Parnavel
Parnavel: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. Use in the elderly
- 13. Drug interactions
- 14. Analogs
- 15. Terms and conditions of storage
- 16. Terms of dispensing from pharmacies
- 17. Reviews
- 18. Price in pharmacies
Latin name: Parnavel
ATX code: C09AA04
Active ingredient: Perindopril (Perindopril)
Manufacturer: Ozone, LLC (Russia)
Description and photo update: 2018-25-10
Prices in pharmacies: from 149 rubles.
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Parnavel is a drug with hypotensive, vasodilating and cardioprotective effects.
Release form and composition
Dosage forms of Parnawela release:
- capsules: solid gelatinous, size No. 2, body - dark blue, lid - gray-lilac (2 mg each), blue (4 mg each) or lilac (8 mg each); the capsules contain a white with a creamy shade or a white mixture of powder with granules or powder; it is permissible to seal the contents of the capsule, which disintegrates when pressed (7, 10 or 30 pcs. in blisters, in a cardboard box 1-10 packs);
- tablets: flat-cylindrical, white or almost white, on one side of the risk, on both sides chamfer (10 or 30 pcs. in blister strip packs, in a cardboard box 1 or 3 packs; 30, 50 or 100 pcs. in polymer containers, in a cardboard box 1 container).
Composition of 1 capsule Parnavel:
- active substance: perindopril erbumin - 2, 4 or 8 mg;
- auxiliary components (2/4/8 mg): microcrystalline cellulose - 106/104/100 mg; potato starch - 3/3/3 mg; magnesium stearate - 1/1/1 mg;
- capsule body: brilliant black dye - 0.1401%; black iron oxide dye - 0.6367%; titanium dioxide - 0.9006%; gelatin - up to 100%;
- capsule cap (2/4/8 mg): titanium dioxide - 2.2075 / 1.6367 / 1%; dye azorubin - 0.0199 / 0.038 / 0.023%; brilliant blue dye - 0.011 / 0/0%; patented blue dye - 0 / 0.0697 / 0.006%; gelatin - up to 100/100/100%.
Composition of 1 tablet Parnavel:
- active substance: perindopril erbumine - 4 mg;
- auxiliary components: lactose (milk sugar) - 66.5 mg; microcrystalline cellulose - 19 mg; magnesium stearate - 1 mg; povidone - 2.5 mg; corn starch - 7 mg.
Pharmacological properties
Pharmacodynamics
Perindopril belongs to oxopeptidases and is an ACE (angiotensin converting enzyme) inhibitor, or kininase II. Converts angiotensin I into a vasoconstrictor angiotensin II, promotes the destruction of the vasodilator bradykinin to an inactive heptapeptide. Due to the suppression of ACE activity, there is a decrease in the level of angiotensin II and the secretion of aldosterone, an increase in renin activity in the blood plasma and the activity of the circulating and tissue kallikrein-kinin system, as well as the activation of the prostaglandin system.
The therapeutic effect of perindopril is due to the properties of the active metabolite of perindoprilat.
The main properties of perindopril:
- decrease in systolic and diastolic blood pressure (BP) while standing and lying;
- acceleration of peripheral blood flow with constant heart rate (heart rate);
- decrease in OPSS (total peripheral vascular resistance), which leads to a decrease in blood pressure;
- increased renal blood flow while the glomerular filtration rate remains unchanged;
- reduction of left ventricular myocardial hypertrophy;
- an increase in the concentration of HDL (high density lipoprotein);
- improving the elasticity of large arteries, eliminating structural changes in small arteries;
- decrease in pre- and afterload, which helps to normalize the work of the heart;
- decrease in the severity of interstitial fibrosis, normalization of the isoenzyme profile of myosin (with prolonged use);
- a decrease in the concentration of uric acid (against the background of hyperuricemia).
The development of the maximum antihypertensive effect is observed 4–6 hours after a single oral administration; the duration of the therapeutic effect is 24 hours, at the end of this period Parnavel still provides 87-100% of the maximum effect.
Perindopril has a rapid antihypertensive effect. Stabilization is usually observed after 30 days of daily intake and persists for a long time. Discontinuation of Parnawel does not lead to withdrawal symptoms.
In chronic heart failure (CHF), therapy helps to reduce the systemic vascular resistance and filling pressure in both ventricles and increase the cardiac index and cardiac output.
Pharmacokinetics
After oral administration, perindopril is rapidly absorbed from the gastrointestinal tract, the time to reach maximum plasma concentrations in the blood is 60 minutes.
Bioavailability is within 65-70%.
20% of the substance in the process of metabolism is transformed into perindoprilat. T 1/2 (half-life) of perindopril from blood plasma - about 60 minutes. The time to reach the maximum plasma concentrations of perindoprilat is 3-4 hours.
When Parnawel is taken with food, there is a decrease in the conversion of perindopril to perindoprilat, which leads to a decrease in the bioavailability of the drug.
The volume of distribution of free perindoprilat is 0.2 l / kg. It binds to blood plasma proteins slightly, the connection to ACE is less than 30% (varies depending on its concentration).
The metabolite is excreted by the kidneys. T 1/2 of the free fraction is approximately 3-5 hours. Dissociation associated with ACE perindoprilat is slow. As a consequence, the effective T 1/2 is 25 hours.
Does not cumulate. With repeated administration of T 1/2 perindoprilat corresponds to the period of its activity.
A slowdown in the excretion of perindoprilat is observed in elderly patients, as well as against the background of renal and chronic heart failure. Perindoprilat is removed during hemodialysis (at a rate of 0.07 l / min) and peritoneal dialysis.
A change in the hepatic clearance of perindopril in patients with liver cirrhosis does not lead to a change in the total amount of perindoprilat formed, and therefore patients from this group do not need dose adjustment.
Indications for use
- arterial hypertension;
- chronic heart failure;
- stable coronary artery disease (ischemic heart disease):
- prevention of the development of repeated stroke (in combination with indapamide) against a background of a burdened history of cerebrovascular diseases (transient cerebral ischemic attack or stroke);
- reducing the likelihood of cardiovascular complications in patients who have previously had myocardial infarction and / or coronary revascularization.
Contraindications
Absolute:
- lactose intolerance, glucose-galactose malabsorption syndrome or lactase deficiency;
- a history of angioedema (hereditary, idiopathic, or angioedema associated with ACE inhibitor therapy);
- pregnancy and lactation;
- age up to 18 years;
- individual intolerance to any component of the drug, as well as other ACE inhibitors.
Relative (Parnavel is prescribed under medical supervision due to the risk of anaphylactoid reactions, neutropenia, agranulocytosis, severe arterial hypotension, renal failure, hemolytic anemia, excessive decrease in blood pressure or due to lack of experience in use):
- renovascular hypertension;
- stenosis of an artery of a single kidney;
- bilateral renal artery stenosis;
- arterial hypotension;
- CHF in the stage of decompensation or CHF IV functional class according to NYHA classification;
- chronic renal failure with CC (creatinine clearance) up to 60 ml / min;
- cerebrovascular diseases, including cerebral circulation insufficiency, coronary artery disease (coronary heart disease), coronary insufficiency;
- hyponatremia / hypovolemia associated with dialysis, vomiting / diarrhea, adherence to a salt-free diet and / or previous diuretic therapy;
- GOKMP (hypertrophic obstructive cardiomyopathy);
- aortic / mitral stenosis;
- condition after kidney transplantation;
- hemodialysis using high-flow polyacrylonitrile membranes, in particular AN69;
- the period before the procedure for apheresis of LDL (low density lipoprotein);
- connective tissue diseases, including SLE (systemic lupus erythematosus) and scleroderma;
- simultaneous desensitizing treatment with allergens, including hymenoptera venom;
- congenital deficiency of glucose-6-phosphate dehydrogenase;
- inhibition of bone marrow hematopoiesis while taking immunosuppressants, allopurinol or procainamide;
- surgical interventions under general anesthesia;
- belonging to the Negroid race;
- hyperkalemia;
- diabetes mellitus (therapy should be carried out under the control of the concentration of glucose in the blood);
- combination therapy with potassium-sparing diuretics, lithium, potassium preparations, concomitant use of potassium-containing salt substitutes;
- elderly age.
Instructions for use of Parnawel: method and dosage
Parnavel is taken orally without chewing, preferably in the morning before meals.
Frequency rate of application - 1 time per day.
The dosage regimen is determined by the nature and severity of the disease, as well as the individual response to the therapy.
Arterial hypertension
The recommended starting dose is 4 mg. Parnavel can be used as monotherapy or in combination with other antihypertensive drugs.
With pronounced activation of the renin-angiotensin-aldosterone system (in particular, against the background of hyponatremia / hypovolemia, renovascular hypertension, severe arterial hypertension or CHF in the stage of decompensation), it is recommended to start therapy with 2 mg per day in one dose. If the desired therapeutic effect was not achieved within a month, with good tolerance, the daily dose can be increased to 8 mg.
The addition of ACE inhibitors in patients taking diuretics can cause the development of arterial hypotension (therapy requires caution; it is recommended to discontinue the diuretic 2-3 days before starting the drug, or start treatment with Parnavel at an initial daily dose of 2 mg). Monitoring of blood pressure, serum potassium and renal function is required. Further dose adjustment is determined by the dynamics of blood pressure. If necessary, diuretic therapy can be resumed.
The recommended daily dose at the beginning of use for elderly patients is 2 mg. Provided it is well tolerated, it can be further increased to 4 mg, if necessary - up to 8 mg (maximum).
Chronic heart failure
Parnavel is prescribed at an initial dose of 2 mg per day (under medical supervision). After 14 days, under the control of blood pressure, the dose can be doubled. Usually, with CHF with clinical manifestations, therapy is carried out in combination with potassium-sparing diuretics, digoxin and / or beta-blockers.
In CHF with renal failure and with a tendency to develop water-electrolyte disturbances (hyponatremia), as well as in patients taking diuretics and / or vasodilators at the same time, Parnavel therapy should be started under strict medical supervision.
In the case of a high risk of clinically pronounced arterial hypotension (in particular, against the background of taking high doses of diuretics), hypovolemia and disturbances in water and electrolyte balance should be eliminated, if possible, before starting therapy.
Prevention of recurrent stroke in patients with a history of cerebrovascular disease
It is recommended to take Parnavel 2 mg per day for 14 days before taking indapamide. After a stroke, treatment can be started at any time (from 14 days to several years).
Stable ischemic heart disease
The recommended starting daily dose is 4 mg. After 14 days, the dose can be doubled, provided that renal function is controlled and well tolerated.
Elderly patients Parnavel is prescribed 2 mg per day. After 7 days, the daily dose can first be increased to 4 mg, then, subject to an assessment of renal function and good tolerability of therapy, up to 8 mg.
Side effects
Possible adverse reactions (> 10% - very common;> 1% and 0.1% and 0.01% and <0.1% - rarely; <0.01%, including isolated messages - very rare):
- lymphatic system and hematopoietic organs: very rarely (with prolonged use in high doses) - a decrease in hematocrit and hemoglobin, thrombocytopenia, agranulocytosis, leukopenia / neutropenia, pancytopenia; very rarely (against the background of a congenital deficiency of glucose-6-phosphate dehydrogenase) - hemolytic anemia;
- digestive system: often - vomiting, nausea, abdominal pain, dysgeusia, diarrhea, dyspepsia, constipation; infrequently - xerostomia; rarely - pancreatitis; very rarely - cholestatic / cytolytic hepatitis, angioedema of the intestine;
- nervous system: often - dizziness, headache, paresthesia; infrequently - mood or sleep disorders; very rarely - confusion of consciousness;
- cardiovascular system: often - a significant decrease in blood pressure; very rarely - arrhythmias, angina pectoris, stroke or myocardial infarction (possibly secondary); with an indefinite frequency - vasculitis;
- musculoskeletal system: often - muscle cramps;
- sense organs: often - tinnitus, visual impairment;
- respiratory organs: often - shortness of breath, cough; infrequently - bronchospasm; very rarely - rhinitis, eosinophilic pneumonia;
- skin: often - skin rash, itching; infrequently - angioedema, urticaria; very rarely - erythema multiforme;
- genitourinary system: impotence; very rarely - renal failure in acute course;
- laboratory parameters: increased concentration of urea in blood serum and creatinine in blood plasma, hyperkalemia; rarely - hypoglycemia, increased activity of hepatic transaminases and serum bilirubin;
- others: often - asthenia; infrequently - increased sweating.
Overdose
The main symptoms: cough, dizziness, bradycardia, marked decrease in blood pressure, stupor, shock, imbalance in water and electrolyte balance, renal failure, tachycardia, hyperventilation, anxiety, palpitations.
Therapy:
- emergency measures: removal of Parnawel from the body, for which gastric lavage and / or the intake of activated charcoal is indicated, then it is necessary to ensure the restoration of the water-electrolyte balance;
- a pronounced decrease in blood pressure: the patient should take a horizontal position with raised legs, after which measures are taken to replenish the BCC (circulating blood volume);
- severe bradycardia, not amenable to drug therapy (including atropine): setting an artificial pacemaker; monitoring of vital functions and concentration of electrolytes / creatinine in blood serum is required.
Perindoprilat can be removed from the systemic circulation by hemodialysis. The use of high flow polyacrylonitrile membranes should be avoided.
special instructions
If an episode of unstable angina (significant or not) develops during the first month of therapy, it is necessary to assess the benefit / risk ratio of further use of Parnawel.
Taking the drug can cause a sharp decrease in blood pressure. Symptomatic arterial hypotension in rare cases can be observed after taking the first dose in patients with uncomplicated arterial hypertension. The presence of an increased risk of its development is noted in the following diseases / conditions: reduced BCC during diuretic therapy, adherence to a strict salt-free diet, hemodialysis, diarrhea / vomiting, severe renin-dependent arterial hypertension.
The most common development of severe arterial hypotension is observed in patients with more severe CHF, taking high doses of loop diuretics, as well as against the background of renal failure or hyponatremia. Careful medical supervision should be established for the condition of such patients. The same warnings apply to patients with coronary artery disease or cerebrovascular diseases, since an excessive decrease in blood pressure in this group of patients can cause myocardial infarction or the development of cerebrovascular complications.
With transient arterial hypotension, therapy should not be canceled. Treatment can be continued after the restoration of the BCC and blood pressure, while it is necessary to carefully select the dose of Parnawel. In some cases, with CHF and normal / low blood pressure during therapy, an additional hypotensive effect may be observed. It is expected and is usually not a reason for discontinuation of the drug. If arterial hypotension is accompanied by clinical manifestations, a dose reduction or complete cancellation of Parnawel may be required.
The arterial hypotension developing in the initial period of therapy in patients with symptomatic heart failure can cause deterioration of renal function. There is evidence of cases of acute renal failure, usually reversible. It is also possible to increase serum concentrations of creatinine and urea (after discontinuation of therapy, the indicators return to normal).
With renovascular hypertension, while taking Parnival, the risk of renal failure and severe arterial hypotension increases. In this regard, the drug should be prescribed with small doses under close medical supervision.
In rare cases, during the use of Parnawel, the development of angioedema is noted. When this violation occurs, the following measures are shown (depending on the location):
- lips, face: therapy is usually not required; antihistamines may be prescribed to reduce the severity of symptoms;
- tongue, vocal folds, larynx: edema can be fatal and, if it develops, requires immediate subcutaneous epinephrine administration and airway management.
The disorder can develop at any time during treatment. More often Parnavel causes angioedema in patients of the Negroid race. A high probability of development is noted in patients with a burdened history.
Due to the risk of an anaphylactic reaction during desensitization (in particular, with the use of hymenoptera venom), it is recommended to cancel the drug before each procedure.
If jaundice appears or the activity of liver enzymes increases, Parnavel is immediately canceled. The patient's condition should be monitored. An appropriate examination is also required.
In the absence of impaired renal function and other complications, the development of neutropenia is noted only in rare cases. Patients with the following diseases / conditions (in isolation or a combination thereof, especially in the presence of existing disorders of renal function) need careful use: systemic connective tissue diseases (SLE, scleroderma), therapy with allopurinol, procainamide, immunosuppressants. During the use of Parnavel, patients with the above risk factors are advised to periodically monitor the number of leukocytes in the blood. If any signs of infection develop, see your doctor.
Against the background of congenital deficiency of glucose-6-phosphate dehydrogenase, isolated cases of hemolytic anemia were observed.
When carrying out the differential diagnosis of persistent, unproductive cough, it should be borne in mind that Parnawel's reception can lead to its development.
The drug should be discontinued 24 hours before surgery. To reduce arterial hypotension, if it is impossible to cancel Parnavel, an increase in BCC is shown.
In patients with decompensated diabetes mellitus, renal and / or heart failure, as well as in patients undergoing therapy with potassium-sparing diuretics, potassium preparations or other drugs that cause an increase in potassium in the blood, there is an increased risk of hyperkalemia.
Against the background of hypoglycemic therapy, patients with diabetes mellitus must carefully monitor the blood glucose concentration for the first few months of taking Parnawel.
Influence on the ability to drive vehicles and complex mechanisms
Due to the likelihood of dizziness and arterial hypotension, patients should be careful when driving vehicles during the period of therapy.
Application during pregnancy and lactation
According to the instructions, Parnavel is not prescribed to women during pregnancy / lactation.
When planning / diagnosing pregnancy, therapy should be canceled as early as possible, replacing Parnavel with another drug with an antihypertensive effect.
In cases of taking the drug in the II-III trimesters of pregnancy, an ultrasound examination of the bones, skull and kidneys of the fetus is required.
Pediatric use
Parnavel is not prescribed to patients under 18 years of age (its effectiveness and safety for patients of this age group have not been established).
With impaired renal function
Parnavel with QC up to 60 ml / min should be administered with caution.
Use in the elderly
Conducting therapy in elderly patients requires caution.
Drug interactions
Possible interactions:
- diuretics, especially with excessive excretion of fluid and / or sodium: severe arterial hypotension is possible; the risk of its development with the abolition of diuretics decreases; also to reduce the risk, a 0.9% sodium chloride solution is injected intravenously, while Parnavel should be taken in a reduced dose (in the future, it must be increased with caution);
- lithium preparations: a reversible increase in the serum lithium content and lithium toxicity is possible; when combined with thiazide diuretics, an increase in the content of lithium in the blood serum may additionally be observed and the risk of developing its toxic effects may increase; the combination of drugs is not recommended, if a combination therapy is required, regular monitoring of the lithium content in the blood serum is required;
- potassium supplements, potassium-sparing diuretics, foods / food supplements containing potassium: possible hyperkalemia; the combination is not recommended; with hypokalemia, combined use is possible with the observance of precautions and with regular monitoring of serum potassium in the blood;
- non-steroidal anti-inflammatory drugs: the antihypertensive effect of Parnawel may be weakened; due to the additive effect of drugs on an increase in serum potassium in the blood, renal function may deteriorate (it is reversible); in rare cases, acute renal failure may occur;
- hypoglycemic agents: it is possible to increase their action up to hypoglycemia (most often observed in patients with renal failure);
- other drugs with an antihypertensive effect, agents for general anesthesia, vasodilators, tricyclic antidepressants, general anesthetics, antipsychotics: an increase in the hypotensive effect is possible;
- myelotoxic drugs: it is possible to increase the myelotoxic effect;
- sympathomimetics: it is possible to weaken the antihypertensive effect (periodically it is required to evaluate the effectiveness of therapy).
Analogs
Parnawel's analogues are: Pyristar, Perineva, Prestarium, Prenessa, Perindopril, KOVEREKS, Stopress, Arentopres.
Terms and conditions of storage
Store in a place protected from light and moisture at temperatures up to 25 ° C. Keep out of the reach of children.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Parnavel
According to reviews, Parnavel is an inexpensive and effective drug used mainly to lower blood pressure. In some cases, a lack of therapeutic effect is noted, as well as the development of side reactions (in the form of dry cough and dry mouth).
Price for Parnavel in pharmacies
The approximate price for Parnavel (30 4 mg tablets) is 284-370 rubles.
Parnavel: prices in online pharmacies
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Drug name Price Pharmacy |
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Parnavel 4 mg capsules 30 pcs. 149 r Buy |
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Parnavel 4 mg tablets 30 pcs. RUB 180 Buy |
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Parnavel 8 mg capsules 30 pcs. 201 RUB Buy |
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Parnavel 4 mg capsules combi-pack 1 + 1 30 pcs. 263 r Buy |
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Parnavel 8 mg capsules combi-pack 1 + 1 30 pcs. 305 RUB Buy |
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Parnavel Amlo 10 mg + 4 mg tablets 30 pcs. 330 RUB Buy |
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Parnavel Amlo 5 mg + 8 mg tablets combi-pack 1 + 1 30 pcs. 330 RUB Buy |
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Parnavel Amlo 10 mg + 4 mg tablets combi-pack 1 + 1 30 pcs. 578 r Buy |
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Parnavel Amlo 5 mg + 4 mg tablets 30 pcs. RUB 625 Buy |
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Parnavel Amlo 5 mg + 4 mg tablets combi-pack 1 + 1 30 pcs. RUB 625 Buy |
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Parnavel Amlo 5 mg + 8 mg tablets 30 pcs. RUB 679 Buy |
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Parnavel Amlo 10 mg + 8 mg tablets combi-pack 1 + 1 30 pcs. 789 r 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!
