibitor group. It is a prodrug from which the active metabolite perindoprilat is formed in the body. Under the influence of the drug, the conversion of angiotensin-I to angiotensin-II, which is a powerful vasoconstrictor, slows down. Vasodilating effect - due to the fact that the concentration of angiotensin-II in the blood plasma decreases. The cardiac output and exercise tolerance increases. Blood pressure decreases within an hour after taking the medicine. The effect reaches its maximum at 4-8 hours and continues throughout the day.
Pharmacokinetics	During metabolism, it is transformed to form an active metabolite - perindoprilate (about 20%) and 5 inactive compounds. The maximum concentration of perindoprilate in the blood plasma is achieved between 3 and 5 hours after taking the tablet. The drug is excreted by the kidneys. If you take the tablet with food, its effect will slow down. In elderly patients, as well as with renal and heart failure, the elimination of perindoprilate slows down, but it still does not accumulate in the body.
Indications for use	Main indications: arterial hypertension, stable ischemic disease heart, chronic heart failure. Also, prevention of recurrent stroke - perindopril is the only ACE inhibitor that has such an indication for use. Typically, patients who have had a stroke or transient ischemic attack are prescribed this medicine along with the diuretic drug indapamide. Perindopril is often prescribed for hypertension in patients with type 1 and type 2 diabetes.

Read the article "

Blood pressure pills: questions and answers

How to bring blood pressure, blood sugar and cholesterol back to normal at the same time. Blood pressure pills prescribed by a doctor used to help well, but now they have become less effective. Why? What to do if the pressure is not reduced even by the most strong tablets What to do if hypertension medications lower your blood pressure too much High blood pressure, hypertensive crisis - features of treatment in young, middle and old age

Watch also the video about the treatment of coronary artery disease and angina pectoris

Learn how to take control of your heart failure

Dosage	Perindopril is taken 1/2 or 1 tablet once a day. This drug is available in tablet form with different dosages(see table with names and prices). The doctor selects the appropriate tablets. In this case, the doctor takes into account the patient’s diagnosis, blood pressure levels, and how well the kidneys are working. Do not prescribe your own dosage! This drug is usually taken in the morning. In the first 1-3 days, you can take it at night, because at the beginning of treatment, fatigue and drowsiness may appear, and then the body adapts.
Side effects	The medicine is usually well tolerated. Severe symptoms are rare. A common side effect is a dry cough. While you are taking this drug, you should have regular blood and urine tests to check your kidney function. Blood creatinine levels may temporarily increase. The doctor will decide how serious it is. Read also “Side effects of perindopril - in detail“.
Contraindications	Contraindications - pregnancy, period breastfeeding, childhood, increased sensitivity to ACE inhibitors. There are no 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 test results worsen, tell your doctor and he will decide what to do.
Pregnancy and breastfeeding	All ACE inhibitors are 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.
Drug interactions	Some medications, if taken together with perindopril, may increase potassium levels in the blood excessively. This is called hyperkalemia, and can be deadly. Risky drugs - 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.
Overdose	An overdose causes an excessive decrease in blood pressure. Symptoms: shock, palpitations, dizziness, anxiety, cough. Treatment - gastric lavage, taking activated carbon. To improve blood flow to the heart and brain, the patient is placed on his back with his legs elevated. Call ambulance! Intravenous injections - 0.9% sodium chloride solution, catecholamines. Perindoprilat, the active metabolite of perindopril, can be removed from the body by dialysis.
Release form	30 and 90 tablets in a polypropylene bottle. The bottle is placed in a cardboard box. On the package there is a control of the first opening.
Storage conditions and periods	No special storage conditions are required. Keep out of the reach of children. Shelf life - 2 years (perindopril erbumine), 3 years (perindopril arginine). Do not use after the expiration date stated on the package.
Compound	The active substance is perindopril arginine or perindopril erbumine. Excipients - acesulfame potassium, aspartame, magnesium stearate, anhydrous colloidal silicon dioxide, dry mixture of lactose and starch.

Prestarium is an original drug,

Perineva - analogue

Online pharmacy delivers throughout Moscow and Russia

Use of perindopril

Perindopril is prescribed to treat hypertension caused by any cause, including kidney problems. In stable coronary heart disease, this drug reduces the risk of first and recurrent heart attacks. It is especially often prescribed to patients diabetes mellitus 2 types. Perindopril is the only ACE inhibitor proven to be effective in preventing recurrent stroke. It inhibits the development of senile dementia, allowing patients to retain memory, clear thinking and concentration longer.

Perindopril itself moderately lowers blood pressure, acts smoothly over 24 hours, and is usually well tolerated. In overweight people and diabetics, it increases tissue sensitivity to insulin and has a beneficial effect on metabolism. Perindopril is often used together with other medications for hypertension and cardiovascular diseases. This drug is not suitable in situations where you need to quickly lower blood pressure or stop a hypertensive crisis.

Side effects: details

Perindopril is usually well tolerated, but sometimes causes side effects, like any other medicine. Below is a table that may be useful to you. The symptoms listed here are experienced by 1-10% of patients treated with this drug.

Dizziness, especially when standing up	Get up slowly from a sitting or lying position, do not rush. If you feel dizzy, sit down for a few minutes. If dizziness when standing up does not go away for several days, consult your doctor.
Dry cough	This is a common side effect that requires stopping perindopril. Instead, another medicine is usually prescribed - an angiotensin-II receptor blocker. See your doctor.
Abdominal pain, indigestion, diarrhea	Eat simple foods that are easy to digest. For a while, give up spicy seasonings and exotic dishes. Eat small portions, but more often.
Constipation	The website Lechenie-Gipertonii.Info promotes a low-carbohydrate diet for the treatment of hypertension in obese people. This diet often causes constipation. How to improve bowel movements without taking harmful laxatives - the technique has been worked out. Read more about “What to do if you have constipation.”
Headache	If headache strong - consult a doctor
Weakness, blurred vision	This side effect may occur if perindopril lowers your blood pressure too much. Do not drive or do hazardous work until you feel better and have clear vision.
Goosebumps, tinnitus, difficulty breathing, taste disturbances, rash, muscle cramps	These are rare but still possible side effects. If any of them cause you serious trouble, consult a doctor.

After a few days of taking the medicine, the body adapts and the side effects may subside. However, sometimes (rarely!) there are severe symptoms:

Difficulty breathing, swelling of the face, mouth, tongue or throat. These are the signs allergic reaction. The skin or whites of the eyes become yellow color. The urine may darken. Jaundice is a rare but possible side effect. Severe rash on the skin.

If you experience any of the above, stop treatment with perindopril and contact your doctor quickly.

Clinical trials: overview

Perindopril has a significant evidence base on the basis of which its indications for use were formulated. The main studies were carried out in the 1990s - the first half of the 2000s. Below are three large international studies that involved more than 29,000 patients. All these studies were designed and conducted to obtain reliable results.

The authors of the EUROPA study wanted to test how perindopril works in patients with coronary heart disease. The results of this study were published in 2003. It turned out that the drug reduces the risk of heart failure, has a beneficial effect on blood vessels and inhibits the development of atherosclerosis. The incidence of heart attacks decreases with treatment with this drug because the arteries supplying the heart are less likely to become clogged with blood clots. Atherosclerotic plaques remain stable and grow more slowly.

PROGRESS study examined the effect of perindopril on the risk of recurrent stroke. 6,105 patients who had already suffered a stroke participated. The results were published in 2001. The study drug reduced the incidence of recurrent stroke, as well as all cardiovascular complications by 26%. According to the results of the PROGRESS study, secondary prevention of stroke was added to the indications for the use of perindopril.

Pharmaceutical companies try to exaggerate the merits of their drugs and compromise the drugs of their competitors. International clinical trials are conducted to avoid this. Patients do not know whether they are taking real medicine or a dummy. Even doctors who give pills to patients don’t know this. Such studies are called double-blind, placebo-controlled. Their results are considered reliable.

The ADVANCE study is the largest, its results were published in 2007. It proved that perindopril reduces the risk of death in patients with type 2 diabetes. The ACE inhibitor inhibited the development of vascular complications of diabetes along with the rest of the treatment that the patients received. Diabetics usually tolerate treatment with perindopril well. This drug may be prescribed with other medications for hypertension and tablets that lower blood sugar.

A combined analysis of the EUROPA, PROGRESS, and ADVANCE studies was presented at the 2008 American Heart Association meeting. It has been confirmed that perindopril reduces the risk of cardiovascular complications in hypertension, including in diabetics. This drug reduced overall mortality by 11%, cardiovascular mortality and the risk of heart attack by 18%. It is advisable to prescribe it or another ACE inhibitor to all patients who have high cardiovascular risk.

Perindopril arginine and its benefits

The active ingredient in Prestarium A tablets is perindopril arginine. It is an ACE inhibitor combined with the amino acid arginine. In the name of the drug, A stands for arginine. Before the advent of arginine salt, perindopril erbumine was used. Analogue preparations from other manufacturers (Perineva, KRKA) still contain erbumine salt. The new version with arginine provides an advantage - the shelf life of the tablets has increased from 2 to 3 years. Otherwise, perindopril arginine and erbumine are the same thing.

The effectiveness of perindopril has been proven in numerous studies involving more than 50,000 patients. In most of these studies, patients were prescribed erbumine salt. Perindopril arginine entered the market in the second half of the 2000s. At first, doctors doubted that the new active substance would be as effective. Clinical trials have been conducted that have proven that erbumine and arginine salts act in the same way. It is enough to take both versions of the tablets once a day. Each dose taken lasts 24 hours or longer.

Official recommendations allow prescribing perindopril in the form of both erbumine and arginine. Indications for use are the same. The choice of a specific medication is at the discretion of the doctor. Information about the effectiveness of various drugs that doctors accumulate from their practical experience plays a role. Analogues are cheaper than the original drug Prestarium. Articles in medical journals promote Perinev's tablets for the treatment of elderly patients who need affordable drugs.

Combination drugs

For most patients, a single hypertension medication is not enough to reduce blood pressure to normal. If the pressure is 160/100 mmHg. Art. and higher, then two drugs are usually immediately prescribed for simultaneous use. In severe cases, you can take a combination of 3-4 antihypertensive drugs. Perindopril is most often prescribed together with indapamide or amlodipine. The effectiveness of such combinations has been confirmed by the results of large studies, which are described below. Combination medications based on perindopril are effective and safe for patients with type 2 diabetes mellitus, as well as for other categories of patients.

If the patient has severe hypertension and high cardiovascular risk, he may be prescribed perindopril, indapamide and amlodipine at the same time. The effectiveness and good tolerability of this triple combination has been proven based on the results of studies conducted in English-speaking countries and in Russia. And if the simultaneous use of 3-4 blood pressure medications does not help, then the method of sympathetic denervation of the renal arteries is used.

See, for example, the article “Results of a prospective open research to evaluate the antihypertensive efficacy and tolerability of Noliprel B-forte in patients with uncontrolled arterial hypertension and type 2 diabetes mellitus (PRACTIC study).” Authors - Sirenko Yu.N., Mankovsky B.N., Radchenko A.D., Kushnir S.N., journal “Arterial Hypertension” No. 4/2012.

Noliprel is a combination tablet containing perindopril and indapamide. If Noliprel is in maximum dose did not help enough, then amlodipine was added to it. The study lasted 3 months. A combination of three hypertension medications kept my blood pressure below 140/90 mmHg. Art. in 74.8% of patients. In the group of patients with type 2 diabetes, blood pressure is below 135/85 mmHg. Art. reached 62.4% of study participants.

Perindopril + amlodipine - Prestance medicine

The drug combination perindopril + amlodipine is widely used in the West and in Russian-speaking countries to treat hypertension and reduce the risk of cardiovascular complications. It is theoretically justified and has proven its effectiveness in practice. A popular medicine that contains perindopril and amlodipine is Prestance. It also has an analogue of Dalnev, which is more affordable.

After Prestans came out on Russian market, Russian Medical Society for arterial hypertension(RMOAG) initiated the BREAKTHROUGH program - “Prestance in the treatment of uncontrolled arterial hypertension - a real chance to improve blood pressure control.” This is a large study involving 4115 patients. It confirmed the high effectiveness of the combination of perindopril and amlodipine. According to some data, this combination reduces blood pressure by 33/20 mm Hg. Art., according to others - by 36/17 mm Hg. Art. About 80% of patients reach the target blood pressure level, and the treatment is well tolerated.

Combination tablets containing perindopril and amlodipine significantly lower blood pressure and are well tolerated. If amlodipine causes swelling of the legs, it is replaced with lercanidipine.

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The drug Prestance is available in four versions, with different doses of active ingredients. This provides the physician with sufficient flexibility in selecting the optimal dosage for the patient. If necessary, the patient can be switched from weak tablets to more powerful ones. In severe cases, a third or even a fourth blood pressure medication is added. In particular, beta blockers are also prescribed to patients diagnosed with coronary heart disease.

Perindopril + indapamide - medicine Noliprel

The combination of perindopril and indapamide is popular because it significantly lowers blood pressure, reduces the risk of death from all causes, as well as the likelihood of heart attack and stroke. However, the treatment is usually well tolerated. The main category of patients who are prescribed perindopril and indapamide together are obese patients with hypertension who have metabolic syndrome or type 2 diabetes. This combination of drugs is also recommended for older people who have isolated systolic hypertension.

It is more convenient for patients to take perindopril and indapamide when both of these drugs are contained in one tablet. Such drugs are Noliprel and its analogue Co-Perineva. The large international ADVANCE study involved 11,140 patients with hypertension and type 2 diabetes. The results were published in 2007. Noliprel in patients with type 2 diabetes reduced overall mortality by 14%, and the risk of mortality from cardiovascular diseases by 18%, compared with placebo.

Combination medications for hypertension containing perindopril and indapamide are often prescribed to patients with type 2 diabetes.

The drug Noliprel is available in three varieties, and Co-Perineva - in four, with different dosages of active ingredients. If necessary, the doctor can switch the patient from weak tablets to stronger ones, which also need to be taken once a day. If necessary, amlodipine can be added as a third drug. Complications of diabetes on the kidneys are not contraindications to the use of Noliprel, but the patient needs to undergo blood tests for creatinine and urine tests for protein more often.

Patient reviews

Perindopril is not a very powerful medicine for blood pressure, and patients note this in their reviews. But it acts mildly and rarely causes side effects other than a dry cough.

Olga Larina

I have been taking perindopril erbumin (Perineva) for 3 months now. A month after starting treatment, my blood pressure leveled off within 24 hours and remained no higher than 130/80 mmHg. Art. And before, every day it rose in the evening.

They were able to successfully choose the medicine for you. Please note that it does not eliminate the causes of the disease, but only muffles the symptoms. Doesn't cause hypertension healthy image life. It gradually destroys blood vessels. If you continue in the same spirit, in a few years the condition of the blood vessels will worsen. More and more will be needed powerful pills. In the end, they will not be able to control the pressure. Normalize your lifestyle in middle age if you want to live longer in retirement.

Artem Kruzhalov

The cardiologist prescribed me perindopril. I have been taking this drug for 4 months now. Usually the pressure is not higher than 130/85 mmHg. Art. But when the weather changes, it increases, despite taking pills. Reaches up to 170/110 mm Hg. Art., headache and other symptoms. I want to switch to some other drug, stronger.

Study the article “Causes of hypertension and how to eliminate them,” then get examined and follow the recommendations. Adopting a healthy lifestyle is the main treatment for hypertension. And any pills only complement it. You can continue to lead a sedentary lifestyle and eat garbage. But in this case, after a few years, no medications will be able to bring your blood pressure under control. This can happen even before retirement. So what will you do then?

Larisa Radchenko

I took perindopril for hypertension for six months. These pills kept my blood pressure well and there was never a sharp increase. But he pestered me persistent cough. The doctor said to switch to Losartan and also add a diuretic medicine. Now I am starting treatment with a new drug. I don’t yet know how good such a replacement will be.

The drug Losartan belongs to the group of angiotensin-II receptor blockers. If perindopril causes a dry cough, then these medications are usually prescribed instead. How well will it help? new drug- cannot be predicted in advance. At the moment, blood pressure pills are selected by trial and error, because there is no more accurate method. Each patient has his own individual reaction. Over time, genetic research will make it possible to accurately predict, but this is still a long way off.

Frequently asked questions and their answers

What to do if perindopril does not lower blood pressure enough? Adding other drugs to it doesn’t help much either. What are the most effective pills for hypertension?

Blood pressure drops quickly and greatly if you take 2-3 medications at the same time. Nowadays, drugs that contain 2-3 active ingredients in one tablet. Read more: “Combined medications for hypertension are the most powerful.” However, medications do not eliminate the cause of the disease, but only muffle the symptoms. If you continue to lead an unhealthy lifestyle, then in a few years the condition of your blood vessels will worsen. In the end, even the most powerful pills will not be able to bring your blood pressure under control. Study the article “Causes of hypertension and how to eliminate them.” Get examined and follow the recommendations that are outlined in it, in addition to taking medications.

The doctor prescribed perindopril 4 mg, one tablet per day. Can I take 1/2 tablet in the morning and evening?

It is recommended to take this medicine once a day. There is no data on what will happen if the daily dose is divided into 2 doses. Taking the medicine once a day is convenient. Each dose lasts 24 hours or longer. Therefore, there is no point in dividing it into two doses.

Do I need to take breaks from taking these pills?

Perindopril must be taken every day, without breaks, even when you have normal pressure. If the effect of the drug weakens, discuss with your doctor what other medications can be added. You cannot stop taking or replace tablets without permission. You also need to take steps to transition to a healthy lifestyle.

I have been taking perindopril for several years for hypertension, also glycine, and also for glaucoma. eye drops Okumed (timolol). I was recently switched to Prestarium A (perindopril arginine). Appeared side effects- The face is swollen and covered in a rash. Could this be a reaction to arginine? Should I switch to perindopril without arginine (Perineva)? Or stop taking ACE inhibitors altogether?

It is difficult to say what caused the side effects you describe. It is unlikely that this is arginine, because blood pressure tablets contain an insignificant dose of it. You need to take 100-200 times more of this amino acid for it to have any effect. First of all, you should suspect an allergy. A low-carbohydrate diet normalizes blood pressure and eliminates most allergens from food, except chicken eggs. It would be a good idea to get tested to find out what foods and chemicals you are allergic to, and also get blood tests for liver function tests. Together with your doctor, try stopping or replacing some medications - and evaluate the effect after 1-2 weeks.

Noliprel helps me well for hypertension. Can it be replaced with two separate tablets, perindopril and indapamide? The reason is that Noliprel has become unaffordable.

Noliprel is a combination medicine that contains perindopril and indapamide in one tablet. It has proven itself well, but it is an original drug, not very cheap. Replace with two separate tablets - you will not be using the original drugs Prestarium and Arifon retard, but cheaper analogues. How effective they will be is impossible to predict. Try it and find out. Manufacturers claim that analogues work no worse than the original drugs. But this does not always turn out to be true.

Prescribed Prestance (perindopril + amlodipine) and Arifon retard for hypertension. It lowers blood pressure well, but swelling of the legs bothers me. I'm guessing it's from amlodipine. Is it possible to replace amlodipine with lercanidipine, which causes less swelling?

Is it possible to replace amlodipine with lercanidipine - yes, but check with your doctor. Be prepared that you will have to take 3 separate tablets every day. Pay attention to taurine for swelling. Read also the detailed article “Lercanidipine”. It provides research data on how much lercanidipine reduces swelling compared to amlodipine.

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Read more about the technique in the article “Treatment of hypertension without drugs“. How to order hypertension supplements from the USA - download instructions. Bring your blood pressure back to normal without the harmful side effects that Noliprel and other “chemical” pills cause. Improve your heart function. Become calmer, get rid of anxiety, sleep like a baby at night. Magnesium with vitamin B6 works wonders for hypertension. You will have excellent health, the envy of your peers.

After a stroke, my father was prescribed to take perindopril, indapamide, amlodipine and also vinpocetine. The dosage of perindopril 10 mg is confusing. Is this a typo? The instructions for the drug say maximum daily dose 8 mg.

Perindopril comes in the form of one of two salts - arginine or erbumine. The maximum daily dose is 8 mg for erbumine salt. Your father was prescribed tablets containing perindopril arginine. It is taken 5 or 10 mg per day. So there is no typo, everything is correct.

conclusions

After reading the article, you have learned everything you need about the drug perindopril, which is prescribed for hypertension and cardiovascular diseases. Above are instructions for the use of this drug, adapted for patients who do not have a medical education. Indications for use and dosages for various diseases. Please also pay attention to contraindications and interactions with other medications. Perindopril acts mildly and causes relatively few side effects. For hypertension, it is usually prescribed along with other drugs. Most often these are indapamide (combined Noliprel tablets) and amlodipine (Prestance tablets).

Manufacturers hype the benefits of perindopril over other ACE inhibitors. For this purpose, paid articles are published in medical journals. But in practice the benefits are not very noticeable. If you need to save money, then perindopril is replaced with other ACE inhibitors, cheaper ones, which can be taken once a day. The most commonly prescribed medications are enalapril, lisinopril, or ramipril. Such a replacement cannot be carried out arbitrarily; it must be agreed with a doctor. No blood pressure pills can replace the transition to a healthy lifestyle - good nutrition, physical activity, stress reduction.

General characteristics. Compound:

Active ingredient: 4 mg perindopril erbumine.

Excipients: lactose (milk sugar), microcrystalline cellulose, croscarmellose sodium (primellose), magnesium stearate.

Antihypertensive drug.

Pharmacological properties:

Pharmacodynamics. 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 I to angiotensin II, which is a powerful vasoconstrictor. As a result of a decrease in the concentration of angiotensin II, a secondary increase in plasma renin activity occurs due to the elimination of negative feedback during 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 after 4-8 hours and continues for 24 hours.

IN clinical studies when using perindopril (monotherapy or in combination with a diuretic), a significant reduction in the risk of recurrent stroke (both ischemic and hemorrhagic), as well as the risk of fatal or disabling strokes, is shown; major cardiovascular complications, including myocardial infarction, incl. With fatal; stroke-related dementia; serious deterioration of cognitive functions. These therapeutic benefits were observed in both patients with arterial hypertension and those with normal blood pressure, regardless of age, gender, presence or absence of diabetes mellitus, and type of stroke.

It has been shown that with the use of perindopril tertbutylamine at a dose of 8 mg/day (equivalent to 10 mg of perindopril arginine) in patients with stable coronary artery disease, there is a significant reduction in the absolute risk of complications provided for by the main criterion of effectiveness (mortality from cardiovascular diseases, incidence of non-fatal myocardial infarction and/or cardiac arrest followed by successful resuscitation) by 1.9%. In patients who had previously suffered a myocardial infarction or coronary revascularization procedure, the absolute risk reduction was 2.2% compared with the placebo group.

Perindopril is used both as monotherapy and in fixed combinations with indapamide and amlodipine.

Pharmacokinetics. After oral administration, perindopril is rapidly absorbed from the gastrointestinal tract. Cmax is reached after 1 hour. Bioavailability is 65-70%.

During metabolism, perindopril is biotransformed to form an active metabolite - perindoprilate (about 20%) and 5 inactive compounds. Cmax of perindoprilat in plasma is achieved between 3 and 5 hours after administration. The binding of perindoprilate to plasma proteins is insignificant (less than 30%) and depends on the concentration of the active substance. Vd of free perindoprilate is close to 0.2 l/kg.

Does not accumulate. Repeated administration does not lead to accumulation and T1/2 corresponds to the period of its activity.

When taken with food, the metabolism of perindopril slows down.

T1/2 of perindopril is 1 hour.

Perindoprilat is excreted from the body by the kidneys; T1/2 of its free fraction is 3-5 hours.

In elderly patients, as well as in renal and heart failure, the elimination of perindoprilate slows down.

Indications for use:

Arterial hypertension.

Chronic heart failure.

Prevention of recurrent stroke (combination therapy with indapamide) in patients who have had a stroke or transient disorder cerebral circulation according to the ischemic type.

Stable coronary artery disease: reducing the risk of cardiovascular complications in patients with stable coronary artery disease.

Directions for use and dosage:

The initial dose is 1-2 mg/day in 1 dose. Maintenance doses - 2-4 mg/day for congestive heart failure, 4 mg (less often - 8 mg) - for arterial hypertension in 1 dose.

In case of renal dysfunction, adjustment of the dosage regimen is required depending on the CC values.

Features of application:

Use during pregnancy and breastfeeding. Perindopril is contraindicated for use during pregnancy and lactation (breastfeeding).

Use for renal dysfunction. In case of renal dysfunction, adjustment of the dosage regimen is required depending on the CC values.

Use in children. Contraindicated in children.

Perindopril should be used with caution in cases of bilateral renal artery stenosis or renal artery stenosis of a single kidney; renal failure; systemic diseases connective tissue; therapy with immunosuppressants, allopurinol, procainamide (risk of developing neutropenia, agranulocytosis); decreased blood volume (taking diuretics, salt-restricted diet, vomiting, diarrhea); angina pectoris; cerebrovascular diseases; renovascular hypertension; diabetes mellitus; chronic heart failure functional class IV according to the NYHA classification; simultaneously with potassium-sparing diuretics, potassium preparations, potassium-containing table salt substitutes, and lithium preparations; with hyperkalemia; surgery/general anesthesia; hemodialysis using high-flow membranes; desensitizing therapy; LDL apheresis; condition after kidney transplantation; aortic stenosis/mitral stenosis/hypertrophic obstructive cardiomyopathy; in patients of the Negroid race.

Cases have been reported arterial hypotension, syncope, stroke, hyperkalemia and renal impairment (including acute renal failure) in predisposed patients, especially when used concomitantly with medicines, which 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.

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 connective tissue diseases, in patients receiving immunosuppressive drugs, allopurinol). Patients with sodium and fluid deficiency must undergo correction of water and electrolyte disturbances before starting treatment.

Side effects:

From the hematopoietic system: eosinophilia, decreased hemoglobin and hematocrit, thrombocytopenia, leukopenia/neutropenia, agranulocytosis, pancytopenia, hemolytic anemia in patients with congenital deficiency of glucose-6-phosphate dehydrogenase.

From the metabolic side: hypoglycemia, hyperkalemia, reversible after discontinuation of the drug, hyponatremia.

From the outside nervous system: paresthesia, headache, dizziness, vertigo, sleep disturbances, mood lability, drowsiness, fainting, confusion.

From the senses: visual disturbances, tinnitus.

From the outside of cardio-vascular system: excessive decrease in blood pressure and associated symptoms, vasculitis, tachycardia, palpitations, disorders heart rate, angina pectoris, myocardial infarction and stroke, possibly due to excessive reduction in blood pressure in high-risk patients.

From the outside respiratory system: cough, shortness of breath, bronchospasm, eosinophilic pneumonia, rhinitis.

From the outside digestive system: constipation, nausea, vomiting, abdominal pain, taste disturbance, dyspepsia, diarrhea, dry oral mucosa, pancreatitis, hepatitis (cholestatic or cytolytic).

From the outside skin and subcutaneous fat: itchy skin, rash, photosensitivity, pemphigus, increased sweating.

Allergic reactions: angioedema, urticaria, erythema multiforme.

From the musculoskeletal system: muscle spasms, arthralgia, myalgia.

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

From the reproductive system: erectile dysfunction.

General reactions: asthenia, pain in chest, peripheral edema, weakness, fever, falls.

From laboratory parameters: increased activity of liver transaminases and bilirubin in the blood serum, increased concentrations of urea and creatinine in the blood plasma.

Interaction with other drugs:

The risk of developing hyperkalemia increases with simultaneous use of perindopril with other drugs that can cause hyperkalemia: aliskiren and aliskiren-containing drugs, potassium salts, potassium-sparing diuretics, ACE inhibitors, angiotensin II receptor antagonists, NSAIDs, heparin, immunosuppressants such as cyclosporine or tacrolimus, trimethoprim.

When used concomitantly with aliskiren in patients with diabetes mellitus or impaired renal function (GFR<60 мл/мин) возрастает риск гиперкалиемии, ухудшения функции почек и повышения частоты сердечно-сосудистой заболеваемости и смертности (у пациентов этих групп данная комбинация противопоказана).

Concomitant use with aliskiren is not recommended in patients who do not have diabetes mellitus or impaired renal function, because there may be an increased risk of hyperkalemia, deterioration of renal function, and increased incidence of cardiovascular morbidity and mortality.

The literature has reported that in patients with established atherosclerotic disease, heart failure, or diabetes mellitus with end-organ damage, concomitant therapy with an ACE inhibitor and an angiotensin II receptor antagonist is associated with a higher incidence of hypotension, syncope, hyperkalemia, and deterioration of renal function (including acute renal failure) compared with the use of only one drug that affects the RAAS. Dual blockade (for example, when combining an ACE inhibitor with an angiotensin II receptor antagonist) should be limited to selected cases with careful monitoring of renal function, potassium and blood pressure.

Concomitant use with estramustine may lead to an increased risk of side effects such as angioedema.

With the simultaneous use of lithium and perindopril, a reversible increase in the concentration of lithium in the blood serum and associated toxic effects is possible (this combination is not recommended).

Simultaneous use with hypoglycemic drugs (insulin, hypoglycemic agents for oral administration) requires special caution, because ACE inhibitors, incl. perindopril, can enhance the hypoglycemic effect of these drugs up to the development of hypoglycemia. As a rule, this is observed in the first weeks of simultaneous therapy and in patients with impaired renal function.

Baclofen enhances the antihypertensive effect of perindopril; with simultaneous use, dose adjustment of the latter may be required.

In patients receiving diuretics, especially those that remove fluid and/or salts, an excessive decrease in blood pressure may be observed at the beginning of perindopril therapy, the risk of which can be reduced by discontinuing the diuretic, replacing fluid or salt loss before starting perindopril therapy, as well as using perindopril at low doses. initial dose with further gradual increase.

In chronic heart failure, when using diuretics, perindopril should be used in a low dose, possibly after reducing the dose of a potassium-sparing diuretic used simultaneously. In all cases, renal function (creatinine concentration) should be monitored in the first weeks of using ACE inhibitors.

The use of eplerenone or spironolactone in doses from 12.5 mg to 50 mg/day and ACE inhibitors (including perindopril) in low doses: in the treatment of heart failure of functional class II-IV according to the NYHA classification with left ventricular ejection fraction<40% и ранее применявшимися ингибиторами АПФ и «петлевыми» диуретиками, существует риск развития гиперкалиемии (с возможным летальным исходом), особенно в случае несоблюдения рекомендаций относительно этой комбинации. Перед применением данной комбинации необходимо убедиться в отсутствии гиперкалиемии и нарушений функции почек. Рекомендуется регулярно контролировать концентрацию креатинина и калия в крови - еженедельно в первый месяц лечения и ежемесячно в последующем.

The simultaneous use of perindopril with NSAIDs (acetylsalicylic acid in a dose that has an anti-inflammatory effect, COX-2 inhibitors and non-selective NSAIDs) may lead to a decrease in the antihypertensive effect of ACE inhibitors. Concomitant use of ACE inhibitors and NSAIDs may lead to deterioration of renal function, including the development of acute renal failure, and an increase in serum potassium, especially in patients with reduced renal function. Use this combination with caution in elderly patients. Patients should receive adequate fluids; It is recommended to carefully monitor renal function, both at the beginning and during treatment.

The hypotensive effect of perindopril may be enhanced when used simultaneously with other antihypertensive drugs, vasodilators, including short- and long-acting nitrates.

Concomitant use of gliptins (linagliptin, saxagliptin, sitagliptin, vitagliptin) with ACE inhibitors (including perindopril) may increase the risk of angioedema due to inhibition of dipeptidyl peptidase IV activity by gliptin.

Concomitant use of perindopril with tricyclic antidepressants, antipsychotic drugs and general anesthesia may lead to increased antihypertensive effects.

Sympathomimetics may reduce the antihypertensive effect of perindopril.

When using ACE inhibitors, incl. perindopril, in patients receiving intravenous gold (sodium aurothiomalate), a symptom complex was described in which facial skin flushing, nausea, vomiting, and arterial hypotension were observed.

Contraindications:

History of angioedema, simultaneous use with aliskiren and aliskiren-containing drugs in patients with diabetes mellitus or impaired renal function (GFR<60 мл/мин/1.73 м2), беременность, лактация, детский и подростковый возраст до 18 лет, повышенная чувствительность к периндоприлу, повышенная чувствительность к другим ингибиторам АПФ.

Storage conditions:

Store at a temperature not exceeding 25 °C in places out of reach of children. Shelf life: 3 years.

Vacation conditions:

On prescription

Package:

10 tablets in strip packs, 3 packs in a cardboard box.

The drug Perindopril is a reliable treatment for hypertension and cardiac dysfunction caused by various reasons, including kidney diseases. It is used for cardiac ischemia and is prescribed for elderly hypertensive patients and those suffering from type II diabetes mellitus.

The drug Perindopril belongs to the group of ACE inhibitors, is a prodrug from which the active metabolite perindoprilat is formed in the body, and is prescribed to patients with various heart diseases and arterial hypertension.

Representatives of this pharmaceutical group are highly effective, quite safe and well tolerated by patients. The mechanism of their action is associated with suppression of the activity of the renin-angiotensin system.

The active substance is perindopril arginine or perindopril erbumine. One film-coated tablet contains the active compound: perindopril erbumine (in the form of tert-butylamine salt) - 2, 4 or 8 mg.

The mechanism of action of perindopril is based on competitive blocking of the action of ACE, which triggers a cascade of systemic vasoconstriction. The end point of action of any ACE inhibitor is to relax the blood vessels, which reduces peripheral vascular resistance and lowers blood pressure.

The hypotensive effect develops during the first hour after taking perindopril, reaches a maximum at 4-8 hours and lasts for 24 hours.

Indications for use Perindopril

What does Perindopril help with? Indications for the use of tablets are the following diseases or conditions:

stable coronary heart disease;
arterial hypertension;
hypertension of renovascular etiology;
prevention of recurrent stroke or stroke after transient ischemic attack;
chronic heart failure.

Instructions for use Perindopril, dosage

The drug Perindopril is used orally in one dose (1 time per day). Treatment usually begins with a standard starting dosage of 1-2 mg per day.

For congestive heart failure, the optimal dosage is 2-4 mg/day, for arterial hypertension – 4-8 mg/mg. Doses are increased from 4 mg to 8 mg over 3-4 weeks.

Your doctor may prescribe you a low dose of Perindopril at the beginning of your treatment and gradually increase your dose. Continue taking Perindopril even if you feel well. Do not stop taking the drug without talking to your doctor.

Features of application

In case of renal dysfunction, adjustment of the dosage regimen is required depending on the CC values.

The combined use of Perindopril and ethanol (alcohol) is not recommended, but does not lead to a destructive effect on the human body.

When using ACE inhibitors and Perindopril, in particular, there is a risk of developing arterial hypotension, headache, dizziness and visual impairment, therefore, during the period of conservative treatment, it is worth abandoning independent driving or other activities that require increased attention, speed and clarity of motor skills. reactions.

If you forget to take a dose of medication, it is strictly prohibited to take a double dosage the next time you take it.

The drug can be used in monotherapy and in combination with other antihypertensive drugs, but only as directed and under the supervision of a specialist.

Caution is required when performing any surgical interventions (including dental) during therapy.

Side effects and contraindications

Side effects of Perindopril:

cough,
headache,
general weakness (asthenia),
dizziness,
diarrhea,
pain in the epigastric region,
stomach upset,
swelling of the face, throat, tongue, lips, eyes, hands, feet,
hoarseness of voice,
difficulty swallowing or breathing,
fainting,
fever, sore throat, chills and other signs of infection,
irregular or fast heartbeat.

Overdose

In case of overdose or poisoning, immediately call an ambulance or consult your doctor. An overdose of some drugs can lead to health hazards and death.

Symptoms: acute arterial hypotension, Quincke's edema. In case of overdose, a dose reduction or complete discontinuation of the drug is required.

– transfer the patient to a horizontal position with raised legs;
– gastric lavage;
– carrying out measures to increase blood volume (introduction of saline and other blood-substituting fluids),
– symptomatic therapy: epinephrine (s.c. or i.v.), antihistamines, hydrocortisone (i.v.);
– carrying out dialysis procedures.

It is necessary to monitor vital signs and serum creatinine and electrolyte concentrations. Perindopril can be removed from the systemic circulation by hemodialysis. The use of highly permeable polyacrylonitrile membranes should be avoided.

Contraindications

Hypersensitivity to perindopril or other ACE inhibitors, childhood (safety and effectiveness have not been determined), pregnancy, lactation, history of angioedema.

Analogues of Perindopril, list

Analogues of Perindopril by scope of application include drugs (list):

Hypernik,
Stoppress,
Noliprel,
Prestarium A,
Perindopril-Richter,
Perinpress,
Perindopril Pfizer,
Perindopril erbumine,
Perindopril tert-butylamine,
Perineva, Prestans,
Arentopres,
Coverex,
Perindid,
Parnavel,
Piristar.

Important - instructions for use of Perindopril, price and reviews do not apply to analogues and cannot be used as a guide to the use of drugs of similar composition or action. All therapeutic prescriptions must be made by a doctor. When replacing Perindopril with an analogue, it is important to consult a specialist; you may need to change the course of therapy, dosages, etc. Do not self-medicate!

pharmachologic effect

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 I to angiotensin II, which is a powerful vasoconstrictor. As a result of a decrease in the concentration of angiotensin II, a secondary increase in plasma renin activity occurs due to the elimination of negative feedback during 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 after 4-8 hours and continues for 24 hours.

Clinical studies with the use of perindopril (monotherapy or in combination with a diuretic) have shown a significant reduction in the risk of recurrent stroke (both ischemic and hemorrhagic), as well as the risk of fatal or disabling strokes; major cardiovascular complications, including myocardial infarction, incl. with fatal outcome; stroke-related dementia; serious deterioration of cognitive functions. These therapeutic benefits were observed in both patients with arterial hypertension and those with normal blood pressure, regardless of age, gender, presence or absence of diabetes mellitus, and type of stroke.

Perindopril is used both as monotherapy and in fixed combinations with indapamide and amlodipine.

Pharmacokinetics

After oral administration, perindopril is rapidly absorbed from the gastrointestinal tract. Cmax is reached after 1 hour. Bioavailability is 65-70%.

During metabolism, perindopril is biotransformed to form an active metabolite - perindoprilate (about 20%) and 5 inactive compounds. Cmax of perindoprilate in plasma is achieved between 3 and 5 hours after administration. The binding of perindoprilate to plasma proteins is insignificant (less than 30%) and depends on the concentration of the active substance. Vd of free perindoprilate is close to 0.2 l/kg.

Does not accumulate. Repeated administration does not lead to cumulation and T 1/2 corresponds to the period of its activity.

When taken with food, the metabolism of perindopril slows down.

T1/2 of perindopril is 1 hour.

Perindoprilat is excreted from the body by the kidneys; T1/2 of its free fraction is 3-5 hours.

In elderly patients, as well as in renal and heart failure, the elimination of perindoprilate slows down.

Indications

Arterial hypertension.

Chronic heart failure.

Prevention of recurrent stroke (combination therapy with indapamide) in patients who have had a stroke or transient ischemic cerebrovascular accident.

Stable coronary artery disease: reducing the risk of cardiovascular complications in patients with stable coronary artery disease.

Dosage regimen

The initial dose is 1-2 mg/day in 1 dose. Maintenance doses - 2-4 mg/day for congestive heart failure, 4 mg (less often - 8 mg) - for arterial hypertension in 1 dose.

Side effect

From the hematopoietic system: eosinophilia, decreased hemoglobin and hematocrit, thrombocytopenia, leukopenia/neutropenia, agranulocytosis, pancytopenia, hemolytic anemia in patients with congenital deficiency of glucose-6-phosphate dehydrogenase.

From the side of metabolism: hypoglycemia, hyperkalemia, reversible after discontinuation of the drug, hyponatremia.

From the nervous system: paresthesia, headache, dizziness, vertigo, sleep disturbances, mood lability, drowsiness, fainting, confusion.

From the senses: visual impairment, tinnitus.

From the cardiovascular system: excessive decrease in blood pressure and associated symptoms, vasculitis, tachycardia, palpitations, cardiac arrhythmias, angina pectoris, myocardial infarction and stroke, possibly due to excessive decrease in blood pressure in high-risk patients.

From the respiratory system: cough, shortness of breath, bronchospasm, eosinophilic pneumonia, rhinitis.

From the digestive system: constipation, nausea, vomiting, abdominal pain, taste disturbance, dyspepsia, diarrhea, dry oral mucosa, pancreatitis, hepatitis (cholestatic or cytolytic).

For the skin and subcutaneous fat: skin itching, rash, photosensitivity, pemphigus, increased sweating.

Allergic reactions: angioedema, urticaria, erythema multiforme.

From the musculoskeletal system: muscle spasms, arthralgia, myalgia.

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

From the reproductive system: erectile disfunction.

General reactions: asthenia, chest pain, peripheral edema, weakness, fever, falls.

From the laboratory parameters: increased activity of liver transaminases and bilirubin in the blood serum, increased concentrations of urea and creatinine in the blood plasma.

Contraindications for use

History of angioedema, simultaneous use with aliskiren and aliskiren-containing drugs in patients with diabetes mellitus or impaired renal function (GFR<60 мл/мин/1.73 м 2), беременность, лактация, детский и подростковый возраст до 18 лет, повышенная чувствительность к периндоприлу, повышенная чувствительность к другим ингибиторам АПФ.

Use during pregnancy and breastfeeding

Perindopril is contraindicated for use during pregnancy and lactation (breastfeeding).

Use in children

Contraindicated in children.

Drug interactions

Concomitant use with estramustine may lead to an increased risk of side effects such as angioedema.

Baclofen enhances the antihypertensive effect of perindopril; with simultaneous use, dose adjustment of the latter may be required.

The use of eplerenone or spironolactone in doses from 12.5 mg to 50 mg/day and ACE inhibitors (including perindopril) in low doses: in the treatment of heart failure of functional class II-IV according to the NYHA classification with left ventricular ejection fraction<40% и ранее применявшимися ингибиторами АПФ и "петлевыми" диуретиками, существует риск развития гиперкалиемии (с возможным летальным исходом), особенно в случае несоблюдения рекомендаций относительно этой комбинации. Перед применением данной комбинации необходимо убедиться в отсутствии гиперкалиемии и нарушений функции почек. Рекомендуется регулярно контролировать концентрацию креатинина и калия в крови - еженедельно в первый месяц лечения и ежемесячно в последующем.

The hypotensive effect of perindopril may be enhanced when used simultaneously with other antihypertensive drugs, vasodilators, including short- and long-acting nitrates.

Concomitant use of perindopril with tricyclic antidepressants, antipsychotic drugs and general anesthesia may lead to increased antihypertensive effects.

Sympathomimetics may reduce the antihypertensive effect of perindopril.

Use for renal impairment

In case of renal dysfunction, adjustment of the dosage regimen is required depending on the CC values.

special instructions

WITH caution Perindopril should be used for bilateral renal artery stenosis or renal artery stenosis of a single kidney; renal failure; systemic connective tissue diseases; therapy with immunosuppressants, allopurinol, procainamide (risk of developing neutropenia, agranulocytosis); decreased blood volume (taking diuretics, salt-restricted diet, vomiting, diarrhea); angina pectoris; cerebrovascular diseases; renovascular hypertension; diabetes mellitus; chronic heart failure functional class IV according to the NYHA classification; simultaneously with potassium-sparing diuretics, potassium preparations, potassium-containing table salt substitutes, and lithium preparations; with hyperkalemia; surgery/general anesthesia; hemodialysis using high-flow membranes; desensitizing therapy; LDL apheresis; condition after kidney transplantation; aortic stenosis/mitral stenosis/hypertrophic obstructive cardiomyopathy; in patients of the Negroid race.

Cases of hypotension, syncope, stroke, hyperkalemia and renal dysfunction (including acute renal failure) have been reported in predisposed patients, especially when used concomitantly 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.

Before starting treatment with perindopril, a renal function test is recommended for all patients.

Dosage form: film-coated tablets Compound:

1 tablet contains: active substance perindopril tosylate 2.50 mg/5.00 mg/10.00 mg, which corresponds to perindopril 1.6975 mg/3.395 mg/6.790 mg; Excipients: lactose monohydrate 35.981 mg/71.962 mg/143.924 mg; corn starch 1.35 mg/2.70 mg/5.40 mg; sodium bicarbonate 0.793 mg/1.586 mg/3.172 mg; pregelatinized corn starch 3.60 mg/7.20 mg/14.40 mg; povidone-KZO 0.90 mg/1.80 mg/3.60 mg; magnesium stearate 0.45 mg/0.90 mg/1.80 mg;

shellFor dosage 2.5 mg : Opadry II white 85 F 18422(partially hydrolyzed polyvinyl alcohol 0.9000 mg; titanium dioxide (E171) 0.5625 mg; macrogol-3350 (polyethylene glycol-3350) 0.4545 mg; talc 0.3330 mg); shell For dosage 5 mg : Opadry II green 85 F 210014(partially hydrolyzed polyvinyl alcohol 1.8000 mg; titanium dioxide (E171) 1.0935 mg; macrogol-3350 (polyethylene glycol-3350) 0.9090 mg; talc 0.6660 mg; indigo carmine aluminum varnish (E132) 0.0144 mg; aluminum varnish of brilliant blue dye (E133) 0.0081 mg; iron oxide yellow dye (E172) 0.0045 mg; aluminum varnish of quinoline yellow dye (E104) 0.0045 mg); shell For dosage 10 mg : Opadry II green 85 F 210013(partially hydrolyzed polyvinyl alcohol 3.6000 mg; titanium dioxide (E171) 2.1330 mg; macrogol-3350 (polyethylene glycol-3350) 1.8180 mg; talc 1.3320 mg; indigo carmine aluminum varnish (E132) 0.0495 mg; aluminum varnish of brilliant blue dye (E133) 0.0315 mg; dye iron oxide yellow (E172) 0.0180 mg; aluminum varnish of quinoline yellow dye(E 1 04) 0.0180 mg).

Description:

Dosage 2.5 mg. Round, biconvex, white film-coated tablets. On one side there is an engraving "T". On a cross section, the core is white or almost white.

Dosage 5 mg. Biconvex capsule-shaped tablets, film-coated, light green in color, with a decorative score along the edge of the tablet on both sides. On one side there is an engraving "T". On a cross section, the core is white or almost white.

Dosage 10 mg. Round, biconvex, green film-coated tablets. On one side there is an engraving "10", on the other - "T". On a cross section, the core is white or almost white.

Pharmacotherapeutic group:Angiotensin-converting enzyme (ACE) inhibitor ATX:

C.09.A.A.04 Perindopril

Pharmacodynamics:

Mechanism of action

Perindopril is an antihypertensive drug from the group of angiotensin-converting enzyme (ACE) inhibitors. ACE (also called kininase II) is an exopeptidase that both converts angiotensin I into the vasoconstrictor angiotensin II and breaks down the vasodilator bradykinin into an inactive heptapeptide. ACE inhibition leads to a decrease in the concentration of angiotensin II in the blood plasma, which causes an increase in plasma renin activity (via a “negative feedback” mechanism) and a decrease in aldosterone secretion.

Since angiotensin-converting enzyme inactivates bradykinin, ACE suppression is accompanied by an increase in the activity of both the circulating and tissue kallikrein-kinin system, while the prostaglandin system is also activated. It is possible that this effect is part of the mechanism of the antihypertensive effect of ACE inhibitors, as well as the mechanism of development of some side effects of drugs of this class (for example, cough).

Perindopril has a therapeutic effect due to the active metabolite perindoprilat. Other metabolites do not have an ACE inhibitory effect in vitro.

Clinical efficacy and safety

Arterial hypertension

Perindopril is effective in the treatment of arterial hypertension of any severity. With the use of the drug, a decrease in both systolic and diastolic blood pressure (BP) is observed in the patient’s “lying” and “standing” positions.

Perindopril reduces total peripheral vascular resistance (TPVR), which leads to a decrease in blood pressure, while peripheral blood flow accelerates without changing heart rate (HR).

Overdose:

Symptoms: marked decrease in blood pressure, shock, stupor, bradycardia, water-electrolyte imbalance (hyperkalemia, hyponatremia), renal failure, hyperventilation, tachycardia, palpitations, dizziness, anxiety, cough.

Treatment: Emergency measures are limited to removing the drug from the body: gastric lavage and/or taking activated charcoal, followed by restoration of water and electrolyte balance.

If there is a pronounced decrease in blood pressure, place the patient in a horizontal position with raised legs and take measures to replenish the circulating blood volume (CBV). With the development of severe bradycardia that is not amenable to drug therapy (including so-called atropine), placement of a pacemaker is indicated. It is necessary to monitor vital signs and serum creatinine and electrolyte concentrations. Perindoprilat, the active metabolite of perindopril, can be removed from the systemic circulation by hemodialysis. The use of high-flow polyacrylonitrile membranes should be avoided.

Interaction:

Drugs that cause hyperkalemia

Some drugs or drugs from other pharmacological groups may increase the risk of developing hyperkalemia: aliskiren-containing drugs, potassium salts, potassium-sparing diuretics, ACE inhibitors, ARA II receptor antagonists, non-steroidal anti-inflammatory drugs (NSAIDs), co-trimoxazole (trimethoprim + sulfamethoxazole), heparin, immunosuppressants such as or, trimethoprim. Combining these drugs increases the risk of hyperkalemia.

Concomitant use is contraindicated

Aliskiren

In patients with diabetes mellitus or impaired renal function (GFR< 60 мл/мин/1,73 м 2 площади поверхности тела) возрастает риск гиперкалиемии, ухудшения функции почек и повышения частоты сердечно-сосудистой заболеваемости и смертности.

Neutral endopeptidase inhibitors

An increased risk of angioedema has been reported with concomitant use of ACE inhibitors and racecadotril (an enkephalinase inhibitor).

When ACE inhibitors are used simultaneously with drugs containing sacubitril (neprilysin inhibitor), the risk of developing angioedema increases, and therefore the simultaneous use of these drugs is contraindicated. ACE inhibitors should be prescribed no earlier than 36 hours after discontinuation of drugs containing sacubitril. Prescription of drugs containing sacubitril is contraindicated in patients receiving ACE inhibitors, as well as within 36 hours after discontinuation of ACE inhibitors.

Extracorporeal treatments

Extracorporeal treatments that expose blood to negatively charged surfaces, such as dialysis or hemofiltration using certain high-strength membranes (eg, polyacrylonitrile membranes) and low-density lipoprotein apheresis using dextran sulfate, are contraindicated due to the increased risk of severe anaphylactoid reactions. If such treatment is necessary, use of a different type of dialysis membrane or use of a different class of antihypertensive drugs should be considered.

Aliskiren

In patients without diabetes mellitus or renal impairment, there may be an increased risk of hyperkalemia, worsening renal function, and increased incidence of cardiovascular morbidity and mortality.

Double blockade of the RAAS

The literature has reported that in patients with established atherosclerotic disease, heart failure, or diabetes mellitus with end-organ damage, concomitant therapy with an ACE inhibitor and an ARB II is associated with a higher incidence of hypotension, syncope, hyperkalemia, and worsening renal function (including acute renal failure). ) compared to the use of only one drug that affects the RAAS. Dual blockade (for example, when combining an ACE inhibitor with an ARB II) should be limited to individual cases with careful monitoring of renal function, plasma potassium and blood pressure.

Estramustine

Concomitant use may result in an increased risk of adverse effects such as angioedema.

Tissue plasminogen activators

Observational studies have shown an increased incidence of angioedema in patients taking ACE inhibitors following the use of alteplase for thrombolytic therapy of ischemic stroke.

Potassium-sparing diuretics (such as triampterene, amiloride), potassium supplements. Typically, during therapy with ACE inhibitors, serum potassium levels remain within normal limits, but some patients may develop hyperkalemia. The combined use of ACE inhibitors and potassium-sparing diuretics (for example, and its derivative, triamterene or amiloride), potassium supplements can cause hyperkalemia (possibly fatal), especially if renal function is impaired (additional effects associated with hyperkalemia). Therefore, it is not recommended to combine with these drugs. These combinations should be prescribed only in case of hypokalemia, taking precautions and regularly monitoring serum potassium levels. Features of the use of spironolactone in heart failure are described below.

Lithium

With the simultaneous use of lithium preparations and ACE inhibitors, a reversible increase in the level of lithium in the blood serum and lithium toxicity may develop. The simultaneous use of ACE inhibitors with thiazide diuretics may further increase the level of lithium in the blood serum and increase the risk of developing its toxic effects. The simultaneous use of Perindopril-Teva and lithium preparations is not recommended. If such combination therapy is necessary, it is carried out under regular monitoring of the lithium content in the blood serum. Co-trimoxazole (trimethoprim+sulfamethoxazole)

When used simultaneously with co-trimoxazole (trimethoprim + sulfamethoxazole), the risk of developing hyperkalemia may increase.

Concomitant use with medications requiring special caution

Potassium-sparing diuretics

Patients taking diuretics, especially those with excessive fluid and/or electrolyte excretion, may experience excessive hypotension when initiating ACE inhibitor therapy. The risk of an excessive decrease in blood pressure can be reduced by discontinuing the diuretic, intravenous administration of 0.9% sodium chloride solution, and by prescribing an ACE inhibitor in lower doses. Further increases in the dose of perindopril should be carried out with caution.

For arterial hypertension In patients receiving diuretics, especially those with excessive fluid and/or electrolyte excretion, the diuretic should either be discontinued before starting the ACE inhibitor (although a potassium-sparing diuretic may be reintroduced later), or the ACE inhibitor should be started at a low dose and then gradually tapered its increase.

When using diuretics in case of CHF An ACE inhibitor should be prescribed at a low dose, possibly after reducing the dose of a concomitantly used potassium-sparing diuretic.

In all cases, renal function (creatinine concentration) should be monitored in the first weeks of using ACE inhibitors.

Potassium-sparing diuretics (,)

Use of eplerenone or spironolactone in doses from 12.5 mg to 50 mg per day and low doses of ACE inhibitors:

In the treatment of heart failure of functional class II -IV according to the NYHA classification with left ventricular ejection fraction<40% и ранее применявшимися ингибиторами АПФ и "петлевыми" диуретиками, существует риск гиперкалиемии (с возможным летальным исходом), особенно в случае несоблюдения рекомендаций относительно этой комбинации препаратов.

Before using this combination of drugs, you must ensure that there is no hyperkalemia and renal dysfunction.

In patients taking ACE inhibitors and mTOR inhibitors simultaneously (,), an increase in the incidence of angioedema was observed (see section "Special Instructions").

Concomitant use with medications requiring some caution

Other antihypertensives and vasodilators

Concomitant use of perindopril with other antihypertensive drugs may enhance the antihypertensive effect of the drug. Concomitant use of nitroglycerin, other nitrates or vasodilators may lead to additional antihypertensive effects.

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.

Concomitant use with ACE inhibitors may increase the risk of developing angioedema due to the inhibition of dipeptidyl peptidase IV (DPP-IV) activity by gliptin.

Tricyclic antidepressants/antipsychotics (neuroleptics)/general anesthetics (general anesthetics)

Concomitant use with ACE inhibitors may lead to increased antihypertensive effect.

Sympathomimetics

Sympathomimetics may reduce the antihypertensive effect of ACE inhibitors. When using such a combination, the effectiveness of ACE inhibitors should be regularly assessed.

Gold preparations

When using ACE inhibitors, including perindopril, in patients receiving intravenous gold (gold), a complex of symptoms was described, including facial flushing, nausea, vomiting, and arterial hypotension.

When used simultaneously with myelotoxic drugs, increased myelotoxic action.

Special instructions:

Stable ischemic heart disease

If an episode of unstable angina (significant or not) develops during the first month of therapy with Perindopril-Teva, it is necessary to assess the benefit/risk ratio of therapy with this drug.

Arterial hypotension

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 excessive reduction in blood pressure is increased in patients with reduced blood volume during diuretic therapy, while following a strict salt-free diet, hemodialysis, as well as with diarrhea or vomiting, or with severe renin-dependent arterial hypertension. Severe arterial hypotension was observed in patients with severe CHF, both in the presence of concomitant renal failure and in its absence. The most common arterial hypotension can develop in patients with more severe CHF, taking loop diuretics in high doses, as well as against the background of hyponatremia or renal failure. Close medical monitoring is recommended for these patients during initiation of therapy and during dosage titration. The same applies to patients with coronary artery disease or cerebrovascular diseases, in whom an excessive decrease in blood pressure can lead to myocardial infarction or cerebrovascular complications.

If arterial hypotension develops, it is necessary to place the patient in a horizontal position with raised legs and, if necessary, administer a 0.9% sodium chloride solution intravenously to increase blood volume. Transient arterial hypotension is not a contraindication for further therapy. After restoration of blood volume and blood pressure, treatment can be continued subject to careful selection of the dose of the drug.

In some patients with CHF and normal or low blood pressure, an additional decrease in blood pressure may occur during therapy with Perindopril-Teva. This effect is expected and is usually not a reason to discontinue the drug. If arterial hypotension is accompanied by clinical manifestations, it may be necessary to reduce the dose or discontinue Perindopril-Teva.

Renal dysfunction

In patients with renal failure (creatinine clearance less than 60 ml/min), the initial dose of Perindopril-Teva should be adjusted in accordance with the clinical clearance (see section "Method of administration and dosage") and then depending on the therapeutic response. For such patients, regular monitoring of potassium levels and serum creatinine concentrations is necessary.

In patients with symptomatic heart failure, arterial hypotension that develops during the initial period of therapy with ACE inhibitors can lead to deterioration of renal function. Cases of acute renal failure, usually reversible, have sometimes been reported in such patients.

In some patients with bilateral renal artery stenosis or renal artery stenosis of a solitary kidney (especially in the presence of renal failure), an increase in serum concentrations of urea and creatinine was observed during therapy with ACE inhibitors, which was 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 Perindopril-Teva, it is necessary to discontinue diuretics and regularly monitor renal function.

In some patients with arterial hypertension in the presence of previously undetected renal failure, especially with concomitant diuretic therapy, there was a slight and temporary increase in serum urea and creatinine concentrations. In this case, it is recommended to reduce the dose of Perindopril-Teva and/or discontinue the diuretic.

Hemodialysis patients

Several cases of persistent, life-threatening anaphylactic reactions have been reported in patients undergoing dialysis using high-flux membranes and concomitantly taking ACE inhibitors. If hemodialysis is necessary, a different type of membrane must be used.

Kidney transplant

There is no experience with the use of Perindopril-Teva in patients who have recently undergone kidney transplantation.

Hypersensitivity, angioedema

Rarely in patients taking ACE inhibitors, incl. , angioedema of the face, extremities, lips, tongue, vocal folds and/or larynx developed. In patients taking mTOR inhibitors concomitantly, the risk of angioedema may be increased. This condition can develop at any time during treatment. If angioedema develops, treatment should be stopped immediately, and the patient should be under medical supervision until symptoms disappear completely. Angioedema of the lips and face usually does not require treatment; Antihistamines can be used to reduce the severity of symptoms. Angioedema of the tongue, vocal folds, or larynx can be fatal. If angioedema develops, it is necessary to immediately administer (adrenaline) subcutaneously and ensure airway patency.

Patients with a history of angioedema not associated with the use of ACE inhibitors may be at high risk of developing angioedema while taking an ACE inhibitor.

In rare cases, angioedema of the intestine develops during therapy with ACE inhibitors. In this case, patients experience abdominal pain as an isolated symptom or in combination with nausea and vomiting, in some cases without previous angioedema of the face and with normal C1-esterase levels. Diagnosis was made using abdominal computed tomography, ultrasound, or surgery. Symptoms disappeared after stopping ACE inhibitors; When carrying out differential diagnosis, it is necessary to take into account the possibility of developing angioedema of the intestine (see section "Side effects").

In black patients taking ACE inhibitors, angioedema was observed more often than in representatives of other races.

Concomitant use of perindopril with the combination is contraindicated, as this increases the risk of developing angioedema. The combination can be used no earlier than 36 hours after taking perindopril. The use of perindopril is possible no earlier than 36 hours after taking the combination.

When taking ACE inhibitors concomitantly with other enkephalinase inhibitors (for example, racecadotril), the risk of developing angioedema may be increased. In patients receiving, ), and tissue plasminogen activators.

Renovascular hypertension

In patients with bilateral renal artery stenosis or arterial stenosis of a single functioning kidney, the risk of developing arterial hypotension and renal failure increases during therapy with ACE inhibitors. The use of diuretics may be an additional risk factor. Deterioration of renal function can be observed with even a slight change in serum creatinine concentration, even in patients with unilateral renal artery stenosis.

Primary hyperaldosteronism

Patients with primary hyperaldosteronism are usually not susceptible to antihypertensive drugs that act by inhibiting the RAAS. Therefore, the use of this drug in such patients is not recommended.

Anaphylactoid reactions during low-density lipoprotein apheresis (LDL apheresis)

In patients prescribed ACE inhibitors during the procedure of LDL apheresis using sulfate, in rare cases, an anaphylactic reaction may develop. It is recommended to temporarily discontinue the ACE inhibitor before each apheresis procedure.

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. It is recommended to temporarily discontinue the ACE inhibitor before 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 liver necrosis, sometimes with death. The mechanism of development of this syndrome is unclear. If jaundice occurs or an increase in liver enzyme activity 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

Cases of neutropenia, agranulocytosis, thrombocytopenia and anemia have been reported in patients treated with ACE inhibitors. With normal renal function in the absence of other complications, neutropenia rarely develops. The drug Perindopril-Teva should be used with great caution in patients with systemic connective tissue diseases (for example, SLE, scleroderma), simultaneously receiving immunosuppressive therapy, or when combining all of these factors, especially with existing renal dysfunction. Such patients may develop severe infections that do not respond to intensive antibiotic therapy. When carrying out therapy with Perindopril-Teva 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 reported.

Negroid race

Like other ACE inhibitors, it is less effective in lowering blood pressure in black patients, possibly due to the higher prevalence of low-renin conditions in the population of this group of patients with arterial hypertension.

Cough

During therapy with ACE inhibitors, a persistent, non-productive cough may develop, which stops after discontinuation of the drug. This should be taken into account in the differential diagnosis of cough.

Surgery and general anesthesia

In patients whose condition requires major surgery or general anesthesia with drugs that cause hypotension, ACE inhibitors, including, may block the formation of angiotensin II with compensatory release of renin. One day before surgery, therapy with ACE inhibitors must be discontinued. If the ACE inhibitor cannot be canceled, then arterial hypotension developing according to the described mechanism can be corrected by increasing the volume of blood volume.

Hyperkalemia

During therapy with ACE inhibitors, including, some patients may experience an increase in potassium levels in the blood. The risk of hyperkalemia is increased in patients with renal and/or heart failure, advanced age (>70 years), decompensated diabetes mellitus, hypoaldosteronism, metabolic acidosis, dehydration, and in patients using potassium-sparing diuretics, potassium supplements, or other drugs that cause hyperkalemia (eg, heparin, co-trimoxazole (trimethoprim + sulfamethoxazole).If it is necessary to prescribe these drugs simultaneously, it is recommended to regularly monitor the potassium level in the blood serum, since hyperkalemia can lead to arrhythmia, sometimes fatal.

Diabetes

In patients with diabetes mellitus taking oral hypoglycemic agents or insulin, blood glucose concentrations should be carefully monitored during the first few months of ACE inhibitor therapy.

Lactose

Perindopril-Teva tablets contain lactose. Therefore, patients with hereditary lactose intolerance, lactase deficiency or malabsorption syndrome should not take this drug.

Double blockade of the RAAS

Cases of hypotension, syncope, stroke, hyperkalemia and renal dysfunction (including acute renal failure) have been reported in susceptible patients, especially when used concomitantly with drugs that affect this system. Therefore, double blockade of the RAAS by combining an ACE inhibitor with an ARA II or aliskiren is not recommended. The simultaneous use of ACE inhibitors with drugs containing is contraindicated in patients with diabetes mellitus and/or with moderate or severe renal failure (GFR less than 60 ml/min/1.73 m 2 body surface area) and is not recommended in other patients.

Mitral stenosis/aortic stenosis/hypertrophic obstructive cardiomyopathy

Perindopril, like other ACE inhibitors, should be administered with caution to patients with left ventricular outflow tract obstruction (aortic stenosis, hypertrophic obstructive cardiomyopathy), as well as to patients with mitral stenosis.

Concomitant use of ACE inhibitors with ARB II is contraindicated in patients with diabetic nephropathy and is not recommended in other patients.

Impact on the ability to drive vehicles. Wed and fur.:It is necessary to take into account the possibility of developing arterial hypotension or dizziness, which may affect the ability to drive vehicles and work with technical equipment that requires increased concentration and speed of psychomotor reactions. Release form/dosage:

Film-coated tablets, 2.5 mg, 5 mg, 10 mg.

Package:

30 tablets in a white polypropylene container with a polyethylene lid with a drying insert equipped with a polyethylene stopper with first opening control. 1 container along with instructions for use in a cardboard box with tamper evident.

Storage conditions:

Store at a temperature not exceeding 25 °C. Keep out of the reach of children!

Best before date:

Do not use after the expiration date.

Conditions for dispensing from pharmacies: On prescription Registration number: LP-002979 Registration date: 28.04.2015/ 28.01.2019 Expiration date: 28.04.2020