Perindopril-Teva - Instructions For Use, Price, Reviews, 5 And 10 Mg, Analogues

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

Perindopril-Teva

Perindopril-Teva: 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: Perindopril-Teva

ATX code: C09AA04

Active ingredient: perindopril (Perindoprilum)

Manufacturer: TEVA Pharmaceutical Works Privat Ltd. Co. (TEVA Pharmaceutical Works Private Ltd. Co.) (Hungary)

Description and photo update: 2019-18-11

Prices in pharmacies: from 273 rubles.

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Perindopril-Teva is an angiotensin-converting enzyme (ACE) inhibitor.

Release form and composition

Dosage form of Perindopril-Teva - film-coated tablets:

• dosage 2.5 mg: biconvex, round, white, with an engraving "T" on one side; the tablet core is almost white or white in cross section;
• dosage 5 mg: biconvex, oval, light green, engraved with "T" on one side, with a decorative line along the edge of the tablet on both sides; the tablet core is almost white or white in cross section;
• dosage 10 mg: biconvex, round, green, engraved with "T" on one side and "10" on the other side; the tablet core is almost white or white in cross section.

In a cardboard box 1 polypropylene container containing 30 tablets, and instructions for the use of Perindopril-Teva.

Composition of 1 tablet:

• active substance: perindopril tosylate - 2.5 / 5/10 mg;
• auxiliary components: magnesium stearate - 0.45 / 0.9 / 1.8 mg; povidone-K30 - 0.9 / 1.8 / 3.6 mg; pregelatinized corn starch - 3.6 / 7.2 / 14.4 mg; sodium bicarbonate - 0.793 / 1.586 / 3.172 mg; corn starch - 1.35 / 2.7 / 5.4 mg; lactose monohydrate - 35.981 / 71.962 / 143.924 mg;
• film shell: tablets with a dosage of 2.5 mg - opadray II white 85F18422 [talc - 0.333 mg; macrogol-3350 - 0.454 5 mg; partially hydrolyzed polyvinyl alcohol - 0.9 mg; titanium dioxide (E171) - 0.562 5 mg]; tablets with a dosage of 5 mg - opadray II green 85F210014 [dye quinoline yellow (E104) - 0.004 5 mg; dye iron oxide yellow (E172) - 0.004 5 mg; dye brilliant blue (E133) - 0.008 1 mg; indigo carmine (E132) - 0.014 4 mg; talc - 0.666 mg; macrogol-3350 - 0.909 mg; titanium dioxide (E171) - 1.093 5 mg; partially hydrolyzed polyvinyl alcohol - 1.8 mg]; tablets with a dosage of 10 mg - opadray II green 85F210013 [quinoline yellow dye (E 104) - 0.018 mg; dye iron oxide yellow (E172) - 0.018 mg; brilliant blue dye (E133) - 0.031 5 mg; indigo carmine (E132) - 0.049 5 mg; talc - 1.332 mg;macrogol-3350 - 1.818 mg; titanium dioxide (E171) - 2.133 mg; partially hydrolyzed polyvinyl alcohol - 3.6 mg].

Pharmacological properties

Pharmacodynamics

Perindopril is an ACE inhibitor. ACE, or kininase, is an exopeptidase that converts angiotensin I to angiotensin II (a vasoconstrictor) and degrades vasodilating bradykinin to an inactive heptapeptide.

By suppressing the activity of ACE, the content of angiotensin II in the blood plasma decreases. Due to this, the secretion of aldosterone decreases and the activity of renin in the blood plasma increases due to the inhibition of negative feedback, which prevents its release. Since ACE inactivates bradykinin, its suppression is accompanied by an increase in the activity of the kallikrein-kinin system (circulating and tissue) with concomitant activation of the prostaglandin system. Presumably, this effect is part of the mechanism of the antihypertensive action of ACE inhibitors and the mechanism of development of some side effects of drugs in this group (for example, cough).

Due to its active metabolite (perindoprilat), perindopril has a therapeutic effect. The rest of the metabolites of the drug in vitro have no inhibitory effect on ACE.

In patients with arterial hypertension (AH), the use of perindopril leads to a decrease in systolic and diastolic blood pressure (BP) in the standing and lying position. The drug reduces the total peripheral vascular resistance, which lowers blood pressure. In this case, the peripheral blood flow is accelerated without an increase in the heart rate, and the renal blood flow is increased without changes from the side of the glomerular filtration rate.

After 4-6 hours after a single oral administration of Perindopril-Teva, the maximum antihypertensive effect is achieved. It persists for 24 hours, after which the substance still provides 87-100% of the maximum effect.

After taking perindopril, blood pressure decreases rather quickly. The stabilization of the antihypertensive effect is noted after 1 month from the start of treatment and persists for a long period. With the termination of therapy, the development of a withdrawal syndrome is not observed.

The drug reduces left ventricular hypertrophy, helps restore the structure of the vascular wall of small arteries and the elasticity of large arteries, has a vasodilator effect. The combined use of Perindopril-Tev with diuretics leads to an increase in the antihypertensive effect and a decrease in the likelihood of hypokalemia while taking the latter.

By reducing preload and afterload, perindopril normalizes heart function. In patients with chronic heart failure (CHF) who received perindopril, there was an increase in the cardiac index, an increase in cardiac output, a decrease in total peripheral vascular resistance, and a decrease in filling pressure in the left and right ventricles of the heart.

The use of perindopril tert-butylamine in a daily dose of 2 to 4 mg (corresponds to a dose of 2.5 to 5 mg of perindopril tosylate or perindopril arginine) both in monotherapy and in combination with indapamide, simultaneously with standard therapy for hypertension and / or stroke or other pathologies is significantly reduces the risk of recurrent hemorrhagic and ischemic stroke in the presence of a history of cerebrovascular pathologies (transient ischemic attack, stroke).

Additionally, the likelihood of severe cognitive impairment, dementia associated with stroke, major cardiovascular complications, including myocardial infarction (including fatal), fatal or disabling strokes, is reduced. These therapeutic benefits were noted in both hypertension and normal blood pressure, regardless of the patient's gender and age, type of stroke, and the presence or absence of diabetes mellitus.

The use of perindopril tert-butylamine at a dose of 8 mg (equivalent to taking 10 mg of perindopril arginine or perindopril tosylate) in patients with stable coronary artery disease (CHD) without signs of heart failure, with a history of coronary revascularization and myocardial infarction, with combined use of a beta-blocker, lipid-lowering drugs and antiplatelet agents significantly reduces the absolute risk of the primary endpoint (cardiac arrest followed by successful resuscitation, myocardial infarction without fatal outcome and / or cardiovascular death).

Pharmacokinetics

After oral administration, Perindopril is rapidly absorbed in the gastrointestinal tract and reaches its maximum plasma concentration within 1 hour. Its bioavailability ranges from 65 to 70%.

Part of the substance (20%) in the process of metabolism is transformed into an active metabolite - perindoprilat. The half-life of perindopril from the blood plasma is 1 hour. The maximum plasma concentration of perindoprilat is reached after 3-4 hours.

Taking the drug simultaneously with food is accompanied by a decrease in the conversion of perindopril to perindoprilat, and accordingly, its bioavailability also decreases. The volume of distribution of free perindoprilat is 0.2 l per 1 kg. The connection with blood plasma proteins is insignificant, the connection of the active metabolite with ACE does not exceed 30%, but depends on its concentration.

Excretion of perindoprilat is carried out by the kidneys. The half-life of the free fraction varies from 3 to 5 hours. Dissociation of the active metabolite associated with ACE is slow. As a result, the effective half-life is 25 hours.

Perindoprilat does not accumulate. Its half-life with repeated administration corresponds to the period of its activity. With CHF, renal failure and in elderly patients, its excretion is slowed down.

The substance is removed by peritoneal dialysis and hemodialysis (rate 70 ml per 1 min, 1.17 ml per 1 sec).

With cirrhosis of the liver, the hepatic clearance of perindopril changes, but the total amount of perindoprilat formed does not change, and therefore no correction of the dosage regimen is required.

Indications for use

• CHF;
• AG;
• prevention of recurrent stroke (in combination with indapamide) in the presence of a history of cerebrovascular pathologies (transient cerebral ischemic attack or stroke);
• stable coronary artery disease (to reduce the likelihood of developing cardiovascular complications in patients who have previously undergone coronary revascularization and / or myocardial infarction).

Contraindications

Absolute:

• a history of angioneurotic edema (hereditary, idiopathic, or developed as a result of taking ACE inhibitors);
• hereditary lactose intolerance, lactase deficiency or malabsorption syndrome;
• combination therapy with aliskiren and drugs containing aliskiren in patients with impaired renal function (glomerular filtration rate <60 ml per minute per 1.73 m ²) or diabetes mellitus;
• pregnancy;
• period of breastfeeding;
• children under the age of 18;
• individual intolerance to the components of the drug and other ACE inhibitors.

Relative (Perindopril-Teva tablets are used under medical supervision):

• bilateral renal artery stenosis;
• stenosis of an artery of a single kidney (due to the likelihood of severe arterial hypotension and renal failure);
• CHF in the stage of decompensation;
• chronic renal failure [creatinine clearance (CC) <60 ml in 1 min];
• the period after kidney transplantation (due to the lack of experience in the clinical use of Perindopril-Teva);
• hypovolemia and hyponatremia due to diarrhea, vomiting, dialysis, adherence to a salt-free diet and / or previous treatment with diuretics;
• renovascular hypertension;
• arterial hypotension;
• cerebrovascular pathologies, including ischemic heart disease, cerebrovascular accident, coronary insufficiency (due to the risk of excessive decrease in blood pressure);
• mitral or aortic valve stenosis;
• hypertrophic obstructive cardiomyopathy;
• hemodialysis using high-flow polyacrylonitrile membranes (to avoid the appearance of anaphylactoid reactions);
• low density lipoprotein apheresis (before the procedure);
• simultaneous desensitizing treatment with allergens (for example, hymenoptera venom, since there is a risk of developing anaphylactoid reactions);
• connective tissue pathologies, including scleroderma, systemic lupus erythematosus;
• inhibition of bone marrow hematopoiesis while taking procainamide, allopurinol or immunosuppressants (there is a possibility of neutropenia and agranulocytosis);
• congenital deficiency of glucose-6-phosphate hydrogenase (there are isolated reports of the development of hemolytic anemia);
• hyperkalemia;
• surgical intervention (general anesthesia; due to the likelihood of developing an excessive decrease in blood pressure);
• diabetes mellitus (it is recommended to control blood glucose);
• belonging to the Negroid race;
• elderly age.

Perindopril-Teva, instructions for use: method and dosage

Perindopril-Teva tablets are taken orally, without chewing, before meals, preferably in the morning. It is recommended to take the drug once a day.

The dosage of the drug is set on an individual basis, depending on the severity of the pathology and the patient's individual response to therapy.

Perindopril-Teva in hypertension can be used both in monotherapy and in combination with other antihypertensive drugs. The initial dose is 5 mg per day, in the morning.

With pronounced activation of the renin-angiotensin-aldosterone system (for example, with severe hypertension, CHF in the stage of decompensation, hyponatremia and / or hypovolemia, renovascular hypertension), the recommended initial dose is 2.5 mg per day in one dose. In cases of ineffectiveness of treatment for 1 month, the dose can be increased 4 times (Perindopril-Teva 10 mg per day in one dose), provided that the previous dose is well tolerated.

It should be borne in mind that the addition of ACE inhibitors to patients receiving diuretics may cause arterial hypotension. In this regard, therapy is recommended with caution, 2–3 days before its start, diuretics should be discontinued or Perindopril-Tev should be taken with 2.5 mg per day in one dose. In this case, it is necessary to control the content of potassium in the blood serum, renal function and blood pressure. Depending on the dynamics of blood pressure in the future, the dose of the drug may be increased. If necessary, the diuretic can be resumed.

The recommended starting daily dose for elderly patients is 2.5 mg. In the future, provided that a lower dose is well tolerated, it can be gradually increased by 2 times (up to 5 mg per day), and, if necessary, 4 times (up to the maximum, that is, up to 10 mg per day in one dose).

For patients with CHF, Perindopril-Teva is prescribed at an initial dose of 2.5 mg per day at one time, in the morning, under medical supervision. After 14 days, under the control of blood pressure, the dose can be increased by 2 times (up to 5 mg per day at a time). Treatment of symptomatic pathology is usually accompanied by the use of digoxin, beta-blockers and / or potassium-sparing diuretics.

Conditions / diseases in which the medicinal product is used under strict medical supervision:

• CHF;
• renal failure;
• hyponatremia (tendency to water electrolyte disturbances);
• combined therapy with vasodilators and / or diuretics.

With a high likelihood of clinically pronounced arterial hypotension (for example, against the background of the use of diuretics in high doses), before taking Perindopril-Tev, water-electrolyte disturbances and hypovolemia should be eliminated, if possible. It is important to monitor blood pressure, serum potassium and renal function before and during treatment.

In order to prevent recurrent stroke in patients with a history of cerebrovascular diseases, the drug is taken at a dose of 2.5 mg per day in one dose for the first 14 days before using indapamide. Therapy can be started at any time (from 14 days to several years) after a stroke.

In case of stable coronary artery disease, start taking with a dose of Perindopril-Teva 5 mg once a day. With good tolerance of this dose, after 14 days, it is increased by 2 times (up to 10 mg per day at one time) under the control of renal function.

Therapy in elderly patients begins with a dose of 2.5 mg per day in one dose. After 7 days, it can be increased by 2 times (up to 5 mg per day at one time). If necessary, after another 7 days, the dose can be increased to 10 mg per day in one dose, while preliminary monitoring of renal function is mandatory. The dose of the drug in elderly patients can be increased only if the previous, lower dose is well tolerated.

The recommended dosage regimen in patients with renal insufficiency, depending on the CC, is:

• CC ≥ 60 ml in 1 min: 5 mg daily daily;
• CC> 30 and <60 ml in 1 min: 2.5 mg per day daily;
• CC> 15 and <30 ml per minute: 2.5 mg per day every other day;
• CC <15, stay on hemodialysis (dialysis clearance of perindoprilat - 70 ml per minute): 2.5 mg on the day of dialysis.

Perindopril-Teva should be taken after a dialysis session.

Correction of the dosage regimen for liver pathologies is not carried out.

In cases where the next dose is missed (in the amount of one or more tablets), the next dose is taken in the usual dose. Do not exceed the recommended dose.

Side effects

Possible adverse reactions (> 10% - very common;> 1% and 0.1% and 0.01% and <0.1% - rarely; <0.01%, including individual messages, - very rare; in cases, when, according to available data, the frequency of occurrence of adverse reactions cannot be calculated, - with an unknown frequency):

• central and peripheral nervous system: often - vertigo, paresthesia, dizziness, headache; infrequently - fainting, drowsiness, sleep or mood disturbances; very rarely - confusion of consciousness;
• cardiovascular system: often - a marked decrease in blood pressure; infrequently - palpitations, tachycardia; very rarely - stroke, myocardial infarction, angina pectoris or arrhythmias, possibly secondary, due to severe arterial hypotension in high-risk patients; with an unknown frequency - vasculitis;
• respiratory organs: often - shortness of breath, cough; infrequently - bronchospasm; very rarely - rhinitis, eosinophilic pneumonia;
• digestive tract: often - diarrhea, nausea, constipation, abdominal pain, vomiting, dyspepsia, dysgeusia; infrequently - dryness of the oral mucosa; rarely - pancreatitis; very rarely - angioedema of the intestine, hepatitis (cholestatic or cytolytic);
• skin: often - itching, rash; infrequently - urticaria, pemphigus, photosensitivity, angioedema of the tongue, larynx and / or vocal cords, mucous membranes, upper and lower limbs, face; very rarely - erythema multiforme;
• musculoskeletal system: often - muscle cramps; infrequently - myalgia, arthralgia;
• genitourinary system: infrequently - impotence, renal failure; very rarely - acute renal failure;
• organ of vision: often - visual impairment;
• organ of hearing: often - tinnitus;
• organs of hematopoiesis and lymphatic system: very rarely (with prolonged use in high doses) - a decrease in hemoglobin and hematocrit, the occurrence of pancytopenia, agranulocytosis, neutropenia, leukopenia, thrombocytopenia; very rarely - hemolytic anemia with congenital deficiency of glucose-6-phosphate dehydrogenase;
• general disorders: often - asthenia; infrequently - increased sweating;
• laboratory parameters: an increase in the content of plasma creatinine and urea in the blood serum, as well as hyperkalemia, reversible after discontinuation of treatment (especially against the background of renovascular hypertension, severe CHF and renal failure); rarely - hypoglycemia, an increase in the activity of bilirubin and hepatic enzymes in the blood serum.

Overdose

The main symptoms: a marked decrease in blood pressure, cough, anxiety, dizziness, palpitations, tachycardia, stupor, hyperventilation, renal failure, bradycardia, shock, imbalance in water and electrolyte balance (hyponatremia, hyperkalemia).

Therapy: emergency measures are reduced to removing the drug from the body - they wash the stomach and / or prescribe the intake of activated carbon, followed by the restoration of the water-electrolyte balance. In cases of a pronounced decrease in blood pressure, the patient is given a horizontal position with raised legs and measures are taken to replenish the volume of circulating blood. With the appearance of severe bradycardia, not amenable to drug therapy, including therapy with atropine, an artificial pacemaker is indicated. It is important to monitor serum creatinine / electrolyte concentrations and vital functions. The active metabolite of the drug can be removed from the systemic circulation by hemodialysis. It is recommended to avoid the use of high flow polyacrylonitrile membranes.

special instructions

In cases of development of an episode of unstable angina pectoris (significant or not) during the first month of taking Perindopril-Tev, an assessment of the benefit / risk ratio of therapy is performed.

Taking ACE inhibitors can lead to a sharp decrease in blood pressure. Symptomatic arterial hypotension in uncomplicated hypertension after taking the first dose of the drug is rare. The likelihood of an excessive decrease in blood pressure is increased in patients with a reduced volume of circulating blood against the background of the use of diuretics, hemodialysis, with vomiting and diarrhea, severe renin-dependent hypertension, adherence to a strict salt-free diet.

In patients with CHF, severe arterial hypotension was observed both with concomitant renal failure and in its absence. Most often, severe arterial hypotension occurs in patients with more severe CHF receiving high doses of loop diuretics, as well as in renal failure or hyponatremia. These patients are advised to be under close medical supervision at the beginning of treatment and when titrating the doses of the drug. The same applies to patients with coronary artery disease or cerebrovascular pathologies, in whom an excessive decrease in blood pressure can lead to cerebrovascular complications or myocardial infarction.

With the development of arterial hypotension, the patient should be given a horizontal position with raised legs; if it is necessary to increase the volume of circulating blood, 0.9% sodium chloride solution should be administered intravenously.

The development of transient arterial hypotension is not a contraindication for further treatment. Therapy, provided that the dose of Perindopril-Teva is carefully selected, can be continued after the restoration of circulating blood volume and blood pressure.

During the period of taking the pills, some patients with low blood pressure or CHF may experience an additional decrease in blood pressure. This effect is expected and in most cases is not a reason for discontinuation of the drug. If hypertension is accompanied by clinical symptoms, it may be necessary to reduce the dose of the drug or cancel it.

The initial dose of Perindopril-Teva in renal failure (CC <60 ml per 1 min) is selected in accordance with CC, and then depending on the therapeutic effect. In such cases, the concentration of creatinine and the content of potassium in the blood serum are regularly monitored.

Against the background of symptomatic heart failure, hypertension, which develops in the initial period of the use of ACE inhibitors, can worsen renal function. In such patients, acute renal failure is sometimes recorded, usually reversible.

Therapy with ACE inhibitors for bilateral renal artery stenosis or stenosis of a solitary kidney artery (especially in the presence of renal failure) led to an increase in serum concentrations of urea and creatinine, which was reversible after its withdrawal.

The use of ACE inhibitors in renovascular hypertension may increase the risk of severe hypertension and renal failure. The use of the drug in such patients should begin with low doses under close medical supervision and subject to further adequate dose selection.

During the first weeks of taking Perindopril-Tev, it is necessary to discontinue diuretics and regularly monitor kidney function.

In some patients with hypertension with previously undetected renal failure, especially with the concomitant use of diuretics, there was a slight and temporary increase in the concentration of creatinine and urea in the blood serum. In such cases, reduce the dose of the drug and / or discontinue diuretic therapy.

There are reports of persistent, life-threatening anaphylactic reactions in patients undergoing hemodialysis using high-flow membranes and simultaneously receiving ACE inhibitors. In this category of patients, it is important to use a different type of membranes if hemodialysis is necessary.

There is no experience of using Perindopril-Teva after a recent kidney transplant.

In rare cases, while taking ACE inhibitors, including perindopril, the development of angioedema of the larynx, vocal folds, tongue, lips, face and / or extremities was noted. This condition can appear at any time during therapy. If it occurs, the drug should be immediately canceled, and the patient should be under medical supervision until the symptoms disappear completely. Angioedema of the face and lips usually does not require therapy; antihistamines may be prescribed to reduce the severity of manifestations. Angioedema of the larynx, vocal folds, or tongue can be fatal. With its development, adrenaline (epinephrine) is immediately administered subcutaneously and airway is ensured. Patients with a history of angioedema not associated with the use of ACE inhibitors,may be at a higher likelihood of developing edema when taken.

The use of ACE inhibitors in low-density lipoprotein apheresis with dextran sulfate in rare cases leads to an anaphylactic reaction. It is recommended to temporarily stop using the drug before each apheresis procedure.

In very rare cases, taking ACE inhibitors during the course of desensitization (for example, hymenoptera venom) leads to the appearance of life-threatening anaphylactic reactions. Before each desensitization procedure, ACE inhibitors are temporarily discontinued.

Sometimes during the period of treatment with ACE inhibitors, a syndrome may develop that begins with cholestatic jaundice and then progresses to fulminant necrosis of the liver, sometimes with a fatal outcome. The mechanism of this syndrome has not been established. The appearance of jaundice or an increase in the activity of liver enzymes during therapy is the reason for the immediate cancellation of Perindopril-Teva. In this case, the patient should be under close supervision. It is also important to conduct an appropriate survey.

Against the background of treatment with ACE inhibitors, the patients had the appearance of anemia, thrombocytopenia, agranulocytosis and neutropenia. In rare cases, patients with normal renal function in the absence of other complications develop neutropenia. Perindopril-Teva should be prescribed with very great care for systemic connective tissue pathologies (for example, scleroderma, systemic lupus erythematosus) against the background of combined immunosuppressive treatment, procainamide or allopurinol, as well as when all of the above factors are combined, especially in patients with an existing disorder kidney function. In such cases, severe infections can develop that do not respond to intensive antibiotic therapy. Prescribing the drug to patients with the above factors requires periodic monitoring of the number of leukocytes in the blood. Also, the patient should be informed about the need to consult a doctor if any signs of infection appear.

With congenital deficiency of glucose-6-phosphate dehydrogenase, isolated cases of hemolytic anemia were recorded.

Perindopril, like other ACE inhibitors, is less effective in black patients in reducing blood pressure. Presumably, this may be due to the greater prevalence of low-rootin states in the population of this group of patients with hypertension.

The use of Perindopril-Teva can serve the development of a persistent, unproductive cough that stops after its withdrawal. This should be taken into account in the differential diagnosis of cough.

When carrying out major surgery or general anesthesia using drugs that cause arterial hypotension, ACE inhibitors, including perindopril, with compensatory release of renin, can block the formation of angiotensin II. The day before the operation, the ACE inhibitor should be canceled. If it is impossible to cancel the ACE inhibitor, arterial hypotension developing according to the described mechanism can be corrected by an increase in the volume of circulating blood.

In some cases, treatment with ACE inhibitors, including perindopril, can lead to an increase in the concentration of potassium in the blood. The likelihood of hyperkalemia increases with heart and / or renal failure, decompensated diabetes mellitus, as well as with the use of potassium-sparing diuretics, potassium preparations or other drugs that cause hyperkalemia (for example, heparin). If the combined use of these drugs is necessary, it is important to regularly monitor the serum potassium content.

In the first few months of the use of ACE inhibitors in patients with diabetes mellitus receiving oral hypoglycemic agents or insulin, careful monitoring of blood glucose concentration is necessary.

Perindopril-Teva tablets contain lactose, and therefore their use is contraindicated in hereditary lactose intolerance, malabsorption syndrome and lactase deficiency.

There are reports of the development of renal dysfunction, including acute renal failure, hyperkalemia, stroke, syncope and arterial hypotension in susceptible patients, especially against the background of combined use with drugs that affect the renin-angiotensin-aldosterone system. In this regard, double blockade of the renin-angiotensin system due to the combination of an ACE inhibitor and an angiotensin II receptor antagonist is not recommended. Combination with aliskiren contraindicated in renal function (glomerular filtration rate <60 mL per min for 1 1,73m ²) or diabetes.

Influence on the ability to drive vehicles and complex mechanisms

Since dizziness or arterial hypotension may develop while taking Perindopril-Teva, patients should be careful when driving and conducting potentially hazardous activities, the implementation of which requires increased attention and speed of psychomotor reactions.

Application during pregnancy and lactation

Perindopril-Teva is not prescribed during pregnancy / lactation.

The drug cannot be used in the first trimester of pregnancy, and therefore, when planning a pregnancy or diagnosing it, it is necessary to cancel it as soon as possible and carry out other antihypertensive treatment.

Appropriate controlled studies of the use of ACE inhibitors in pregnancy have not been conducted. The limited data available on the effect of the drug in the first trimester of pregnancy indicate that its use does not lead to fetal malformations associated with fetotoxicity.

In the II and III trimesters of pregnancy, the drug can cause neonatal toxic effects in the fetus (hyperkalemia, arterial hypotension, renal failure) and fetotoxic effects (slowing the ossification of the fetal skull bones, oligohydramnios, decreased renal function). If Perindopril-Teva was still used during this period, an ultrasound examination of the bones of the skull and kidneys of the fetus is necessary.

Since there are no data on the possible release of the drug into breast milk, its use during lactation is not recommended. If it is necessary to use the drug during this period, breastfeeding is stopped.

Pediatric use

Patients under 18 years of age are not prescribed Perindopril-Teva, since there are no data on the effectiveness and safety of its use in patients of this age group.

With impaired renal function

• the use of Perindopril-Teva is contraindicated: impaired renal function (glomerular filtration rate <60 ml per minute per 1.73 m ²);
• application requires medical supervision: stenosis of the artery of a single kidney, bilateral stenosis of the renal arteries, chronic renal failure (creatinine clearance <60 ml per minute), condition after kidney transplantation.

For violations of liver function

There are no special recommendations for the use of the drug in patients with impaired liver function.

Use in the elderly

Elderly patients are prescribed Perindopril-Teva with caution.

Drug interactions

Immunosuppressants (trimethoprim, tacrolimus or cyclosporine), heparin, non-steroidal anti-inflammatory drugs, angiotensin II receptor antagonists, ACE inhibitors, potassium-sparing diuretics, potassium salts, aliskiren-containing drugs, aliskiren, when used in combination with Perindopril, may increase the likelihood of developing hypersensitivity. The combined use of these drugs is contraindicated.

Against the background of the combined use of the drug with aliskiren, the likelihood of deterioration of renal function, the development of hyperkalemia, an increase in the frequency of cardiovascular pathologies and deaths in patients with impaired renal function (glomerular filtration rate <60 ml per 1 min) or diabetes mellitus increases. The combined use of these drugs is not recommended. In patients without diabetes or renal impairment, this combination may increase the risk of impaired renal function, hyperkalemia, increased incidence of cardiovascular disease and mortality.

There are reports of a higher frequency of deterioration of renal function (including acute renal failure), the development of hyperkalemia, syncope and hypotension in patients with established atherosclerotic pathology, heart failure or diabetes mellitus with target organ damage with the combined use of an ACE inhibitor and an angiotensin receptor antagonist II in comparison with therapy with only one drug that affects the renin-angiotensin system.

Double blockade (for example, when an ACE inhibitor is combined with an angiotensin II receptor antagonist) should be limited to isolated cases with careful monitoring of blood pressure, blood potassium and renal function.

At the beginning of therapy with Perindopril-Teva, patients receiving diuretics, especially against the background of excessive excretion of electrolytes and / or fluids, may experience excessive arterial hypotension. The likelihood of an excessive decrease in blood pressure can be reduced by discontinuing diuretics, administering 0.9% sodium chloride solution intravenously, using an ACE inhibitor at lower doses. The subsequent increase in the dose of the drug should be carried out with caution.

In cases of hypertension in patients using diuretics (especially against the background of excessive excretion of electrolytes and / or fluids), the latter should either be canceled before starting therapy with an ACE inhibitor, or the ACE inhibitor should be used at a low dose with a further gradual increase. Subsequently, a potassium-sparing diuretic may be re-prescribed.

In most cases, against the background of the use of ACE inhibitors, the serum potassium content remains within the normal range, however, hyperkalemia may occur in some patients. The combined use of potassium preparations, potassium-sparing diuretics (amiloride, triamterene, spironolactone and its derivative eplerenone), ACE inhibitors, food supplements, or potassium-containing products can lead to hyperkalemia. In this regard, the appointment of these combinations is not recommended. Their use is possible only in cases of hypokalemia, provided that serum potassium is regularly monitored and precautions are taken.

In cases of using diuretics against the background of CHF, ACE inhibitors should be prescribed in a low dose, possibly after a decrease in the dose of a concomitantly used potassium-sparing diuretic.

In the first weeks of therapy with ACE inhibitors, renal function (creatinine concentration) should be monitored in all cases.

In the treatment of NYHA functional class II – IV heart failure with left ventricular ejection fraction <40% and previously used ACE inhibitors and loop diuretics, there is a risk of hyperkalemia (with a possible fatal outcome), especially if the recommendations for this drug combination are not followed. Before using this combination, it is important to ensure that there is no renal impairment and hyperkalemia. It is important to regularly (weekly during the first month of therapy and monthly thereafter) monitor the concentration of potassium and creatinine in the blood.

The combined use of lithium and Perindopril-Teva preparations can lead to lithium toxicity and a reversible increase in the concentration of lithium in the blood serum. The combined use of the drug with thiazide diuretics can further increase the concentration of lithium in the blood serum and increase the likelihood of its toxic effects. This combination is not recommended. If the use of this combination of funds is necessary, therapy should be carried out under regular monitoring of the concentration of lithium in the blood serum.

Non-steroidal anti-inflammatory drugs can weaken the effect of ACE inhibitors. This combination has an additive effect on increasing serum potassium concentration, which can lead to impaired renal function. This effect is in most cases reversible. Rarely, especially in patients with pre-existing renal impairment (for example, in elderly patients, with dehydration), acute renal failure may develop.

Other antihypertensive drugs and vasodilators may enhance the antihypertensive effect of Perindopril-Teva. The combined use of vasodilators, other nitrates or nitroglycerin can lead to an additional antihypertensive effect.

Simultaneous treatment with hypoglycemic agents (oral hypoglycemic drugs or insulin) and ACE inhibitors can increase the hypoglycemic effect, up to the onset of hypoglycemia. Usually, this phenomenon appears in the first weeks of combination therapy in patients with renal failure.

Perindopril-Teva can be administered in combination with acetylsalicylic acid (as an antiplatelet drug), nitrates, beta-blockers and / or thrombolytic agents.

The antihypertensive effect of perindopril may be enhanced by general anesthetics (general anesthetics), antipsychotics (neuroleptics), and tricyclic antidepressants; weaken - sympathomimetics. The use of the latter combination requires regular evaluation of the effectiveness of ACE inhibitors.

The drug can enhance the myelotoxic effect of myelotoxic drugs.

Analogs

The analogues of Perindopril-Teva are Prestarium, Stopress, Perineva Ku-tab, Perindopril-VERTEX, Hypernik, Perindopril-TAD, Parnavel, Arentopres, Prenessa, Pyristar, etc.

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.

Shelf life is 2 years.

Terms of dispensing from pharmacies

Dispensed by prescription.

Reviews about Perindopril-Teva

According to reviews, Perindopril-Teva is a safe and effective drug used in the treatment of heart disease.

Among the disadvantages, the likelihood of side effects from the kidneys is noted.

Price for Perindopril-Teva in pharmacies

The approximate price for Perindopril-Teva for a pack of 30 tablets is:

• Perindopril-Teva 5 mg - 286 rubles;
• Perindopril-Teva 10 mg - 370 rubles.

Perindopril-Teva: prices in online pharmacies

Drug name Price Pharmacy

Perindopril-Teva 5 mg film-coated tablets 30 pcs. 273 r Buy

Perindopril-Teva 10 mg film-coated tablets 30 pcs. 339 r Buy

Perindopril-Teva tablets p.o. 10mg 30 pcs. 390 RUB Buy

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!