The prestarium medicine and the instructions for use refers to the inhibitors of the angiotensin of the converting enzyme (ACE). Tablets 2.5 mg, 5 mg, 10 mg and with arginine are used to reduce the level arterial pressure When improving it. With what pressure take, it will be shown in the article. Patient reviews and recommendations doctors indicate that this medicine Helps in the therapy of arterial hypertension and heart failure.

Release form and composition

The medicine is produced in a tablet form.

• Dosage: 2 mg, 4 mg and 8 mg.
• Dosages Preshaum A: 2.5 mg, 5 mg and 10 mg.
• Bi-Preshaum is produced in doses of 5 + 5, 10 + 5 and 10 + 10 mg.

Each tablet contains tertbutylaminic salt of perindopril and additional components: magnesium stearate, hydrophobic silicon dioxide, lactose monohydrate.

Perjdopril Arginine + excipients (preshairium a).

The combination of the bi-pretarium additionally enters Amlodipine.

Preshairium Combi contains Indapamide.

pharmachologic effect

The medicine has a hypotensive effect, that is, reduces blood pressure. For long use Preshairum are created by favorable conditions for restoring the elasticity of arterial vessels, as well as reduce the hypertrophy of the left ventricle.

The drug normalizes the work of the heart, reducing the pre- and postload, reduces myocardial hypertrophy and arrhythmia frequency. The medication reduces the overall peripheral resistance of the vessels, reduces the pressure of the left and right ventricles and moderately sees the heart rate.

What does preshairium help from?

Indications for the use of drug include the pathological states of the body, accompanied by an increase in the level of systemic blood pressure, they include:

• Stable IBS: to reduce the risk of cardiovascular complications.
• Isolated arterial hypertension.
• Preventing cardiovascular complications related to intravascular formation of thromboms.
• Prevention of development of the re-stroke of the brain against the background of increased pressure.

Also, the drug is used in chronic heart failure to reduce the functional load on the heart by reducing the level of blood pressure.

Instructions for use

Preshaum is prescribed inside 1 time per day in the morning, before meals. Arterial hypertension The recommended initial dose is 5 mg 1 time per day, in the morning. With the ineffectiveness of therapy for a month, the dose can be increased to 10 mg 1 time per day.

When appointing ACE inhibitors to patients with severe activated RAAS (with renovascular arterial hypertension, violation water salt balance, therapy diuretics, severe arterial hypertension, cardiac decompensation) An unpredictable sharp decrease in blood pressure may be observed, for the prevention of which it is recommended to stop receiving diuretics 2-3 days before the expected start of therapy with the prestarium preparation.

The instruction reports that if it is impossible to cancel diuretics, the initial dose of the drug is 2.5 mg. It is necessary to control the kidney functions and the content of serum potassium. Subsequently, if necessary, the dose can be increased.

In elderly patients, treatment should be started with a dose of 2.5 mg per day, and in the future, if necessary, gradually increase it up to maximum dose 10 mg per day.

Reducing the risk of cardiovascular complications

With a stable IBA therapy with a drug prestarium should be started with a dose of 5 mg 1 time per day for 2 weeks. Then daily dose Must be increased to 10 mg 1 time per day (depending on the kidney function).

Prevention of re-stroke

In patients with cerebrovascular diseases in history, therapy with prestarium therapy should be started with a dose of 2.5 mg for the first 2 weeks before the introduction of Indapamide. Therapy should be started in any (from 2 weeks to several years) time after the suffered stroke.

Heart failure

Treatment with the drug Preshaum in combination with non-blocking diuretics and / or digoxin and / or beta-adrenoblockers, it is recommended to begin under thorough medical supervision, assigning a drug in a primary dose of 2.5 mg 1 time per day, in the morning.

Subsequently, depending on tolerability and response to therapy, after 2 weeks of treatment, the dose of the drug can be increased to 5 mg 1 time per day.

In patients with high risk of development of symptomatic arterial hypotension, for example, with reduced salts in the presence of or without hyponatremia, hypovolemia or reception of diuretics, before the start of receiving the prescript, whenever possible, the listed states must be adjusted.

Such indicators as the magnitude of the blood pressure, kidney function and the potassium content in the blood plasma should be monitored both before the start and in the process of therapy.

Contraindications

Medicine Preshaum and not prescribe with:

• angioedema edema;
• breastfeeding;
• galactosemia;
• intolerance of ACE inhibitors;
• tooling pregnancy.

Application of the drug is limited when:

• treatment with immunosuppressants;
• after kidney transplant;
• with renovascular hypertension;
• in the stenosis of the aortic valve;
• hyponatremia;
• with hypercalemia;
• with systemic pathology of the connective tissue;
• reduction of BCC (hemodialysis, resolving diet, diarrheal syndrome, abundant vomiting, the use of diuretic medicines).

Sideflines

The use of pretarium can cause a deterioration in the work of the kidneys, the development of acute renal failure, cough, bronchospasm, rhinitis, eosinophilic pneumonia, breathing problems, dry mouth, pancreatitis, cholestatic jaundice, nausea, diarrhea, pain in the abdomen, constipation, rash and itching on the skin, multiform erythema, violation of taste, degradation of appetite.

There are reviews about the prescript, confirming the fact that the medicine can cause:

• asthenia;
• vision, sleep, sexual function;
• arrhythmia;
• increased sweating;
• dizziness;
• worsening mood;
• tinnitus;
• confusion of consciousness;
• convulsions;
• angina;
• severe pressure reduction;
• heart attack or stroke.

In addition, against the background of the treatment with the prestarium and the analogues of the drug, neutropenia, thrombocytopenia, carcitetopenia, agranulocytosis, hypercalemia, increase the activity of liver enzymes, leukopenia, reduced hemoglobin, hematocrit is observed.

Children, during pregnancy and breastfeeding

It is not recommended for the use of the drug Preshaurium in 1 trimester of pregnancy. When planning or confirming pregnancy, you need to go to alternative therapy. Adequate strictly controlled clinical studies To study the action of ACE inhibitors in 1 trimester of pregnancy was not carried out.

In a limited amount of applications of ACE inhibitors in 1 trimester of pregnancy, there were no malformations associated with fetotoxicity.

Perindopril is contraindicated in 2 and 3 trimesters of pregnancy, because There are data on the manifestation of fetotoxicity (reducing the kidney function, an oligohydramnion (a pronounced decrease in the volume of the ammunition fluid), delay in the formation of the bones of the skull) and neonatal toxicity (violation of the kidney function, hypotension, hypercalemia).

If perindopril therapy was carried out in 2 and / or 3 trimesters of pregnancy, it is necessary to spend ultrasound procedure The functions of the kidneys and the fetus skull. It is not known whether perindopril is distinguished with breast milk in humans, so the use of the drug during lactation (breastfeeding) is not recommended.

special instructions

Patients with chronic heart failure, making digoxin or diuretics, is prescribed a minimum dose of the drug, while treatment is carried out in conditions of careful medical control. Elderly patients and patients with renal failure dosage selected strictly individually.

Before starting therapy, kidney examination is required. As a rule, treatment begins with a minimal dose of the prescript, which, with a patient's adequate reaction, gradually increases. Patients with a deficit of fluid and sodium before the start of therapy are adjusted by water-electrolyte disorders.

During the treatment period, hemodialysis is prohibited using polyacrylonitrile membranes. This can increase the risk of developing an anaphylactic reaction.

Medicinal interaction

It is not recommended that the simultaneous use of prescript with diuretics, potassium and lithium preparations, muscle relatives, anesthetics, neuroleptics, sympathomimetics, NSAIDs, tricyclic antidepressants, and with some other antihypertensive agents, are not recommended.

When taking with tricyclic antidepressants or neuroleptics, the risk of postural hypotension increases. Indomeucine reduces the antihypertensive effect of the drug. In the complex with insulin, the development of hypoglycemia may cause an increase in glucose tolerance.

Reception of the drug with potassium-saving diuretics, substitutes of salt and potassium drugs decreases the content of aldosterone, which causes delay in potassium in the body due to the violation of its elimination.

Analogs of prestarium medication

The structure determines the analogues:

1. Anthopress.
2. Stopress.
3. Hypernik.
4. Perindopril Erbumin.
5. Parothel.
6. Perindopril Arginine.
7. Perindopril Trat-Butylamine.
8. Perinpress.
9. Covelex.

Vacation conditions and price

The average price of the pretarium A (Tablets 5 MG No. 30) in Moscow is 480 rubles. In Kiev, it is possible to buy a medicine for 126 hryvnia, in Kazakhstan - for 3540 tenge. In Minsk, the pharmacy is offered a drug for 18.2 white. ruble. Released without a recipe.

The shelf life of the tablets is 3 years from the date of their manufacture. There is no special conditions for storing the drug. It should be stored in the original factory packaging and inaccessible to children.

The official medical instruction on the use of the manufacturer of the press is presented in the photo (click to enlarge):

Preshairium photo 1.

The pretance is a drug containing a combination of two active substances (perindopril + amlodipine), which are used to treat essential hypertensive diseases and other cardiovascular disorders. In the official pharmacological classification of ATH, the pretance is denoted by C09BB04 code.

Preparation "Prestentes"

Description of the mechanism of the drug

Perindopril is not actually an effective substance, but only the so-called prodrug, from which the body occurs in the body - perindospots. This product is an enzyme inhibitor (ACE), which produces a hypertensive hormone hormone in the body of angiotensin II from its predecessor of angiotensin I. In addition, the enzyme turns bradykin, which expands blood vessels, into ineffective metabolite. On the one hand, the inhibition of ACE leads to a decrease in the concentration of angiotensin II in the blood, on the other hand, contributes to the activity of Brudikinin.

Attention! The second effect may also contribute to the development of dry cough.

Pharmacodynamics drug

Amlodipine inhibits the influx of calcium ions into muscular cells of the heart and blood vessels. This influx, however, is necessary to reduce the muscles. The hypotensive action of amlodipine is based on a direct relaxing effect on the muscles of the vessels.

The exact method of action by which amlodipine removes spasms in coronary arteries is not yet fully known. In any case, two effects complement each other: amlodipine expands all small arteries and reduces resistance against which the heart should swap blood. Since the heartbeat remains unchanged, it facilitates the work of the heart and reduces energy consumption and the need for oxygen.

In addition, Amlodipine probably causes the expansion of the arteries and in the heart, both in normal and in the affected areas. This improves the supply of oxygen organs in patients with coronary artery spasm (vasospadic angina). The premium is removed for a long time from the body, which is required to take into account when appointing new drugs.

Attention! Additional information on the pharmacology of the pretance can be found in the RLS directory.

Indications for the use of the pretance

The pretance is used in adults to reduce increased blood pressure, which does not have an obvious physical reason. Sometimes the prettern is used to treat myocardial deficiency.

Prestenance: Application Instructions

Prestentes is designed to treat the first line of patients with hypertension. As a rule, the doctor prescribes one tablet per day, and then gradually increases the dosage to therapeutic - 2 tablets in the morning and in the evening.

With myocardial deficiency, the tablet is divided by half. The drug is taken with food and is powered by sufficient liquid. It is worth noting that it is possible to raise the dose of pretance only under the guidance of the attending cardiologist.

It was shown that the prettern is effective in older patients. Depending on the kidney function, the doctor will exercise caution at the beginning of drug intervention. After the start of therapy, it is necessary to constantly check the function of nephrons in elderly patients.

Important! The presence of prescription in pharmacies is released. Correct the treatment scheme for hypertension and write drugs can only be prescribed.

Analogs of the Preparation "Prestentes"

Basic trade names of substitutes of pretanses:

• Dalneva (country-producer - Slovenia);
• Perindopril plus amlodipine (Russian production);
• Amlopress.

Preparation "Amles"

Contraindications for the use of pretance

Absolute contraindications to the use of pretance:

• Hypersensitivity to the IAPF as a whole and the calcium channels of dihydropyridine calcium channels;
• Hereditary predisposition to the formation of edema in various parts of the body;
• Severe hypotension;
• Apoplex or cardiogenic shock;
• Occlusion aorta;
• Severe myocardial failure;
• Irreversible disorders of the function of nephrons.

Only after careful consideration of benefits / risks and under the control of the doctor may be used in the following cases:

• Connecting tissue anomalies in blood vessels;
• General weakness of the heart muscle;
• Treatment of black patients, because they are more often reacting swelling quint;
• Primary hyperaldosteroneism (adrenal hyperfunction);
• Moderate nephropathy (creatinine clearance from 30 to 60 milliliters / min), but the combination of drugs should be applied with extreme caution.

Pregnancy and lactation

Prestance should not be used during the first three months of pregnancy, if the doctor does not consider it necessary. In later pregnancy, use is completely prohibited.

Pregnancy

It is not known whether the individual components of the pretance in breast milk fall. Therefore, the doctor will decide whether it is worth stopping breastfeeding or treatment with the pretrial. At the same time, it will appreciate the risks of the harmful effects of breastfeeding for the child and the benefits of therapy for a woman. Most likely, the doctor will prefer other therapy of increased pressure with greater safety when used during breastfeeding, especially when feeding newborn or premature babies.

The safety and effectiveness of the pretrial in children under 18 is not installed. Therefore, the use of the drug in this age group is possible only at the discretion of the doctor.

Side effects of pretance

Frequent side effects of the drug:

• Dizziness;
• Cough;
• Holding water in fabrics.

General adverse reactions of the pretance:

• Excess potassium in blood;
• Increase the concentration of monosaccharides in the blood;
• Multiform Erythema;
• Chronic fatigue syndrome.

Unusual side effects of pretance:

• Runny nose;
• Excess of immature blood cells;
• Hypersensitivity;
• Hyponatremia;
• Affective disorders (including anxiety);
• Insomnia;
• Depression;
• Drowsiness;
• Violations of taste;
• Loss of consciousness;
• Hearing loss;
• Tremor;
• Heart palpitations;
• Inflammation of blood vessels;
• Bronchokonstriction;
• Dry mouth;
• Hyperhydrosis;
• Hair loss;
• Subcutaneous bleeding;
• Swelling of the face;
• Photosensitivity of the skin;
• Pain in the spinal column;
• Hypercines;
• Pain in the joints;
• Malgia;
• Urination disorders
• Renal dysfunction;
• Erectile dysfunction;
• Gynecomastia
• Painful chest syndrome;
• Malaise;
• Fibromyalgia;
• Changes in body weight.

Rare Side Phenomena of Prestenas:

• Twilight consciousness syndrome;
• Elevated bilirubin in the blood.

Very rare adverse reactions of the drug:

• A sharp decrease in the number of leukocytes in the blood;
• Lowering the number of neutrophils;
• Agranulocytosis;
• Pancytopenia;
• Coagulation disorders;
• Hemolytic anemia;
• Arterial hypertension;
• Acute nephropathy;
• Panic attack;
• Mental lability;
• Neurasthenia.

Side effects of the drug unknown frequency:

• Unintentional movements by the face or language.

The aforementioned side effects arose in clinical trials with therapy of the pretance. Pancitopenia is manifested in the form of inflammation of the throat or severe fever. With such symptoms caused by the drug, it is recommended to immediately consult a doctor.

Prestenance: interaction and compatibility of drugs

The pretrials cannot be used with other antihypertensive means, such as AT1 receptor antagonists or alianis. Otherwise, this may lead to a higher strength of unwanted side effects, such as hypotension, hypercalemia and a decrease in the function of nephron. Strengthening side effects is most often observed in diabetics.

Preparations containing angiotensin receptor antagonists

The pretrials cannot be combined with potassium salts, potassium-saving diuretics, other IAPF, non-steroidal anti-inflammatory drugs, heparin and substances to suppress the body's protective forces. It is necessary to carry out constant monitoring of potassium content in the bloodstream to avoid hazardous hyperkalemia.

It is strictly forbidden to drink this drug along with alcohol (alcohol). There are cases when such a combination led to a cardiovascular collapse and long-term negative consequences.

When the antidepressant is introduced with the content of lithium and the pretance, it may increase the toxic first. Therefore, co-use is not recommended, and if it is necessary from a medical point of view, it is important to carefully monitor the concentration of lithium in the blood.

Miorosant Datrolren can not be used with the pretrial, if the patient has a tendency to overheating. In animal studies, with a combination of amlodipine with dancer and verapamil, fatual heart arrhythmias and disorders of peripheral and central blood circulation were observed.

Dress Dentrenolen

If the following active ingredients are used with the pretance, the doctor must exercise special caution:

• Antidiabetic medicines (insulin, for example), can cause an increase in blood sugar or hypoglycemia;
• Baclofen, beta-blockers (Concor), and vasodilators (containing nitrates) can enhance the hypotensive effect;
• Nonal diuretics lead to a sharp decrease in blood pressure, especially in the event of a salt deficiency after the start of therapy inhibitor ACE;
• Rifampicin and St. John's wort can weaken the effect of the drug;
• Inhibitor HIV-1 protease, ketoconazole and itraconazole, macrolide antibiotics, such as erythromycin can increase the concentration of the active substance so much that a dose reduction is required;
• Antidiabetic means from the Gliptinov group (Saxagliptin, Sitagliptin, Wildagliptin) increase the risk of developing swelling of smooth muscle cells;
• Tricyclic antidepressants, psychotropic drugs and anesthetics additionally reduce blood pressure;
• Alpha sympathomimetics, glucocorticoids and anti-epileptic drugs are weakened by the main hypotonic effect of the pretance.

Amyifostin can increase the antihypertensive effect of amlodipine. In rare cases, the injected drugs can cause redness of the face, nausea and vomiting, low blood pressure.

Grapefruit juice leads to a strong decrease in blood pressure in some patients, and therefore it should be avoided. This is due to the fact that grapefruit components are inhibitors of cytochrome P450.

A strong decrease in blood glucose concentration with simultaneous treatment with APE antagonists and antidiabetic preparations is more likely to be more likely during the first weeks in patients with complicated nephropathy.

Food "Human" for children: Quick description

The above nutrition for children is made in Germany. This manufacturer is a powerful milk powder complex, which consists of more than 8,000 farmer milk enterprises.

"Human" today is one of the main leaders of Europe among the milk processing plants. In addition to baby food, this manufacturer is also manufactured by high-quality milk products.

Advantages of baby food "Human":

1. Products do not contain genetic components. These enterprises for the processing of milk are in close relationship with farms. The cow's milk, which is sick, is not at all used for the production of children's nutrition. Animals are fed only by natural feeds. Also, the company uses the closure of production cycle (when there is no contact of the milk with air).
2. Baby food is enriched with vitamins and other substances useful.
3. Tall
4. Baby food of this manufacturer is contained in a special packaging, which is air and light-tight.
5. All products are produced according to a single identical unique recipe for any country in the world. It meets all the established quality standards.
6. The manufacturer is constantly working on improving the existing and development of new products.

Production of the brand "Human"

The company "Human" offers its small consumers a wide selection of dairy mixtures developed according to a special recipe. The above products complies with all the requirements of WHO and European Pediatricians Society.

Children's Food Milk Milk Fat, Serum Milk Deminineralized, Vegetable Fats, Maltodextrin, Calcium Orthophosphate, Fat Fat, Potassium Chloride, Vitamins (Ascorbic, Topopherol Acetate, Niacin, Pantothenic Acid, Retinol, Riboflavin, Pyridoxine, Tiamine, Folic Acid, Biotin , D3, K, Cyanocoballamine), sodium citrate, iron, sodium chloride, and other auxiliary and special for a specific age category of substances.

Food Children's "Human" includes such species as:

• liquid shape (o-on, pre);
• baby Baby Mixtures;
• milk porridge;
• medical nutrition;
• silent porridge;
• hypoallergenic mixtures (on-1-2, SL).

Human - baby food for newborns

If the child was born prematurely, for him this manufacturer developed a special mixture of "Human 0".

Human Pred - baby food, which is a ready-made mixture, which is contained in a special jar. It is made exclusively fresh milk, so there is a slightly high cost.

One of the advantages of this nutrition is that it is convenient to take it with himself in the maternity hospital or, for example, on a conventional walk. Human Pred is produced only in liquid form, and specialists advise from it. It is necessary to start feeding a newborn.

The main products of the above manufacturer

The basic manufacturer includes the following products:

• "Human 1" - designed for babies to age until six months.
• "Human 2" - designed for semi-annual crumbs.
• "Human 3" - designed for a child by age from 10 months.
• "Human 4" - designed for the baby after a year.

The above designation numbers significantly facilitates the binding to age and means a more raw product. But experts warn that it is necessary to switch to a new mixture only considering the weight and appetite of the child.

If, for example, a child in 5 months is not fought and climbs, it is already advisable to try the next product for him.

Special mixes

Food Children's "Human Hypoallergenic" is intended for kids who have a manifestation of allergy symptoms on cow's milk protein. The main principle of the action of such a mixture is that there are already split protein in its composition. It is easily absorbed by the body of the infant and does not cause allergies. This is distinguished by the nutrition of children's "Human" from other mixtures, which often make drugs.

The particular pride of this manufacturer is the healing nutrition, which is used in the case of observation of the child problems from the head of the gastrointestinal tract. Experts recommend using the following mixtures depending on disorders in the digestive organs:

• with colic - "anticolics";
• in diarrhea - LP + SCB;
• when constipation - "Bifidus".

It is worth noting that the above nutrition is not a high-speed medicine. The mechanism of action of the mixture is aimed at stabilizing the operation of the entire digestive system. Its main goal is to teach the body to cope with the ailment.

Porridge from the producer "Human"

Muffin silent are made without adding sugar and gluten. This nutrition is the best option for the first dust for the crumbs, which has symptoms of allergies on the milk protein of cow. Very often, the data of Kashi specialists recommend mixing with the Human manufacturer offers its small consumers buckwheat, oatmeal, rice, corn-rice, corn-rice with an apple and rice with pumpkin porridge without milk. A fairly wide range!

Milk porridge "Human" - baby food, which is characterized by the presence of 13 vitamins, iodine, calcium and the absence of crystalline sugar. This is an exceptionally environmentally friendly product made of natural raw materials. The manufacturer offers a fairly large assortment of this nutrition: Multi-Slask Sweet Dreams, buckwheat, buckwheat with a pear, buckwheat with an apple, oat, oatmeal with peach, corn-rice with vanilla, as well as milk porridge with cookies.

How to prepare the above nutrition for children?

"Human" - baby food, the instruction to which it recommends to prepare it as follows:

1. The required amount of water you need to boil and cool up to about 50 degrees Celsius. You can also warm the children's water "Human".

2. Liquid break into a bottle.

3. Add the desired amount of residues of measuring mixtures.

4. Close the bottle and thoroughly shake it until the mixture is completely dissolved.

Before you start feeding a baby, you need to check the temperature of baby food in a bottle. Some drops shake on the inside of the wrist.

One resume spoon contains approximately 4.3 g of the mixture.

For a newborn baby, baby food is determined by the doctor. For the baby age from 2 to 8 weeks, it is recommended to give 3 spoons of measuring on 90 ml of water. Feed such a crumb preferably 7-8 times a day.

For toddlers by age up to 4 months, it is necessary to prepare food from 5 spoons of measuring and 150 ml of water. Eating for such a child is 5-6 times a day.

For the crumbs after 4 months, the mixture is prepared from 6 spoons of measuring and 180 ml of water. To feed such a baby should be 4-5 times a day.

After half a year, food intake by a child is carried out 2-3 times. 5, 6 or 7 spoons of measuring mixtures are used on respectively 150, 180 or 210 ml of water, depending on the appetite of the baby.

"Human" (baby food): reviews

Today you can meet quite a lot of responses of satisfied moms, which gave their aforementioned manufacturer. Women note that they are pretty tasty (tried themselves). If the baby has manned allergy symptoms, then quickly pediatricians have appointed Hypoallergenic Product "Human" (baby food).

MNN: Perindopril

Manufacturer: Krka, D.D., Novo Place

Anatomy-therapeutic-chemical classification: Perindopril

Registration number in Kazakhstan: № RK-LS-5№014922

Registration period: 16.01.2015 - 16.01.2020

Instruction

Tradename

Presession®

International non-proprietary title

Perindopril

Dosage form

Tablets 2 mg, 4 mg, 8 mg

Structure

One tablet contains

active substance -erbumin perindopril 2 mg, 4 mg or 8 mg,

excipients: Calcium chloride hexahydrate, monohydrate lactose, crosspovidone, microcrystalline cellulose, silicon colloididoid dioxide, magnesium stearate

Description

Tablets round white or almost white color, slightly twofold, with a fan (for dosage 2 mg).

The tablets of the oval shape of white or almost white, slightly double-screwed, with the risk on one side and the fma (for dosage 4 mg).

Tablets round white or almost white color, slightly twofold, with risky on one side and faceted (for dosage 8 mg).

Pharmacotherapeutic group

Preparations affecting the renin angiotensin system. Inhibitors of angiotensin-polescent enzyme (ACE). Perindopril

Code ATH C09AA04

Pharmacological properties

Pharmacokinetics

After acceptance inside, the perindopril is quickly absorbed, and the maximum concentration in the blood plasma is achieved within 1 hour. Bioavailability ranges from 65 to 70%.

About 20% of the adopted perindopril turns into a perindoid-active metabolite. In addition to active metabolite, 5 more inactive metabolites of the drug have been identified. The half-life (T1 / 2) perindopoid is 1 hour. The maximum concentration (Cmax) of the blood plasma perindoprote is reached within 3 - 4 hours.

The simultaneous meal slows down the transformation of the perindopril into the perindospota, and, therefore, the bioavailability decreases, so the perindopril should be taken inside, one day per day, before breakfast.

The volume of the distribution is approximately 0.2 l / kg for unrelated perindoprote. The binding of proteins is minor (binding perindoprote with angiotensin converting enzymes is less than 30%), but it depends on the concentration.

The perindoid is derived from the urine and T1 / 2 unrelated fraction is approximately 3 to 5 hours. The disintegration of the perindoid associated with ACE leads to an increase in effective T1 / 2 to 25 hours. With a reusable administration of the drug, the stabilization of pharmacokinetic parameters is achieved for 4 days. After a reusable reception did not accumulate perindopril.

In elderly patients and in patients with heart or renal failure, the removal of perindospots decreases. When the kidney function is impaired, it is recommended to change the dose depending on severity.

violations (Creatinine clearance level).

Perindoid is derived from blood circulation by dialysis, its clearance is 70 ml / min.

In cirrhosis, the kinetics of perindopril changes, while the hepatic clearance of the initial molecule is reduced by 2 times, however, the amount of formed perindoprote does not change, and therefore, during this disease, the dose of the drug can not be changed.

Pharmacodynamics

Presessse® is an inhibitor of an angiotensin of the converting enzyme (ACE). The enzyme - kinase is oxopeptidase, which contributes to the conversion of angiotensin I to angiotensin II and destroys the Bradykinin vasodilator to an inactive hectapeptide. Inhibition of ACE leads to a decrease in the formation of angiotensin II in plasma, which is accompanied by an increase in the activity of renin in the blood plasma (due to the inhibition of negative feedback) and a decrease in the secretion of aldosterone. Since the ACE inactivates Bradykinin, the suppression of the ACE is accompanied by an increase in the activity of both the circulating and tissue kallyrein-kinin system (the prostaglandin system is activated). Perhaps this particular

the mechanism contributes to action inf inhibitor, reduced blood pressure and partially promotes the emergence of some side effects (for example, cough).

Perindopril acts through its active metabolite perindoprote.

Arterial hypertension

Presessa® is effective at any stage of arterial hypertension: light, moderate, severe; With a decrease in systolic and diastolic blood pressure (in the position "lying" and "standing"). Presession® reduces the total peripheral resistance of the vessels, which leads to a systemic decrease in blood pressure. In this case, the peripheral blood flow accelerates, however, the frequency of heart abbreviations (CSS) does not increase.

The renal blood flow increases, but the speed of glomerular filtration does not change. After receiving a single dose, the maximum antihypertensive effect is achieved after 4 to 6 hours and continues at least 24 hours; The residual effect is 87-100% of the maximum effect. Reduced blood pressure occurs quickly. In patients with a good response to treatment, normalization is achieved within a month and is preserved without tachyphylaxia. Treatment interruption is not accompanied by cancellation syndrome.

Perindopril reduces left ventricular hypertrophy.

Perindopril has a vasodilatory action, improves the elasticity of large arteries and reduces the ratio of the medium / clearance of small arteries. Additional therapy with thiazide diuretics enhances the effect. The combination of the ACE and thiazide diuretics inhibitor also leads to a decrease in risk of hypokalemia on the background of diuretics.

Heart failure

Presessa® reduces the work of the heart by reducing the pre- and postload.

In patients with heart deficiency of Presecess® reduces the filling pressure in the right and left ventricles, reduces the total peripheral resistance of the vessels , Enhances the cardiac index and cardiac output.

Patients S. cerebrovascular diseases in history

In patients with cerebrovascular diseases in history (stroke or transient ischemic episodes in the last 5 years) Presessse® helps to reduce the risk of re-stroke (both ischemic and hemorrhagic nature) by 28%. It has also been established that perindopril, in general, reduces the risk of development: fatal or strokes leading to disability, (by 33%), cardiovascular complications, such as death, non-infamary myocardial infarction and non-infamorestal stroke (by 26%), dementia, A stroke associated with a stroke (by 34%), serious deterioration of cognitive functions (45%), major coronary events, including a non-infamary myocardial infarction and mortality from ischemic heart disease (by 26%).

These therapeutic advantages were observed both in patients with arterial hypertension and in patients with normal arterial pressure, regardless of age, gender, presence or absence of diabetes and stroke type. It has been established that active therapy for 5 years avoids the development of a single stroke per 23 patient and one significant cardiovascular complication per 18 patients.

Patients with stable ischemic heart disease:

In patients with signs of ischemic heart disease without clinical signs of heart failure, received perindopril at a dose of 8 mg 1 time per day, in addition to conventional therapy (including platelet inhibitors, hypolypidemic drugs and beta-blockers), a significant absolute decrease in the primary end point was observed by 1 , 9% (reduction of the relative risk of development by 20%, 95% di -<0,001), у пациентов с инфарктом миокарда и / или реваскуляризацией в анамнезе, абсолютное снижение на 2.2%, (снижение относительного риска на 22.4% (95% ДИ - р <0,001) по сравнению с плацебо.

Indications for use

Arterial hypertension:

Treatment of arterial hypertension

Heart failure:

Treatment of symptomatic heart failure

Stable coronary artery disease:

Reducing the risk of cardiovascular complications in patients with myocardial infarction in history and / or revascularization.

Prevention re-stroke (as part of comprehensive therapy with Indapamide) patients S.cerebrovascular diseases in history stroke or transient cerebralischemic attack

Method of application and dose

Praesza® tablets should be taken before meals, 1 time per day, in the morning.

The dose is selected individually for each patient, depending on the condition of the patient and the level of blood pressure.

Arterial hypertension

Presession® can be used in monotherapy or in combination with other antihypertensive means.

In patients with an activated renin-angiotensin-aldosterone system (in particular, with renovascular hypertension, with decrees of intercellular fluid and / or salts, with heart failure or severe hypertension), there may be an excessive decrease in blood pressure after the first dose. For such patients, the recommended initial dose of Presession® is 2 mg and the beginning of treatment should be carried out under the supervision of the doctor.

After 1 month of treatment, the dose can be increased to 8 mg per day.

At the beginning of the treatment of Presense®, especially in patients receiving diuretics, symptomatic arterial hypotension may develop, so the drug should be prescribed with caution to such patients, since they may have a decrease in the amount of intercellular fluid and / or salts; If possible, cancel the reception of diuretics 2-3 days before the start of therapy perindopril.

Patients with hypertension, which cannot be canceled by therapy with diuretics, treatment with perindopril should begin with a dose of 2 mg. The kidney function and potassium level in the blood plasma should be monitored. The subsequent doses of perindopril should be adjusted depending on the response of the patient's blood pressure response. If necessary, the therapy with diuretics can be resumed.

Treatment of elderly patients should be started with a dose of 2 mg, which gradually can be increased to 4 mg, and if necessary, after a month to 8 mg, depending on the kidney function (see table below).

Symptomatic heart failure

Perindopril combined with non-blocking diuretics and / or digoxin and / or beta blocker, it is recommended to apply under careful medical supervision with a recommended initial dose of 2 mg taken in the morning. With good tolerance, the dose can be increased by 2 mg with an interval of at least 2 weeks to 4 mg once a day.

The dose correction should be based on the clinical reaction of each patient. With a severe form of heart failure and in patients with increased risk (patients with impaired kidney function and tendency to electrolyte violations, patients receiving simultaneous treatment with diuretics and / or vazodilative drugs), treatment should be started under careful control.

Patients with an increased risk of the development of symptomatic hypotension, (patients with salt deficiency, with hyponatremia or without, patients with hypovolemia or patients who received vigorous diuretics therapy), before the treatment of perindopril, it is necessary to adjust these conditions, if possible, before the start of treatment with perindopril. Both, and during treatment with perindopril, the level of blood pressure, the kidney function and the level of potassium in the blood plasma should be carefully monitored.

:

Perindopril should be prescribed at a dose of 4 mg once a day during

two weeks, then increase to 8 mg once a day, depending on the kidney function, and provided that the dose of 4 mg is well tolerated by the patient.

Elderly patients should be prescribed at a dose of 2 mg once a day during the first week, then 4 mg once a day next week before increasing the dose of up to 8 mg once a day, depending on the kidney function (see table below) . Dose should be increased only with good tolerance of previous lower doses of the drug.

Prevention re-stroke

The initial dose of perindopril in patients with cerebrovascular diseases in the history is 2 mg per day. After two weeks, the dose should be increased to 4 mg per day and apply for two more weeks before the purpose of Indapamide. There is a time you can start at any time, from two weeks to several years after the first stroke.

Dose correction with renal failure

Dosage in patients with renal failure should be based on creatinine clearance, as indicated in the table below:

Table: dose correction with renal failure.

* Dialysis clearance of perindopril is 70 ml / min.

Patients in hemodialysis should be prescribed after dialysis procedure.

Dose correction with hepatic insufficiency

When prescribing patients with impaired dose correction, the dose is not required.

Application in pediatrics

The efficiency and safety of the use of the drug in children is not installed, so the use of the drug in children is not recommended.

Side effects

Often (OT. 1/100 BC<1/10)

Headache, Dizziness, Vertigo and Paresthesia

Vision vision

Noise in ears

Hypotension and effects associated with hypotension

Cough, Dyshuge

Nausea, vomiting, abdominal pain, disgusting, dyspepsia, diarrhea, constipation

Rash, itching

Muscular cramps

Asthenia

Infrequently (OT. 1/1000 to<1/100)

Sleep disorder or mood swings

Bronchospasm

Dry mouth

Angioedema swelling of the face, limbs, lips, mucous membranes, language,

Renal failure

Impotence

Sweating

Rarely (OT 1/10,000 Do. <1/1,000)

- reduced hemoglobin and hematocrit, thrombocytopenia,

leukopenia / neutropenia, agranulocytosis or barbecue

Rarely (<1/10,000), в единичных случаях (cannot be estimated on the basis of available data)

- Concision confusion

Arrhythmia, angina, myocardial infarction and stroke may be secondary

in relation to excessive hypotension in high-risk patients

Eosinophilic pneumonia, rhinitis

Pancreatitis

Hepatitis (cytolithic or cholestatic)

Multiform Erythema

Acute renal failure

Hemolytic anemia (in patients with congenital deficiency G-6PDH)

Research:

An increase in blood urea levels and creatinine in blood plasma, as well as hypercalemia, reversible after the cessation of drug intake, may occur, especially in patients with renal failure, severe form of heart failure, and renovascular hypertension. The increase in the level of liver enzymes and bilirubin in blood plasma was reported in rare cases.

Contraindications

hypersensitivity to perindopril and other components of the drug or any other inhibitor of ACE

angioedema edema in history against the background of therapy inhibitors of ACE

healthy or idiopathic angioedema edema

pregnancy and lactation period

Medicinal interactions

Patients accepting diuretics, and especially patients with fluid deficiency and / or saltmay experience an excessive decrease in blood pressure after the start of therapy with the ACE inhibitor. The hypotensive effect can be reduced by stopping the reception of diuretics, increasing the consumption of salt and fluid before starting therapy with low and progressive doses of perindopril.

Although the level of potassium in the blood plasma, usually remains within the normal range, hypercalemia may occur in some patients receiving perindopril. Application toaliuszer Diuretikov (Spironolactone, triamteren. or amyloride), Kalivaadditives or potassium-containingsubstitutes sololi. May lead to a significant increase in potassium level in blood plasma. Therefore, a combination of perindopril with the above-mentioned drugs is not recommended, but if necessary, simultaneous use due to hypokalemia, they must be used with caution, and with frequent control of the level of potassium in the blood plasma.

With simultaneous use lithium and ACE inhibitors have been reported than reversible increments of lithium concentrations in blood plasma and toxicity. Sharing with thiazide diuretics can increase the risk of lithium toxicity and lead to an even greater increase in the risk of lithium toxicity when applying with ACE inhibitors. The simultaneous use of perindopril with lithium is not recommended, but if necessary, a thorough monitoring of the level of lithium in blood plasma should be carried out;

Prenation Non-steroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid at a dose 3 g / per dayit may reduce the antihypertensive effect of ACE inhibitors. In addition, the NSAIDs and ACE inhibitors have an additive effect on an increase in the level of potassium in the plasma of blood, which can lead to a deterioration in the kidney function. These effects are usually reversible. In rare cases, acute renal failure may occur, especially in patients with impaired kidney function (elderly patients or patients with hypovolemia).

The simultaneous use of antihypertensive preparations and vasodilators It may increase the hypotensive effect of perindopril. Simultaneous use with nitroglycerin, other nitrates or other vasodilators, can lead to a further decrease in blood pressure.

The simultaneous use of ACE inhibitors and antidiabetic preparations (insulin, oral hypoglycemic drugs)may cause an increased sugar-based effect with the risk of hypoglycemia development. This phenomenon is more often observed during the first weeks of combination treatment and in patients with renal failure.

Perindopril can be used in combination with acetylsalicylic acid (when used as thrombolytic), thrombolytic and beta blockers and / or nitrates.

Simultaneous application defined anesthetics, tricyclic antidepressants and neuroleptics With ACE inhibitors can lead to a further decrease in blood pressure.

Sympathomimetics Can reduce the antihypertensive effect of ACE inhibitors.

special instructions

Stable ischemic heart disease

In the event of an episode of unstable angina during the first month of therapy with perindopril, a thorough analysis of the benefit / risk ratio should be carried out to continue treatment.

Hypotension ACE inhibitors can cause a decrease in blood pressure. Symptomatic arterial hypotension rarely develops in patients with an uncomplicated form of hypertension, and develops in patients with a reduced volume of circulating blood, due to diuretic therapy, while observing strict residue diet, hemodialysis, with vomiting and diarrhea and in patients with severe renin-dependent arterial hypertension. . Symptomatic arterial hypotension is observed in patients with symptomatic heart failure, both in the presence of concomitant renal failure and in its absence. Most often, this is noted in patients with a more severe degree of heart failure receiving "loop" diuretics in high doses, in hyponatremia, or by impaired kidney function. In patients with increased risk of symptomatic arterial hypotension, treatment should begin and adjust doses under careful medical control.

Such an approach is also used in patients with coronary heart disease or with cerebrovascular diseases in which pronounced arterial hypotension can lead to the development of myocardial infarction or cerebrovascular complications.

In the event of the development of the patient's arterial hypotension, it is necessary to transfer to the "lying on the back" position, and, if necessary, it is necessary to carry out intravenous administration of a physiological solution. The transient hypotensive reaction is not a contraindication to the subsequent doses, which can usually be taken without complications if the blood pressure increased after an increase in blood volume.

In the case of patients with stagnant heart failure, with normal or low arterial pressure, the reception of perindopril can lead to an even stronger reduction in systemic blood pressure. This effect can be assumed, and it is not the cause of cessation of treatment. If hypotension becomes chronic, then it may be necessary to reduce the dose or stop receiving perindopril.

Stenosis of aortic and mitral valve, hypertrophic cardiomyopathy

Like other ACE inhibitors, perindopril should be prescribed with caution in patients with stenosis of a mitral valve or obstruction of the output tract of the left ventricle (for example, aortic stenosis or hypertrophic cardiomyopathy).

Violated kidney function

In cases of impaired kidney function (Creatinine clearance<60 мл / мин), начальную дозу периндоприла следует скорректировать в зависимости от клиренса креатинина, а также в зависимости от реакции пациента на лечение. Постоянный контроль уровня калия в плазме крови и креатинина являются частью нормальной медицинской практики для этих пациентов.

In patients with symptomatic heart failure, hypotension, appearing due to the treatment of ACE inhibitors, can lead to a further increase in the violation of the kidney function. As reported, in this situation, acute renal failure, usually reversible.

In some patients with bilateral stenosis of the renal artery or stenosis of the artery of the only functioning kidney receiving the treatment of ACE inhibitors, increased urea levels in blood and creatinine in blood plasma, which, as a rule, are reversible after the cessation of therapy. This may especially take place in the case of patients with renal failure. With renovascular arterial hypertension, there is an increased risk of developing severe arterial hypotension and renal failure. Treatment of such patients begin under careful medical supervision with the appointment of the drug in small doses and further adequate selection of the dose. Since treatment with diuretic means can be a factor contributing to the above, during the first few weeks of perindopril therapy, it is necessary to cease treatment with diuretic means and control the kidney function.

W.some patients with arterial hypertension with invisible signs of previously available kidney vessels, there were an increase in blood urea levels and creatinine in blood plasma appeared, as a rule, minor and transient, especially when perindopril was taken simultaneously with diuretics. Such a phenomenon is more likely in patients with chronic renal failure. In this case, a dose reduction may be required and / or the cessation of diuretics and / or perindopoid reception.

Hemodialysis patients

The appearances of anaphylactoid reactions were reported among patients on hemodialysis using high-flow membranes and at the same time hosting ACE inhibitors. In such patients, it is necessary to consider the possibility of using another type of membranes for dialysis or other antihypertensive agents.

Kidney transplantation

Data on the use of perindopril in patients, there are no recent kidney transplantation.

Increased sensitivity / angioedema edema

Among patients who took ACE inhibitors, including perindopril, on the development of angioedema edema, limbs, lips, mucous membranes, language, voice gap and / or larynx, rarely reported. This can happen at any time throughout the treatment. In such cases, the treatment of perindopril must be discontinued and take appropriate measures to ensure the complete disappearance of the symptoms in the patient. The angioedema edema of the face and lips usually does not require treatment, antihistamines can be used to facilitate symptoms in the patient.

An angioedema edema in the area of \u200b\u200bthe larynx can be fatal. If the swelling of the language, the voice gap or larynx threatens the development of the obstruction of the respiratory tract, it is necessary in the shortest possible time to carry out urgent therapy, which includes the introduction of the adrenaline solution, and take measures to ensure respiratory tract. The patient must be under careful medical supervision to the complete and sustainable disappearance of symptoms.

Patients with diseases of the Queen's swelling in history, not related to therapy inhibitors of ACE, may be susceptible to increased risk of angioedema edema in the case of admission of ACE inhibitors.

Anaphylactoid reactions when carrying out the pit ​​ Low density lipoproteins (LDL)

In patients receiving ACE inhibitors during the apheresis of low density lipoproteins (LDL) dextran sulfate, in rare cases, life-threatening anaphyactic reactions are possible. The development of these reactions can be avoided by temporary cancellation of the ACE inhibitor before each procedure of apheresis.

Anaphylactoid reactions for desensitization

Patients who received the ACE inhibitors during the desensitization course (for example, the poison of the refilled) experienced anaphylactoid reactions. The development of these reactions in these same patients could be avoided by temporary cancellation of the ACE inhibitor, however, they appear after careless re-appointment of the drug.

Liver failure

During the treatment of ACE inhibitors, in rare cases, the development of the syndrome, which begins with the cholestatic jaundice and then progresses to the fulminant necrosis of the liver and (sometimes) with a fatal outcome. The mechanism of development of this syndrome is unclear. If a jaundice appears during the intake of an ACF inhibitor or an increase in liver enzymes, the drug received should be immediately canceled, and the patient must be under careful medical supervision.

Neutropenia/ agranulocytosis /thrombocytopenia / anemia

In patients who took ACE inhibitors, cases of neutropenia / agranulocytosis, thrombocytopenia and anemia were noted. In patients with normal kidney function in the absence of other complications, neutropenia is rare.

Perindopril must be prescribed very carefully to patients with collands of vascular diseases, patients receiving immunosuppressants, allopurinol or procainamide, as well as with a combination of these factors, especially with existing kidney function disorders. In some of these patients, severe infections can develop, non-intensive antibiotic therapy. When prescribing perindopril to such patients, it is recommended to periodically monitor the number of leukocytes in the blood and the patient should be warned that in the event of any signs of infection, it is necessary to immediately consult a doctor. There were reports of sporadic cases of hemolytic anemia in patients with congenital insufficiency of G6-PD.

Racial differences

The use of angiotensin-converting enzyme inhibitors in dark-skinned patients leads to a higher level of angioedema edema than the rest of patients.

Like other angiotensin-converting enzyme inhibitors, perindopril is less effective in reducing blood pressure in dark-skinned people than the rest, perhaps because of more

the high prevalence of low renin status among the dark population with hypertension.

CoughDuring treatment, ACE inhibitors may arise a steady, unproductive cough, which passes after the cessation of therapy. The cough caused by the use of ACE inhibitors should be considered as part of the distinguishing diagnosis of cough.

Operation / anesthesia

In patients who have suffered serious operations, or during general anesthesia with hypotensive drugs, perindopril can block the formation of angiotensin II, secondary to the compensatory release of renin. Treatment must be discontinued in one day before the operation. If the doctor assumes the occurrence of hypotension due to this mechanism, treatment can be directed to an increase in the volume of circulating blood.

HypercalemiaIn some patients during the treatment of ACE inhibitors, including perindopril, the level of potassium in the blood plasma can increase. Increased risk of development of hypercalemia, patients with renal failure, uncontrolled diabetes, are susceptible; Patients at the same time taking potassium-saving diuretics, potassium supplements or potassium-containing salt substitutes; or patients taking other preparations that can lead to hypercalemia (for example, heparin). In the case of the expediency of simultaneous use of Enalapril with any of the above-mentioned agents, it is recommended to regularly monitor the level of potassium in the blood plasma.

Patients with diabetes

In patients with diabetes mellitus receiving antidiabetic oral preparations or insulin, during the first month of treatment inhibitors of ACE, it is necessary to thoroughly conduct glycemic control of blood sugar.

Information about auxiliary substances

Presession® tablets® contain lactose. Patients with rare hereditary problems of the intolerance of galactose, lactase deficiency of Laktase or Mal Absorption syndrome glucose-galactose should not take this drug.

Use in pediatrics

The effectiveness and safety of the use of the drug in children is not established, and therefore the appointment of the drug, children are not recommended.

Impact on the ability to control vehicles and potentially hazardous mechanisms

Care should be taken when driving vehicles and work with potentially hazardous mechanisms due to the possible development of dizziness.

Overdose

Symptoms: Acute hypotension, bradycardia, dizziness, alarm, cough, electrolyte disorders, renal failure shock state.

Treatment: Hitting a horizontal position, intravenous administration of the physiological solution, washing the stomach of adsorbents and sodium sulfate for 30 minutes after taking the drug, infusion of angiotensin II and / or catecholamines. In the event of an overdose, the patient must be under close attention, preferably in the intensive therapy block. The content of electrolytes and creatinine in the patient's serum should be constantly monitored. If necessary, cardiography. Perindopril can be removed from systemic blood circulation with hemodialysis (using polyacrylonitrile high-flow membranes).

Release form and packaging