What are Perineva tablets for? Perineva - an assistant in the fight against high blood pressure Swelling of the legs is possible from taking the medicine Perineva

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 every fifth adult. 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 death sentence, not a reason to fall into despair. Advances in modern pharmacology make it possible to control the disease while maintaining an optimal quality of life. Of course, this is possible if you consult 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 medications that can correct the condition of hypertensive patients, ACE inhibitors stand out. Among them are the latest generation medications, developed by specialists so that they are well tolerated by patients and side effects are rare.

ACE inhibitors: how they work

The general scheme is as follows: angiotensin I is formed from plasma beta-globulins, including angiotensinogen, under the influence of renin. It does not affect vascular tone and remains neutral. This component is susceptible to the action of ACE (that is, angiotensin converting enzyme). In this way, 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. This is how the blood vessels narrow.

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

Therefore, doctors have developed medicinal products that control the production of angiotensin II and subsequent hormonal surges. In particular, it was possible to achieve this goal with Perinev’s blood pressure tablets.

Perineva: farm dossier

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

In the drug formula:

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

Thus, the main component is . The drug is classified as a pharmaceutical product that has hypotensive, cardioprotective, and vasodilating effects.

Pharmacodynamic characteristics

Perindopril (or kinase II) is an ACE inhibitor related to exopeptidases. It is considered a prodrug; it further produces an active metabolite called perindopril at. Transforms angiotensin I into a vasoconstructor, allowing the destruction of 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 drops;
Adjusts in the direction of reducing OPSS;
Accelerates peripheral blood flow;
Does not increase heart rate;
As noted in the instructions, it also accelerates blood flow in the kidneys without affecting glomerular filtration rates.

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

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

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 note a decrease in uric acid levels. With long-term use, the isoenzyme myosin profile is stabilized. The clinical significance of the interstitial type of fibrosis also decreases.

The drug tends to remove some transformations in small arteries and optimize the elasticity of large arteries. Pre- and afterload on the heart is reduced. In CHF, peripheral vascular resistance decreases, as does ventricular filling pressure. Cardiac output increases, as does the cardiac index.

Pharmacokinetic characteristics

The medicinal composition is absorbed quite quickly from the digestive tract; it takes an hour for peak plasma levels to be reached. Biological availability – within 65-70%.

Approximately 20% of the absorbed component becomes the active metabolite perindoprilate. Its plasma maximum concentration is fixed after 3.5 hours, and the half-life is equal to an hour. The substance has an insignificant connection with blood proteins (from the plasma part), but 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, somewhat reduces the transformation of perindopril into perindoprilat, which reduces drug bioavailability.

Who is it shown to?

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

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

Who shouldn't drink

Perineva, as well as its analogues, has absolute and relative contraindications for use. 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 of angioedema earlier.

With such diagnoses or characteristics, 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 prognosis, he will decide whether he can drink Perineva or whether he should look for another remedy with less threat.

Relative restrictions in application

This primarily concerns CHF in the decompensated stage. Patients with arterial hypotension should not take the medicine; only certain calculations on the part of the doctor can allow taking Perineva.

Among the relative contraindications:

Aortic/mitral valve stenosis;
Renovascular type hypertension;
Obstructive cardiomyopathy (hypertrophic type);
Cerebrovascular diseases, which include ischemia of the heart muscle, insufficiency of cerebral blood flow, and coronary insufficiency;
CRF (creatinine clearance is taken into account);
Bilateral stenosis of the nephroarteries or arterial stenosis of the only existing kidney, as well as post-transplant 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;
The patient belongs to the Negroid race;
Age over 65;
Parallel therapy with allergens (desensitizing).

If the doctor who prescribes your medicine for some reason does not know about some of your diseases, current or previously, be sure to tell him about them. This happens if the patient comes to the appointment not with a medical card, but with an insert sheet. 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 significant activation of the RAAS (and this is typical for patients with severe hypertension, renovascular type hypertension and decompensatory CHF), the initial dosage will not exceed 2 mg. If the effectiveness of treatment turns out to be insufficient, the daily dosage may be increased over time to 8 mg.

If Perineva is taken by a patient who is also taking a diuretic, then in order to avoid the development of hypotension, the inhibitor should be started three days after stopping the diuretic. Or (the doctor is also considering this option), he will prescribe Perineva 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 medication therapy can be resumed if requested.

Elderly hypertensive patients are also prescribed a minimum starting dosage of 2 mg.

Use for other cardiovascular diseases

In order to prevent stroke (repeated), persons with cerebrovascular diseases are recommended to take the medicine 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 medicine is prescribed in the same starting dose – 2 mg. After two weeks, if the dynamics are positive, it is raised to 4 mg. For clinical manifestations of the disease, beta-blockers, digoxin and certain diuretics may additionally be prescribed.

If a specialist predicts a high probability of developing hypertension, for example, due to large doses of a diuretic, before prescribing Perineva, electrolyte disturbances and hypovolemia (as far as possible) should be corrected. Before/during therapy, it is necessary 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. After two weeks, under strict monitoring of renal function, this dosage can be doubled. Elderly patients with this diagnosis are tried to begin treatment with the lowest dose of 2 mg. If the dose is ineffective, after preliminary monitoring of renal function (this point is mandatory), after a week the dosage is raised to 4 mg, and after another 7 days it is increased to 8 mg.

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

About negative reactions

The side effects of Perineva are described in detail in the instructions. It should be noted that they often occur against the background of incorrect medication use, suboptimal combination therapy, as well as the patient’s poor lifestyle.

The frequency of recording negative reactions is as follows: more than or equal to 1 case in 10 receptions is interpreted as “very often”, more than or equal to 1 in 100, but less than 1 in 10 – “often”. “Infrequently” is one case or more in a thousand, but not less than 1 in 100. “Rarely” is a ratio of more than one case per 10,000 appointments, but not less than 1 in 1000. “Very/extremely rare” is more than 1 to 10,000 with the inclusion of individual messages.

Negative reactions:

Heart and blood vessels. A significant decrease in blood pressure is often recorded. Very rarely, use results in angina pectoris, arrhythmia, stroke and acute MI cannot be ruled out. Vasculitis occurs with unknown frequency.
Digestive system. It often results in indigestion, constipation and nausea, and possibly vomiting. Dyspepsia and abdominal pain cannot be excluded with the same frequency. Infrequently, a patient complains of unusual dry mouth. Rarely, pancreatitis will be a negative scenario. Hepatitis (various types) is very rare.
Respiratory system. Patients often complain of cough and shortness of breath, rarely experience bronchospasm, and very rarely does treatment result in a runny nose and eosinophilic pneumonia.
CNS and PNS. There are often complaints of headaches, paresthesia, and dizziness. Mood changes and sleep disturbances occur infrequently. Very rarely there are pathologies of consciousness associated with spatial disorientation, memory gaps, difficulties in concentration and performing automatic simple actions.
Sensors. Patients often complain of unusual ear noise, and complaints of visual defects often arise.
ODE. Muscle cramp syndrome is often recorded.
Genitourinary profile. Erectile dysfunction and renal failure rarely arise as a negative treatment scenario. ARF is extremely rare.
Lymphatic system and hematopoiesis. Hemolytic anemia very rarely occurs in certain susceptible individuals. With long-term therapy at maximum doses, thrombocytopenia and agranulocytosis are possible, as well as neutropenia, reduced hemotocrit and hemoglobin.
Leather. The largest organ of our body can react to Perineva's therapy with skin rashes and itching. Urticaria appears less frequently, as does angioedema of the face and arms/legs. Erythema multiforme is very rarely observed.
Laboratory diagnostics can detect hyperkalemia, an increase in markers of blood plasma creatinine and serum urea. Especially in people with severe CHF. Rarely, hypoglycemia, increased bilirubin in the blood serum, and increased liver fermentation occur.

Among other reactions, asthenic syndrome is often noted, and hyperhidrosis is rarely observed.

In case of overdose

The main signs of overdose are a significant decrease in blood pressure, palpitations and bradycardia, tachycardia, as well as disturbances in water and electrolyte balance. Hyperventilation, anxiety, coughing and quite a bit of 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 and elevate his lower limbs. The patient's blood volume is replenished, angiotensin II is administered intravenously, as well as (possibly optionally) a catecholamine solution. With developed bradycardia, which is not amenable to drug treatment, the pacemaker is strengthened. Therapy for overdose is usually carried out with monitoring of vital signs, the level of creatinine and electrolytes in the serum part of the biofluid.

Removal of the substance from the systemic circulation is permissible by hemodialysis, but, it is important, the use of high-flow polyacrylonitrile membranes should be avoided during this procedure.

Notes

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

Like other ACE inhibitors, Perineva can provoke a sharp drop in blood pressure. But in people with uncomplicated hypertension, such a “first dose” effect is rarely recorded. But a pathological decrease in blood pressure can manifest itself in patients with reduced blood volume 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 parallel use of loop diuretics, and also with AN. These patients must be seriously monitored throughout the entire period of treatment; the correct, accurate dosage of the drug is very important for them. This remark is also true for patients with cardiac ischemia and cerebrovascular diseases. In them, an excessive decrease in pressure is dangerous for acute MI and complications of the cerebrovascular type.

This is important:

Transient (i.e., passing) arterial hypertension cannot be considered an indication for interruption of therapy; after restoration of blood volume and stabilization of blood pressure, treatment continues.
If hypotension is characterized by clinical symptoms, the dosage of the pharmacological agent is adjusted (sometimes it is canceled altogether).
In situations with the development of an episode of unstable angina (even if it is minor), the benefit/risk proportion is assessed in patients with cardiac ischemia in the first weeks.
If a person undergoing treatment has angioedema, Perineva is canceled immediately - 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.
If during treatment the patient develops jaundice, the medication is discontinued and an examination is carried out, since Perineva can lead to a serious chain of pathologies, starting with cholestatic jaundice.
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 take hypoglycemic agents, the glucose level is clearly monitored at the start of Perineva’s therapy.

Those patients who are awaiting surgical intervention in the near future, as a rule, stop the medication one day before. This is because anesthesia during surgery lowers blood pressure. If it is impossible to cancel the ACE inhibitor, hypotension is corrected by increasing the volume of blood volume.

If, during therapy, a patient develops a non-productive, incessant cough, this is usually a reaction to the medication. It stops after its cancellation.

Gestation and lactation

Perineva is not prescribed during pregnancy. If during treatment the patient becomes pregnant, the medicine is immediately discontinued. If it is used by a pregnant woman in late gestation, the treatment may result in fetotoxic effects. Among them are oligohydramnios and decreased nephrofunctionality, as well as delayed ossification of the baby’s skull bones. The drug can also provoke 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 medication should be discontinued during lactation. Or, on the contrary, the course of treatment requires the cessation of lactation, its temporary suspension. These questions 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 people with different indicators of physical health use relatively often. For example, people drink Nimesulide or Diclofenac for joint pain, osteochondrosis, post-traumatic pain, etc. These compounds are also used for so-called colds.

But not all patients think about whether it is possible to combine NSAIDs with other medications that are often used in 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 renal function to deteriorate. In some cases, things turn into the development of acute renal failure. If a patient has diseased kidneys, and he drinks Aspirin along with Perineva, acute renal failure is highly likely to develop.

Therefore, before taking a painkiller or anti-inflammatory pill, remember that you are taking Perineva, which does not combine well with them. And what you can take 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 Perineva can be prescribed in combination with pharmaceuticals such as nitrates, beta-blockers, thrombolytics, as well as acetylsalicylic acid in doses with an antiplatelet effect.

In pharmacies, the drug product is sold 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 Perineva are not recommended to drive or operate complex mechanisms during treatment. Headaches, dizziness, confusion, and lack of concentration cannot be ruled out. All this can cause an emergency.

If any negative reactions occur, rush to consult your doctor.

Perineva: instructions for use and reviews

Perineva is an ACE inhibitor (angiotensin-converting enzyme).

Release form and composition

Dosage form - tablets: almost white or white, slightly biconvex, with a chamfer: round in dosage of 2 and 8 mg or oval in dosage of 4 mg, on one side of the 4 and 8 mg tablets there is a dividing line (in blister packs 10 pcs., in a cardboard box 3, 6 or 9 packs; in blister packs of 14 pcs., in a cardboard box 1, 2, 4 or 7 packs; in blister packs of 30 pcs., in a cardboard box 1, 2 or 3 packs).

Composition of 1 tablet:

perindopril erbumine, semi-finished granules – 38.39/76.78/153.56 mg;
active substance semi-finished granule – perindopril erbumine – 2/4/8 mg;
auxiliary components of semi-finished granules: calcium chloride hexahydrate, lactose monohydrate, crospovidone;
excipients of tablets: colloidal silicon dioxide, microcrystalline cellulose, magnesium stearate.

Pharmacological properties

Pharmacodynamics

Perindopril or kinase II is an angiotensin-converting enzyme (ACE) inhibitor, belongs to exopeptidases and is a prodrug from which the active metabolite perindoprilat is formed. Converts angiotensin I to angiotensin II (vasoconstrictor) and destroys the vasodilator bradykinin to an inactive hectapeptide. Due to the suppression of ACE activity, the level of angiotensin II decreases, plasma renin activity increases (negative feedback of renin release is inhibited) and aldosterone secretion decreases. ACE destroys bradykinin, so suppression of this enzyme also leads to an increase in the activity of the circulating and tissue kallikrein-kinin system, while activating the prostaglandin system.

The therapeutic effect of the drug is due to the effect of the active metabolite – perindoprilate.

Perindopril lowers blood pressure (both diastolic and systolic) in the lying and standing positions. It reduces total peripheral vascular resistance (TPVR), as a result of which blood pressure (BP) decreases. At the same time, peripheral blood flow accelerates, but the heart rate (HR) does not increase. As a rule, renal blood flow also accelerates, but the glomerular filtration rate does not change. It takes 4–6 hours for the maximum hypotensive effect to develop after a single oral dose; the effect persists for 24 hours, but even after 24 hours, 87–100% of the maximum effect is still provided. Blood pressure decreases quickly. Stabilization of the hypotensive effect is observed after 1 month of regular use of Perineva and persists for a long time. Discontinuation of therapy does not cause the development of withdrawal syndrome.

The active substance reduces myocardial hypertrophy of the left ventricle. Increases the concentration of high-density lipoproteins (HDL); in patients with hyperuricemia, reduces the concentration of uric acid. With long-term use, it normalizes the myosin isoenzyme profile and reduces the severity of interstitial fibrosis.

The drug eliminates structural changes in small arteries and improves the elasticity of large arteries. By reducing pre- and post-load, it normalizes heart function. In chronic heart failure (CHF), it reduces peripheral vascular resistance, filling pressure in the right and left ventricles, increases cardiac output and cardiac index. When taking the drug in an initial daily dose of 2 mg in patients with CHF I and II functional classes according to the NYHA classification, there is no statistically significant decrease in blood pressure compared to placebo.

Pharmacokinetics

Perindopril in tablet form is rapidly absorbed from the gastrointestinal tract, requiring 1 hour to achieve maximum plasma concentration. Bioavailability is about 65–70%.

About 20% of the absorbed substance is converted into the active metabolite perindoprilat. The maximum content in plasma is observed after 3–4 hours. Half-life (T 1/2) – 1 hour. The volume of distribution of unbound perindoprilate is 0.2 l/kg. The connection with blood plasma proteins is insignificant, the connection with ACE is less than 30%, but depends on its concentration. Excreted by the kidneys. Does not accumulate. T1/2 of the unbound fraction is 3–5 hours; in patients with chronic heart and renal failure and the elderly, excretion is slow.

In patients with liver cirrhosis, the hepatic clearance of perindopril changes, but the total amount of metabolite formed remains unchanged, so dose adjustment of Perineva is not required.

Food reduces the conversion of perindopril to perindoprilat, thereby reducing the bioavailability of the drug.

Perindoprilat is removed by peritoneal dialysis and hemodialysis (rate 70 ml/min., 1.17 ml/sec.).

Indications for use

According to the instructions, Perineva is intended for the treatment of arterial hypertension and chronic heart failure.

The drug is used (as part of complex therapy with indapamide) to prevent recurrent stroke in patients with a history of cerebrovascular diseases.

An ACE inhibitor is also prescribed for stable coronary heart disease (CHD) to reduce the risk of cardiovascular complications in patients who have undergone coronary revascularization and/or myocardial infarction.

Contraindications

Absolute contraindications (conditions/diseases for which the drug is prohibited from taking):

age under 18 years;
Lapp lactase deficiency, hereditary galactose intolerance, glucose-galactose malabsorption syndrome;
a history of idiopathic, hereditary or angioedema developed as a result of taking ACE inhibitors;
increased individual sensitivity to any component of the drug or other ACE inhibitors.

Relative contraindications (conditions/diseases in which the use of the drug is possible, but only after assessing the benefits and risks, with extreme caution and under special medical supervision):

CHF in the stage of decompensation;
arterial hypotension;
hypertrophic obstructive cardiomyopathy;
aortic or mitral valve stenosis;
renovascular hypertension;
cerebrovascular diseases (including coronary heart disease, cerebrovascular insufficiency, coronary insufficiency);
chronic renal failure (creatinine clearance less than 60 ml/min);
bilateral renal artery stenosis or stenosis of the artery of a single kidney;
condition after kidney transplantation;
hemodialysis using high-flow polyacrylonitrile membranes;
the period before the low-density lipoprotein (LDL) apheresis procedure;
severe hypovolemia and hyponatremia (for example, due to vomiting, diarrhea, salt-free diet, dialysis, previous diuretic therapy);
hyperkalemia;
congenital deficiency of glucose-6-phosphate dehydrogenase;
connective tissue diseases such as systemic lupus erythematosus or scleroderma;
diabetes mellitus;
inhibition of bone marrow hematopoiesis due to the use of immunosuppressants, procainamide, allopurinol;
surgical intervention;
old age;
belonging to the Negroid race;
simultaneous desensitizing therapy with allergens (for example, hymenoptera venom).

Instructions for use of Perineva: method and dosage

It is advisable to take Perinev tablets before meals, once a day - in the morning.

The doctor selects the dose for the patient personally, based on the indication and individual effectiveness of treatment.

Regardless of the indications, the dosage can be increased only if the drug is well tolerated at the previous dose used.

Arterial hypertension

The drug is used either as monotherapy or as part of a combination treatment, in combination with other antihypertensive drugs.

The recommended starting dose of Perineva is 4 mg. For patients with pronounced activation of the RAAS (renin-angiotensin-aldosterone system), for example, with severe arterial hypertension, renovascular hypertension, decompensated CHF, hyponatremia, hypovolemia - 2 mg. If the effect is insufficient after a month of treatment, the daily dose can be increased to 8 mg.

If Perineva is prescribed to patients receiving diuretics, in order to avoid the development of arterial hypotension, it is recommended to start taking perindopril 2-3 days after stopping the diuretic or prescribe it at a minimum dose of 2 mg. In this case, the concentration of potassium ions in the blood serum, blood pressure and renal function should be monitored. Depending on the dynamics of blood pressure, the dose can be increased. Diuretic therapy is resumed if necessary.

Elderly patients are prescribed perindopril at a dose of 2 mg at the beginning of therapy. Further, according to indications, it is increased to 4 mg and, if the effect is still not enough, to 8 mg.

Prevention of recurrent stroke in patients with a history of cerebrovascular diseases

Perineva is taken at a dose of 2 mg 2 weeks before the appointment of indapamide.

You can start preventive therapy after a stroke at any time, even after several years, but not earlier than 2 weeks.

Chronic heart failure

The optimal starting dose is 2 mg. After 2 weeks, if necessary, under the control of blood pressure, it is increased to 4 mg. If the disease is accompanied by clinical manifestations, beta-blockers, potassium-sparing diuretics and/or digoxin are additionally prescribed.

In case of CHF, renal failure, a tendency to electrolyte disturbances (hyponatremia), or the simultaneous use of diuretics and/or vasodilators, treatment should be started under the strict supervision of a physician.

If there is a high risk of developing clinically significant arterial hypotension (for example, with concomitant use of a diuretic in high doses), it is recommended, if possible, to eliminate electrolyte disturbances and hypovolemia before prescribing Perineva. Before and during therapy, blood pressure, the concentration of potassium ions in the blood serum and the state of renal function should be constantly monitored.

Stable ischemic heart disease

Elderly patients begin to be treated with a dose of 2 mg. If the effect is insufficient, after mandatory preliminary monitoring of renal function, after a week it can be increased to 4 mg, and after another week - to 8 mg.

In case of renal failure, the dose is determined based on the results of a kidney function test, namely the creatinine clearance (CC):

CC > 60 ml/min – 4 mg/day;
CC 30–60 ml/min – 2 mg/day;
CC 15–30 ml/min – 2 mg every other day;
QC< 15 мл/мин (гемодиализ) – 2 мг в день диализа.

During treatment, monitoring of the concentration of creatinine and potassium ions in the blood serum is required.

Side effects

Separation of side effects by prevalence: very often - > 1/10, often - from > 1/100 to< 1/10, нечасто – от >1/1000 to< 1/100, редко – от >1/10000 to< 1/1000, очень редко – < 1/10000, включая отдельные сообщения.

Side effects that may occur during perindopril therapy:

from the organ of hearing: often – tinnitus;
from the organ of vision: often – visual impairment;
from the central and peripheral nervous system: often – paresthesia, headache, dizziness; uncommon – mood changes, sleep disturbances; very rarely - confusion;
from the respiratory system: often – shortness of breath, cough; uncommon – bronchospasm; very rarely – rhinitis, eosinophilic pneumonia;
from the musculoskeletal system: often – muscle cramps;
from the genitourinary system: infrequently – impotence, renal failure; very rarely - acute renal failure;
from the digestive tract: often - diarrhea, constipation, dyspepsia, abdominal pain, nausea, vomiting, dysgeusia; uncommon – dryness of the oral mucosa; rarely - pancreatitis; very rarely - hepatitis (cholestatic or cytolytic);
from the cardiovascular system: often – marked decrease in blood pressure; very rarely - angina pectoris, arrhythmias, as well as stroke and myocardial infarction (in patients at high risk, possibly secondary, due to severe arterial hypotension); frequency unknown – vasculitis;
from the hematopoietic organs and lymphatic system: very rarely in patients with congenital deficiency of glucose-6-phosphate dehydrogenase - hemolytic anemia; very rarely with long-term use of the drug in high doses - agranulocytosis, thrombocytopenia, pancytopenia, leukopenia/neutropenia, decreased hemoglobin concentration and hematocrit;
from the skin: often – skin rashes, itching; uncommon – urticaria, angioedema of the face and extremities; very rarely - erythema multiforme;
laboratory tests: hyperkalemia, increased concentrations of plasma creatinine and urea in the blood serum, especially in patients with severe CHF, renovascular hypertension and renal failure (reversible after discontinuation of the drug); rarely - hypoglycemia, increased bilirubin in the blood serum and liver enzyme activity;
other reactions: often – asthenia; uncommon – increased sweating.

Overdose

Signs of overdose: marked decrease in blood pressure, bradycardia, palpitations, tachycardia, water and electrolyte imbalance (hyperkalemia, hyponatremia), hyperventilation, cough, anxiety, dizziness, renal failure, shock.

If there is a pronounced decrease in blood pressure, it is necessary to lay the patient down and elevate his legs, replenish the circulating blood volume (CBV), and, if possible, administer angiotensin II and/or a catecholamine solution intravenously. If bradycardia develops that is not amenable to drug therapy (including atropine), a pacemaker (artificial pacemaker) is installed. Treatment of overdose should be carried out under the monitoring of vital functions of the body, the concentration of creatinine and electrolytes in the blood serum. The drug can be removed from the systemic circulation by hemodialysis, but the use of high-flow polyacrylonitrile membranes should be avoided.

Special instructions

Like other ACE inhibitors, perindopril can cause a sharp decrease in blood pressure. Symptomatic hypotension after the first dose is rare in patients with uncomplicated hypertension. An excessive decrease in blood pressure is likely in individuals with reduced blood volume due to a strict salt-free diet, hemodialysis, diuretic therapy, vomiting and diarrhea, as well as with renin-dependent hypertension, severe CHF, including the concomitant presence of renal failure. More often, a pronounced decrease in blood pressure is observed in patients with severe CHF receiving high doses of loop diuretics, as well as in renal failure and hyponatremia. These categories of patients require careful monitoring at the beginning of treatment and during the selection of the optimal dose. The same applies to patients with coronary heart disease and cerebrovascular diseases, since an excessive decrease in blood pressure in them is fraught with myocardial infarction and cerebrovascular complications.

If the patient has arterial hypotension, it is necessary to place him in a horizontal position and raise his legs; if necessary, administer sodium chloride solution intravenously to increase the blood volume. Transient (passing) arterial hypotension is not a contraindication for continued treatment. After restoration of blood pressure and blood volume, therapy can be resumed, only it is necessary to select the correct dose of Perineva.

In some patients with CHF, including those with low blood pressure, the drug may cause an additional decrease in blood pressure. This effect is expected and is often not a reason to stop therapy. In cases where arterial hypotension is accompanied by clinical symptoms, reduce the dose of the drug or discontinue it completely.

If an episode (even a minor one) of unstable angina develops in patients with stable coronary heart disease during the first month of using Perineva, the benefit-risk ratio for further treatment should be assessed.

Patients with a history of angioedema not associated with ACE inhibitors are at high risk of angioedema as a reaction to perindopril.

If angioedema develops, Perineva must be discontinued immediately. For swelling of the lips and face, no special treatment is required; it is enough to take antihistamines to reduce the severity of symptoms. Swelling of the tongue, larynx, or glottis can lead to death. If such a reaction occurs, it is necessary to inject adrenaline (epinephrine) subcutaneously and ensure airway patency. More often, angioedema during therapy with ACE inhibitors occurs in patients of the Negroid race.

In rare cases, anaphylactic reactions develop in patients who undergo LDL apheresis using dextran sulfate absorption during treatment with Perineva; therefore, it is recommended to discontinue the ACE inhibitor before each procedure. The same applies to patients who are prescribed a course of desensitization - the drug should be temporarily discontinued before each procedure.

If during treatment there is an increase in the activity of liver enzymes or jaundice appears, the drug should be discontinued and appropriate examination carried out, since Perineva can cause the development of a syndrome starting with cholestatic jaundice and progressing to a fulminant course of hepatitis with extensive liver necrosis, even death.

ACE inhibitors may contribute to the development of renal failure and severe arterial hypotension in patients with renovascular hypertension, so treatment should be started with small doses, under close medical supervision and with further adequate titration of the drug dose. During the first weeks of taking Perineva, it is necessary to discontinue diuretics and constantly monitor renal function.

In some cases, in patients with arterial hypertension and previously undiagnosed renal failure, especially with concomitant use of diuretics, there may be a slight and temporary increase in creatinine and urea concentration in the blood serum, which requires a reduction in the dose of the drug and/or discontinuation of the diuretic.

Patients on hemodialysis should not use high-strength membranes for the session, otherwise persistent, life-threatening anaphylactic reactions may develop.

In patients with diabetes mellitus receiving insulin or taking oral hypoglycemic agents, blood glucose levels should be kept under control when initiating Perineva therapy.

Patients awaiting planned surgery or other procedures using anesthesia with drugs that can cause arterial hypotension should discontinue the ACE inhibitor one day before. If this is not possible, arterial hypotension can be corrected by increasing blood volume.

Perindopril may increase the concentration of potassium ions in the blood. The likelihood of developing hyperkalemia increases with renal and/or heart failure, decompensated diabetes mellitus, and in case of simultaneous use of potassium-sparing diuretics, potassium supplements or other drugs that can cause hyperkalemia (for example, heparin). If the combined use of these drugs is justified, the level of potassium in the blood serum should be constantly monitored.

When conducting a differential diagnosis of cough in a patient, it should be taken into account that perindopril can cause a persistent, non-productive cough - it stops after discontinuation of the drug.

Impact on the ability to drive vehicles and complex mechanisms

The drug can cause dizziness and arterial hypotension, which can affect reaction speed and concentration, which should be taken into account by drivers and persons employed in potentially hazardous industries.

Use during pregnancy and lactation

Perineva is contraindicated during pregnancy. If pregnancy occurs during treatment, the drug should be discontinued immediately. When used in later stages, perindopril can cause fetotoxic (oligohydramnios, decreased renal function, delayed ossification of the skull bones) and neonatal toxic (renal failure, hyperkalemia, arterial hypotension) effects. If for some reason the drug was used in the II-III trimesters, it is necessary to conduct an ultrasound examination of the fetal kidneys and skull bones.

There is no data on the penetration of perindopril into breast milk, therefore, if it is necessary to use Perineva, women are advised to stop breastfeeding.

Use in childhood

The safety and effectiveness of the drug in children and adolescents under 18 years of age have not been confirmed, therefore Perineva is not used in pediatric practice.

For impaired renal function

In patients with kidney disease, the drug is used with caution; the dose is determined individually depending on the degree of renal dysfunction and therapeutic response. Treatment should be carried out under regular monitoring of creatinine and potassium ions in the blood serum.

For liver dysfunction

For diseases and impaired liver function, dose adjustment of Perineva is not required.

Use in old age

Perineva is used with caution. Treatment in old age should be started with a dose of 2 mg/day. If the effect is insufficient, but only if the drug is well tolerated, after a week it can be increased to 4 mg, and after another week - to 8 mg.

Drug interactions

sympathomimetics: the effectiveness of perindopril may be reduced. If the use of such a combination is necessary, the effectiveness of Perineva should be regularly assessed;
diuretics: excessive arterial hypotension may develop. The risk can be reduced by intravenous administration of sodium chloride solution 0.9%, the use of perindopril in lower doses, or discontinuation of the diuretic;
Potassium supplements, potassium-sparing diuretics, potassium-containing foods and dietary supplements: the risk of hyperkalemia increases. Such combinations are undesirable except in cases of hypokalemia;
Lithium preparations: a reversible increase in the concentration of lithium in the blood serum and the development of toxicity are possible. The use of this combination is not recommended. If combined use of drugs is necessary, serum lithium levels should be monitored;
hypoglycemic agents: their effect may be enhanced and hypoglycemia may develop; the risk is especially high in patients with renal failure in the first weeks of combination therapy;
tricyclic antidepressants, antipsychotics (neuroleptics), agents for general anesthesia (general anesthetics): the hypotensive effect of the drug may be enhanced;
non-steroidal anti-inflammatory drugs, including acetylsalicylic acid in a daily dose of 3000 mg: the effect of perindopril may be weakened, the risk of increasing the level of potassium ions in the blood serum increases, as a result of which renal function may deteriorate (reversible effect), in rare cases, up to the development of acute renal failure, especially in patients with concomitant renal impairment, for example, dehydration and the elderly;
other antihypertensive agents and vasodilators: the antihypertensive effect may be enhanced.

If necessary, Perineva can be prescribed in combination with drugs such as nitrates, β-blockers, thrombolytic drugs, acetylsalicylic acid in doses that have an antiplatelet effect.

Analogues

Analogs of Perineva are: Coverex, Arentopres, Perindopril, Perindopril-Teva, Perindopril-Richter, Perindopril-TAD, Perindopril-C3, Parnavel, Hypernik, Prestarium, Perinpress, Perineva, Perineva Ku-tab, Piristar, Prenessa, Stopress.

Terms and conditions of storage

Keep away from children.

Storage conditions: temperature not higher than 30 °C.

Shelf life – 3 years.

The drug has antihypertensive, diuretic and vasodilating effects.

It has a pronounced dose-dependent antihypertensive effect, independent of the age and body position of the patient and not accompanied by reflex tachycardia. Does not affect lipid metabolism (total cholesterol, LDL, VLDL, HDL, triglycerides and carbohydrates), incl. in patients with diabetes mellitus. Reduces the risk of hypokalemia caused by diuretic monotherapy.

Co. Perineva dilates the veins, reducing the load on the heart (both preload and afterload). The use is equally effective for arterial hypertension of any severity level - mild, moderate or severe.

The antihypertensive effect lasts for 24 hours. A stable decrease in blood pressure is achieved within 1 month with the use of the drug without increasing heart rate. Discontinuation of treatment does not lead to the development of withdrawal syndrome.

Indications for use

What is Ko Perineva used for? According to the instructions, the drug is prescribed in the following cases:

for the treatment of essential hypertension.

Instructions for use of Co Perinev, dosage

Prescribed orally 1 time/day, preferably in the morning before breakfast, with a sufficient amount of liquid.

If possible, the drug should be started by selecting doses of perindopril and indapamide separately. If clinically necessary, it is possible to prescribe combination therapy with the drug immediately after monotherapy.

According to the instructions, the initial dose is 1 tablet of Co Perinev 0.625 mg + 2 mg \ 1 time per day. If after 30 days of daily use adequate blood pressure control is not achieved, the dose of the drug should be increased to 1.25 mg + 4 mg. The maximum daily dose is 1 tablet of Co Perineva 2.5 mg + 8 mg.

For elderly patients, Co-Perineva is prescribed after monitoring renal function and blood pressure at an initial daily dose of 0.625 mg + 2 mg.

The maximum daily dose for patients with moderately severe renal failure (creatinine clearance 30–60 ml/min) is 1 tablet of Co Perineva 1.25 mg + 4 mg.

Patients with CC ≥ 60 ml/min do not require dose adjustment. During the period of use of the drug, it is necessary to regularly monitor the concentration of creatinine and serum potassium content in the blood.

Side effects

The instructions warn about the possibility of developing the following side effects when prescribing Co Perinev:

From the side of the central nervous system: dizziness, girdling headaches, insomnia, vertigo, parasthesia, fainting, instability of the emotional background.
Disorders of the senses: decreased concentration, tinnitus.
From the hematopoietic system: thrombocytopenia, neutropenia, leukopenia, anemia, agranulocytosis.
Gastrointestinal disorders: stomach pain, constipation, loss of appetite, flatulence, nausea, diarrhea, exacerbation of pancreatitis, jaundice.
Allergic reactions: angioedema, skin itching, rashes, urticaria, eczema.
From the heart and blood vessels: decreased blood pressure, arrhythmia, bradycardia, tachycardia, angina pectoris, myocardial infarction.
Others: dry cough, rhinitis, muscle spasms, cramps in the calf muscles, shortness of breath, decreased libido, increased sweating, changes in laboratory parameters (concentration of uric acid, potassium, liver enzymes, creatinine).

According to doctors, serious side effects rarely develop in patients. More often they are short-lived, mild or moderate, and disappear after discontinuation of the drug or dose adjustment.

Contraindications

It is contraindicated to prescribe Co Perineva in the following cases:

Individual intolerance to certain elements of the drug composition, allergic reactions;
The occurrence of hereditary or consequential angioedema;
Acute renal failure;
Rejection of lactose by the body;
Liver failure of varying degrees of severity;
Particular care should be taken when taking the medicine during heart failure and dialysis.

After suffering serious illnesses, fractures, operations, chemical and other courses of treatment, the drug should be taken only after consultation with a doctor!

Interaction

The drug should not be combined with ACE inhibitors and lithium preparations, as the level of lithium in the blood may increase. If co-administration is necessary, lithium levels should be monitored.

Take with extreme caution, as it may increase the hypotensive effect. Blood pressure and kidney function should be monitored and the dose adjusted if necessary.

Neuroleptics and tricyclic antidepressants enhance the effect of hypotension and increase the likelihood of orthostatic hypotension.

Tetracosactitol and GCS help reduce the hypotensive effect.

When taken simultaneously with any other antihypertensive drugs, there is a possibility of a stronger manifestation of the hypotensive effect.

Overdose

Symptoms of overdose: vomiting, nausea, muscle cramps, drowsiness, dizziness, confusion, decreased water and electrolyte balance, oliguria, significant decrease in blood pressure.

Patients with a pronounced decrease in blood pressure should be transferred to a supine position and raise their legs up, after which measures aimed at increasing the volume of circulating blood (intravenous administration of 0.9% sodium chloride solution) are prescribed. Perindoprilat can be removed from the body using dialysis.

Analogues of Co Perineva, price in pharmacies

If necessary, you can replace Co Perinev with an analogue of the active substance - these are the following drugs:

Ko Parnavel,
Co-prenessa,
Perindid,
Perindapam,
Perindopril-Indapamide.

When choosing analogues, it is important to understand that the instructions for use, price and reviews do not apply to drugs with similar effects. It is important to consult a doctor and not change the drug yourself.

Also see review, pros and cons.

Price in Russian pharmacies: Co-Perinev tablets 1.25 mg+4 mg 30 pcs. – from 431 to 502 rubles, tablets 0.625 mg + 2 mg 30 pcs. – from 280 to 297 rubles, according to 437 pharmacies.

The drug should be stored out of the reach of children at a temperature not exceeding 30°C. Shelf life – 2 years. Sale by doctor's prescription.

Perineva is a medicine intended to treat high blood pressure. The active substance of Perineva, 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 drug works, you need to know how blood pressure is regulated in the body. Regulatory mechanisms can be systemic or local. Local ones act at the level of the vascular wall and “correct” the result of the work of systemic mechanisms, based on the immediate needs of a particular organ.

Systemic mechanisms regulate blood pressure at the level of the body as a whole. According to their mechanism of action, they are divided into nervous and humoral. As the name implies, nervous mechanisms carry out regulation using 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 blood vessels of the brain, myocardium, and zona glomerulosa of the adrenal cortex. Renin production is regulated by:

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

Renin transforms the protein angiotensinogen synthesized by the liver into the low-active hormone angiotensinogen I. It enters the lungs through the bloodstream, where under the action of angiotensin-converting enzyme (ACE) it is converted into active angiotensin II.

Functions of angiotensin II:

Narrows arteries, including coronary ones;
Causes myocardial hypertrophy;
Stimulates the release of vasopressin (also known as 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,

Aldosterone, which is produced under the influence of angiotensin II, is the most important regulator of the volume of extracellular fluid in the body. It increases the readsorption (reabsorption) of sodium and water in the kidneys. The volume of circulating blood increases, which in turn increases blood pressure even more.

Perineva: how it works

Perineva blocks ACE, thus reducing the amount of angiotensin II in the body and eliminating its vasoconstrictor effects. At the same time, aldosterone secretion decreases, sodium and fluid retention 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:

Kidney effects:

Normalization of intraglomerular hemodynamics;
Reduction of 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 effect: reduces the permeability of the cells of the inner wall (endothelium) of blood vessels and reduces the amount of lipoproteins in them.

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

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

How to use Perineva

Arterial hypertension,
For cardioprotection in chronic heart failure,
For cardioprotection after myocardial infarction or surgery on the coronary arteries, provided that the ischemic process is stable,
To prevent recurrence of stroke in patients who have had it once.

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 mmHg. art and/or diastolic, “lower” blood pressure > 90 mm. rt. Art. Increased 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 called hypertension. The Ministry of Health of the Russian Federation in clinical recommendations from 2013 offers 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.

Dosage regimen and principles of dose selection

Recommended target blood pressure numbers 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 - 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 sudden normalization is poorly tolerated, 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 these pressure values. Further, the rate of decline is selected individually. The lower limit for reducing SBP is 115-110 mmHg, DBP is 75-70 mmHg; at excessively low levels, the risk of myocardial infarction and stroke increases again.

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 package.

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 starting the Perineva course, or begin treatment with a dosage of 2 mg, also gradually increasing to 4 mg. Doses are selected using the same principle for patients suffering from chronic heart failure.

After a month of regular use, the effectiveness of the drug is assessed. 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,
Mitral or aortic valve stenosis - since cardiac output cannot increase in these conditions, it is not able to compensate for the decrease in peripheral vascular resistance,
Renovascular hypertension,
Chronic cardiovascular failure in the stage of decompensation.

May worsen renal failure in patients with bilateral renal artery stenosis or stenosis of the artery of a solitary kidney.

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

Perineva should be used with extreme caution by women of fertile age. Planned pregnancy is an indication for changing the antihypertensive drug.

Overdose and side effects

In case of an overdose, blood pressure decreases excessively, up to shock, renal failure develops, breathing intensity decreases (hypoventilation), heart rate can change in the direction of both tachycardia and bradycardia, dizziness, anxiety, and cough are possible.

In case of overdose, the patient must be placed with his legs elevated and the blood volume must be replenished with intravenous solutions. Angiotensin II is also administered intravenously; in its absence, catecholamines are administered.

Side effects:

Analogues of Perineva

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

Prestarium. The drug, produced by the French company Servier, was the first medicine based on perindopril that appeared at the disposal of doctors. It was on this drug that all studies were conducted on the effectiveness of perindopril, reducing cardiovascular risk (a 20% reduction was proven), and a positive effect on the condition of the walls of blood vessels. Cost from 433 rubles.
Perindopril-Richter. Manufactured by the Hungarian company Gedeon-Richter. Price from 245 rubles.
Parnavel. Produced by the Russian company Ozon. Price from 308 rubles.

When choosing from the possible options the optimal one in terms of price and quality ratio, you need to remember that today, of all the manufacturers of generic drugs, only the KRKKA company has proven the bioequivalence (compliance with the original drug) of its product.

The cost of Perineva in pharmacies is from 244 rubles.

Ko-Perineva

Monotherapy with perindopril (Perineva) allows you to achieve target blood pressure values in patients with stages 1-2 of hypertension in 50% of cases. In addition, often therapy for arterial hypertension should begin immediately 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 in the form of one tablet.

Co-perineva is produced in 3 dosages:

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

Cost in pharmacies – from 269 rubles.

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

Contraindications

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

Azotemia, anuria;
Liver failure.

Side effects

In addition to the side effects characteristic of perindopril, Co-perineva can cause:

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

Perinev tablets have a cardioprotective and vasodilatory effect, and also exhibit a hypotensive effect.

The drug is based on the following components: perindopril, lactose, calcium salt of hydrochloric acid, povidone (enterosorbent), pyrogenic silicon dioxide, microcrystalline cellulose, magnesium stearate.

Stabilization of blood pressure is observed after a month of treatment. Regular use of the drug helps reduce hypertrophic changes in the heart muscle. Prescribing 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.

Clinical and pharmacological group

Perineva has a hypotensive, vasodilating and cardioprotective effect.

Conditions for dispensing from pharmacies

Dispensed with a doctor's prescription.

Prices

How much does Perineva cost in pharmacies? The average price is 250 rubles.

Release form and composition

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 white and round in shape. Packages contain 30 or 90 tablets, as well as official instructions for use.

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

Other Ingredients:

Silicon oxides;
lactose;
cellulose;
Magnesium stearates;
povidones;
Calcium chloride.

Ko-Perineva

It should be noted that Perineva’s therapy is effective only in 50% of clinical cases. To achieve a more lasting result, treatment of stage 1 and 2 hypertension is carried out with two active ingredients. The most effective combination is perindopril and indapaid. It is this combination of active ingredients that is presented in Co-Perinev tablets.

The drug is presented in three dosages:

Perindopril, 2 mg, indapamide, 0.625 mg;
Perindopril, 4 mg, indapamide, 1.25 mg;
Perindopril, 8 mg, indapamide, 2.5 mg.

Co-Perineva is prescribed as the main medication for the treatment of hypertension.

Pharmacological effect

The active substance of Perineva, perindopril, belongs to oxopeptidases and is an ACE or kininase inhibitor. It is capable of converting angiotensin into a vasoconstrictor and destroying the vasodilator bradykinin into the inactive substance hectapeptide. This effect leads to a decrease in the level of angiotensin, the secretion of aldosterone and an increase in the activity of renin in the blood plasma and the prostaglandin system.

Perindopril reduces systolic and diastolic blood pressure, accelerates peripheral blood flow without increasing heart rate. The maximum effect after taking the tablets occurs after five hours and lasts throughout the day. Stabilization of health is observed after a month of therapy, the cessation of which is not accompanied by withdrawal syndrome. Perindopril reduces left ventricular myocardial hypertrophy, the severity of interstitial fibrosis, and the concentration of uric acid in hyperuricemia.

Indications for use

Among the main indications for the use of the drug are the following:

to prevent recurrence;
with stable ischemic heart disease;
to prevent recurrent stroke, while the drug can be used exclusively in combination therapy with indapamide drugs.

For monotherapy and complex treatment, different dosages of the drug can be prescribed, taking into account the patient’s condition. In some cases, despite a suitable diagnosis, the doctor may prohibit taking Perineva. This risk is especially high in old age.

Contraindications

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

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

Relative contraindications (take with caution) are the following conditions: cardiomyopathy;

anesthesia;
diseases affecting connective tissues;
persons over 60 years of age;
diabetes mellitus;
kidney failure;
decreased sodium level;
decreased circulating blood volume;
increased potassium levels in the blood;
heart failure in the stage of decompensation;
cerebrovascular diseases;
kidney transplantation.

Use during pregnancy and lactation

According to the instructions, Perineva is contraindicated during pregnancy. If pregnancy occurs, the drug should be discontinued immediately. The use of perindopril in the second and third trimesters of pregnancy can lead to the development of fetotoxic (oligohydramnios, impaired renal function, slowing down the process of ossification of the fetal skull) and neonatal toxic (hyperkalemia, arterial hypotension, renal failure) effects.

Dosage and method of administration

The instructions for use indicate that Perinev tablets should be taken in the morning before breakfast, without chewing or crushing, and with a sufficient amount of water. The medicine is taken once a day, starting with a minimum dose of 2 mg, gradually increasing if necessary. The maximum daily dose should not exceed 8 mg.

For arterial hypertension, Perineva's medicine can be used both in monotherapy and simultaneously with other drugs that lower blood pressure. The initial daily dose should not exceed 4 mg. If therapy does not bring results within a month, the dose can be increased to 8 mg (if the previous dose was tolerated normally). Before you start taking this drug, you must stop taking diuretics for at least 3 days, since the combined use of these drugs can lead to arterial hypotension. Elderly patients are not recommended to take a dose higher than 2 mg per day at the beginning of the course. If necessary, with normal tolerance, you can increase to 4 mg and then to 8 mg.
In case of chronic heart failure, the drug should be taken exclusively under medical supervision; you should start with a minimum dose (2 mg). The dose can be increased to 4 mg no earlier than after a week.
As a prophylactic against recurrent stroke, the initial dose of the drug is 2 mg. You can start taking the drug as early as two weeks after suffering a stroke.
The recommended dose for ischemic heart disease is 4 mg. When monitoring kidney function, after two weeks the dose can be doubled (8 mg).

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

There is no need to adjust the dose for liver diseases.

Side effects

In general, the drug is well tolerated by patients, however, adverse reactions may occur during therapy:

From the respiratory system - cough, shortness of breath, broncho-obstruction and bronchospasm;
From the nervous system - dizziness and headaches, drowsiness, lethargy, emotional instability, possible development of seizures;
From the genitourinary system - impaired potency in men and libido in women, the development of nephritis, renal failure, increased creatinine levels in the blood;
From the digestive system - pain in the epigastric region, nausea, heaviness in the stomach, dry mouth, sometimes vomiting, diarrhea or constipation, impaired liver function;
Allergic reactions - development of urticaria, Quincke's edema, skin rash, itching.

Overdose

In case of overdose, the patient may experience the following symptoms: shock, renal failure, bradycardia, a sharp decrease in blood pressure, hyponatremia, dizziness, cough, hyperkalemia, tachycardia, anxiety, hyperventilation, palpitations.

If there is a sharp decrease in blood pressure, the patient should take a lying position, slightly raise his legs, and it is also necessary to take measures to replenish the blood volume. For bradycardia that does not respond to therapy (in particular, anthropine), it is necessary to install a pacemaker (artificial pacemaker). Perindopril can be removed from the bloodstream by hemodialysis.

Special instructions

Before you start using the drug, read the special instructions:

Cases of hypotension, syncope, stroke, hyperkalemia and renal dysfunction (including acute renal failure) have been reported in predisposed patients, especially when used concomitantly with drugs that affect the RAAS. Therefore, dual blockade of the RAAS by combining an ACE inhibitor with an angiotensin 2 receptor antagonist or aliskiren is not recommended.
In patients undergoing surgery using general anesthesia, the drug should be discontinued one day before the upcoming surgery.
During treatment with Perineva, it is possible to develop a persistent, non-productive cough that stops after discontinuation of therapy. This fact must be taken into account when diagnosing cough.
In patients with diabetes mellitus taking oral hypoglycemic agents or insulin, blood glucose levels should be monitored during the first months of Perineva therapy.

During treatment with the drug, dizziness or an excessive decrease in blood pressure may develop, which may affect the patient’s ability to drive vehicles and operate other technical equipment.

Drug interactions

The drug may interact with other medications, increasing or decreasing their or its own effects. This effect is also important to consider when taking several medications simultaneously.

Here are some examples of interaction:

With immunosuppressants: the risk of developing leukopenia increases.
When used with antipsychotics: the hypotensive effect is enhanced.
When used with drugs for general anesthesia: the general hypotensive effect is enhanced.
When used with diuretics: hypovolemia may occur or blood pressure may decrease.
When used with potassium-sparing diuretics: the potassium level in the blood may increase - and this is very dangerous.
With insulin: There may be an increase in glucose tolerance and a decrease in insulin requirements.
With baclofen: the latter enhances the hypotensive effect, as a result of which blood pressure may change significantly;
With metformin: functional renal failure may occur. A similar effect occurs when using iodine-containing contrast agents.
When taken with lithium drugs: the concentration of lithium in the blood plasma may increase, and therefore you should not combine Co-Perinev with these drugs.
When used simultaneously with acetylsalicylic acid and other NSAIDs: the hypotensive effect of the drug may decrease, but the risk of kidney problems increases, including acute renal failure. If you already have kidney problems, simultaneous use of the drugs is strictly contraindicated.

And this is only a part of the possible interactions that can occur with the simultaneous use of various medications. Therefore, be sure to consult with your doctor about what unusual effects may occur if you use several different medications at the same time.