Perinev tablets from what and their use. Ko-Perineva is an effective antihypertensive drug. Indications and contraindications

Perineva: instructions for use and reviews

Content

With a steady increase in blood pressure, to prevent complications after a stroke, doctors prescribe the medication Perineva (Perineva). This medicine with antihypertensive properties dilates blood vessels, removes excess water from the body, prolongs the desired therapeutic effect for a day. Detailed instructions for the use of Perineva provides a complete description of the medication. Self-medication is strictly contraindicated.

The composition of Perineva

The drug is produced in the form of tablets and semi-finished granules. The product is intended for oral use. White pills have a biconvex shape with a risk on one side. Tablets are packed in blisters of 10, 14 and 30 pcs. Instructions for use are attached. On sale, the drug is dominated by two types, depending on the concentration of the active substance - 4 and 8 mg. Features of the chemical composition:

Pharmacodynamics and pharmacokinetics

Perineva is an ACE inhibitor (antihypertensive drug) with vasodilatory and cardioprotective effects in the body. The active metabolite of perindopril called perindoprilat creates a therapeutic effect: it lowers blood pressure by activating peripheral blood flow, while keeping the pulse at an acceptable level. Perindoprilat increases the elasticity of arteries, prevents their structural changes, normalizes myocardial function, reduces preload and afterload.

When taken orally in a single dose, Perinev is rapidly absorbed from the alimentary canal and enters the bloodstream. The bioavailability index is 65–70%. The maximum concentration in the blood plasma of the active substance reaches 60 minutes after the use of the tablet. The therapeutic effect is maintained throughout the day. The active metabolite is excreted by the kidneys with urine, does not accumulate. Parallel food intake reduces the bioavailability of Perineva. Stabilization of blood pressure at an acceptable level is observed after 1 month of conservative therapy.

Indications for use Perinev

The drug is characterized by local action in the body. Instructions for use Perineva contains a list of medical indications:

• stable ischemia of the heart (CHD);
• arterial hypertension;
• chronic heart failure;
• prevention of complications after a stroke;
• coronary artery bypass grafting, laser transmyocardial revascularization (as part of rehabilitation therapy).

Method of application and dosage

Perinev tablets are intended for oral administration. The drug must be swallowed whole, do not chew first, drink plenty of water. It is recommended to drink a single dose in the morning - 30 minutes before breakfast, always on an empty stomach. The number of daily approaches is 1. The course of treatment is determined on an individual basis. Daily dosages depend on the condition of the patient, the diagnosis:

• arterial hypertension as part of monotherapy: 4 mg per day (table 1);
• heart failure: 2 mg per day (0.5 tab.), with good tolerance of the drug, the daily dose is increased to 1 tab.;
• heart failure of the myocardial form: 0.5–1 tab. per day;
• prevention of recurrent stroke in patients with a history of cerebrovascular pathologies: 0.5 tab. per day for 2 weeks;
• stable cardiac ischemia: the initial dosage is 4 mg per day, which after 2 weeks is increased to 8 mg per day (with good tolerance by the body).

special instructions

Perinev's tablets, subject to medical recommendations, are well tolerated by the body, do not cause an addictive effect. To avoid complications, in the treatment of arterial hypertension, it is necessary to study the instructions of both specialists and those described in the instructions for use of the medication:

1. With conservative treatment of Perineva, a dry cough may appear, which disappears immediately after the drug is discontinued. It is important to differentiate the cough reflex from SARS, lung oncology.
2. When undergoing a long course of drug therapy, it is important to monitor blood parameters by laboratory methods - the level of platelets and hemoglobin. Doctors do not exclude the occurrence of thrombocytopenia and anemia.
3. Since the chemical composition of Perineva contains lactose, the drug is not prescribed to patients with individual intolerance to this component or malabsorption syndrome.
4. After using the tablets, weakness, dizziness may occur. During the course of Perineva, doctors do not recommend driving a vehicle, they advise you to temporarily refrain from performing work that requires increased concentration.
5. In the treatment of elderly patients, daily doses of the drug must be adjusted on an individual basis.
6. If the patient is to undergo surgery with the involvement of general anesthesia, the use of Perineva tablets should be abandoned a day in advance.
7. In patients with diabetes mellitus, when prescribing Perineva, it is required to control the level of glucose in the blood. With an increase, immediately stop further use, replace the medicine.
8. Perinev's pressure tablets are not allowed to be used during pregnancy. Clinical studies have shown that drug therapy in the 2nd and 3rd trimesters can lead to extensive pathologies of intrauterine development of the fetus from the kidneys, skull, and liver.
9. During lactation, it is also desirable to refuse such a pharmaceutical appointment, since clinical studies of this category of patients have not been conducted. It is known that the active substance of the drug is excreted in breast milk.

drug interaction

The drug Perineva is prescribed as monotherapy or as part of complex treatment. In the latter case, it is required to first study the information on drug interactions, which are described in detail in the instructions for use:

1. In combination with diuretics, the drug creates a pronounced hypotensive effect, so this combination is best excluded.
2. With the simultaneous administration of perindopril with potassium preparations, potassium-sparing diuretics, hyperkalemia develops.
3. Perindopril, when used simultaneously with lithium preparations, increases the concentration of the latter in the blood plasma. This leads to severe symptoms of intoxication of the body.
4. When Perineva is combined with non-steroidal anti-inflammatory drugs (NSAIDs), an antihypertensive effect is observed, but the load on the kidneys increases. With prolonged therapy, renal failure develops.
5. To enhance the hypotensive effect of perindopril, doctors prescribe an additional intake of vasodilators.
6. Hypoglycemic agents and insulin in combination with the studied drug enhance the hypoglycemic effect, contribute to the development of glycemia.
7. Tricyclic antidepressants, general anesthetics, antipsychotics, when used simultaneously, enhance the therapeutic effect of perindopril.
8. The drug is allowed to be combined in one regimen of drug therapy with nitrates, beta-blockers, acetylsalicylic acid, thrombolytics.
9. Sympathomimetics weaken the therapeutic effect of perindopril.

Side effects of Perineva

Perinev's medicine at the beginning of the course may worsen the patient's well-being. The instructions for use contain a list of side effects:

• from the digestive system: nausea, heaviness in the abdomen, impaired liver function, signs of dyspepsia, dry mouth, epigastric pain, dysgeusia (taste disorder), pancreatitis, prolonged diarrhea;
• from the respiratory system: bronchospasm, dry cough, shortness of breath, rhinitis, bronchial obstruction, eosinophilic pneumonia;
• from the nervous system: migraine, paresthesia, lethargy, dizziness, convulsions, emotional instability, unreasonable anxiety, confusion;
• from the genitourinary system: impotence, decreased libido, nephritis, increased creatinine in the blood, renal failure;
• on the part of the skin: urticaria, skin rash, itching, angioedema, anaphylactic shock, erythema multiforme;
• from the cardiovascular system: angina pectoris, arterial hypotension, arrhythmia, stroke, myocardial infarction, vasculitis;
• on the part of the hematopoietic organs: thrombocytopenia, pancytopenia, neutropenia, leukopenia, agranulocytosis, hemolytic anemia (in patients with congenital deficiency of glucose-6-phosphate dehydrogenase), a decrease in the concentration of hematocrit and hemoglobin;
• others: asthenia, increased sweating, tinnitus, decreased visual acuity, cholestatic or cytolytic hepatitis, hypercalcemia, increased liver enzymes, hypochloremia, hypoglycemia, hypokalemia.

Overdose

If the dosage of the drug prescribed in the instructions is exceeded, side effects increase. For example, orthostatic hypotension develops in the body, the heart rhythm is disturbed. Due to the increased toxicity of Perineva, symptoms of kidney and liver damage occur. Other overdose symptoms: bradycardia, palpitations, hyperventilation, tachycardia, fluid and electrolyte imbalance, shock, renal failure. To normalize the patient's condition, doctors perform hemodialysis, control the concentration of electrolytes and creatinine in the blood serum.

Contraindications

Perinev's medicine is not suitable for all patients. The instructions for use provide an extensive list of medical contraindications:

• glucose/galactose malabsorption syndrome;
• lactase deficiency;
• hypersensitivity of the body to the active substances of the drug;
• angioedema in history;
• galactose intolerance;
• age up to 18 years.

The instructions for use contain other medical restrictions. Relative medical contraindications:

• hyponatremia, hypovolemia;
• hyperkalemia;
• connective tissue damage;
• decompensated heart failure;
• stenosis of the arteries of the kidneys;
• renovascular hypertension;
• kidney transplant;
• hypertrophic obstructive cardiomyopathy;
• elderly age;
• diabetes.

Terms of sale and storage

Perineva is a prescription drug sold in the city's pharmacies. Store the medicine in a dry, cool, dark place. It is important to avoid contact with young children, exposure to sunlight. The expiration date is indicated on the packaging.

Perineva's analogs

If the medicine did not fit or caused side effects, it is necessary to replace Perinev with an analogue. Reliable medicines with similar pharmacological properties:

1. Arentopres. Antihypertensive pills, which, according to the instructions, are required to be taken 1 time per day. Daily dose - 1-2 pcs. depending on medical indications. The course of treatment is determined by the doctor.
2. Hypernic. Prescription drug, ACE inhibitor. The initial dose is 4 mg 1 time per day. With low efficiency of drug therapy, the dosage can be doubled. According to the instructions, 3 days before the start of the course, it is required to stop the use of diuretics.
3. Coverex. The daily dose is selected individually in each clinical case. It is recommended to take the tablets 1 time per day, preferably on an empty stomach in the morning (immediately after waking up).
4. Parnavel. A drug with antihypertensive, vasodilatory and cardioprotective effects. According to the instructions, it is recommended to take 1 table for 2 months. drug in the morning, on an empty stomach.
5. Perinpress. Tablets for full course use. According to the instructions, the medication is required to be taken 1 time per day in the morning. Maintenance dose for heart failure - 2-4 mg, for arterial hypertension - 4 mg.
6. Perindopril. ACE inhibitor with diuretic properties. According to the instructions, it is supposed to take 2 mg per day. In the absence of a therapeutic effect, the daily dose is increased to 4 mg, but not earlier than after 2 weeks.

Price Perineva

The average cost of a medication is 200-500 rubles. The price depends on the configuration and concentration of active substances in the chemical composition.

Perinev's medicine includes the following components:

• perindopril erbumine;
• lactose monohydrate, hexahydrate, crospovidone;
• colloidal silicon dioxide, MCC, magnesium stearate.

Release form

The drug is available in the form of round white biconvex tablets with a score on one side of 8, 4 or 2 mg. The blister contains 10, 14 or 30 tablets.

pharmachologic effect

Perineva has a hypotensive, vasodilating and cardioprotective effect.

Pharmacodynamics and pharmacokinetics

Perindopril has a therapeutic effect due to perindoprilat (active metabolite). It reduces systolic and diastolic pressure, OPSS, resulting in a decrease in blood pressure. At the same time, the peripheral blood flow accelerates, but the pulse does not increase.

The maximum effect appears after taking an average of 4-6 hours and lasts for a day.

Decreases pretty quickly. Pressure stabilization is observed after about a month of therapy. After discontinuation of treatment, withdrawal syndrome does not develop.

Increases the elasticity of arteries, helps to eliminate their structural changes. Normalizes the work of the heart muscle, reduces preload and afterload .

Maximum concentration perindopril in the blood after taking it is observed in an hour. It is rapidly absorbed from the gastrointestinal tract. Bioavailability - 65-70%.

Simultaneous eating with the drug reduces the conversion of perindopril to perindoprilat which consequently reduces its bioavailability. Excreted through the kidneys, does not accumulate.

Indications for use

What are Perinev's tablets from? Perineva is prescribed in the following cases:

• prevention of repeated (complex therapy together with);
• chronic heart failure ;
• arterial hypertension ;

Contraindications

The drug should not be taken when:

• sensitivity to any component of the drug;
• glucose/galactose malabsorption syndrome ;
• age up to 18 years;
• lactase deficiency ;
• history of angineurotic edema (angioneurotic, idiopathic or hereditary edema as a result of taking ACE inhibitors);
• galactose intolerance .

With caution, the drug is used for:

• bilateral stenosis of the renal arteries ;
• renovascular hypertension ;
• stenosis of the artery of a single kidney ;
• stages of decompensated heart failure ;
• hyponatremia, hypovolemia ;
• hyperkalemia ;
• cerebrovascular diseases ;
• hypertrophic obstructive cardiomyopathy ;
• after kidney transplant;
• connective tissue diseases ;
• general anesthesia;
• in old age.

Side effects

As a result of taking Perinev, the following side effects may occur:

• , ;
• noise in ears;
• visual impairment;
• a significant decrease in blood pressure, vasculitis ;
• , bronchospasm, cough, eosinophilic pneumonia ;
• abdominal pain, nausea, dysgeusia, , , , , dry mouth, cholestatic or cytolytic hepatitis ;
• , swelling of limbs, face, rash, ;
• muscle cramps;
• , ;
• increased sweating, asthenia ;
• decrease in hemoglobin and hematocrit, neutropenia , leukopenia , thrombocytopenia , pancytopenia , (manifested when used at high doses over a long period of time), hemolytic anemia (rarely seen in patients with glucose-6-phosphate dehydrogenase deficiency);
• increased concentration of urea and creatinine, hyperkalemia (reversible after discontinuation of the drug), hypoglycemia increased activity of liver enzymes.

Application instruction of Perineva (Way and dosage)

The drug should be taken 1 time, in the morning, inside, before meals.

The instructions for the tablets note that the dose is selected for each patient individually, depending on the severity of the disease and the response to therapy.

At arterial hypertension Perinev's medicine can be used both in monotherapy and simultaneously with other drugs that reduce blood pressure. The initial daily dose should not exceed 4 mg. If within a month the therapy does not bring results, the dose can be increased to 8 mg (with normal transfer of the previous dose).

Before you start taking this drug, you must stop taking diuretics at least 3 days in advance, since the combined use of these drugs can lead to arterial hypotension.

At chronic heart failure take the drug only under medical supervision, you should start with a minimum dose (2 mg). You can increase the dose to 4 mg no earlier than a week later.

As prophylactic from a repeated stroke, the dose of the drug to start is 2 mg. You can start taking the drug as early as two weeks after the stroke.

At kidney disease the dose of the drug is prescribed individually, based on the diagnosis and the degree of impairment. It is necessary to constantly monitor the patient's condition, in particular, the level of creatinine and potassium ions in the blood.

Adjust dose when liver diseases there is no need.

Overdose

In case of an overdose, the patient may experience the following symptoms: shock, kidney failure , bradycardia , a sharp drop in blood pressure, hyponatremia , dizziness, cough, hyperkalemia , anxiety, hyperventilation , heartbeat.

With a sharp drop in blood pressure the patient should take a prone position, slightly raise his legs, it is also necessary to take measures to replenish the BCC. With bradycardia, which is not amenable to therapy (in particular, anthroponym ), you need to install pacemaker (artificial pacemaker). Perindopril can be removed from the bloodstream by hemodialysis.

Interaction

Simultaneous adoption of Perineva with diuretics may lead to arterial hypotension. You can reduce the risk of its occurrence by stopping the intake of diuretics or taking the drug in lower doses. In the future, increasing the dose of Perineva should be administered with caution.

Combination of perindopril with , products and additives , as well as potassium preparations may lead to the development of hyperkalemia. They should be prescribed exclusively for hypokalemia with the utmost care, while controlling the level of ions.

Perindopril together with lithium preparations can cause lithium toxicity and increase the level of lithium in the blood, so it is not recommended to prescribe them at the same time. If necessary, such a combination should monitor the concentration of lithium in the blood.

A decrease in the antihypertensive effect may occur as a result of the combination of Perineva with NSAIDs . Also, such therapy can lead to a deterioration in the condition of the kidneys. In some cases, this can lead to acute renal failure.

The antihypertensive effect of perindopril may be enhanced by the simultaneous use of other drugs that lower blood pressure, or vasodilators .

Hypoglycemic agents (including, insulin ) and Perinev in combined use can cause an increase in the hypoglycemic effect, up to glycemia.

Sympathomimetics cause the therapeutic effect of perindopril, when they are prescribed, it is necessary to control the effectiveness of Perineva.

may enhance the hypotensive effect antidepressants , antipsychotics and general anesthetics .

It is possible to combine Perineva with nitrates , acetylsalicylic acid , beta-blockers and thrombolytic agents .

Terms of sale

On prescription.

Storage conditions

In a dark place at a temperature of 25 ° C.

Best before date

special instructions

Perindopril is not recommended to be taken concomitantly with lithium preparations , potassium-sparing diuretics and preparations containing potassium , products and additives .

At diabetes the first 3 months of taking Perineva in patients should monitor the level of glucose in the blood.

When driving, you should take into account the risk of side effects such as dizziness and a sharp decrease in pressure.

Perineva's analogs

The following drugs are considered analogues of this drug: arenthopres , hypernik , coverex , perinpress , .

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 a slight 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 domestic drug for stabilizing blood pressure. Available in two dosages - 4 and 8 mg. It is prescribed by a doctor and dispensed by prescription. With prolonged use, unwanted reactions are possible, for example, cough and bronchospasm.

The price of the drug depends on the dosage and number of tablets (30 or 90 pcs.) And ranges from 250 to 1200 rubles.

In case of intolerance to the active substance, inability to purchase it due to high cost or defect, inefficiency and other factors, the question of selecting analogues of Perinev's drug is relevant.

The choice of substitutes should be agreed with the doctor - they are dispensed by prescription, have restrictions on the appointment and side effects.

As part of perindopril from the group of ACE inhibitors. When ingested, it turns into the active component perindoprilat, which has the following therapeutic effects:

• lowers blood pressure and, with constant intake and accumulation, maintains 24 hours;
• increases the endurance of the heart to physical activity;
• reduces the risk of developing hemorrhagic and ischemic stroke;
• reduces the likelihood of a stroke leading to death or disability;
• helps to reduce the incidence of myocardial infarction in patients, disorders of the heart and blood vessels, deterioration of cognitive functions (memory, mental performance);
• reduces the likelihood of complications in angina pectoris.

The drug is indicated for single-component treatment or in case of ineffectiveness in combination with diuretics (indapamide) and other antihypertensive drugs (amlodipine).

Indications for use Perinev

The medicine is used in the following cases:

1. to stabilize high blood pressure;
2. chronic heart failure;
3. after a primary stroke for the prevention of complications in conjunction with indapamide;
4. stable angina.

The drug is strictly prescription, dosage and combinations with other medicines are prescribed by a therapist or cardiologist.

Perineva - instructions for use

The medication is taken once a day, the course of treatment is from 2 weeks to several years.

The drug Perineva is cumulative, without prior agreement with the doctor, you should not cancel the reception. In some cases, adverse reactions occur - allergies, cough, bronchospasm.

The initial dosage is 2 or 4 mg. If necessary, the doctor may prescribe Perinev 8 mg or supplement with amlodipine, indapamide. Possible replacement for combination drugs.

How to take Perinev - before or after meals

Tablets should be taken before meals with plenty of water. Preferred time is morning.

Perinev's analogs

Replacement of the drug must be agreed with the doctor. Analogues are released according to the appointment of a specialist and in a certain way issued a prescription.

Perinev substitutes contain the same substance - perindopril, other components or are supplemented with other active substances. Before purchasing, you should read the instructions for use, ask clarifying questions to your doctor.

Approximate prices of Perinev's analogues indicating the country of origin

The domestic analogue of Dalnev combines the properties of two drugs at once - amlodipine and perindopril (Perineva). As a result, it does the following:

• reduces blood pressure, stabilizes the state of hypertension;
• dilates blood vessels;
• reduces the load on the myocardium;
• reduces myocardial oxygen demand;
• improves the quality of life, reduces the risk of death and complications after a stroke and heart attack.

The Dalnev analog is used if Perinev's medicine is ineffective or for convenience in multicomponent treatment.

Preductal OD 80 mg

Analog Preductal OD is a French drug based on trimetazidine. It is an antianginal agent, that is, it reduces myocardial oxygen starvation during ischemia and angina pectoris, reduces the frequency of IHD attacks, and improves the quality of life of patients. Released by prescription.

Noliprel A

The drug Noliprel A is a complex remedy for arterial hypertension. Contains perindopril, like Perineva, and the diuretic component indapamide. As a result, blood pressure decreases faster and more effectively. An analog is prescribed in cases where Perineva or Perindopril therapy is ineffective. Other cases of application are associated arterial hypertension with kidney pathologies and diabetes mellitus.

Kapoten

Analog Kapoten is a Russian drug from the group of ACE inhibitors containing captopril. It is prescribed for high blood pressure, chronic heart failure and after myocardial infarction. It is taken 2-3 times a day. Serves as an ambulance to quickly reduce pressure. There are two ways to use it - drink it with water or put it under the tongue for emergency action.

Telmista

The imported analogue of Telmista contains a different substance - telmisartan. It is used to lower and stabilize blood pressure. Additionally, it is produced with a diuretic component under the trade name Telmista N.

Amprilan

Analogue Amprilan is based on the substance ramipril, which belongs to the group of ACE inhibitors. Like Perineva, it reduces and normalizes high blood pressure, reduces the load on the myocardium, improves the condition of patients after a heart attack and stroke.

Which is better - Ramipril or Perineva, is determined individually. Both drugs maintain blood pressure for 24 hours. The difference - the maximum effect after taking Amprilan or Ramipril is observed after 3-6 hours, Perineva - 4-8 hours.

A cheap analogue of Enalapril is a drug for high blood pressure from the group of ACE inhibitors. It is taken twice a day. Produced by domestic and foreign pharmaceutical companies.

The price of the drug is 10–20 times lower, so the question is which is better - Enalapril or Perineva. The first drug maintains pressure for only 12 hours and is drunk twice, the second acts for 24 hours. Both medicines are cumulative and can cause coughing to varying degrees. Which is better, more efficient and safer individually.

The drug Amlodipine is used to reduce pressure and reduce the load on the myocardium, oxygen starvation during ischemia. In some cases, it may cause swelling.

It is difficult to determine which is better - Perineva or Amlodipine. They belong to different groups of antihypertensive drugs, are often prescribed together or the components are included in complex preparations (for example, Dalneva).

Prestarium or Perineva - which is better

Prestarium A is an original drug based on perindopril. Available in two dosages - 5 and 10 mg and two forms - regular tablets and soluble in the mouth. The dispersible form is convenient for people who find it inconvenient to drink water (for example, there is no opportunity at work) and have difficulty swallowing. The price for 30 tablets is more expensive than Perineva.

When choosing between Prestarium and Perineva, with financial possibilities, the first medicine is recommended. It is original, which means it has been clinically studied in patients with arterial hypertension, stable angina pectoris, who have had myocardial infarction and stroke.

When taking Prestarium, according to the reviews of doctors and patients, cough and bronchospasm are less likely to occur as a side effect.

Which is better - Perineva or Perindopril

Perindopril is a cheap Russian analogue of Perineva, available in dosages of 4 and 8 mg. Produced by the following domestic companies: Biochemist, Pranafarm, Izvarino, Severnaya Zvezda. The price is lower than Prestarium and Perineva. Side effects are more common.

Perindopril of foreign manufacturers is available in pharmacies: Richter (analogous to Perineva 4 mg and 8 mg) and Teva (dosages as in Prestarium - 5 and 10 mg).

The properties and composition of Perinev and the analogue of Perindopril are identical: perindopril is included, which turns into the active metabolite perindoprilat.

Medications are cumulative, stabilize blood pressure, improve quality of life and reduce the risk of complications in coronary artery disease, myocardial infarction and stroke. When choosing between analogues, it is advisable to give preference to proven manufacturing companies, consult a cardiologist.

Perineva or Lozap

Lozap is an analogue of Perineva based on losartan. Reduces and stabilizes pressure, is used in cases where there is an individual intolerance to perindopril or side effects (bronchospasm, cough) have appeared.

Both drugs - an analogue of Lozap and Perinev - are modern drugs for hypertension, are well tolerated and act for 24 hours.

Lisinopril or Perineva - which is better

Lisinopril is a cheap analogue of Perineva with the active ingredient of the same name. It belongs to the same group - ACE inhibitors. Taken once.

Which is better - Perineva or Lisinopril, depends on individual characteristics, the presence of other pathologies.

Perineva or Lorista - which is better after stenting

Lorista is an analogue of Perineva containing losartan. Does not cause cough and other undesirable effects characteristic of ACE inhibitors. Applied once. There is a combination of losartan and hydrochlorothiazide (a diuretic) in the assortment of pharmacies under the trade name Lorista N and ND.

Which is better - Losartan or Perineva, it is better to decide with a cardiologist in each individual case.

The choice of Perineva substitutes is best agreed with a specialist. Analogues are sold by prescription. It can be replaced on its own only with structural analogues with the chemical name Perindopril.

FAQ

Answers to actual questions of buyers are given.

1. What is the difference between Perineva or Perindopril?
   

   In two medicines, the same active substance is perindopril. They differ in manufacturer, auxiliary components, bioavailability (efficiency), quality. When replacing, you should choose proven analogues.

2. Perineva diuretic or not?
   

   The drug contains perindopril and belongs to the group of antihypertensive drugs (ACE inhibitors). Does not have a diuretic effect.