Ko-Perineva - Instructions For The Use Of Tablets, Price, Reviews, Analogues

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

Ko-Perineva

Ko-Perineva: 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-Perineva

ATX code: C09BA04

Active ingredient: indapamide + perindopril (indapamide + perindopril)

Producer: KRKA (Slovenia), KRKA-RUS, LLC (Russia)

Description and photo update: 2018-25-10

Prices in pharmacies: from 280 rubles.

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Ko-Perineva is a combined drug with a vasodilator, diuretic, hypotensive effect, used in the treatment of essential hypertension.

Release form and composition

Ko-Perineva is produced in the form of tablets: biconvex, round, almost white or white; 0.625 mg + 2 mg - a short line is engraved on one side; 1.25 mg + 4 mg - with a line on one side and with a chamfer; 2.5 mg + 8 mg - with a line on one side (in a cardboard box 3, 6 or 9 blisters, 10 pcs. In each).

Active ingredients in 1 tablet:

• indapamide - 0.625; 1.25 or 2.5 mg;
• erbumine perindopril - 2, 4 or 8 mg (semi-finished granules of erbumine perindopril K - 37.515; 75.03 or 150.06 mg).

Additional components (0.625 mg + 2 mg / 1.25 mg + 4 mg / 2.5 mg + 8 mg):

• semi-finished product granules: calcium chloride hexahydrate - 0.6 / 1.2 / 2.4 mg; crospovidone - 4/8/16 mg; lactose monohydrate - 30.915 / 61.83 / 123.66 mg;
• tablets: magnesium stearate - 0.225 / 0.45 / 0.9 mg; microcrystalline cellulose - 11.25 / 22.5 / 45 mg; colloidal silicon dioxide - 0.135 / 0.27 / 0.54 mg; sodium bicarbonate - 0.25 / 0.5 / 1 mg.

Pharmacological properties

Pharmacodynamics

Co-Perineva is one of the combined drugs with antihypertensive, diuretic and vasodilating effects. It contains perindopril, an ACE (angiotensin converting enzyme) inhibitor, and indapamide, a thiazide-like diuretic.

As a result of the use of the drug, the development of a pronounced antihypertensive effect is observed, which has a dose-dependent nature and is not accompanied by reflex tachycardia. The action of Ko-Perineva does not depend on the position of the patient's body and his age. The metabolism of lipids [total cholesterol, LDL (low density lipoprotein), VLDL (very low density lipoprotein), HDL (high density lipoprotein), carbohydrates and TG (triglycerides)] does not affect, including in patients with diabetes. Reduces the likelihood of hypokalemia caused by diuretic monotherapy.

The antihypertensive effect lasts for 24 hours.

While taking Ko-Perineva, a stable decrease in blood pressure (blood pressure) is achieved within 1 month without an increase in heart rate (heart rate). Discontinuation of the drug does not lead to withdrawal symptoms.

Perindopril

The mechanism of action of perindopril is associated with inhibition of ACE activity, as a result of which the formation of angiotensin II decreases and the secretion of aldosterone decreases. Does not cause sodium and fluid retention, reflex tachycardia (with a long course). The development of an antihypertensive effect is observed in patients with low / normal blood plasma renin activity.

The main metabolite of perindopril, showing activity, is perindoprilat, the rest of the metabolites are inactive.

Due to the expansion of veins and a decrease in OPSS (total peripheral vascular resistance), the pre- and afterload on the heart decreases.

In heart failure, perindopril has the following effects:

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

Perindopril has an effect in all forms of arterial hypertension. The development of the maximum antihypertensive effect is observed 4-6 hours after a single oral administration, its duration is 24 hours.

Due to its vasodilating properties, the substance helps to restore the elasticity of large arteries. In combination with a thiazide-like diuretic, an increase (additive synergism) of the antihypertensive effect of perindopril is observed.

Indapamide

Indapamide is a diuretic (sulfonamide derivative). It inhibits the reabsorption of sodium in the cortical segment of the renal tubules, which leads to an increase in the excretion of chlorine and sodium by the kidneys, and, as a result, to an increase in diuresis, to a lesser extent increases the excretion of magnesium and potassium.

Due to the ability to selectively block slow calcium channels, indapamide reduces systemic vascular resistance and increases the elasticity of the arterial walls. Has a hypotensive effect in doses that do not have a pronounced diuretic effect. With an increase in the dose, the antihypertensive effect does not increase, while the likelihood of adverse reactions increases.

In patients with arterial hypertension, including patients with diabetes mellitus, indapamide does not affect the metabolism of lipids and carbohydrates.

Pharmacokinetics

The pharmacokinetic parameters of the active components do not change with combined use in comparison with monotherapy.

Perindopril

After oral administration, perindopril is rapidly absorbed from the gastrointestinal tract. Its bioavailability is within 65-70%. The conversion of perindopril to perindoprilat is reduced by food intake. T _1/2 (half-life) from blood plasma - 60 minutes.

Cmax (maximum concentration of the substance) in blood plasma is reached 3-4 hours after ingestion. Perindopril should be taken in the morning before breakfast, once a day. If this dosing regimen is observed, the equilibrium concentration is reached within 4 days.

Perindopril is metabolized in the liver to form one active metabolite (perindoprilat) and five inactive metabolites.

The binding of perindoprilat to blood plasma proteins is dose-dependent and amounts to 20%. Perindoprilat easily passes through the histohematogenous barriers, excluding the blood-brain barrier, in a small amount penetrates into breast milk and through the placenta. The substance is excreted by the kidneys, T _1/2 - about 17 hours. Does not cumulate.

Excretion of perindoprilat is slowed down in elderly patients, patients with heart and renal failure

In renal failure, it is recommended to use reduced doses of the drug (based on the severity). The dialysis clearance of perindoprilat is 70 ml / min.

The kinetics of perindopril in liver cirrhosis changes (hepatic clearance decreases by 2 times). In this case, the total amount of perindoprilat formed does not change, so there is no need for dose adjustment.

Indapamide

Indapamide is almost completely and rapidly absorbed in the gastrointestinal tract. Due to the intake of food, there is a slight slowdown in absorption, but this does not significantly affect the amount of indapamide absorbed. The time to reach Cmax in blood plasma after ingestion of a single dose is 60 minutes. The binding of the substance to blood plasma proteins is 79%. T _1/2 is in the range 14-24 hours (average 18 hours). Does not cumulate.

Metabolism takes place in the liver. Most of the dose (70%) is excreted by the kidneys, mainly in the form of metabolites (the fraction of the unchanged drug is about 5%), about 22% is excreted in the intestines with bile (inactive metabolites). The pharmacokinetic parameters of indapamide in patients with renal insufficiency do not change significantly.

Indications for use

According to the instructions, Ko-Perineva is prescribed for the treatment of essential hypertension.

Contraindications

Absolute:

• severe renal failure with CC (creatinine clearance) <30 ml / min;
• a history of indications of angioedema (angioedema, idiopathic or hereditary) while taking other ACE inhibitors;
• refractory hyperkalemia;
• stenosis of an artery of a single kidney, bilateral stenosis of the renal arteries;
• liver failure in severe course, including in combination with encephalopathy;
• untreated decompensated heart failure (there is no sufficient experience of use);
• lactose intolerance, glucose-galactose malabsorption or lactase deficiency;
• combined use with drugs that lengthen the QT interval on the ECG, as well as drugs with antiarrhythmic action, which can cause ventricular tachycardia like a pirouette;
• dialysis (there is no sufficient experience of use);
• age up to 18 years;
• pregnancy and the period of breastfeeding;
• individual intolerance to any component of the drug.

Relative (Ko-Perineva is prescribed under medical supervision):

• systemic connective tissue diseases, including systemic lupus erythematosus, scleroderma;
• oppression of bone marrow hematopoiesis;
• combination therapy with immunosuppressants (associated with the likelihood of developing agranulocytosis and neutropenia);
• angina pectoris;
• a decrease in the volume of circulating blood (salt-free diet, taking diuretics, diarrhea, vomiting);
• renovascular hypertension;
• cerebrovascular diseases;
• diabetes;
• hyperuricemia (especially with urate nephrolithiasis and gout);
• chronic heart failure (NYHA IV functional class);
• lability of blood pressure;
• the period before the procedure of LDL apheresis;
• hemodialysis, which uses high-flow polyacrylonitrile membranes;
• condition after kidney transplantation;
• combination with desensitizing therapy with allergens (in particular, using hymenoptera venom);
• hypertrophic obstructive cardiomyopathy;
• aortic / mitral stenosis;
• elderly age.

Instructions for use of Ko-Perineva: method and dosage

Co-Perinev's tablets are taken orally, washed down with a sufficient amount of liquid, preferably in the morning before meals.

Frequency rate of admission - 1 time per day.

If possible, the use of Co-Perineva should be started with the selection of doses of drugs containing one component. In cases of clinical need, combination therapy can be prescribed immediately after monotherapy.

The initial dose is 1 tablet 0.625 mg + 2 mg once a day. If after 30 days of daily use adequate control of blood pressure is not achieved, the dose of the drug should be increased to 1.25 mg + 4 mg. The maximum daily dose is 2.5 mg + 8 mg.

For elderly patients, Ko-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 insufficiency (CC 30-60 ml / min) is 1 tablet 1.25 mg + 4 mg.

No dose adjustment is required in patients with CC ≥ 60 ml / min. During the period of use of the drug, it is necessary to regularly monitor the concentration of creatinine and serum potassium in the blood.

Side effects

Perindopril affects the RAAS (renin-angiotensin system) and, while taking indapamide, reduces the excretion of potassium ions by the kidneys. The risk of hypokalemia when using Co-Perineva is 2, 4 or 6% (when taking 0.625 mg + 2 mg, 1.25 mg + 4 mg or 2.5 mg + 8 mg, respectively).

Possible adverse reactions (> 10% - very common;> 1% and 0.1% and 0.01% and <0.1% - rarely; <0.01%, including individual messages - very rare; with an unknown frequency - in cases where it is impossible to determine the frequency of occurrence of violations from the available data):

• nervous system: often - paresthesia, vertigo, dizziness, headache; infrequently - sleep disturbances, mood lability; very rarely - confusion of consciousness;
• hematopoietic organs: very rarely - thrombocytopenia, leukopenia / neutropenia, agranulocytosis, aplastic anemia, hemolytic anemia, anemia;
• cardiovascular system: often - a marked decrease in blood pressure, including orthostatic hypotension; very rarely - arrhythmias, including atrial fibrillation, bradycardia, ventricular tachycardia, as well as myocardial infarction, angina pectoris, possibly secondary, which is associated with a decrease in blood pressure in patients belonging to the high-risk group; with an unspecified frequency - ventricular tachycardia of the pirouette type (possibly fatal);
• sense organs: often - tinnitus, visual impairment;
• digestive system: often - constipation, xerostomia, impaired taste, dyspepsia, vomiting, decreased appetite, nausea, abdominal pain and epigastric pain, diarrhea; very rarely - angioedema of the intestine, pancreatitis, jaundice; with an unknown frequency - hepatic encephalopathy (in patients with hepatic insufficiency);
• respiratory system: often - a long-lasting dry cough that disappears after the cancellation of Ko-Perineva, shortness of breath; infrequently - bronchospasm; very rarely - rhinitis, eosinophilic pneumonia;
• musculoskeletal system: often - muscle spasms;
• skin and subcutaneous fat: often - skin rash / itching, maculopapular rash; infrequently - urticaria, angioedema, spreading to the extremities, face, lips, oral mucosa, tongue, larynx and / or vocal folds; hypersensitivity reactions (mainly dermatological, in patients with a burdened history of allergic reactions); worsening of the course of systemic lupus erythematosus; very rarely - erythema multiforme, photosensitivity reactions, toxic epidermal necrolysis, Stevens-Johnson syndrome;
• reproductive system: infrequently - impotence;
• urinary system: infrequently - renal failure; very rarely - acute renal failure;
• laboratory parameters: rarely - hypercalcemia; with an unknown frequency - an increase in QT on the ECG, a slight increase in the concentration of creatinine in the blood plasma (after discontinuation of therapy, the violation disappears; in most cases it occurs against the background of stenosis of an artery of a single kidney or stenosis of the renal arteries, renal failure, arterial hypertension during treatment with diuretics), hyponatremia with hypovolemia (can lead to orthostatic hypotension and a decrease in circulating blood volume), an increase in the concentration of uric acid and glucose in the blood serum while taking the drug, an increase in the activity of liver enzymes, hypochloremia (can lead to compensatory metabolic alkalosis; the severity of the effect and the likelihood of its development assessed as low), hypokalemia (of particular importance for patientswho are at risk), hyperkalemia (often reversible);
• others: often - asthenia; infrequently - increased sweating.

According to the data of clinical studies, the adverse reactions that occur during the use of Co-Perineva correspond to the safety profile of the combination of perindopril with indapamide established earlier. In rare cases, the development of serious adverse events in the form of arterial hypotension, cough, acute renal failure, hyperkalemia and, possibly, angioedema is observed.

Overdose

The main symptoms: muscle cramps, a marked decrease in blood pressure, vomiting, nausea, dizziness, confusion, drowsiness, oliguria up to anuria (associated with a decrease in the volume of circulating blood); possible violations of the water-electrolyte balance.

Therapy: the appointment of activated carbon / gastric lavage, restoration of water-electrolyte balance in stationary conditions. Patients with a pronounced decrease in blood pressure should be transferred to the supine position and their legs raised up, after which measures are prescribed to increase the volume of circulating blood (intravenous administration of 0.9% sodium chloride solution). Perindoprilat can be eliminated from the body by dialysis.

special instructions

Transient arterial hypotension is not a contraindication for further continuation of therapy.

In some cases, without a previous impairment of renal function, while taking the drug, signs of acute renal failure develop, which requires the cancellation of Co-Perineva. In the future, it is possible to resume combination therapy using low doses or to take perindopril and indapamide as monotherapy. Patients belonging to this group need regular monitoring of the content of potassium and creatinine in the blood serum every 2 weeks from the start of the treatment course and every subsequent 2 months of taking Co-Perineva.

The development of acute renal failure is more common in patients with severe chronic heart failure or initial impairment of renal function.

With dynamic monitoring of the condition of patients, attention should be paid to a decrease in the content of electrolytes in the blood plasma and possible symptoms of dehydration (in particular, after prolonged vomiting or diarrhea). This is associated with a high risk of a sudden drop in blood pressure.

Reception of Ko-Perineva does not prevent the occurrence of hypokalemia, especially in patients with renal failure or diabetes mellitus.

Perindopril

During the treatment period, the development of neutropenia / agranulocytosis, anemia and thrombocytopenia is not excluded. Neutropenia in patients with normal renal function in the absence of other complications develops rarely, it usually goes away on its own after the withdrawal of the ACE inhibitor.

Due to the likelihood of developing severe infections that are not amenable to intensive therapy with antibacterial drugs, Co-Perineva should be prescribed with caution in patients with connective tissue diseases and simultaneously receiving immunosuppressive therapy, procainamide or allopurinol, especially against the background of existing renal dysfunction. When prescribing the drug, it is recommended to periodically monitor the number of leukocytes in the blood. In cases of the appearance of any signs of a disease of an infectious etiology (sore throat, fever), you should immediately consult a doctor.

In rare cases, while taking the drug, the development of angioedema of the lips, face, tongue, larynx and / or uvula of the upper palate may be observed, which requires immediate discontinuation of the drug. Patients should be monitored until signs of edema have completely disappeared.

If angioedema has spread only to the face and lips, the disorder in most cases goes away on its own. Antihistamines can be used for symptomatic treatment. Swelling of the larynx or tongue can lead to airway obstruction and death. When such symptoms appear, immediate subcutaneous administration of epinephrine at a dose of 0.3-0.5 ml at a dilution of 1: 1000 and / or ensuring airway patency is indicated.

If in the patient's history there are indications of Quincke's edema unrelated to the use of ACE inhibitors, the risk of its occurrence while taking Co-Perineva is increased.

On the background of therapy with ACE inhibitors, in rare cases, angioedema of the intestine develops, characterized by abdominal pain with / without nausea and vomiting, sometimes without prior angioedema of the face. The disorder is diagnosed using ultrasound / computed tomography or at the time of surgery. After discontinuation of the drug, the symptoms disappear.

The development of anaphylactoid reactions during desensitization procedures can be avoided by temporarily canceling the ACE inhibitor at least 24 hours in advance.

To prevent anaphylactoid reactions during LDL apheresis, ACE inhibitor therapy should be discontinued before each procedure.

When a dry cough occurs, a possible relationship with treatment should be considered. The question of further taking the drug is decided by the doctor individually.

Reception of Co-Perineva can cause a blockade of the RAAS, and therefore a sharp decrease in blood pressure and / or an increase in the concentration of creatinine in the blood plasma is possible, which is evidence of the onset of acute renal failure. Violation is more often observed when taking the first dose of the drug or during the first 2 weeks of therapy.

Before prescribing Ko-Perineva, elderly patients need to assess renal function and plasma potassium levels in the blood. The initial dose should be selected depending on the degree of decrease in blood pressure, which minimizes the likelihood of a sharp decrease.

With regard to the risk of arterial hypotension, the most vulnerable are patients with cerebral circulation insufficiency and coronary heart disease. Co-Perineva patients in this group should be prescribed an initial dose of 0.625 mg + 2 mg. The drug in the same initial dose is used in patients with diagnosed / suspected renal artery stenosis (in stationary conditions under the control of renal function and plasma potassium), chronic heart failure and type 1 diabetes mellitus.

Perindopril in patients of the Negroid race, in comparison with representatives of other races, has a less pronounced hypotensive effect.

The use of Ko-Perineva in patients undergoing surgery under general anesthesia can lead to a pronounced decrease in blood pressure, especially in cases of using drugs for general anesthesia with hypotensive action (the drug should be discontinued 12 hours before the operation).

When a significant increase in the activity of hepatic transaminases or jaundice appears, Co-Perineva is canceled.

In patients after kidney transplantation or in patients on hemodialysis during the period of therapy, anemia may develop.

During the use of Ko-Perineva, hyperkalemia may develop, which can cause serious cardiac arrhythmias, sometimes fatal. Risk factors include renal failure, diabetes mellitus, old age, some concomitant conditions (decreased circulating blood volume, acute heart failure in the stage of decompensation, metabolic acidosis), simultaneous use with potassium-sparing diuretics (spironolactone, eplerenone, triamterene, amiloride), potassium preparations or potassium-containing substitutes for table salt and other drugs that increase the plasma potassium content in the blood (in particular, heparin).

Indapamide

In cases of development of photosensitivity reactions during therapy, Ko-Perinev should be canceled. If it is necessary to resume therapy, open skin areas must be protected from exposure to artificial ultraviolet and sun rays.

Consideration must be given to the likelihood of hyponatremia occurring, leading to serious complications. Before starting treatment, the plasma sodium content in the blood should be determined and during the period of therapy, regular monitoring of plasma electrolytes should be carried out.

While taking the drug, there is an increased likelihood of developing hypokalemia (less than 3.4 mmol / l). The risk group includes elderly patients, malnourished patients, patients with liver cirrhosis, ascites, peripheral edema, ischemic heart disease, chronic heart failure. In these patients, hypokalemia enhances the toxic effect of cardiac glycosides and increases the risk of arrhythmia.

Also, patients with an increased QT interval on an ECG are at increased risk. Hypokalemia contributes to the development of severe cardiac arrhythmias, especially pirouette-type arrhythmias, which can be fatal. For the first time, the determination of the plasma potassium content in the blood should be carried out within the first week of using the drug.

Co-Perineva reduces the excretion of calcium by the kidneys, which leads to a temporary and insignificant increase in the calcium content in the blood plasma. Severe hypercalcemia may be associated with latent hyperparathyroidism. Before conducting a study of the function of the parathyroid glands, the drug must be canceled.

With an increased concentration of uric acid in the blood plasma, taking Co-Perineva can lead to an increase in the frequency of exacerbation of the course of gout.

Hypovolemia associated with a decrease in circulating blood volume or hyponatremia at the beginning of treatment can lead to a decrease in the glomerular filtration rate and be accompanied by an increase in the concentration of creatinine and urea in the blood plasma.

Athletes should take into account that indapamide may give a false positive reaction during doping control.

Influence on the ability to drive vehicles and complex mechanisms

Given the likelihood of an individual reaction to Ko-Perineva, patients should be careful when driving vehicles.

Application during pregnancy and lactation

It is contraindicated to take Co-Perinev tablets for women during pregnancy / breastfeeding.

Pediatric use

It is contraindicated to take Ko-Perineva to children under 18 years of age.

With impaired renal function

Prescribing Ko-Perineva in case of severe renal failure (CC <30 ml / min) is contraindicated.

For violations of liver function

It is contraindicated to prescribe Ko-Perineva in case of severe hepatic failure, including with encephalopathy.

Use in the elderly

Elderly patients should take Ko-Perineva under medical supervision.

Drug interactions

Not recommended combinations:

• lithium preparations: associated with a reversible increase in the concentration of lithium in the blood serum, which increases the risk of its toxic effect; in cases of the need for combination therapy, lithium concentration indicators should be carefully monitored;
• potassium-sparing diuretics (amiloride, spironolactone, triamterene, eplerenone): associated with a possible increase in serum potassium in the blood, up to a lethal outcome. If a combination therapy is required, regular monitoring of ECG parameters and plasma potassium levels is required.

Combinations requiring special care:

• baclofen: associated with potentiation of the hypotensive effect; control of renal function, blood pressure is required, if necessary, the dose of antihypertensive drugs is adjusted;
• nonsteroidal anti-inflammatory drugs, including acetylsalicylic acid in high doses (from 3000 mg per day): associated with a decrease in the hypotensive effect of ACE inhibitors, an increased risk of renal dysfunction, up to the development of acute renal failure, an increase in serum potassium, especially with pre-existing renal dysfunction; elderly patients need special care; before the start of treatment, it is necessary to compensate for the loss of fluid, and also regularly at the beginning / during the course of therapy, to monitor kidney function;
• insulin and hypoglycemic agents for oral administration (sulfonylurea derivatives): associated with an increase in their hypoglycemic effect (in very rare cases) in patients with diabetes mellitus; there may be an increase in glucose tolerance and a decrease in insulin requirements, which requires dose adjustment;
• drugs that can cause ventricular polymorphic tachycardia such as pirouette - antiarrhythmic drugs (amiodarone, quinidine, hydroquinidine, disopyramide, dofetilide, bretilium tosylate, ibutilide, sotalol); some antipsychotics (thioridazine, cyamemazine, chlorpromazine, levomepromazine, trifluoperazine), benzamides (sultopride, amisulpride, sulpiride, tiapride), butyrophenones (droperidol, haloperidol), other antipsychotics (pimastiliside, other drugs, bileprin cisapride, diphemanil methyl sulfate, erythromycin (intravenous), moxifloxacin, terfenadine, sparfloxacin, pentamidine, vincamine (intravenous), astemizole, methadone: associated with an increased risk of hypokalemia; combinations are recommended to be avoided,in cases of the need for combination therapy, it is necessary to monitor the potassium content in the blood serum and the QT interval on the ECG;
• cardiac glycosides: associated with increased toxicity of cardiac glycosides; in combination therapy, it is necessary to monitor the plasma potassium content in the blood, ECG indicators and, if necessary, adjust the dose of these drugs;
• drugs that can cause hypokalemia - tetracosactide, amphotericin B (intravenous), mineralo- and glucocorticoids (systemic use), laxatives that stimulate intestinal motility (use of drugs that do not affect intestinal motility, possibly): associated with an increase the risk of developing hypokalemia; when carrying out combined treatment, the content of potassium in the blood plasma should be monitored, patients receiving cardiac glycosides need special attention.

Combinations requiring caution:

• antipsychotics, tricyclic antidepressants: associated with increased hypotensive effect and increased risk of orthostatic hypotension;
• other drugs with an antihypertensive effect: associated with an increase in the antihypertensive effect;
• tetracosactide, glucocorticosteroids: associated with a decrease in the hypotensive effect;
• allopurinol, procainamide, cytostatic immunosuppressants, glucocorticosteroids (with systemic use): associated with an increased risk of leukopenia;
• high-dose diuretics (loop and thiazide): associated with the likelihood of hypovolemia, a pronounced decrease in blood pressure;
• means for general anesthesia: associated with an increase in their hypotensive effect;
• metformin: associated with an increased risk of developing lactic acidosis;
• iodine-containing contrast media: associated with an increased risk of acute renal failure, especially when using substances containing high doses of iodine; before using these drugs, you need to replenish the circulating blood volume;
• cyclosporine: associated with an increase in the plasma concentration of creatinine in the blood (the concentration of cyclosporine remains unchanged), even in the absence of dehydration and severe loss of sodium ions;
• preparations containing calcium salts: associated with the likelihood of hypercalcemia.

Analogs

The analogues of Ko-Perineva are: Indapamide / Perindopril-Teva, Co-Parnavel, Co-prenessa, Perindid, Noliprel, Perindapam, Perindopril-Indapamide.

Terms and conditions of storage

Store out of the reach of children at temperatures up to 30 ° C.

The shelf life is 3 years.

Terms of dispensing from pharmacies

Dispensed by prescription.

Reviews about Ko-Perinev

According to reviews, Ko-Perineva effectively and quickly reduces blood pressure. The drug has a long-term sustained effect. In many cases, patients note that during the period of therapy, adverse reactions of varying severity develop.

The price for Ko-Perineva in pharmacies

The approximate price for Ko-Perineva for 30 tablets per pack is:

• dosage 0.625 mg + 2 mg - 265–324 rubles;
• dosage 1.25 mg + 4 mg - 407-470 rubles;
• dosage 2.5 mg + 8 mg - 476-596 rubles.

Ko-Perineva: prices in online pharmacies

Drug name Price Pharmacy

KO-Perineva tablets 2mg + 0.625mg 30 pcs. 280 RUB Buy

Co-Perineva 0.625 mg + 2 mg tablets 30 pcs. 280 RUB Buy

Co-Perineva 1.25 mg + 4 mg tablets 30 pcs. 436 r Buy

KO-Perineva tablets 4mg + 1.25mg 30 pcs. 466 r Buy

KO-Perineva tablets 8mg + 2.5mg 30 pcs. 544 r Buy

Co-Perineva 2.5 mg + 8 mg tablets 30 pcs. 544 r Buy

Co-Perineva 1.25 mg + 4 mg tablets 90 pcs. 692 RUB Buy

Co-Perineva 2.5 mg + 8 mg tablets 90 pcs. 820 RUB Buy

KO-Perineva tablets 4mg + 1.25mg 90 pcs. RUB 968 Buy

KO-Perineva tablets 8mg + 2.5mg 90 pcs. 1139 RUB Buy

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Anna Kozlova Medical journalist About the author

Education: Rostov State Medical University, 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!