Perinev from what these pills. Ko-Perineva is an effective antihypertensive drug. Prevention of recurrent stroke in patients with a history of cerebrovascular disease

Tablets 0.625 mg. + 2 mg:

• The active substance of the semi-finished product-granules: Perindopril erbumine - 2 mg;
• Auxiliary substances of the semi-finished product granules: calcium chloride hexahydrate - 0.6 mg; lactose monohydrate - 30.915 mg; crospovidone - 4 mg;
• Excipients: microcrystalline cellulose - 11.25 mg; sodium bicarbonate - 0.25 mg; colloidal silicon dioxide - 0.135 mg; magnesium stearate - 0.225 mg.

Tablets 1.25 mg. + 4 mg:

• The active substance of the semi-finished product-granules: Perindopril erbumine - 4 mg;
• Auxiliary substances of semi-finished granules: calcium chloride hexahydrate - 1.2 mg; lactose monohydrate - 61.83 mg; crospovidone - 8 mg;
• Excipients: microcrystalline cellulose - 22.5 mg; sodium bicarbonate - 0.5 mg; colloidal silicon dioxide - 0.27 mg; magnesium stearate - 0.45 mg.

Tablets 2.5 mg. + 8 mg.:

• The active substance of the semi-finished product-granules: Perindopril erbumine - 8 mg;
• Auxiliary substances of the semi-finished product granules: calcium chloride hexahydrate - 2.4 mg; lactose monohydrate - 123.66 mg; crospovidone - 16 mg;
• Excipients: microcrystalline cellulose - 45 mg; sodium bicarbonate - 1 mg; colloidal silicon dioxide - 0.54 mg; magnesium stearate - 0.9 mg.

Tablets, 0.625 mg + 2 mg, 1.25 mg + 4 mg, 2.5 mg + 8 mg. 10 tab. in a blister pack made of combined OPA/Al/PVC material and aluminum foil. 3 blister packs (10 tablets each) are placed in a pack of cardboard.

Description of the dosage form

Tablets 0.625 mg + 2 mg: round, biconvex, white or almost white with a bevel, a short line is engraved on one side.

Tablets 1.25 mg + 4 mg: round, biconvex, white or almost white, scored on one side and chamfered.

Tablets 2.5 mg + 8 mg: round, biconvex, white or almost white, scored on one side.

pharmachologic effect

Vasodilator, diuretic, hypotensive.

Pharmacokinetics

The combined use of perindopril and indapamide does not change their pharmacokinetic parameters compared with the separate administration of these drugs.

Perindopril after oral administration is rapidly absorbed from the gastrointestinal tract. Bioavailability is 65-70%. Eating reduces the conversion of perindopril to perindoprilat. T1 / 2 of perindopril from blood plasma is 1 hour.

Cmax in blood plasma is reached 3-4 hours after ingestion. Since the intake with food reduces the conversion of perindopril to perindoprilat and the bioavailability of the drug, perindopril should be taken once a day in the morning, before breakfast. Taking perindopril 1 time per day, the equilibrium concentration is reached within 4 days.

In the liver, it is metabolized to form an active metabolite, perindoprilat. In addition to the active metabolite of perindoprilat, perindopril forms 5 more inactive metabolites. Plasma protein binding of perindoprilat is dose-dependent and is 20%. Perindoprilat easily passes through the blood-tissue barriers, excluding the BBB, a small amount passes through the placenta and into breast milk. It is excreted by the kidneys, T1 / 2 of perindoprilat is about 17 hours. It does not accumulate.

In elderly patients, in patients with renal and heart failure, the excretion of perindoprilat is slowed down.

The kinetics of perindopril is changed in patients with cirrhosis of the liver: hepatic clearance is reduced by half. However, the amount of perindoprilat formed does not decrease, which does not require dose adjustment.

Indapamide. Quickly and almost completely absorbed in the gastrointestinal tract. Eating somewhat slows down absorption, but does not significantly affect the amount of absorbed indapamide. Cmax in blood plasma is reached 1 hour after a single oral dose. It binds to plasma proteins by 79%. T1 / 2 is from 14 to 24 hours (average - 18 hours). Does not accumulate.

Metabolized in the liver. It is excreted by the kidneys (70%) mainly in the form of metabolites (the fraction of unchanged drug is about 5%) and by the intestine with bile in the form of inactive metabolites (22%). In patients with renal insufficiency, the pharmacokinetic parameters of indapamide do not change significantly.

Pharmacodynamics

Co-Perineva is a combination drug containing an ACE inhibitor - perindopril and a thiazide-like diuretic - indapamide. The drug has antihypertensive, diuretic and vasodilating effects.

Ko-Perineva has a pronounced dose-dependent antihypertensive effect, which does not depend on the age and position of the patient's body and is not accompanied by reflex tachycardia. Does not affect lipid metabolism (total cholesterol, LDL, VLDL, HDL, triglycerides (TG) and carbohydrates), incl. in patients with diabetes mellitus. Reduces the risk of developing hypokalemia due to diuretic monotherapy.

The antihypertensive effect persists for 24 hours.

A stable decrease in blood pressure is achieved within 1 month on the background of the use of the drug Ko-Perinev without an increase in heart rate. Termination of treatment does not lead to the development of the "withdrawal" syndrome.

Perindopril - an ACE inhibitor, the mechanism of action of which is associated with inhibition of ACE activity, leading to a decrease in the formation of angiotensin II - eliminates the vasoconstrictor effect of angiotensin II, reduces the secretion of aldosterone. The use of perindopril does not lead to sodium and fluid retention, does not cause reflex tachycardia during long-term treatment. The antihypertensive effect of perindopril develops in patients with low or normal plasma renin activity.

Perindopril acts through its main active metabolite, perindoprilat. Its other metabolites are inactive. The action of the drug Ko-Perinev leads to:

• varicose veins (decrease in preload on the heart) due to changes in PG metabolism;
• decrease in OPSS (decrease in afterload on the heart).

In patients with heart failure, perindopril contributes to:

• decrease in filling pressure of the left and right ventricles;
• increase in cardiac output and cardiac index;
• increased regional blood flow in the muscles.

Perindopril is effective in arterial hypertension of any severity: mild, moderate and severe. The maximum antihypertensive effect develops 4-6 hours after a single oral administration and persists for a day. Termination of therapy does not lead to the development of the "withdrawal" syndrome.

It has vasodilating properties and restores the elasticity of large arteries. The addition of a thiazide-like diuretic enhances (addition) the antihypertensive effect of perindopril.

Indapamide is a sulfonamide derivative and is a diuretic. Inhibits sodium reabsorption in the cortical segment of the renal tubules, increasing the excretion of sodium and chlorine by the kidneys, thus leading to increased diuresis. To a lesser extent, increases the excretion of potassium and magnesium. Possessing the ability to selectively block "slow" calcium channels, indapamide increases the elasticity of arterial walls and reduces peripheral vascular resistance. It has a hypotensive effect in doses that do not have a pronounced diuretic effect. Increasing the dose of indapamide does not increase the antihypertensive effect, but increases the risk of adverse events.

Indapamide in patients with arterial hypertension has no effect on lipid metabolism: TG, LDL and HDL and carbohydrate metabolism, even in patients with diabetes mellitus and arterial hypertension.

Indications for use of Ko-perinev

Essential hypertension.

Contraindications to the use of Ko-perinev

• hypersensitivity to the active substance, any ACE inhibitor, sulfonamide derivatives or any excipients of the drug;
• angioedema (hereditary, idiopathic or angioedema) while taking other ACE inhibitors (in history);
• severe renal failure;
• bilateral stenosis of the renal arteries, stenosis of the artery of a single kidney;
• refractory hyperkalemia;
• lactose intolerance, lactase deficiency or glucose-galactose malabsorption;
• simultaneous administration of drugs that lengthen the QT interval on the ECG, simultaneous administration with antiarrhythmic drugs that can cause ventricular tachycardia of the "pirouette" type;
• severe liver failure (including with encephalopathy);
• pregnancy, breastfeeding period, age up to 18 years (efficacy and safety have not been established);
• given the lack of sufficient experience of use, Ko-Perinev should not be taken by patients on dialysis and patients with untreated decompensated heart failure.

With caution: systemic connective tissue diseases (including systemic lupus erythematosus (SLE), scleroderma), immunosuppressant therapy (risk of developing neutropenia, agranulocytosis), inhibition of bone marrow hematopoiesis, decreased BCC (diuretics, salt-free diet, vomiting, diarrhea) , angina pectoris, cerebrovascular diseases, renovascular hypertension, diabetes mellitus, chronic heart failure (NYHA functional class IV), hyperuricemia (especially accompanied by gout and urate nephrolithiasis), blood pressure lability, elderly patients, hemodialysis using high-flow polyacrylonitrile membranes; before the LDL apheresis procedure, simultaneous desensitizing therapy with allergens (for example, hymenoptera venom); condition after kidney transplantation, stenosis of the aortic and / or mitral valve, hypertrophic obstructive cardiomyopathy.

Ko-perinev Use in pregnancy and children

Pregnancy. Taking the drug Ko-Perinev is contraindicated during pregnancy. When planning pregnancy or when it occurs while taking Ko-Perinev, you should immediately stop taking the drug and prescribe another antihypertensive therapy. Do not use Co-Perinev in the first trimester of pregnancy. Controlled clinical studies on the use of ACE inhibitors in pregnant women have not been conducted. Limited data suggest that the use of ACE inhibitors in the first trimester did not lead to fetal malformations associated with fetotoxicity, but the fetotoxic effect of ACE inhibitors cannot be completely excluded. The drug Ko-Perinev is contraindicated in the II and III trimesters of pregnancy. Long-term use of ACE inhibitors in the II and III trimesters of pregnancy can lead to impaired fetal development (decrease in kidney function, oligohydramnios, slowing of ossification of the skull bones) and the development of complications in the newborn (renal failure, arterial hypotension, hyperkalemia).

Long-term use of thiazide diuretics in the third trimester of pregnancy can cause hypovolemia in the mother and a decrease in uteroplacental blood flow, which leads to fetoplacental ischemia and fetal growth retardation. In rare cases, while taking diuretics, the fetus / newborn may develop hypoglycemia and thrombocytopenia. If a woman took an ACE inhibitor in the II and III trimesters of pregnancy, it is recommended to conduct an ultrasound scan of the kidneys and skull of the fetus / newborn.

Newborns whose mothers received therapy with ACE inhibitors may experience arterial hypotension, so newborns should be under close medical supervision.

breastfeeding period. The drug Ko-Perinev is contraindicated during breastfeeding.

It is not known whether perindopril is excreted in breast milk.

Indapamide is excreted in breast milk. Causes a decrease or suppression of lactation. The newborn may develop hypersensitivity to sulfonamide derivatives, hypokalemia and "nuclear" jaundice.

It is necessary to evaluate the significance of therapy for the mother and decide whether to stop breastfeeding or stop taking the drug.

Koperineva side effects

Perindopril has an inhibitory effect on the RAAS and reduces the excretion of potassium ions by the kidneys while taking indapamide. The risk of developing hypokalemia (serum potassium content less than 3.4 mmol / l) in patients treated with Ko-Perinev at a daily dose of 0.625 mg / 2 mg is 2%, 1.25 mg / 4 mg - 4% and 2 .5 mg / 8 mg - 6%.

WHO classification of the incidence of side effects: very often - ≥1 / 10; often - from ≥1 / 100 to

On the part of the hematopoietic organs: very rarely - thrombocytopenia, leukopenia / neutropenia, agranulocytosis, aplastic anemia, hemolytic anemia (there are reports with the use of ACE inhibitors). In certain clinical situations (conditions after kidney transplantation or in patients on hemodialysis or peritoneal dialysis), ACE inhibitors can cause anemia.

From the side of the central and peripheral nervous system: often - paresthesia, headache, dizziness, vertigo; infrequently - mood lability, sleep disturbances; very rarely - confusion.

From the senses: often - visual impairment, tinnitus.

From the side of the cardiovascular system: often - a pronounced decrease in blood pressure, incl. orthostatic hypotension; very rarely - arrhythmias, incl. and bradycardia, ventricular tachycardia, atrial fibrillation, as well as angina pectoris, myocardial infarction, possibly secondary, due to a decrease in blood pressure in high-risk patients; the frequency is unknown - ventricular tachycardia of the "pirouette" type (possibly fatal).

On the part of the respiratory system: often - dry, long-lasting cough against the background of the use of ACE inhibitors and disappearing after their withdrawal; dyspnea; infrequently - bronchospasm; very rarely - eosinophilic pneumonia, rhinitis.

From the digestive system: often - constipation, dryness of the oral mucosa, decreased appetite, nausea, epigastric pain, abdominal pain, impaired taste perception, vomiting, dyspepsia, diarrhea; very rarely - pancreatitis, angioedema of the intestine, jaundice; the frequency has not been established - in the case of liver failure, there is a possibility of developing hepatic encephalopathy.

From the side of the skin and subcutaneous fat: often - itching, skin rash, maculopapular rash; infrequently - angioedema of the face, limbs, lips, oral mucosa, tongue, vocal folds and / or larynx, urticaria; hypersensitivity reactions, mainly dermatological, in patients with a burdened allergic history; deterioration in the course of SLE; very rarely - erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome; isolated cases of photosensitivity reactions.

From the musculoskeletal system: often - muscle spasms.

From the urinary system: infrequently - renal failure; very rarely - acute renal failure.

From the reproductive system: infrequently - impotence.

Others: often - asthenia; infrequently - increased sweating.

Laboratory indicators: rarely - hypercalcemia; the frequency is unknown - an increase in QT on the ECG; increase in the concentration of uric acid and glucose in the blood serum while taking the drug; increased activity of liver enzymes; a slight increase in plasma creatinine concentration, reversible after discontinuation of therapy, which often develops against the background of stenosis of the renal arteries or stenosis of the artery of a single kidney, arterial hypertension during diuretic therapy, with renal failure; hypokalemia, especially significant for patients at risk; hypochloremia can lead to compensatory metabolic alkalosis (the probability and severity of the effect are low); hyperkalemia is often reversible; hyponatremia with hypovolemia, leading to a decrease in BCC and orthostatic hypotension.

According to clinical studies, side effects are consistent with the previously established safety profile of the combination of perindopril and indapamide. In rare cases, the following serious adverse events have developed: hyperkalemia, acute renal failure, arterial hypotension and cough, angioedema may develop.

drug interaction

lithium preparations. With the simultaneous use of lithium preparations and ACE inhibitors, cases of a reversible increase in the concentration of lithium in the blood serum have been reported. Simultaneous administration of thiazide diuretics may increase the concentration of lithium in the blood plasma and the risk of its toxic effect while taking an ACE inhibitor.

Simultaneous use of the drug Ko-Perinev with lithium preparations is not recommended. If co-administration is necessary, serum lithium concentrations should be carefully monitored.

Baclofen - potentiation of the hypotensive effect. It is necessary to control blood pressure, kidney function and, if necessary, adjust the dose of antihypertensive drugs.

NSAIDs, incl. high doses of acetylsalicylic acid (more than 3 g / day). The simultaneous use of ACE inhibitors with NSAIDs (including acetylsalicylic acid in doses that have an anti-inflammatory effect, COX-2 inhibitors and non-selective NSAIDs) reduces the hypotensive effect of ACE inhibitors, increases the risk of developing renal dysfunction, up to the development of acute renal failure, increases serum potassium blood, especially in patients with pre-existing renal dysfunction.

This combination is recommended to be used with caution, especially in elderly patients. Before starting treatment, patients need to compensate for fluid loss, as well as regularly monitor kidney function both at the beginning of therapy and during treatment.

Tricyclic antidepressants, antipsychotics (neuroleptics). Enhance the hypotensive effect and increase the risk of developing orthostatic hypotension (additive effect).

GCS, tetracosactide. Reducing the hypotensive effect (fluid retention and sodium ions as a result of the action of GCS).

Other antihypertensive drugs: it is possible to increase the hypotensive effect of the drug Ko-Perinev.

Perindopril

Potassium-sparing diuretics (spironolactone, triamterene, amiloride, eplerenone) and potassium preparations: ACE inhibitors reduce the loss of potassium by the kidneys caused by the diuretic. When used together with ACE inhibitors, it is possible to increase the content of potassium in the blood serum up to a lethal outcome. If simultaneous use of an ACE inhibitor and the above drugs is necessary (in the case of confirmed hypokalemia), care should be taken and regular monitoring of the content of potassium in the blood plasma and ECG parameters should be carried out.

Simultaneous use requiring special care

Hypoglycemic agents for oral administration (sulfonylurea derivatives) and insulin: the use of ACE inhibitors (described for captopril and enalapril) in very rare cases may increase the hypoglycemic effect of sulfonylurea derivatives and insulin in patients with diabetes mellitus; with their simultaneous use, it is possible to increase glucose tolerance and reduce the need for insulin, which may require dose adjustment of hypoglycemic agents for oral administration and insulin.

Simultaneous use requiring caution

Allopurinol, cytostatic immunosuppressants, corticosteroids (with systemic use) and procainamide: the simultaneous use of these drugs with ACE inhibitors may increase the risk of developing leukopenia.

General anesthetic agents: ACE inhibitors may increase the hypotensive effect of some general anesthetic agents.

Diuretics (thiazide and loop): the use of diuretics in high doses can lead to hypovolemia (due to a decrease in BCC), and the addition of perindopril to therapy can lead to a pronounced decrease in blood pressure.

Indapamide

Simultaneous use requiring special care

Drugs that can cause ventricular polymorphic tachycardia of the "pirouette" type: there is a risk of hypokalemia, indapamide should be used with caution simultaneously with drugs that can cause ventricular tachycardia of the "pirouette" type, such as: antiarrhythmic drugs (quinidine, hydroquinidine, disopyramide, amiodarone, dofetilide, ibutilide, bretylium tosylate, sotalol); some antipsychotics (chlorpromazine, cyamemazine, levomepromazine, thioridazine, trifluoperazine), benzamides (amisulpride, sulpiride, sultopride, tiapride), butyrophenones (droperidol, haloperidol), other antipsychotics (pimozide); other drugs such as bepridil, cisapride, diphemanil methyl sulfate, erythromycin IV, halofantrine, mizolastine, moxifloxacin, pentamidine, sparfloxacin, vincamine IV, methadone, astemizole, terfenadine. Simultaneous use with the above drugs should be avoided. It is necessary to control the content of potassium in the blood serum in order to avoid hypokalemia, in the development of which it is necessary to carry out its correction, to control the QT interval on the ECG.

Drugs that can cause hypokalemia: amphotericin B when administered intravenously, gluco- and mineralocorticoids (with systemic administration), laxatives that stimulate intestinal motility (laxatives that do not stimulate intestinal motility should be used), tetracosactide - an increase in the risk of developing hypokalemia ( additive effect). It is necessary to control the content of potassium in the blood plasma, if necessary, its correction. Particular attention should be paid to patients simultaneously receiving cardiac glycosides.

Cardiac glycosides: hypokalemia enhances the toxic effect of cardiac glycosides. With the simultaneous use of indapamide and cardiac glycosides, the content of potassium in the blood plasma, ECG parameters should be monitored and, if necessary, the dose of cardiac glycosides should be adjusted.

Simultaneous use requiring caution

Metformin: functional renal failure while taking diuretics, especially loop diuretics, while used with metformin increases the risk of developing lactic acidosis. Metformin should not be used if the plasma creatinine concentration exceeds 15 mg/l (135 µmol/l) in men and 12 mg/l (110 µmol/l) in women.

Preparations containing calcium salts: with simultaneous use, hypercalcemia may develop due to a decrease in calcium excretion by the kidneys.

Cyclosporine: it is possible to increase the concentration of creatinine in the blood plasma without changing the concentration of cyclosporine in the blood plasma, even in the absence of a pronounced loss of sodium ions and dehydration.

Dosage of Ko-perinev

Inside, 1 time per day, preferably in the morning before breakfast, drinking plenty of fluids.

If possible, the drug should be started with the selection of doses of single-component drugs. In case of clinical necessity, it is possible to prescribe a combination therapy with Ko-Perinev immediately after monotherapy.

Doses are given for the indapamide/perindopril ratio.

Initial dose - 1 tab. drug Ko-Perinev (0.625 mg / 2 mg) 1 time per day. If after 1 month of taking the drug it is not possible to achieve adequate control of blood pressure, the dose of the drug should be increased to 1 table. drug Ko-Perinev (1.25 mg / 4 mg) 1 time per day.

If necessary, to achieve a more pronounced hypotensive effect, it is possible to increase the dose of the drug to the maximum daily dose of the drug Ko-Perinev - 1 table. (2.5 mg / 8 mg) 1 time per day.

Elderly patients. Initial dose - 1 tab. drug Ko-Perinev 0.625 mg / 2 mg 1 time per day. Treatment with the drug should be prescribed after monitoring renal function and blood pressure.

Patients with impaired renal function. The drug Ko-Perinev is contraindicated in patients with severe renal insufficiency (Cl creatinine less than 30 ml / min).

Patients with moderately severe renal insufficiency (Cl creatinine 30-60 ml / min) are recommended to start therapy with the required doses of drugs (in monotherapy) that are part of the drug Ko-Perinev; the maximum daily dose of Co-Perinev is 1.25 mg / 4 mg.

Patients with Cl creatinine equal to or greater than 60 ml / min, dose adjustment is not required. During therapy, it is necessary to regularly monitor the concentration of creatinine and the content of potassium in the blood serum.

Patients with impaired liver function. The drug is contraindicated in patients with severe hepatic impairment. With moderately severe hepatic insufficiency, dose adjustment is not required.

Children and teenagers. The drug Ko-Perinev should not be used in children and adolescents under 18 years of age, because. there are insufficient data on efficacy and safety.

Overdose

Symptoms: pronounced decrease in blood pressure, nausea, vomiting, muscle cramps, dizziness, drowsiness, confusion, oliguria up to anuria (due to a decrease in BCC); possible violations of the water and electrolyte balance (low sodium and potassium in the blood plasma).

Treatment: gastric lavage and / or administration of activated charcoal, restoration of water and electrolyte balance in a hospital setting. With a pronounced decrease in blood pressure, it is necessary to transfer the patient to a supine position with legs raised up; further, measures should be taken to increase the BCC (introduction of 0.9% sodium chloride solution in / in). Perindoprilat, the active metabolite of perindopril, can be eliminated from the body by dialysis.

Hypertension and the complications that this cardiovascular disease entails can be called a negative (from a medical point of view) sign of the times. And all because this disease occurs in at least one in five adults. If we add here the unexamined, those who have been sick for years, but avoid doctors, the statistics will be even more depressing.

But hypertension (arterial hypertension) is not a sentence, not a reason to fall into despair. Achievements of modern pharmacology allow to control the disease, while maintaining the optimal quality of life. Of course, this is possible if you see a doctor on time, and not at the stage when the target organs are already significantly affected - the heart, kidneys, brain, blood vessels, eyes. Among the drugs that can correct the state of hypertension, ACE inhibitors stand apart. They include the latest generation of medicines, developed by specialists so that their patients are well tolerated, and side effects are rare.

ACE inhibitors: how it works

The general scheme is as follows - from plasma beta-globulins, from angiotensinogen among them, angiotensin I is formed under the influence of renin. It does not affect vascular tone, it remains neutral. This component is amenable to the action of ACE (that is, angiotensin converting enzyme). Thus, the vasoactive peptide angiotensin II is formed: it has an inherent effect on vascular tone precisely due to irritation of receptors that are sensitive to angiotensin. So the blood vessels constrict.

Under the action of such an active angiotensin, norepinephrine and aldosterone, as well as antidiuretic hormone, are released. And now, if the entire process described above takes place with high intensity, a person develops hypertension. And the pressure can increase to a critical level, provoke a hypertensive crisis and vascular accidents.

Therefore, doctors have developed medicinal products that control the process of producing angiotensin II, subsequent hormonal surges. In particular, this goal was achieved with Perinev's pressure pills.

Perineva: farm dossier

This medicinal product is classified as an ACE inhibitor, it is available only in tablet form. Pills of white color (or with slightly dark impurities). Those in doses of 2 and 8 mg are roundish, but those in 4 mg are oval. There are 10 pieces in a cell package, and from 3 to 9 such packages in a box.

In the formula of the drug:

• Perindopril erbumine, semi-finished granules;
• Additional components are chloride and calcium hexahydrate, crospovidone and lactose monohydrate (this is an addition to granules), but for pills - silicon dioxide, magnesium stearate and cellulose.

Thus, the main component is . The drug belongs to pharmaceutical products that have a hypotensive, cardioprotective, and vasodilatory effect.

Pharmacodynamic characteristics

Perindopril (or kinase II) is an ACE inhibitor related to exopeptidases. It is considered a prodrug, and then an active metabolite called perindopril at is released from it. Transforms angiotensin I into a vasoconstructor, allows you to destroy bradykinin with the formation of an inactive hectapeptide.

Due to the fact that ACE activity decreases, plasma renin is activated, and aldosterone production decreases. And since ACE destroys bradykinin, inhibition of this enzyme leads to increased activation of the kallikrein-kinin system. The prostaglandin system is immediately activated.

Perindopril :

• Lowers blood pressure, and SBP, and DBP;
• Regardless of whether the patient is standing or lying down, blood pressure falls;
• Corrects downward OPSS;
• Accelerates peripheral blood flow;
• Does not increase heart rate;
• Accelerates, as noted in the instructions, and blood flow in the kidneys, without affecting the glomerular filtration rate.

To develop a peak hypotensive effect, you need to wait about 4-6 hours after ingestion. This action will be extended for 24 hours. But, as doctors say, even after a day the effect will remain at 87-100%. We can say that blood pressure drops quickly, but at the same time smoothly - and this is the most comfortable scheme for hypertensive patients.

As for the stabilization of the hypotensive state, it can be expected in a month of the regular schedule. And it keeps for a long time. When you stop drinking Perineva, there will be no withdrawal syndrome.

It has been proven that the active ingredient also reduces hypertrophic transformations of the left ventricular myocardium. It also increases the concentration of high-density lipoproteins. Individuals with hyperuricemia report a decrease in uric acid levels. With long-term use, the isoenzyme myosin profile stabilizes. The clinical significance of the interstitial type of fibrosis also decreases.

The drug tends to remove some of the transformations in the arteries of a small order, to optimize the elasticity of the large arteries. Reduced pre- and afterload on the heart. With CHF, OPSS decreases, as well as ventricular filling pressure. The cardiac output increases, as well as the cardiac index.

Pharmacokinetic characteristic

The medicinal composition is rapidly absorbed from the digestive tract, it takes an hour for the peak plasma content to be reached. Biological availability - within 65-70%.

Approximately 20% of the absorbed component becomes the active metabolite perindoprilat. Its plasma limiting concentration is fixed after 3.5 hours, and the half-life is one hour. With blood proteins (from the plasma part), the substance has an insignificant connection, while the connection with ACE does not reach 30%, but it depends on the content of the ingredient.

Evacuation is carried out through the kidneys. Food, as scientists have proven, slightly reduces the transformation of perindopril to perindoprilat, which reduces drug bioavailability.

Who is shown

In the detailed instructions for the use of the described Perineva, two main indications for admission are indicated - this is, in fact, arterial hypertension, as well as CHF. Often, this particular medication is applicable in combination therapy with indapamide - this is done to prevent a recurrent stroke in people who now or previously have cerebrovascular diseases in the active phase.

In addition, the ACE inhibitor in question can be prescribed for stable cardiac ischemia in order to reduce the risk of cardiovascular events in people who have experienced acute MI or coronary revascularization.

Who can't drink

Perineva, as well as its analogues, has absolute and relative contraindications for taking. So, for example, a categorical ban applies to children - this medication is not prescribed to persons under the age of majority in principle.

Among the absolute contraindications:

• Galactose intolerance and lactase deficiency, as well as glucose-galactose malabsorption syndrome;
• High individual sensitivity to formula ingredients or other representatives of this pharmaceutical group;
• Idiopathic nature angioedema earlier.

With such diagnoses or features, the patient, together with the doctor, needs to look for other therapeutic regimens. If we talk about relative contraindications, then in this case the doctor will evaluate all the risks that a particular patient has. And based on his forecast, he will decide whether he can drink Perineva or should he look for another remedy with less threat.

Relative limitations in use

This, above all, concerns CHF in the decompensated stage. You should not drink medicine for patients with arterial hypotension, only certain calculations on the part of the doctor can allow Perineva to be taken.

Relative contraindications include:

• Stenosis of the aortic / mitral valves;
• Renovascular type hypertension;
• Obstructive cardiomyopathy (hypertrophic type);
• Cerebrovascular diseases, which include ischemia of the heart muscle, insufficiency of cerebral blood flow, as well as coronary insufficiency;
• CRF (creatinine clearance is taken into account);
• Bilateral stenosis of the nephroarteries or arterial stenosis of the only available kidney, as well as post-transplantation status;
• Hemodialysis using special membranes;
• Hyperkalemia, hyponatremia and hypovolemia;
• Condition after surgery;
• Connective tissue diseases - for example, systemic lupus erythematosus, scleroderma;
• Diabetes mellitus of any type;
• Inhibition of hematopoiesis in the bone marrow, associated with the use of immunosuppressants;
• Belonging of the patient to the Negroid race;
• Age over 65;
• Parallel therapy with allergens (desensitizing).

If the doctor who prescribes the medicine for you, for some reason, does not know about some of your diseases, current or past, be sure to tell him about them. This happens if the patient comes to the appointment not with a medical card, but with a leaflet. He may forget to mention this or that disease, the doctor will not take this into account, and the therapy may be incorrect (and therefore dangerous).

How to use for hypertension

The medicine can be used both in monotherapy and as one of the complex components - your doctor is responsible for this choice. The recommended starting dosage of Perineva is 4 mg. For those individuals who have a significant activation of the RAAS (and this is typical for patients with severe hypertension, with renovascular type hypertension and decompensatory CHF), the initial dosage will not exceed 2 mg. If the effectiveness of treatment is insufficient, the daily dosage may eventually be raised to 8 mg.

If Perinev is drunk by a patient who simultaneously drinks a diuretic, then in order to avoid the development of hypotension, the inhibitor should be started three days after the diuretic is discontinued. Or (the doctor is also considering this option), he will prescribe Perinev at a dose of 2 mg, the minimum possible for this medication. In such a situation, monitoring of the content of potassium ions in the serum component of the blood, blood pressure and kidney functionality is indicated. Looking at the dynamics of these indicators, the doctor will adjust the dosage. Diuretic therapy may be resumed if requested.

Elderly hypertensive patients are also prescribed the minimum starting dosage - 2 mg.

Use in other cardiovascular diseases

In order to prevent a stroke (repeated), people with cerebrovascular diseases are recommended to drink a medicine of 2 mg 1/24 two weeks before the appointment. The start of preventive therapy is indicated by the doctor no earlier than 2 weeks after the stroke.

For patients with CHF, the drug is prescribed in the same starting dose - 2 mg. After two weeks, with positive dynamics, it is raised to 4 mg. With clinical manifestations of the disease, beta-blockers, digoxin and certain diuretics may be additionally prescribed.

If a specialist predicts a high probability of developing hypertension, for example, due to large doses of a diuretic, before prescribing Perineva, electrolyte failures, hypovolemia (as far as this is realistic) should be corrected. Before / during therapy, it is imperative to monitor blood pressure, the level of potassium ions in the serum part of the biofluid, as well as the state of nephrofunction.

Treatment for stable cardiac ischemia

Starting dosage - 4 mg 1/24. Two weeks later, under the strictest control of renal function, this dosage can be doubled. Elderly patients and with this diagnosis try to start treating with the lowest dose of 2 mg. If the dose is ineffective, after a preliminary control of renal function (this item is required), after a week the dosage is raised to 4 mg, and after another 7 days it is adjusted to 8 mg.

During therapy, physicians monitor the content of creatinine, as well as potassium ions in the serum component of the blood.

About negative reactions

Side effects of Perineva are detailed in the instructions. It should be noted that they often occur against the background of incorrect medication, suboptimal combined therapy, as well as the patient's wrong lifestyle.

The frequency of fixation of negative reactions is as follows - more than and equal to 1 case per 10 receptions is interpreted as "very often", more than or equal to 1 in 100, but less than 1 in 10 - "often". “Uncommon” is one or more cases in a thousand, but not less than 1 in 100. “Rare” is a ratio of more than one case per 10,000 appointments, but not less than 1 in 1,000. “Very / extremely rare” is more than 1 to 10000 with the inclusion of individual messages.

Negative reactions:

1. Heart and blood vessels. A significant decrease in blood pressure is often recorded. Very rarely, the reception turns into angina pectoris, arrhythmia, stroke and acute MI cannot be ruled out. Vasculitis occurs with an undetermined frequency.
2. The digestive system. Reception is often manifested by digestive disorders, constipation and nausea, possibly vomiting. Dyspepsia and abdominal pain are not excluded with the same frequency. Infrequently, the patient complains of unusual dry mouth. Pancreatitis will rarely be a negative scenario. Hepatitis (different types) is very rare.
3. Respiratory system. Often patients complain of cough and shortness of breath, infrequently they have bronchospasm, very rarely the reception turns into a runny nose and eosinophilic pneumonia.
4. CNS and PNS. Often there are complaints of headaches, paresthesia, dizziness. Infrequently, there are mood changes, as well as sleep disorders. Very rarely there are pathologies of consciousness associated with spatial disorientation, gaps in memory, difficulties in concentrating and performing automatic simple actions.
5. Sensors. Patients often complain about unusual tinnitus, often there are complaints about visual defects.
6. OH YEAH. Often fixed muscle convulsive syndrome.
7. Urogenital profile. Rarely occurs as a negative scenario for the treatment of erectile dysfunction, renal failure. It is extremely rare for ARF to occur.
8. Lymphatic system and hematopoiesis. In certain individuals with a predisposition to this, hemolytic anemia very rarely occurs. With long-term therapy at maximum doses, thrombocytopenia and agranulocytosis are possible, as well as neutropenia, reduced hemotocrit and hemoglobin.
9. Leather. The largest organ of our body can often respond to Perineva's therapy with a skin rash, itching. Urticaria appears less often, as well as angioedema of the face and arms / legs. Very rarely, erythema multiforme is noted.
10. Laboratory diagnostics can fix hyperkalemia, an increase in markers of blood plasma creatinine and serum urea. Especially in people with severe CHF. Rarely, hypoglycemia, elevated serum bilirubin, and activation of hepatic fermentation occur.

Among other reactions, asthenic syndrome is often noted, infrequently - hyperhidrosis.

In case of overdose

The main signs of an overdose are a significant decrease in blood pressure, palpitations and bradycardia, tachycardia, as well as disruptions in water and electrolyte balance. Hyperventilation of the lungs, anxiety, coughing and considerable dizziness are possible. A shock reaction and renal failure cannot be ruled out.

If the pressure has decreased significantly, it is recommended to lay the victim down, raise his lower limbs. The patient's blood volume is replenished, angiotensin II is administered intravenously, and also (possibly - at choice) a catecholamine solution. With developed bradycardia, which is not amenable to drug treatment, the pacemaker is increased. Therapy for overdose is routinely carried out with monitoring of vital signs, creatinine and electrolytes in the serum part of the biofluid.

Removal of the substance from the systemic circulation is acceptable by hemodialysis, but, importantly, the use of high-flow polyacrylonitrile membranes in this procedure should be avoided.

Remarks

The combined therapy of Perineva with lithium, potassium, potassium-sparing diuretics, as well as potassium-containing products and / or dietary supplements is not considered optimal.

As well as other ACE inhibitors, Perineva can provoke a sharp drop in blood pressure. But in people with uncomplicated hypertension, this effect of the “first dose” is recorded infrequently. But a pathological decrease in blood pressure can manifest itself in patients with reduced BCC due to a serious salt-free diet, diuretic therapy, and hemodialysis.

Also, it is worth noting that often a significant drop in blood pressure in people with CHF (severe) is recorded with the parallel intake of loop diuretics, and also with AN. These patients should be closely monitored throughout the entire period of treatment, the correct, accurate dosage of the medication is very important for them. This remark is also true for patients with ischemia of the heart, cerebrovascular diseases. In them, an excessive decrease in pressure is dangerous for acute myocardial infarction and complications of the cerebrovascular type.

It is important:

1. Transient (that is, passing) arterial hypertension cannot be considered an indication for interruption of therapy, after the restoration of BCC and stabilization of blood pressure, treatment continues.
2. If clinical symptoms are inherent in hypotension, the dosage of the pharmacological agent is adjusted (sometimes it is canceled altogether).
3. In situations with the development of an episode of unstable angina pectoris (even if it is insignificant) in patients with cardiac ischemia, the benefit / risk ratio is assessed in the first weeks.
4. If an angioedema occurs in a person being treated, Perinev is canceled urgently - with swelling of the face or lips, only standard antihistamines are needed, but with swelling of the tongue and larynx, as well as the glottis, the situation can get out of control. Help must be urgent.
5. If, during treatment, the patient develops jaundice, the medication is canceled, an examination is carried out, since Perineva can lead to a serious chain of pathologies that start with cholestatic jaundice.
6. In some situations, in patients with hypertension and previously undefined PN (in particular, when taking diuretics), there may be a temporary and insignificant increase in creatinine and urea in the serum part of the biological fluid.

In persons diagnosed with diabetes mellitus, who receive insulin or drink hypoglycemic agents, at the start of Perineva's therapy, the glucose indicator is clearly monitored.

Those patients who expect surgery in the near future, as a rule, cancel the medicine a day. This is due to the fact that anesthesia during surgery lowers blood pressure. If it is not possible to stop the ACE inhibitor, hypotension is corrected by an increase in BCC.

If, during therapy, the patient develops an unproductive, incessant cough, this is usually a reaction to the medication. It terminates upon its cancellation.

Gestation and lactation

Perineva is not prescribed during pregnancy. If during the course of treatment the patient becomes pregnant, the medicine is urgently canceled. If it is used by a pregnant woman in late gestation, the treatment may result in fetotoxic effects. Among them, oligohydramnios and a decrease in nephrofunctionality, as well as delayed ossification of the bones of the skull in a baby. Able to provoke the drug and neonatal toxic effects - hypotension, renal failure.

If, for one reason or another, the medication was used in the second and third trimesters, it is important to do an ultrasound of the fetus - to monitor the condition of the cranial bones and kidneys.

There is no data on whether perindopril passes into breast milk, so the drug should be discarded during lactation. Or, on the contrary, the course of treatment requires the rejection of lactation, its temporary suspension. These issues should be discussed with your doctor and gynecologist.

Can it be combined with NSAIDs

NSAIDs are a category of drugs with a particular frequency of use. These include anti-inflammatory and analgesic medications, which are used relatively often by people with different indicators of somatic health. For example, people drink Nimesulide or Diclofenac for joint pain, osteochondrosis, post-traumatic pain, etc. These compounds are also used for the so-called colds.

But not all patients think about whether it is possible to combine NSAIDs with other medications, often used courses. So, if you combine them with Perineva's treatment, a weakening of the hypotensive effect cannot be ruled out. The level of K ions in the blood may increase, causing deterioration in renal functionality. In some cases, the case turns into the development of acute renal failure. If a patient has diseased kidneys, and he drinks Aspirin along with Perineva, acute renal failure has a high probability of developing.

Therefore, before drinking an anesthetic or anti-inflammatory pill, remember that you are taking Perineva, which does not go well with them. And what can be taken in case of a cold or joint pain, check with your doctor.

What can be combined with if necessary

If there is such a request, then Perinev can be prescribed in combination with such pharmaceuticals as nitrates, beta-blockers, thrombolytics, as well as with acetylsalicylic acid in doses with antiplatelet action.

In pharmacies, the medicinal product is dispensed by prescription. The price of Perinev tablets is from 210 rubles for 30 pills / 4 mg to 1000 rubles for 90 pills of 8 mg.

Driving

The medicine is associated with certain risks from the nervous system, therefore, all persons taking Perinev are not recommended to drive and work with complex mechanisms during the treatment process. It is impossible to exclude headaches, dizziness, confusion of consciousness, deconcentration. All this can lead to an emergency.

If you experience any severity of a negative reaction, hurry to contact your doctor.

Perineva is a drug used to normalize blood pressure, facilitate the work of the heart, and improve blood flow. All recommendations that include instructions for use should be followed to ensure maximum safety and efficacy of the drug. Prices for different dosages, reviews of doctors and patients, Perineva's analogues in Russia (substitutes) will complement the data on the medicinal product.

Compound

Perindopril (international name Perindopril) is an active substance that provides all the pharmacological actions of the drug. Included in the preparation Perineva (in Latin INN - Perineva) in the amount of 2, 4, 8 mg. Combined forms of Co-Perinev are produced, containing Perindopril in the indicated doses and (diuretic) in the amount of 0.625; 1.25 or 2.5 mg.

Other Ingredients:

• silicon oxides;
• lactose;
• cellulose;
• magnesium stearates;
• povidone;
• calcium chloride.

Release form

Perineva is produced by KRKA (Slovenia) in the form of tablets that are taken orally. Each tablet, regardless of the dosage of the active substance, is colored white, round in shape. In packs of 30 or 90 tablets, as well as official instructions for use.

pharmachologic effect

Pharmacological group - ACE inhibitor (angiotensin-converting enzyme). The mechanisms of action of the chemical substance Perindopril are associated with the blocking of an enzyme involved in the conversion of an inactive vasoconstrictor factor into an active form.

Therapeutic effects of the drug:

• a rapid decrease in blood pressure in the vessels;
• increased blood flow;
• decrease in the resistance of the walls of blood vessels;
• expansion of the lumen of blood vessels;
• diuretic action (for combined forms);
• reducing the load on the heart;
• improvement of myocardial blood supply.

Indications for use

Indications for the use of Perineva are such diseases:

• hypertension of various forms;
• prevention of strokes and heart attacks;
• ischemia of the heart muscle;
• heart failure (chronic forms).

Contraindications

The following conditions are considered complete contraindications to the use of the drug:

• allergies;
• pregnancy;
• syndromes of malabsorption of galactose and glucose;
• lactase deficiency;
• lactation;
• children under 18 years of age;
• galactose intolerance;
• angioedema when using other drugs in this group.

Relative contraindications (taken with caution) are the following conditions:

• failure of the kidneys;
• reduced sodium levels;
• reduced volume of circulating blood;
• increased levels of potassium in the blood;
• heart failure in the stage of decompensation;
• cerebrovascular disease;
• cardiomyopathy;
• anesthesia;
• diseases affecting connective tissues;
• persons over 60;
• diabetes;
• kidney transplants.

Instructions for use

Important! The first doses of Perineva should be taken in the supine position to avoid a sharp drop in pressure at the beginning of therapy.

The drug is used only inside before meals (30-40 minutes). The daily dose is taken once (morning, before lunch, less often in the evening), washed down with 100-150 ml of water.

Method of application for adults: the initial daily dose should be minimal and not exceed 2 mg (rarely 4 mg at very high pressures). Gradually (not more than once every 2 days) increase the dose to an average therapeutic dose of 4-8 mg.

Important! In the treatment of diseases in case of ineffectiveness of Perineva, they switch to the use of Ko-Perineva containing the thiazide diuretic Indapamide.

The first effects of taking the drug appear half an hour after taking the dose. The dosage and duration of taking the medicine is always selected strictly individually. It is forbidden to stop treatment on your own, as the patient's condition may worsen.

Overdose

The consequences of exceeding the dosage of the drug are as follows:

• shock state;
• a sharp drop in pressure;
• cough (dry, without sputum);
• slow heart rate, which can be replaced by tachycardia;
• kidney failure;
• reduced sodium levels;
• severe anxiety;
• dizziness;
• sensations of palpitations, feelings of squeezing in the region of the heart.

Therapy for overdose is only symptomatic. In severe conditions, drug withdrawal or dose reduction may be required.

Side effects

The following side effects often develop:

• lack of taste sensations;
• stomach ache;
• nausea;
• skin itching;
• skin rashes;
• dry, agonizing cough (should tell the doctor).

Less common side effects may develop:

• dizziness;
• feeling of heat;
• sore throat;
• weakness;
• heart rhythm disturbances;
• sensations of tinnitus;
• elevated levels of potassium in the blood;
• swelling of the limbs;
• kidney failure;
• respiratory disorders;
• changes in the composition of the blood;
• increased sweating;
• increase in blood glucose levels.

Interaction with other tools

The effectiveness of Perineva is enhanced when combined with such means:

1. Neurolytics.
2. Diuretics (except potassium-sparing).
3. Anesthetics.
4. Vasoconstrictor.
5. Other groups of antihypertensive drugs.
6. Antidepressants.

Reduce the effectiveness of Perineva:

• NSAIDs;
• sympathomimetics.

Perineva enhances the effectiveness and toxicity of such drugs:

• hypoglycemic;
• preparations containing lithium salts.

The compatibility of Perineva with the following drugs should be avoided:

• Cyclosporine;
• potassium-sparing diuretics;
• preparations containing potassium salts.

During pregnancy and lactation

Perinev is not prescribed during pregnancy due to the high probability of toxic effects on the fetus (indicated in the official annotation).

The safety of Perineva pressure tablets during breastfeeding (lactation) has not been established. The medicine can have a negative effect on the baby. Perineva, in case of need for use during breastfeeding, requires the suspension of breastfeeding.

With alcohol

It is extremely important to exclude any interactions of the drug with alcohol. With the combination of Perineva and alcohol, the effect of lowering pressure and the negative effect on the heart and liver are enhanced. This compatibility causes an increase in the manifestations of side effects of the drug.

Analogues

On the basis of Perindopril, such synonyms (analogues) foreign or Russian (cheap) are produced:

• Perindopril of various manufacturers;
• Coverex;
• Prenes;
• Prestarium;
• Erupnil;
• Promepril;
• Hiten;
• Stoppress;
• Peristar;
• Ordilat.

The listed domestic (Russian) and imported analogues of Perineva have the same composition. The only difference is the manufacturer.

In the absence of effectiveness from the therapy or if this active substance is intolerant, the drug can be replaced with other antihypertensive drugs from the following list:

Important! Replacement is carried out only by the doctor who treats this patient.

Best before date

Perinev can be applied three years from the date of issue. The expiration date indicates that the drug should not be taken.

Terms of sale and storage

Perineva is released from pharmacies only if patients have prescriptions in Latin.

It is allowed to store at room temperature (no more than 25⁰С), in dry rooms. The medicine should be kept out of the reach of children.

special instructions

Before starting the use of the drug, it is important to inform the doctor about the presence of such diseases:

• allergy to any drugs of this group of drugs;
• liver disease;
• kidney pathology;
• diseases associated with blood clotting disorders.

Patients who are on a low-salt diet should inform the doctor to adjust the dosage regimen.

Patients over 60 years of age may be more sensitive to the drug. Therefore, it may be necessary to lower the dose and adjust the course of treatment in consultation with the doctor.

You should refuse to drive vehicles until the patient's reaction to the drug, which can cause dizziness, fainting, is clarified.

Before the introduction of general anesthesia, the use of Perineva should be discontinued.

With prolonged use of the drug, the following indicators are regularly monitored:

• the level of potassium in the blood;
• the number of leukocytes in the blood;
• kidney function;
• urine composition.

Price

The cost of Perinev's medicine is different:

• 4 mg No. 30 costs from 220 rubles;
• 4 mg No. 90 - from 480 rubles;
• 8 mg No. 30 - from 330 rubles;
• 8 mg No. 90 - from 820 rubles;
• Ko-Perineva 2 / 0.625 No. 30 - from 260 rubles;
• Ko-Perineva 4 / 1.25 No. 30 - from 400 rubles;
• Ko-Perineva 8 / 2.5 No. 30 - from 470 rubles;
• Ko-Perineva 8 / 2.5 No. 90 - from 913 rubles.

Perineva is a drug intended for the treatment of high blood pressure. Perineva's active ingredient, perindopril, belongs to the class of angiotensin-converting enzyme (ACE) inhibitors. The drug is produced by the Slovenian company KRKKA, which has a production branch in Russia.

To understand exactly how the remedy works, you need to know how blood pressure is regulated in the body. Regulation mechanisms are systemic and local. Local ones act at the level of the vascular wall and “correct” the result of the work of systemic mechanisms, based on the momentary needs of a particular organ.

Systemic mechanisms regulate blood pressure at the level of the body as a whole. According to the mechanism of action, they are divided into nervous and humoral. As the name implies, nervous mechanisms carry out regulation with the help of the peripheral nervous system. Humoral mechanisms regulate systemic blood flow with the help of active substances dissolved in the blood.

One of the main mechanisms that controls systemic blood flow and, as a result, regulates blood pressure is the Renin-Angiotensin-Aldosterone system.

Renin is a hormone-like substance that is produced in the cells of the arterioles of the vascular glomeruli of the kidneys. It is also synthesized by the endothelium - the inner lining of the vessels of the brain, myocardium, glomerular zone of the adrenal cortex. Renin production is regulated by:

• The pressure in the blood-bearing vessel, namely, the degree of its stretching;
• The content of sodium in the distal tubules of the kidneys - the more it is, the more active is the secretion of renin;
• Sympathetic nervous system;
• By the principle of negative feedback, reacting to the content of angiotensin and aldosterone in the blood.

Renin transforms the angiotensinogen protein synthesized by the liver into the inactive hormone angiotensinogen I. With the blood flow, it enters the lungs, where it is converted into active angiotensin II under the action of angiotensin-converting enzyme (ACE).

Functions of angiotensin II:

• Narrows arteries, including coronary;
• Causes myocardial hypertrophy;
• Stimulates the release of vasopressin (aka antidiuretic hormone) in the pituitary gland, which retains water in the body, reducing its excretion by the kidneys;
• Stimulates the production of aldosterone in the adrenal glands

Perineva: how it works

Perineva blocks ACE, thus reducing the amount of angiotensin II in the body and eliminating its vasoconstrictive effects. In parallel, the secretion of aldosterone decreases, the retention of sodium and fluid in the body decreases. This reduces the volume of circulating blood and, as a result, reduces the pressure in the arterial system.

In general, the effects of the drug can be divided into the following groups:

Changes in the cardiovascular system:

Effects from the kidneys:

• Normalization of intraglomerular hemodynamics;
• Reducing proteinuria.

From the endocrine system:

• Reducing tissue resistance to insulin (important for patients with metabolic syndrome and type 2 diabetes);
• prevention of angiopathy and nephropathy caused by diabetes.

From other metabolic processes:

• Increased excretion of uric acid by the kidneys (important for patients with gout);
• Anti-atherosclerotic action: reduces the permeability of the cells of the inner wall (endothelium) of blood vessels and reduces the amount of lipoproteins in them.

With prolonged regular use, Perineva exhibits the so-called chronic antihypertensive effect. The reproduction and growth of smooth muscle cells in the middle wall of the artery decreases, which increases their lumen and restores elasticity.

A decrease in arterial wall hypertrophy, together with the already mentioned decrease in myocardial hypertrophy, reduces hemodynamic resistance in peripheral vessels, and therefore blood pressure also decreases.

How to use Perineva

• arterial hypertension,
• For cardioprotection in chronic heart failure,
• For cardioprotection after myocardial infarction or coronary artery surgery, subject to the stability of the ischemic process,
• To prevent recurrence of stroke in patients who once had it.

When to start using Perineva

The main indication for this is arterial hypertension. It is understood as an increase in systolic, “upper” blood pressure > 140 mm Hg. st and / or diastolic, “lower” blood pressure> 90 mm. rt. Art. An increase in pressure can be secondary, caused by diseases of other organs (glomerulonephritis, adrenal tumors, etc.) and primary, when it is impossible to identify and eliminate the cause of the disease.

Primary (essential) hypertension accounts for 90% of all cases of high blood pressure and is referred to as hypertension. The Ministry of Health of the Russian Federation in clinical guidelines of 2013 proposes the following criteria for its diagnosis:

Thus, the indication for the use of perindopril (Perineva) is a regular isolated increase in systolic blood pressure to 140 mm or more. rt. Art., or diastolic up to 90 mm. rt. Art. and more.

Reception regimen and principles of dose selection

The recommended targets for blood pressure are less than 140/90 (for patients with diabetes mellitus - less than 140/85). The previously used concept of “working pressure” was recognized as incorrect - in order to prevent complications and reduce the likelihood of cardiovascular death, it is necessary to achieve target indicators. If the pressure is excessively high and its abrupt normalization is poorly tolerated, the correction is carried out in several stages.

In the first 2-4 weeks, blood pressure drops by 10-15% of the initial level, then the patient is given a month to get used to such pressure values. Further, the rate of decline is selected individually. The lower limit of the decrease in SBP is 115-110 mm Hg, DBP is 75-70 mm Hg, at excessively low levels, the risk of myocardial infarction and stroke again increases.

Perineva (perindopril) is one of the first choice drugs recommended for the correction of high blood pressure. Available in the form of tablets of 2, 4 and 8 mg; 30 or 90 pieces per pack.

The medicine is taken once a day, in the morning. The initial dosage is 4 mg, for pensioners - 2 mg, gradually increasing to 4 mg. Patients taking diuretics should stop using them 2-3 days before the start of the course of Perineva, or start treatment with a dosage of 2 mg, also gradually increasing to 4 mg. According to the same principle, doses are selected for patients suffering from chronic heart failure.

After a month of regular intake, the effectiveness of the drug is evaluated. If the target blood pressure is not achieved, it is necessary to switch to a dosage of 8 mg.

For patients with stable coronary artery disease, Perineva is prescribed at a starting dosage of 4 mg, after 2 weeks they switch to 8 mg.

Contraindications:

special instructions

Perineva can provoke an excessive decrease in blood pressure when:

• cerebrovascular pathologies,
• Simultaneous use of diuretics,
• Loss of electrolytes: after a salt-free diet, vomiting or diarrhea,
• After hemodialysis,
• Stenosis of the mitral or aortic valves - since cardiac output in these conditions cannot increase, it is not able to compensate for the decrease in peripheral vascular resistance,
• renovascular hypertension,
• Chronic cardiovascular insufficiency in the stage of decompensation.

May exacerbate renal failure in patients with bilateral renal artery stenosis or stenosis of the artery to a single kidney.

May provoke anaphylactoid reactions in patients undergoing desensitization therapy with allergens, patients on hemodialysis using high-flow membranes, patients of the black race.

Perinev should be used with extreme caution in women of childbearing age. Planned pregnancy is an indication for changing the antihypertensive drug.

Overdose and side effects

In case of an overdose, blood pressure drops excessively, up to shock, kidney failure develops, respiratory intensity (hypoventilation) decreases, heart rate can change both towards tachycardia and bradycardia, dizziness, anxiety, and coughing are possible.

In case of an overdose, it is necessary to lay the patient down, raising his legs, replenish the bcc, by intravenous administration of solutions. Angiotensin II is also administered intravenously, in its absence - catecholamines.

Side effects:

Perineva's analogs

To date, more than 19 drugs based on perindopril have been registered in the Russian Federation. Here is some of them:

• Prestarium. The drug, manufactured by the French company Servier, was the first drug based on perindopril that appeared at the disposal of doctors. It was on this drug that all studies on the effectiveness of perindopril, a decrease in cardiovascular risk (a decrease of 20%), and a positive effect on the condition of the walls of blood vessels were carried out. The cost is from 433 rubles.
• Perindopril-Richter. Production of the Hungarian company "Gedeon-Richter". Price from 245 rubles.
• Parnavel. Production of the Russian company Ozon. Price from 308 rubles.

When choosing from the possible options the best in terms of price-quality ratio, you need to remember that today, of all manufacturers of generic drugs, only KRKKA has proved the bioequivalence (correspondence to the original medicine) of its product.

The cost of Perineva in pharmacies is from 244 rubles.

Ko-Perineva

Monotherapy with perindopril (Perineva) allows achieving the target values ​​of blood pressure in patients with 1-2 stages of hypertension in 50% of cases. In addition, often the therapy of arterial hypertension should immediately begin with a combination of two active substances.

The combination of perindopril and indapamide (thiazide diuretic) has proven to be one of the most effective. For the convenience of patients, this combination is available as a single tablet.

Co-perinev is produced in 3 dosages:

1. Perindopril 2 mg + indapamide 0.625 mg;
2. Perindopril 4 mg + indapamide 1.25 mg;
3. Perindopril 8 mg + indapamide 2.5 mg.

The cost in pharmacies - from 269 rubles.

Used to treat arterial hypertension. Dosage selection is carried out individually, according to the same principles as in monotherapy.

Contraindications

In addition to those already indicated for perindopril, for Ko-perineva:

• Azotemia, anuria;
• Liver failure.

Side effects

In addition to the adverse events characteristic of perindopril, Ko-perinev can cause:

• Hemolytic anemia, hemorrhagic vasculitis - extremely rare;
• Photosensitivity, erythema multiforme - very rare;

Perineva helped parents and quite well, reduced pressure for a long time. Perinev tablets have different dosages and, accordingly, different prices. It is important that the doctor selects the dosage, which is why I will not describe how the parents took Perineva.

Perineva has a lot of contraindications, but, on the other hand, they are absolutely the same for all analogues. Parents had no side effects on Perineva's reception. I read the reviews, I realized that my parents were lucky, many people have problems after using this drug.

Over time, the parents switched to other drugs to reduce pressure. In general, doctors recommend combining various drugs for high blood pressure and changing them periodically.

Perinev tablets have a cardioprotective and vasodilating effect, and also show a hypotensive effect. The basis of the drug includes components: perindopril, lactose, calcium salt of hydrochloric acid, povidone (enterosorbent), pyrogenic silicon dioxide, microcrystalline cellulose, magnesium stearate.

Perindoprilat, which is part of Perinev, is an active metabolite that contributes to the normalization of impulse conduction, has a general peripheral vascular resistance, which directly affects the reduction in blood pressure. The action of the drug does not adversely affect the processes occurring in the cardiac cycle.

Manifestations of the maximum effect occurs 4-6 hours after taking the pill and lasts about a day.

Stabilization of blood pressure is observed after a month of treatment. Regular intake of the drug helps to reduce hypertrophic changes in the heart muscle. The appointment of long-term treatment courses can reduce the severity of interstitial pulmonary fibrosis, while normalizing the isoenzymes of fibrillar proteins, which are the main components of contractile muscles.

Perineva tablets 4 and 8 mg photo

Taking the drug helps to increase the concentration of high density lipoproteins. This significantly reduces the risk of atherosclerosis and other cardiovascular pathologies.

For the treatment of chronic heart failure, Perineva is often included in the therapeutic regimen in order to:

Reduce blood pressure in the ventricles in the stress phase;
- increase the volume of blood pumped by each ventricle into the main vessel during cardiac contraction;
- increase the cardiac index (calculated as follows: the value of the minute volume of blood circulation is divided by the area of ​​the body);
- reduce the total peripheral vascular pressure.

At the end of the therapeutic course, withdrawal syndrome does not occur.

Perinev tablets are prescribed in the following situations:

• Persistent increase in blood pressure (hypertension);
• As a prevention of the development of recurrent cerebral hemorrhage, especially if the previous stroke led to serious cerebral disorders (Perineva in this case is prescribed with drugs that contain indapamide - Indapressin, Indapsan, Ionic);
• Ischemic heart disease (develops against the background of insufficient oxygen supply to the heart muscle through the coronary arteries);
• If there is a high risk of cerebrovascular or myocardial complications due to acute myocardial infarction.

Also, the drug is prescribed after coronary artery bypass grafting or laser transmyocardial revascularization.

The tablet should be taken once a day - preferably in the morning 30 minutes before breakfast. The dosage is selected individually, taking into account the characteristics of the disease, as well as the presence of other pathologies.

Characteristic features of the use of Perinev for each disease:

With arterial hypertension, Perineva is prescribed as monotherapy (sometimes as part of complex treatment). Dosage - one tablet (four mg) per day.

If there is a violation of the renin-angiotensin-aldosterone system in combination with dehydration, heart failure or a persistent increase in blood pressure, then the drug is prescribed with caution - the initial dose is 0.5 tablets (2 mg) with a gradual increase in dosage with good tolerance.

With myocardial form of heart failure, 0.5-1 tablet of Perineva is prescribed. Be sure to monitor the level of blood pressure during therapeutic treatment. If chronic heart failure has been diagnosed, then in addition to an antihypertensive agent, it is recommended to prescribe potassium-sparing diuretics, beta-blockers, and cardiac glycosides to achieve a cardiotonic and antiarrhythmic effect.

To prevent the development of a recurrent stroke, 0.5 tablets of Perineva are prescribed for two weeks, then treatment is carried out with indapamide-containing drugs.

With coronary heart disease, the medication is prescribed one tablet at a time, after a few weeks the dosage is doubled.

Application features

Dose adjustment is carried out in elderly patients (if the patient is older than 60 years, then the dose is halved). A creatinine test is required.

Perinev with diuretics is not always combined. Often, doctors, in order to avoid a sharply hypotensive effect, completely cancel diuretic drugs.

If the study reveals a slight violation of amino acid-protein metabolism, then the patient is prescribed no more than a tablet. With a decrease in creatinine from 15 to 60 µmol / l, the patient is prescribed no more than 0.5 tablets.

Instructions for the use of Perineva indicate that the parallel use of non-steroidal anti-inflammatory drugs can lead to a deterioration in kidney function, which threatens to disrupt the water, electrolyte and nitrogen balance.

The drug Perineva has a number of contraindications, therefore, before using the tablets, you should definitely consult with your doctor.
The list of conditions and diseases in which the drug is not prescribed:

• individual intolerance to perindoprilat, as well as other components of the drug;
• glucose-galactose malabsorption;
• hypolactasia - lactose intolerance;
• Quincke's edema in history due to treatment with angiotensin-converting enzyme inhibitors.

Perineva is not prescribed for children and adolescents under 18 years of age. The drug tends to penetrate the utero-placental barrier, so it is not prescribed to pregnant women. If a woman is breastfeeding, then for the duration of treatment it is recommended that the baby be transferred to an adapted mixture, and to maintain lactation, breast milk must be expressed and poured out.

With caution, the drug is prescribed for stenosis of the aortic or mitral valve, severe hyponatremia, hemolytic anemia and diabetes mellitus.

In case of an overdose, the patient may experience the following reactions:

• pronounced decrease in blood pressure;
• state of shock or collapse;
• increase in potassium and decrease in sodium in the blood;
• acute renal failure;
• frequent and intense breathing, leading to an imbalance of oxygen and carbon dioxide in the blood (this is fraught with the development of dizziness, shortness of breath, weakness, loss of consciousness);
• a sharp increase (up to 240 beats) or a decrease (up to 30-50 beats) in heart rate;
• anxiety, coughing.

With the development of the above symptoms during the treatment of Perineva, an ambulance should be urgently called for the patient. Before the arrival of the doctors, the patient should be laid down, open the window, unbutton the top buttons on the clothes.

The doctors' comments about Perinev are as follows: with proper use (here, the accuracy of the diagnosis and the correctly selected dosage are taken into account), patients experience a stable decrease in blood pressure and ischemic attacks. However, doctors also note the "reverse side of the coin" - there is difficulty in choosing an individual dosage, so patients sometimes develop negative life-threatening symptoms.

Analogues of the drug Perinev for action and indications:

1. Enapril,
2. lisinopril,
3. captopril,
4. Captopres.

Perineva Ku-Tab;

Perinpress;

Piristar;

Prestarium;

Coverex.

Despite the pharmacy availability of medical products, it is strictly forbidden to replace one drug with another on your own! Important - instructions for the use of Perinev, price and reviews do not apply to analogues and cannot be used as a guide for the use of drugs of similar composition or action. All therapeutic appointments must be made by a doctor. When replacing Perinev with an analogue, it is important to get expert advice, it may be necessary to change the course of therapy, dosages, etc.

Do not self-medicate!

Indications for the use of the drug Perineva

Arterial hypertension;

Chronic heart failure;

Prevention of recurrent stroke (as part of complex therapy with indapamide) in patients with a history of cerebrovascular disease (stroke or transient cerebral ischemic attack);

Stable coronary artery disease: reduced risk of cardiovascular complications in patients with previous myocardial infarction and / or coronary revascularization.

Release form of the drug Perineva

Tablets 2 mg; blister pack 10 carton pack 3;

Tablets 2 mg; blister pack 10 carton pack 6;

Tablets 2 mg; blister pack 10 cardboard pack 9;

Tablets 2 mg; blister pack 14 carton pack 1;

Tablets 2 mg; blister pack 14 carton pack 2;

Tablets 2 mg; blister pack 14 carton pack 4;

Tablets 2 mg; blister pack 14 carton pack 7;

tablets 2 mg; blister pack 30 carton pack 1;

Tablets 2 mg; blister pack 30 carton pack 2;

Tablets 2 mg; blister pack 30 carton pack 3;

Pharmacodynamics of the drug Perinev

Perindopril has a therapeutic effect due to the active metabolite - perindoprilat.

Perindopril reduces both systolic and diastolic blood pressure in the supine and standing positions. Perindopril reduces OPSS, which leads to a decrease in blood pressure. At the same time, peripheral blood flow is accelerated. However, the heart rate does not increase. Renal blood flow usually increases while glomerular filtration rate does not change. The maximum antihypertensive effect is achieved 4-6 hours after a single oral administration of perindopril; the hypotensive effect persists for 24 hours, and after 24 hours the drug still provides from 87 to 100% of the maximum effect. The decrease in blood pressure develops rapidly. Stabilization of the antihypertensive effect is observed after 1 month of therapy and persists for a long time. Termination of therapy is not accompanied by a "withdrawal" syndrome. Perindopril reduces left ventricular myocardial hypertrophy. With long-term administration, it reduces the severity of interstitial fibrosis, normalizes the isoenzyme profile of myosin. Increases the concentration of HDL, in patients with hyperuricemia reduces the concentration of uric acid.

Perindopril improves the elasticity of large arteries, eliminates structural changes in small arteries.

Perindopril normalizes the work of the heart, reducing pre- and afterload.

In patients with CHF during perindopril therapy, the following was noted:

Decrease in filling pressure in the left and right ventricles;

Reducing OPSS;

Increased cardiac output and cardiac index.

Reception of the initial dose of perindopril (2 mg) in patients with CHF I-II functional class according to the NYHA classification was not accompanied by a statistically significant decrease in blood pressure compared with placebo.

Pharmacokinetics of the drug Perinev

After oral administration, perindopril is rapidly absorbed from the gastrointestinal tract and reaches maximum plasma concentrations within 1 hour. Bioavailability is 65-70%, 20% of the total amount of absorbed perindopril is converted to perindoprilat (active metabolite). T1 / 2 from the blood plasma of perindopril is 1 hour. Cmax of perindoprilat in plasma is reached after 3-4 hours.

Taking the drug during a meal is accompanied by a decrease in the conversion of perindopril to perindoprilat, respectively, the bioavailability of the drug decreases. The volume of distribution of unbound perindoprilat is 0.2 l/kg. The binding to plasma proteins is negligible, the binding of perindoprilat to ACE is less than 30% and depends on its concentration.

Perindoprilat is excreted by the kidneys. T1 / 2 of the unbound fraction is about 3-5 hours. It does not accumulate. In elderly patients, in patients with renal and chronic heart failure (CHF), the excretion of perindoprilat is slowed down. Perindoprilat is removed during hemodialysis (speed - 70 ml / min, 1.17 ml / s) and peritoneal dialysis.

In patients with cirrhosis of the liver, the hepatic clearance of perindopril changes, while the total amount of perindoprilat formed does not change and correction of the dosing regimen is not required.

Use of the drug Perineva during pregnancy

During pregnancy, the use of the drug is contraindicated. It should not be used in the first trimester of pregnancy, therefore, when pregnancy is confirmed, Perinev should be discontinued as soon as possible. The drug is contraindicated in the II-III trimesters of pregnancy, since the use during this period of pregnancy can cause fetotoxic effects (decreased kidney function, oligohydramnios, slowing down the ossification of the fetal skull bones) and neonatal toxic effects (renal failure, arterial hypotension, hyperkalemia). If, nevertheless, the drug was used in the II-III trimesters of pregnancy, then it is necessary to conduct an ultrasound scan of the kidneys and bones of the fetal skull.

The use of the drug Perineva during lactation is not recommended due to the lack of data on the possibility of its penetration into breast milk. If necessary, the use of the drug during lactation, breastfeeding should be discontinued.

Contraindications to the use of the drug Perineva

Hypersensitivity to perindopril or other components of the drug, as well as to other ACE inhibitors;

Angioedema in history (hereditary, idiopathic or angioedema due to the use of ACE inhibitors);

Age up to 18 years (efficacy and safety not established);

Hereditary galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption syndrome.

Carefully:

Renovascular hypertension, bilateral stenosis of the renal arteries, stenosis of the artery of a single kidney - the risk of developing severe arterial hypotension and renal failure;

CHF in the stage of decompensation, arterial hypotension;

Chronic renal failure (Cl creatinine -