Co-Parnavel - Instructions For Use, Reviews, Analogs, The Price Of Tablets

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Co-Parnavel

Co-Parnavel: instructions for use and reviews

1. 1. Release form and composition
2. 2. Pharmacological properties
3. 3. Indications for use
4. 4. Contraindications
5. 5. Method of application and dosage
6. 6. Side effects
7. 7. Overdose
8. 8. Special instructions
9. 9. Application during pregnancy and lactation
10. 10. Use in childhood
11. 11. In case of impaired renal function
12. 12. For violations of liver function
13. 13. Use in the elderly
14. 14. Drug interactions
15. 15. Analogs
16. 16. Terms and conditions of storage
17. 17. Terms of dispensing from pharmacies
18. 18. Reviews
19. 19. Price in pharmacies

Latin name: Co-Parnavel

ATX code: C09BA04

Active ingredient: indapamide (Indapamide), perindopril (Perindopril)

Manufacturer: LLC "Ozon" (Russia)

Description and photo update: 2019-10-07

Prices in pharmacies: from 196 rubles.

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Co-Parnavel is a combined antihypertensive drug.

Release form and composition

The drug is available in the form of tablets: almost white or white, round, flat-cylindrical, with a chamfer, a dividing line is applied on one side (10, 20 or 30 pcs. In blisters, in a cardboard box 1, 2, 3, 4, 5 or 10 packs; 10, 20, 30, 40, 50 or 100 pieces each in polyethylene terephthalate, or polypropylene cans, sealed with PP / PE screw caps with first opening control / push-turn system or pull-on caps made of polyethylene with first opening control, in a cardboard box of 1 can. Each box also contains instructions for the use of Co-Parnawel).

1 tablet contains:

• active ingredients: indapamide - 0.625 mg + perindopril (in the form of perindopril erbumine) - 2 mg or indapamide - 1.25 mg + perindopril (in the form of perindopril erbumine) - 4 mg;
• auxiliary components: microcrystalline cellulose, lactose monohydrate (milk sugar), povidone-K25, corn starch, magnesium stearate.

Pharmacological properties

Pharmacodynamics

Co-Parnavel is a combined antihypertensive drug, the pharmacological properties of which are due to the synergism of the combined use of active ingredients - indapamide and perindopril.

Indapamide is a thiazide-like diuretic, belongs to the group of sulfonamides, its pharmacological properties are close to thiazide diuretics. The mechanism of action of indapamide is associated with inhibition of sodium reabsorption in the cortical segment of the renal tubules, which increases the excretion of sodium, chlorine and, to a lesser extent, magnesium and potassium by the kidneys, increases diuresis and lowers blood pressure (BP). The antihypertensive effect is due to an improvement in the elasticity of large arteries, a decrease in total peripheral vascular resistance (OPSR), and a decrease in left ventricular hypertrophy. In monotherapy, doses of indapamide, which have a minimal diuretic effect, allow maintaining the hypotensive effect for 24 hours. An increase in the dose of a thiazide-like diuretic does not affect the degree of lowering blood pressure, but causes an increase in the risk of developing adverse events. Indapamide does not affect carbohydrate metabolism and lipid metabolism - high density lipoprotein cholesterol (HDL) and low density lipoprotein (LDL), total cholesterol, triglycerides.

Perindopril is an angiotensin-converting enzyme (ACE) inhibitor. Against the background of inhibition of ACE activity, there is a decrease in the formation of angiotensin II, a hormone that has a vasoconstrictor effect and causes the destruction of bradykinin to an inactive heptapeptide. As a result, the secretion of aldosterone is blocked, the activity of renin in the blood plasma increases, with prolonged use of perindopril, its effect on the vessels in the kidneys and muscles causes a decrease in OPSS. The therapeutic effect of Co-Parnawel, associated with the action of the active metabolite, perindoprilat, is not accompanied by the development of reflex tachycardia or fluid and salt retention. While taking perindopril, the work of the heart is normalized due to varicose veins (decrease in preload) and a decrease in systemic vascular resistance (decrease in afterload). Its vasodilating action,helps to restore the structure of the vascular wall of small arteries and the elasticity of large vessels, reduces left ventricular hypertrophy.

The use of perindopril in chronic heart failure reduces filling pressure in the left and right ventricles of the heart and systemic vascular resistance, increases cardiac output and increases cardiac index, increases peripheral blood flow in the muscles.

Perindopril is indicated for the treatment of hypertension of any severity in patients with low and normal renin activity in the blood plasma.

After a single dose, the antihypertensive effect is achieved in 4-6 hours and lasts for 24 hours, followed by a pronounced (about 80%) residual ACE inhibition.

Co-Parnavel has a dose-dependent antihypertensive effect in the "standing" and "lying" position, both on systolic (upper) and diastolic (lower) blood pressure, which persists for 24 hours. The clinical effect usually occurs less than 30 days after the start of drug use and is not accompanied by tachycardia. Discontinuation of treatment in patients does not cause withdrawal.

When combined with thiazide diuretics, the antihypertensive effect of Co-Parnawel is enhanced.

Pharmacokinetics

The combined use of indapamide and perindopril does not change the pharmacokinetic parameters characteristic of monotherapy with these drugs.

Perindopril

After taking Co-Parnavel inside, the absorption of perindopril in the gastrointestinal tract (gastrointestinal tract) occurs quickly. Its maximum concentration (C _max) in blood plasma is reached within 1 hour. The active substance does not possess pharmacokinetic activity. 27% of the dose of perindopril taken orally in the form of perindoprilat, the main active metabolite, C _{max of} which is reached 3-4 hours after ingestion, enters the bloodstream. The other 5 metabolites of perindopril have no pharmacological activity. Concomitant food intake reduces its bioavailability, so perindopril should be taken 1 time per day, on an empty stomach.

The relationship between the concentration of perindopril in blood plasma and its dose is linear.

The binding of perindoprilat to blood plasma proteins is less than 20%, mainly to ACE. The volume of distribution of free perindoprilat is 0.2 l / kg.

Perindopril is excreted through the kidneys. The half-life (T _1/2) of the free fraction is approximately 17 hours. In this regard, it takes 4 days to reach an equilibrium concentration of a substance in plasma.

With heart and renal failure, as well as in elderly patients, the excretion of perindopril is slowed down.

The dialysis clearance of perindopril is 70 ml / min.

With cirrhosis of the liver, correction of the dosage regimen is not required, since a 2-fold decrease in hepatic clearance of perindopril does not affect the total amount of perindoprilat formed.

Indapamide

After oral administration, indapamide is absorbed from the gastrointestinal tract quickly and completely. Its C _max in blood plasma is reached after 1 hour.

The binding of indapamide to blood plasma proteins is 79% of the dose taken. T _1/2 averages 18 hours. Upon repeated administration, the substance does not accumulate. It is excreted in the form of inactive metabolites through the kidneys - 70%, by the intestines about 22%.

In renal failure, the pharmacokinetics of indapamide does not change.

Indications for use

The use of Co-Parnawel is indicated for patients with essential hypertension requiring combination therapy.

Contraindications

Absolute:

• severe renal failure [creatinine clearance (CC) less than 30 ml / min], including patients on hemodialysis;
• bilateral stenosis of the renal arteries, stenosis of the artery of the only functioning kidney;
• severe liver dysfunction, hepatic encephalopathy;
• simultaneous use with aliskiren in patients with diabetes mellitus or impaired renal function (CC less than 60 ml / min);
• a history of indications of angioedema (Quincke's edema) due to the action of an ACE inhibitor;
• hereditary or idiopathic angioedema;
• hypokalemia;
• combination with drugs that can cause arrhythmias like "pirouette" or lengthen the QT interval, potassium and lithium preparations, potassium-sparing diuretics;
• high plasma potassium;
• lactose intolerance, glucose-galactose malabsorption syndrome, lactase deficiency;
• untreated heart failure in the stage of decompensation;
• period of pregnancy;
• breast-feeding;
• age up to 18 years;
• hypersensitivity to ACE inhibitors or sulfonamide derivatives;
• individual intolerance to the components of the drug.

With caution, Co-Parnavel tablets should be prescribed in case of reduced circulating blood volume (BCC) due to adherence to a diet with limited salt, prolonged vomiting, diarrhea and / or previous diuretic therapy, with renovascular hypertension, coronary heart disease, chronic heart failure IV functional class according to the NYNA (New York Heart Association) classification, aortic valve stenosis, hypertrophic obstructive cardiomyopathy (GOKMP), cerebrovascular pathologies (including cerebrovascular insufficiency), systemic connective tissue diseases (including systemic lupus erythematosus, scleroderma), diabetes mellitus, renal disease (CC 30-60 ml / min), condition after kidney transplantation,hemodialysis using high-flow polyacrylonitrile membranes, inhibition of bone marrow hematopoiesis, hyperuricemia (especially in patients with gout or urate nephrolithiasis), concomitant use of immunosuppressants or desensitizing therapy, BP lability, before the apheresis procedure with LDL, for the treatment of general anesthetic surgery elderly patients or patients of the black race.for the treatment of elderly patients or patients of the Negroid race.for the treatment of elderly patients or patients of the Negroid race.

Co-Parnavel, instructions for use: method and dosage

Co-Parnavel tablets are taken orally, without chewing, with a sufficient amount of liquid, preferably before breakfast (on an empty stomach) once a day.

The dose is selected individually, taking into account the clinical condition of the patient and the tolerability of the treatment.

The recommended daily dosage for the ratio of indapamide + perindopril: initial dose - 1 pc. at a dose of 0.625 mg + 2 mg. If, after 30 days of therapy, it is not possible to achieve adequate blood pressure control, you should switch to taking the drug at a dose of 1.25 mg + 4 mg - 1 pc. in a day.

If you accidentally skip the next dose, the use of Co-Parnival should be continued in the usual dosing regimen.

For elderly patients with normal renal function, dose adjustment is not required.

In case of moderate severity of renal failure (CC 30–60 ml / min), treatment of essential hypertension, which requires the combined use of indapamide and perindopril, is recommended to start with dosage forms of drugs intended for monotherapy.

In case of impaired renal function (CC 60 ml / min or more), dose adjustment is not required.

Treatment should be accompanied by regular monitoring of serum creatinine and potassium concentrations.

With moderate hepatic dysfunction, dose adjustment of Co-Parnawel is not required.

Side effects

The frequency of side effects, determined according to the recommendations of the WHO (World Health Organization) [> 0.1 - very often; 0.01–0.1 - often; 0.001–0.01 - infrequently; 0.0001-0.001 - rarely; <0.0001 - extremely rare (including individual messages); with an unspecified frequency - the frequency cannot be calculated from the available data]:

• on the part of the lymphatic and circulatory systems: extremely rarely - leukopenia, neutropenia, thrombocytopenia, agranulocytosis, hemolytic anemia, aplastic anemia; patients after kidney transplantation or hemodialysis session may develop anemia;
• on the part of the cardiovascular system: infrequently - a marked decrease in blood pressure (including orthostatic hypotension); extremely rare - heart rhythm disturbance, including bradycardia, atrial fibrillation, ventricular tachycardia, angina pectoris, myocardial infarction; with an unknown frequency - arrhythmia of the "pirouette" type, including with a lethal outcome;
• from the central nervous system: often - headache, dizziness, paresthesia, vertigo; infrequently - mood lability, sleep disturbance; extremely rarely - confusion of consciousness; with an unknown frequency - fainting;
• from the digestive system: often - decreased appetite, dryness of the mucous membrane of the mouth, impaired taste, abdominal pain, nausea, vomiting, constipation, diarrhea, epigastric pain, dyspepsia; extremely rarely - angioedema of the intestine, pancreatitis, cholestatic jaundice; with an unknown frequency - hepatic encephalopathy in liver failure;
• from the respiratory system, chest and mediastinal organs: often - dry cough, shortness of breath; infrequently - bronchospasm; extremely rare - rhinitis, eosinophilic pneumonia;
• from the organ of hearing: often - tinnitus;
• on the part of the organ of vision: often - visual impairment;
• dermatological reactions: often - itchy skin, rash, maculopapular rash; infrequently - urticaria, angioedema of the lips, tongue, face, vocal folds and / or larynx, hemorrhagic vasculitis, hypersensitivity reactions in the presence of a predisposition to allergic and asthmatic reactions, with an acute course of systemic lupus erythematosus, an exacerbation of the disease is possible; extremely rarely - erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, photosensitivity reactions;
• from the urinary system: infrequently - renal failure; extremely rare - acute renal failure;
• from the reproductive system: infrequently - impotence;
• on the part of the musculoskeletal system and connective tissue: often - muscle spasms;
• laboratory parameters: rarely - hypercalcemia; with an unknown frequency - an increase in the QT interval on electrocardiography (ECG), an increase in the level of uric acid and glucose in the blood, hyperkalemia (usually transient), hypokalemia (more significant in patients at risk), hyponatremia or hypovolemia (including those causing dehydration and orthostatic hypotension), an increase in the activity of hepatic transaminases, a slight increase in the level of creatinine in the urine and blood plasma (more often with renal artery stenosis, renal failure, or during treatment of hypertension with diuretics);
• general disorders: infrequently - hyperhidrosis.

Overdose

• symptoms of an overdose of Co-Parnawel: drowsiness, a significant decrease in blood pressure, dizziness, nausea, vomiting, confusion, muscle cramps, a decrease in BCC, causing oliguria or anuria, possibly a decrease in the level of sodium and potassium in the blood plasma;
• treatment: it is required to immediately wash the stomach and / or induce vomiting, and then give the patient activated charcoal. With a pronounced decrease in blood pressure, the patient should be laid on his back, legs raised to an elevation. After hospitalization, the appointment of procedures aimed at restoring water and electrolyte balance is shown. If it is necessary to increase the BCC, intravenous administration of 0.9% sodium chloride solution is performed. For excretion of perindoprilat from the body, dialysis may be prescribed.

special instructions

When prescribing Co-Parnawela, studies should be carried out to assess the state of the patient's renal function and the content of potassium and sodium in the blood plasma. Regular monitoring of plasma electrolytes is required during the entire period of treatment.

Treatment of patients with renal artery stenosis should be initiated in a hospital setting.

If signs of acute renal failure appear during therapy with a combined antihypertensive agent, treatment should be discontinued. It is recommended to resume therapy in this category of patients with low doses of Co-Parnawel or with monotherapy with perindopril and indapamide, accompanying treatment with regular monitoring of potassium and creatinine in serum.

The appearance of arterial hypotension is not a reason for discontinuation of therapy; after restoration of the BCC and blood pressure, treatment can be resumed.

Patients with connective tissue diseases who are simultaneously taking immunosuppressive drugs, procainamide or allopurinol, especially with impaired renal function, are at risk of developing severe infections that are not amenable to intensive antibacterial therapy. Therefore, their treatment is recommended to be accompanied by periodic monitoring of the number of leukocytes in the blood. Patients should also be informed about the need for immediate medical attention at the first signs of an infectious disease (fever, sore throat).

If symptoms of angioedema develop (face, lips, tongue, larynx and / or uvula of the upper palate), the drug should be stopped immediately and, if necessary, the patient should be prescribed antihistamine therapy. It should be borne in mind that if there is a history of Quincke's edema, which is not associated with the intake of ACE inhibitors, the risk of its development may be increased when taking Co-Parnawel. In addition, when making a differential diagnosis of abdominal pain in patients taking ACE inhibitors, it is recommended to take into account the possible development of angioedema of the intestine, for confirmation of which an ultrasound or computed tomography of the abdominal cavity is required.

During the period of immunotherapy with hymenoptera venom, it is not recommended to take Co-Parnavel, therefore ACE inhibitors should be canceled no later than 24 hours before the desensitization procedure.

To avoid the development of life-threatening anaphylactoid reactions, therapy with an ACE inhibitor should be discontinued before each procedure of LDL apheresis using high-flow membranes.

High-flow polyacrylonitrile membranes are not recommended for hemodialysis while taking Co-Parnawel.

It should be borne in mind that the appearance of a dry cough in a patient in some cases may be due to the intake of an ACE inhibitor. The decision on the possibility of continuing therapy must be made by the doctor individually.

Blockade of the RAAS (renin-angiotensin-aldosterone system) caused by taking an ACE inhibitor can lead to a sharp decrease in blood pressure and / or an increase in the concentration of creatinine in the blood plasma. Similar consequences of RAAS activation are more often observed after taking the first dose or during the first 14 days of drug therapy in patients with such pathological conditions as severe hypovolemia, decreased plasma electrolytes, renal artery stenosis, chronic heart failure, liver cirrhosis with edema and ascites, initially low blood pressure. Sometimes arterial hypotension and / or renal failure develop acutely. It is recommended to resume therapy in these cases with a lower dose of the combination of perindopril and indapamide.

For elderly patients, the initial dose should be selected taking into account the individual degree of blood pressure reduction, especially in chronic heart failure of functional class IV according to the NYHA classification or a decrease in BCC. This will avoid a sharp drop in blood pressure.

With ischemic heart disease and cerebrovascular insufficiency, the risk of developing arterial hypotension is increased. Accordingly, to this category of patients, Co-Parnavel should be used with extreme caution, starting with a dose of 0.625 mg + 2 mg.

In chronic heart failure of the IV functional class according to the NYHA classification and diabetes mellitus type 1, treatment should be started under close medical supervision.

In black patients, ACE inhibitors have a less pronounced antihypertensive effect.

With a significant increase in the activity of liver enzymes or the appearance of jaundice, Co-Parnawel should be discontinued.

The use of a thiazide-like diuretic in patients with impaired liver function can cause the development of hepatic encephalopathy. In this case, therapy should be stopped immediately.

During the treatment period with Co-Parnavel, it is necessary to avoid exposure to direct sunlight and artificial ultraviolet rays on exposed skin.

In emaciated patients or in old age, with cirrhosis of the liver, the presence of peripheral edema, ascites, ischemic heart disease, chronic heart failure, an increased QT interval on the ECG, taking the drug increases the risk of hypokalemia. It should be borne in mind that as a result of the appearance of hypokalemia in this category of patients, there may be an increase in the likelihood of arrhythmia and an increase in the toxic effect of cardiac glycosides. Therefore, during the first seven days from the beginning of the course, it is necessary to determine the potassium content in the blood plasma and then regularly repeat the test.

Before examining the function of the parathyroid glands, taking Co-Parnawel must be canceled.

It is important for athletes to take into account that during doping control against the background of treatment with a combined antihypertensive agent, it is possible to obtain a false positive reaction.

Influence on the ability to drive vehicles and complex mechanisms

During the period of taking Co-Parnawel, patients are advised to be careful when driving or working with devices that require increased attention and high speed of psychomotor reactions.

Application during pregnancy and lactation

The use of Co-Parnival is contraindicated during the period of gestation and breastfeeding.

When planning pregnancy, a woman should switch to another antihypertensive therapy.

If conception occurred during the period of therapy with ACE inhibitors, the newborns should be under close medical supervision for the development of arterial hypotension.

Pediatric use

The efficacy and safety of the use of Co-Parnavel in children and adolescents has not been established, therefore, it is contraindicated to prescribe the drug to patients under 18 years of age.

With impaired renal function

The appointment of Co-Parnawel is contraindicated in patients with severe renal insufficiency (CC less than 30 ml / min), including patients on hemodialysis, with bilateral renal artery stenosis, artery stenosis of the only functioning kidney.

The drug should be used with caution in renal failure (CC 30-60 ml / min), hemodialysis using high-flow polyacrylonitrile membranes, in the period after kidney transplantation.

In case of impaired renal function (CC 60 ml / min or more), dose adjustment of Co-Parnawel is not required.

For violations of liver function

The appointment of Co-Parnavela is contraindicated in case of severe liver dysfunction, hepatic encephalopathy.

With moderate liver dysfunction, dose adjustment is not required.

Use in the elderly

Co-Parnavel should be used with caution in old age, with normal renal function, dose adjustment is not required.

Drug interactions

• lithium preparations: the use of lithium preparations against the background of ACE inhibitors can cause the development of toxic effects due to a reversible increase in the concentration of lithium in the blood plasma. The additional presence of a thiazide-like diuretic contributes to the aggravation of these processes. Therefore, the combination of lithium preparations with a combination of indapamide and perindopril is not recommended. If necessary, their joint appointment requires regular monitoring of the level of lithium in the blood plasma;
• baclofen: increased antihypertensive effect and the need to reduce the dose of Co-Parnawel may cause its combination with baclofen; blood pressure and renal function should be monitored;
• non-steroidal anti-inflammatory drugs (NSAIDs), non-selective NSAIDs, acetylsalicylic acid at a dose of more than 3 g per day, cyclooxygenase-2 (COX-2) inhibitors: concomitant therapy with these drugs can reduce the hypotensive effect of Co-Parnavel It should be borne in mind that ACE inhibitors in combination with NSAIDs increase the risk of deterioration of renal function, up to the development of acute renal failure and an increase in serum potassium, especially with reduced renal function. These combinations require caution, especially when administered to elderly patients, it is necessary to monitor renal function (at the beginning of joint use and periodically during therapy) and compensate for fluid loss;
• tricyclic antidepressants, antipsychotics (antipsychotics): against the background of taking drugs of these classes, an additive effect occurs, the antihypertensive effect increases and the likelihood of orthostatic hypotension increases;
• tetracosactide, glucocorticosteroids: help to reduce the antihypertensive effect due to fluid and sodium ion retention under the influence of corticosteroids;
• other antihypertensive drugs: the additional use of other drugs for the treatment of hypertension enhances the antihypertensive effect;
• aliskiren: taking aliskiren in patients with diabetes mellitus or with impaired renal function (CC less than 60 ml / min) increases the risk of deteriorating renal function and the incidence of cardiovascular pathologies (including fatal outcomes), and the development of hyperkalemia. All other patients may also have these disorders;
• potassium-sparing diuretics (eplerenone, triamterene, amiloride, spironolactone), potassium preparations, potassium-containing substitutes for table salt: care should be taken when combining the drug with these agents due to the fact that they contribute to a significant increase in serum potassium levels, the development of cardiac arrhythmias, including fatal ones. If it is necessary to prescribe this combination to patients with confirmed hypokalemia, treatment should be carried out under regular monitoring of the concentration of potassium in the blood plasma and ECG parameters;
• immunosuppressants (including cyclosporin, tacrolimus), heparin, trimethoprim: the combination of these drugs with ACE inhibitors increases the risk of hyperkalemia;
• sulfonylurea derivatives, insulin: in patients with diabetes mellitus, the hypoglycemic effect of sulfonylurea or insulin derivatives may increase;
• angiotensin II receptor antagonists (ARA II): in patients with diabetes mellitus with target organ damage, atherosclerotic disease or heart failure, when combined with ARA II, a double blockade of the RAAS occurs, which causes a higher incidence of hyperkalemia, arterial hypotension, and deterioration of renal function (up to acute renal failure), fainting. If it is impossible to avoid this combination, treatment should be carried out under close monitoring of blood pressure, renal function and potassium content in blood plasma;
• estramustine: increases the risk of angioedema and other side effects;
• linagliptin, saxagliptin, sitagliptin, vildagliptin: taking gliptins inhibits the activity of dipeptidyl peptidase IV, which can cause the development of angioedema;
• allopurinol, cytostatics, immunosuppressive agents, procainamide, glucocorticosteroids for systemic use: the combination of Co-Parnavel with these agents is accompanied by an increased risk of leukopenia;
• means for general anesthesia: help to enhance the antihypertensive effect of Co-Parnawel. Therefore, with a planned surgical operation, the anesthesiologist should be warned about the treatment with perindopril, the ACE inhibitor should be stopped 12 hours before the start of general anesthesia;
• thiazide and loop diuretics: concomitant therapy with high doses of diuretics can lead to arterial hypotension;
• gold preparations: the infusion of sodium aurothiomalate can cause flushing of the skin of the face, arterial hypotension, nausea, vomiting in patients;
• drugs that can cause pirouette-type arrhythmias: special care should be taken when combined with antiarrhythmic drugs (disopyramide, amiodarone, quinidine, hydroquinidine, dofetilide, ibutilide, sotalol, bretilium tosylate), antipsychotics (levomepromazine, thioridazine, cyclamlorpromazine), pimozide, benzamides (sultopride, tiapride, amisulpride, sulpiride), droperidol, haloperidol, bepridil, cisapride, diphemanil methyl sulfate, erythromycin (intravenous), mizolastine, moxifloxacin, pentamidinum, asthomopharmaceutical terfenadine and other drugs that cause arrhythmias such as "pirouette". It is necessary to control the QT interval and prevent the development of hypokalemia;
• amphotericin B (intravenous), glucocorticosteroids and mineralocorticosteroids for systemic use, laxatives that stimulate gastrointestinal motility, tetracosactide: combination with the listed drugs may cause hypokalemia;
• cardiac glycosides: it is necessary to monitor the ECG parameters and the concentration of potassium in the blood plasma in patients on concomitant therapy with cardiac glycosides, in order to timely correct the dosage regimen;
• metformin: the risk of developing lactic acid lactic acidosis increases when combined with metformin. You can not use metformin in men with a plasma creatinine concentration above 15 mg / l, in women - 12 mg / l;
• iodine-containing contrast agents: before using iodine-containing contrast agents, especially in high doses, to reduce the risk of developing acute renal failure, it is necessary to compensate for the BCC;
• cyclosporine: with normal fluid and sodium ions, the combination with cyclosporine can cause an increase in plasma creatinine concentration, the circulating cyclosporine content does not change.

Analogs

The analogues of Co-Parnavela are Indapamide / Perindopril-Teva, Perindopril-Indapamid Richter, Co-Perineva, Co-prenessa, Noliprel, Noliprel A Bi-forte, Noliprel forte, Perindapam, Perindid, Perindopril PLUS Indapamide, etc.

Terms and conditions of storage

Keep out of the reach of children.

Store at temperatures up to 25 ° C in a dark place.

The shelf life is 3 years.

Terms of dispensing from pharmacies

Dispensed by prescription.

Reviews about Co-Parnawel

Patients leave mostly positive reviews about Co-Parnawel. They note that it is especially effective when the simultaneous administration of two antihypertensive drugs is required: it quickly normalizes blood pressure, improves the general condition and quality of life. The advantages of the drug, along with the effectiveness, also include the ease of administration and affordable cost.

The price of Co-Parnavel in pharmacies

The price of Co-Parnavel for a package containing 30 tablets at a dose of 0.625 mg + 2 mg can range from 436 rubles, at a dose of 1.25 mg + 4 mg - from 520 rubles.

Co-Parnavel: prices in online pharmacies

Drug name Price Pharmacy

Co-Parnavel 1.25 mg + 4 mg tablets 30 pcs. 196 r Buy

Co-Parnavel 1.25 mg + 4 mg tablets combi-pack 1 + 1 30 pcs. RUB 380 Buy

Co-Parnavel 0.625 mg + 2 mg tablets combipack 1 + 1 30 pcs. 399 RUB Buy

Maria Kulkes Medical journalist About the author

Education: First Moscow State Medical University named after I. M. Sechenov, specialty "General Medicine".

Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!