Co-Perineva tablets 0.625 mg+2 mg 30 pcs.

Pharmacodynamics and pharmacokinetics

Co-Perineva is a combination drug containing perindopril and indapamide .

The drug has an antihypertensive effect, the effectiveness of which does not depend on the patient’s age, body position, and is not accompanied by tachycardia. Does not affect lipid metabolism, including in patients with diabetes . When taking the drug, the risk of hypokalemia .

The antihypertensive effect persists throughout the day.

After just a month of taking the drug, a decrease in blood pressure is achieved. If treatment is stopped, there is no risk of withdrawal syndrome .

Perindopril is extremely effective in the fight against arterial hypertension (all forms of severity). 4-6 hours after taking the medicine, the maximum antihypertensive effect develops, which lasts throughout the day.

Perindopril after administration is quickly absorbed from the gastrointestinal tract. Bioavailability is 65-70%. 3-4 hours after administration, the maximum level of the drug in the blood plasma is reached. It is metabolized in the liver, forming an active (perindoprilat) and five inactive metabolites. A small amount of perindoprilate passes into breast milk and through the placenta. Excreted through the kidneys.

The elimination of perindoprilate is slowed down in patients with heart and renal failure and patients over 65 years of age. In patients suffering from liver cirrhosis, hepatic clearance is reduced by half, however, the level of perindoprilate is not reduced.

Indapamide is almost completely absorbed from the gastrointestinal tract; simultaneous intake of food can slow down this process. After an hour, the maximum level in the blood is reached. Metabolized in the liver. Excreted through the kidneys and intestines.

Compatibility of Perineva and alcohol

? The drug is used in the form of tablets, so there is a load on the body, starting with the gastrointestinal tract. Dyspeptic disorders occur and a person may vomit. The medicine is eliminated along with the digestive masses without causing an antihypertensive effect.

When the substance enters the blood, it spreads throughout the internal organs. There is a load on the heart and blood vessels. The latter expand excessively, the patient feels a loss of strength and loses consciousness. There is a risk of heart attack, stroke, which can lead to sudden death.

Contraindications

The drug Co-Perineva is contraindicated in the following cases:

• sensitivity to any element of the drug;
• lactose intolerance;
• refractory hyperkalemia;
• angioedema;
• bilateral renal artery stenosis;
• lactase deficiency;
• liver failure;
• glucose-galactose malabsorption;
• renal failure;
• renal artery stenosis;
• pregnancy, lactation, children under 18 years of age.

You should take the drug with caution in the following cases:

• connective tissue diseases ( scleroderma , SLE );
• immunosuppressant therapy;
• inhibition of bone marrow hematopoiesis;
• angina pectoris;
• renovascular hypertension;
• decrease in blood volume;
• hyperuricemia;
• diabetes;
• cerebrovascular diseases.

When to take the drug, after how long

To reduce blood pressure, wait until there is no ethanol in the body. It should not be in the bloodstream, gastrointestinal tract, liver, kidneys, or central nervous system. If a person has taken a single dose of alcohol, wait no more than 1 day from the end of the hangover.

If you drink alcohol frequently, it is recommended to wait at least 5-7 days for ethyl alcohol to be removed from the tissues. Alcoholism is a contraindication for taking the drug. A person must undergo addiction treatment before taking the drug.

Side effects

The use of the drug may cause the following side effects:

• thrombocytopenia , agranulocytosis , hemolytic anemia , leukopenia , aplastic anemia ;
• vertigo , paresthesia , dizziness , headache , unstable mood, sleep disturbance, in rare cases - confusion ;
• tinnitus, blurred vision;
• orthostatic hypotension , arrhythmias ( bradycardia , atrial fibrillation , ventricular tachycardia ), myocardial infarction , angina pectoris ;
• dry cough , shortness of breath , bronchospasm , rhinitis , eosinophilic pneumonia ;
• dry mouth, constipation , nausea, abdominal pain, loss of appetite, epigastric pain, vomiting , diarrhea , dyspepsia , pancreatitis , jaundice ;
• angioedema (face, lips, limbs, here, tongue, larynx), rash, urticaria , itching ;
• muscle spasms;
• renal failure;
• impotence;
• asthenia , increased sweating.

Organs affected by the toxin

The combined use of pharmacological agents and alcohol has a toxic effect on the internal organs and environments of the body. Alcohol, entering into a chemical reaction with a medicine, leads to poisoning, disrupts physiological processes, enhances or weakens the healing properties of drugs.

The liver suffers more than other organs. She gets hit twice. Many medications have a side effect - hepatotoxicity, destroy cells, and disrupt the physiology of the organ. In the liver, alcohol breaks down to ethanal, a substance 20-30 times more toxic than ethanol, which causes the death of hepatocytes.

Dangerous groups of drugs for the organ in combination with alcohol:

• anti-inflammatory;
• hormonal;
• antibacterial;
• antifungal;
• glucose control agents for diabetes mellitus;
• anti-tuberculosis;
• cytostatics (chemotherapy drugs);
• tranquilizers (anti-epileptic, psychotropic).

In second place among the internal organs exposed to the harmful effects of alcohol together with medications are the heart and vascular system. Strong drinks during drug therapy constrict blood vessels and increase blood pressure. The simultaneous intake of alcohol and chemical substances leads to failure of the myocardium and increases the risk of developing an attack of angina pectoris and a heart attack.

A mixture of ethanol and pharmaceuticals disrupts the quality of the blood and reduces clotting. This is dangerous due to internal bleeding and strokes.

Instructions for use (Method and dosage)

The medicine Co-Perineva is taken 1 time per day, orally, in the morning before breakfast, with water.

Doses are listed in the indapamine/perindopril ratio.

To begin with, you should take one tablet (0.625/2 mg) per day. If it is not possible to achieve blood pressure control within a month, the dose is increased to one tablet (1.25/4 mg). To achieve the most pronounced effect, you should increase the daily dose to the limit - one tablet (2.5/8 mg).

For elderly patients, the initial dose is one tablet (0.625/2 mg). Treatment with the drug can be prescribed in case of control of blood pressure and kidney function.

Patients with moderate renal impairment are started on the lowest dose, with the maximum allowed dose being 1.25/4 mg.

Compound

Overdose

Symptoms of overdose: vomiting , nausea , muscle cramps , drowsiness , dizziness , confusion , decreased water and electrolyte balance, oliguria , significant decrease in blood pressure.

If the above symptoms appear, you should rinse your stomach, then take activated charcoal to restore the water and electrolyte balance. If the pressure decreases significantly, the patient should lie on his back and raise his legs, then inject a 0.9% sodium chloride solution.

When can you drink alcohol if you are taking or have taken the drug?

The possibility of drinking alcoholic beverages depends on the patient’s diagnosis. If therapy has completed, but he is at risk for internal hemorrhage in organs or hypertensive crisis, the doctor gives a complete ban on drinking drinks containing ethyl alcohol.

If there are no serious risks, you can drink small doses of alcohol after finishing taking the drug.

Wait 2-3 weeks. To obtain permission, contact your doctor. Only he decides how long after you can drink alcohol.

Interaction

You should not combine Co-Perineva with ACE inhibitors and lithium preparations, as the level of lithium in the blood may increase. If co-administration is necessary, lithium levels should be monitored.

Baclofen with extreme caution , as it may increase the hypotensive effect. Blood pressure and kidney function should be monitored and the dose adjusted if necessary.

Neuroleptics and tricyclic antidepressants enhance the effect of hypotension and increase the likelihood of orthostatic hypotension.

Tetracosactide and GCS help reduce the hypotensive effect.

When taken simultaneously with any other antihypertensive drugs, there is a possibility of a stronger manifestation of the hypotensive effect.

Perindopril

At the same time, it is not recommended to use it with potassium-sparing diuretics ( Spironolactone , Amiloride , Eplerenone , Triamterene ) and potassium supplements. When used in parallel, the level of potassium in the blood may increase, which can lead to death. If joint therapy is necessary (for hypokalemia), it is necessary to monitor potassium levels and ECG parameters.

It is recommended to take Co-Perineva together with insulin and hypoglycemic agents with extreme caution. leukopenia increases when used with cytostatic immunosuppressants, Allopurinol , GCS and procainamide . When used with general anesthesia agents, their hypotensive effect may increase. When used in high doses, thiazide and loop diuretics can lead to hypovolemia .

Indapamide

Drugs that cause ari must be taken with caution, since there is a possibility of developing hypokalemia . It is recommended to take Indapamide with caution with medications such as antipsychotics ( cyamemazine , trifluoperazine , chlorpromazine , etc.), antiarrhythmic drugs ( Amiodarone , hydroquinidine , ibutilide , tosylate etc.), benzamides ( sultopride , Tiapride , Sulpiride , Amisulpride ), butyrophenones ( Haloperidol , Droperidol ), other drugs ( Astemizole , mizolastine , sparfloxacin , methadone , bepridil , halofantrine , terfenadine , cisapride ).

Medicines that can cause hypokalemia : tetracosactide , laxatives that stimulate intestinal motility, Amphotericin B , glucocorticoids, mineralocorticoids, cardiac glycosides.

lactic acidosis increases when used with Metformin .

Patients taking high-dose iodine contrast agents are at risk of kidney failure. Hypercalcemia can develop when taking medications containing calcium salts.

Co-Perineva® (Co-Perineva®)

Co-Perineva®

Lithium preparations

The simultaneous use of Co-Perineva® with lithium preparations is not recommended (see section “Interaction with other drugs”).

Renal dysfunction

Therapy with Co-Perineva® is contraindicated in patients with severe renal failure (creatinine clearance less than 30 ml/min). In some patients with arterial hypertension without previous renal impairment, laboratory signs of functional renal failure may appear during therapy with Co-Perineva®. In this case, treatment with Co-Perineva® should be discontinued. In the future, combination therapy can be resumed using low doses of Co-Perineva® or using perindopril and indapamide in monotherapy.

Such patients require regular monitoring of potassium levels and creatinine concentrations in the blood serum 2 weeks after the start of therapy and every subsequent 2 months of therapy with Co-Perineva®.

Renal failure often develops in patients with severe CHF or underlying renal impairment, including renal artery stenosis.

Arterial hypotension and water-electrolyte imbalance

In the case of initial hyponatremia, there is a risk of a sudden decrease in blood pressure (especially in patients with renal artery stenosis). Therefore, during dynamic monitoring of patients, attention should be paid to possible symptoms of dehydration and a decrease in plasma electrolytes, for example, after prolonged diarrhea or vomiting. Such patients require regular monitoring of plasma electrolytes.

With a pronounced decrease in blood pressure, intravenous administration of 0.9% sodium chloride solution may be required.

Transient arterial hypotension is not a contraindication for further continuation of therapy. After restoration of blood volume and blood pressure, you can resume therapy with Co-Perineva®, using low doses of the drug or using perindopril and indapamide in monotherapy.

Potassium content

The combined use of perindopril and indapamide does not prevent the development of hypokalemia, especially in patients with diabetes or renal failure. As with the combined use of other antihypertensive drugs and a diuretic, regular monitoring of potassium levels in the blood plasma is necessary.

Special information on excipients

It should be taken into account that the excipients of the drug Co-Perineva® include lactose monohydrate, therefore the drug is contraindicated in patients with lactose intolerance, lactase deficiency or glucose-galactose malabsorption syndrome (see section “Contraindications”).

Children and teenagers

Prescribing Co-Perineva® to children and adolescents under 18 years of age is contraindicated due to the lack of data on the effectiveness and safety of perindopril and indapamide. both in monotherapy and in combined use in patients of this age group.

Indapamide

Hepatic encephalopathy

In the presence of liver dysfunction, taking thiazide and thiazide-like diuretics can lead to the development of hepatic encephalopathy. In this case, you should immediately stop taking Co-Perineva®.

Photosensitivity

There are reports of cases of increased photosensitivity while taking thiazide and thiazide-like diuretics. If a photosensitivity reaction develops while taking Co-Perineva®, treatment should be discontinued. If there is a need to resume use of the drug Co-Perineva®, you should protect exposed skin from direct exposure to sunlight and artificial ultraviolet rays.

Water and electrolyte balance

Sodium content in blood plasma

Before starting treatment with Co-Perineva®, it is necessary to determine the sodium content in the blood plasma, and then regularly monitor it while taking the drug. Hyponatremia at the initial stage may not be accompanied by clinical symptoms, so regular laboratory monitoring is necessary. More frequent monitoring of plasma sodium levels is indicated in elderly patients and patients with liver cirrhosis. Treatment with any diuretics can cause hyponatremia, sometimes leading to serious complications. Hyponatremia accompanied by hypovolemia can lead to dehydration and orthostatic hypotension. A simultaneous decrease in the content of chloride ions can lead to the development of secondary compensatory metabolic alkalosis: the frequency of its occurrence and severity are insignificant.

Potassium content in blood plasma

Therapy with thiazide and thiazide-like diuretics is associated with a risk of hypokalemia. Hypokalemia (less than 3.4 mmol/L) should be avoided in the following high-risk patients: elderly patients, malnourished patients (both those receiving and not receiving concomitant drug therapy), patients with cirrhosis (with edema and ascites) , IHD, CHF. Hypokalemia in these patients increases the toxic effect of cardiac glycosides and increases the risk of developing arrhythmia.

A high-risk group includes patients with a prolonged QT interval on the ECG. both congenital and caused by the action of drugs.

Hypokalemia, like bradycardia, contributes to the development of severe cardiac arrhythmias, especially arrhythmias, which can be fatal. In all the described cases, regular monitoring of potassium levels in the blood plasma is necessary. The first determination of potassium content in the blood plasma should be carried out within the first week from the start of therapy with Co-Perineva®.

Calcium content in blood

Thiazide and thiazide-like diuretics may reduce renal excretion of calcium, leading to a slight and temporary increase in plasma calcium. Severe hypercalcemia may be a consequence of latent hyperparathyroidism. Before studying the function of the parathyroid glands, you should stop taking diuretics.

Plasma glucose concentration

Glucose concentrations should be monitored in patients with diabetes, especially in the presence of hypokalemia.

Uric acid

In patients with elevated concentrations of uric acid in the blood plasma, the frequency of gout attacks may increase during therapy.

Diuretics and kidney function

Thiazide and thiazide-like diuretics are fully effective only in patients with normal or slightly impaired renal function (plasma creatinine concentration in adult patients below 25 mg/l or 220 µmol/l). In elderly patients, the standard plasma creatinine concentration should be adjusted taking into account age, body weight and gender, in accordance with the Cockroft formula:

CC = (140 - age)

×
body weight/0.814
x
plasma creatinine concentration,
where: age is in years, body weight is in kg, creatinine concentration is in µmol/l.

For women, this formula should be adjusted by multiplying the result by a factor of 0.85.

At the beginning of treatment with diuretics, patients may experience a temporary decrease in GFR and an increase in plasma creatinine and urea concentrations due to hypovolemia and hyponatremia. This transient functional renal failure is not dangerous for patients with unchanged renal function, but its severity may increase in patients with renal failure.

Athletes

Indapamide may give a positive reaction during doping control.

Choroidal effusion/acute myopia/acute angle-closure glaucoma

Sulfonamides and their derivatives can cause an idiosyncratic reaction, leading to the development of choroidal effusion with visual field impairment, acute transient myopia and acute angle-closure glaucoma. Symptoms include acute onset of decreased visual acuity or eye pain and usually occur within hours to weeks of starting the drug. If left untreated, acute angle-closure glaucoma can lead to permanent vision loss. First of all, it is necessary to stop taking the drug as quickly as possible. If intraocular pressure remains uncontrolled, emergency medical treatment or surgery may be required. Risk factors for the development of an acute attack of angle-closure glaucoma are a history of allergic reactions to sulfonamide derivatives and penicillins.

Perindopril

Double blockade of the RAAS

There is evidence of an increased risk of arterial hypotension, hyperkalemia and renal dysfunction (including acute renal failure) with simultaneous use of ACE inhibitors and ARB II or aliskiren. Therefore, double blockade of the RAAS by combining an ACE inhibitor with ARA II or aliskiren is not recommended (see sections “Pharmacological properties. Pharmacodynamics” and “Interaction with other drugs”). If a double blockade is necessary, then this should be performed under the strict supervision of a specialist with regular monitoring of kidney function, potassium levels in the blood plasma and blood pressure. Concomitant use with aliskiren or drugs containing aliskiren in patients with diabetes and/or moderate or severe renal impairment (GFR < 60 ml/min/1.73 m2 body surface area) is contraindicated and is not recommended in other patients.

Concomitant use of ACE inhibitors with ARB II is contraindicated in patients with diabetic nephropathy and is not recommended in other patients.

Potassium-sparing diuretics, potassium supplements and potassium-containing salt substitutes

Usually serum potassium levels remain within normal limits, but hyperkalemia may occur in some patients taking perindopril. Potassium-sparing diuretics (eg, spironolactone, triamterene, or amiloride), potassium supplements, or potassium-containing salt substitutes may cause significant increases in serum potassium levels. Caution should also be exercised when using perindopril concomitantly with other drugs that increase serum potassium levels, such as trimethoprim and co-trimoxazole (sulfamethoxazole + trimethoprim), since trimethoprim is known to act similarly to the potassium-sparing diuretic amiloride. Therefore, simultaneous use of perindopril with the above drugs is not recommended. If simultaneous use is necessary, caution should be exercised and plasma potassium levels should be regularly monitored.

Neutropenia/agranulocytosis/thrombocytopenia/anemia

There are reports of the development of neutropenia/agranulocytosis, thrombocytopenia and anemia during the use of ACE inhibitors. In patients with normal renal function and without concomitant risk factors, neutropenia rarely develops and resolves spontaneously after discontinuation of ACE inhibitors. Perindopril should be used with extreme caution in patients with systemic connective tissue diseases (including SLE, scleroderma), as well as while taking immunosuppressants, allopurinol or procainamide, especially in patients with impaired renal function. These patients may develop severe infections that do not respond to intensive antibiotic therapy.

If perindopril is prescribed, it is recommended to periodically monitor the number of leukocytes in the blood. The patient should be warned that if any signs of an infectious disease appear (sore throat, fever), consult a doctor immediately.

Increased sensitivity/angioedema

When taking ACE inhibitors, including perindopril, in rare cases, the development of angioedema of the face, extremities, lips, tongue, vocal folds and/or larynx may occur. This can happen at any time during therapy. If these symptoms occur, use of Co-Perineva® should be stopped immediately and the patient should be observed until signs of edema completely disappear. If the swelling affects only the face and lips, it usually goes away on its own, or antihistamines can be used to treat the symptoms. Angioedema, accompanied by swelling of the tongue or larynx, can lead to airway obstruction and death. If such symptoms appear, epinephrine (adrenaline) at a dilution of 1:1000 (0.3 ml or 0.5 ml) should be immediately administered subcutaneously and/or the airway should be secured.

A higher risk of developing angioedema has been reported in black patients.

Patients with a history of angioedema not associated with taking ACE inhibitors may have an increased risk of developing it when taking drugs of this group (see section "Contraindications").

In rare cases, angioedema of the intestine develops during therapy with ACE inhibitors. In this case, patients experience abdominal pain as an isolated symptom or in combination with nausea and vomiting, in some cases without previous angioedema of the face and with normal C-1 esterase activity. The diagnosis is made using computed tomography of the abdominal cavity, ultrasound, or at the time of surgery. Symptoms disappear after stopping ACE inhibitors. In patients with abdominal pain receiving ACE inhibitors. When making a differential diagnosis, it is necessary to take into account the possibility of developing angioedema of the intestine.

mTOR
inhibitors In patients concomitantly taking mTOR inhibitors (eg, sirolimus, everolimus, temsirolimus), therapy may be accompanied by an increased risk of developing angioedema (eg, swelling of the upper respiratory tract or tongue with or without respiratory distress).

Tissue plasminogen activators:

Observational studies have shown an increased incidence of angioedema in patients taking ACE inhibitors after the use of alteplase for thrombolytic therapy of ischemic stroke.

Neutral endopeptidase inhibitors:

When ACE inhibitors are used simultaneously with drugs containing sacubitril (neprilysin inhibitor), the risk of developing angioedema increases, and therefore the simultaneous use of these drugs is contraindicated. ACE inhibitors should be prescribed no earlier than 36 hours after discontinuation of drugs containing sacubitril. Prescription of drugs containing sacubitril is contraindicated in patients receiving ACE inhibitors, as well as within 36 hours after discontinuation of ACE inhibitors.

Anaphylactoid reactions during desensitization procedures

There are isolated reports of the development of prolonged, life-threatening anaphylactoid reactions in patients receiving ACE inhibitors during desensitizing therapy with hymenoptera venom (bees, wasps). ACE inhibitors should be used with caution in patients with a history of allergies or those prone to allergic reactions undergoing desensitization procedures. The use of an ACE inhibitor should be avoided in patients receiving immunotherapy with hymenoptera venom. However, the development of anaphylactoid reactions can be avoided by temporarily discontinuing the ACE inhibitor at least 24 hours before the start of the desensitization procedure.

Anaphylactoid reactions during LDL apheresis

In rare cases, life-threatening anaphylactoid reactions have developed in patients receiving ACE inhibitors during LDL apheresis using dextran sulfate. To prevent an anaphylactoid reaction, ACE inhibitor therapy should be discontinued before each apheresis procedure.

Hemodialysis

Anaphylactoid reactions have been reported in patients receiving ACE inhibitors during hemodialysis using high-flux membranes (eg, AN69®). Therefore, it is advisable to use a different type of membrane or use an antihypertensive drug of a different pharmacotherapeutic group.

Primary aldosteronism

Patients with primary hyperaldosteronism usually do not respond to antihypertensive drugs that inhibit the RAAS, so the use of perindopril is not recommended.

Cough

During therapy with an ACE inhibitor, a dry persistent cough may occur, which disappears after discontinuation of drugs from this group. If a dry cough appears, you should be aware of the possible connection of this symptom with taking an ACE inhibitor. If the doctor believes that ACE inhibitor therapy is necessary for the patient, taking Co-Perineva® can be continued.

Risk of arterial hypotension and/or renal failure (in patients with CHF, fluid and electrolyte imbalance, etc.)

In some pathological conditions, significant activation of the RAAS may be observed, especially with severe hypovolemia and a decrease in the content of electrolytes in the blood plasma (due to a salt-free diet or long-term use of diuretics), arterial hypotension, renal artery stenosis, CHF or cirrhosis of the liver with edema and ascites.

The use of an ACE inhibitor causes 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, indicating the development of functional renal failure, which is more often observed when taking the first dose of Co-Perineva® or during the first two weeks therapy.

Elderly patients

Before starting to take Co-Perineva®, renal function and potassium levels in the blood plasma should be assessed. The initial dose of Co-Perineva® is selected depending on the degree of blood pressure reduction, especially with a decrease in blood volume and loss of electrolytes. Such measures help to avoid a sharp decrease in blood pressure.

Atherosclerosis

The risk of arterial hypotension exists in all patients, however, special caution should be observed when using Co-Perineva® in patients with coronary artery disease and cerebrovascular insufficiency. In such patients, treatment should begin with a dose of Co-Perineva® 0.625 mg + 2 mg (initial dose).

Renovascular hypertension

The treatment method for renovascular hypertension is revascularization. However, the use of ACE inhibitors has a beneficial effect in patients both awaiting surgery and in cases where surgery is not possible.

Treatment with Co-Perineva® in patients with diagnosed or suspected renal artery stenosis should begin in a hospital setting with a dose of Co-Perineva® 0.625 mg + 2 mg, monitoring renal function and potassium levels in the blood plasma. Some patients may develop functional renal failure, which is reversible after discontinuation of the drug.

When using ACE inhibitors in patients with bilateral renal artery stenosis or renal artery stenosis of a single functioning kidney, there is an increased risk of developing arterial hypotension and renal failure. Concomitant use of diuretics may be a contributing factor. Renal failure can develop with minor changes in serum creatinine concentration in patients even with unilateral renal artery stenosis.

CHF

In patients with CHF (functional class IV according to the NYHA classification) and in patients with type 1 diabetes (risk of a spontaneous increase in potassium in the blood plasma), treatment should begin with an initial dose of 0.625 mg + 2 mg of Co-Perineva® and under medical supervision.

Patients with arterial hypertension and coronary artery disease should not stop taking beta-blockers; the combination of perindopril and indapamide should be used together with beta-blockers.

Diabetes

In patients with type 1 diabetes (the risk of spontaneous increases in potassium levels in the blood plasma), treatment should begin with a low dose of the drug and under close medical supervision.

During the first month of therapy with ACE inhibitors, blood glucose concentrations should be carefully monitored in patients with diabetes treated with oral hypoglycemic agents or insulin.

Ethnic characteristics

Perindopril, like other ACE inhibitors. has a less pronounced antihypertensive effect in patients of the Negroid race compared to representatives of other races. This difference may be due to the fact that black patients with arterial hypertension are more likely to have low renin activity.

Surgical interventions/General anesthesia

The use of ACE inhibitors in patients undergoing surgery under general anesthesia can lead to a significant decrease in blood pressure, especially when using general anesthetic agents that have an antihypertensive effect.

It is recommended to stop taking ACE inhibitors, including perindopril, the day before surgery, warning the anesthesiologist about the use of ACE inhibitors.

Aortic stenosis/mitral stenosis/HOCM

ACE inhibitors should be used with caution in patients with left ventricular outflow tract obstruction.

Liver failure

In rare cases, while taking ACE inhibitors, cholestatic jaundice occurs; as this syndrome progresses, fulminant liver necrosis develops, sometimes with a fatal outcome. The mechanism of development of this syndrome is unclear. If jaundice appears or a significant increase in the activity of “liver” transaminases in the blood plasma while taking ACE inhibitors, taking Co-Perineva® should be discontinued.

Anemia

Anemia may develop in patients after kidney transplantation or in patients undergoing hemodialysis. In this case, the decrease in hemoglobin is greater, the higher its initial value. This effect does not appear to be dose-dependent, but may be related to the mechanism of action of ACE inhibitors.

Hyperkalemia

The use of ACE inhibitors may cause hyperkalemia due to inhibition of aldosterone release, which is usually mild in patients with normal renal function. Risk factors for hyperkalemia are renal failure, old age (over 70 years), diabetes, some concomitant conditions (dehydration, acute decompensation of CHF, metabolic acidosis), simultaneous use of potassium-sparing diuretics (such as spironolactone, eplerenone, triamterene, amiloride), as well as drugs potassium or potassium-containing substitutes for table salt and the use of other drugs that increase the level of potassium in the blood plasma (for example, heparin, trimethoprim or co-trimoxazole (sulfamethoxazole + trimethoprim) and especially aldosterone antagonists or ARA II). Hyperkalemia can lead to severe heart rhythm disturbances, sometimes fatal. Caution should be exercised when using ACE inhibitors and potassium-sparing diuretics and ARB II simultaneously; it is necessary to monitor renal function and serum potassium levels.

Analogs

Level 4 ATX code matches:
Akkuzid

Enap-N

Iruzid

Co-Diroton

Enalozide

Enap NL

Enapril-N

Capozide

Tritace Plus

Enzix

Liprazid

Co-Renitec

Hartil N

Hartil D

Noliprel

Kaptopres

special instructions

It is not recommended to take it in parallel with lithium preparations.

Therapy is strictly contraindicated in patients with impaired renal function. Patients suffering from hypertension may experience symptoms of renal failure . In this case, you should stop treatment with Co-Perineva. Later, therapy can be repeated, prescribing minimal doses, or indapamide and perindopril can be used in monotherapy. These patients should have their blood creatinine and potassium levels checked every two weeks.

The combination of indapamide and perindopril cannot prevent the development of hypokalemia , especially in cases where the patient has diabetes mellitus or renal failure. In this case, the level of potassium in the blood must be monitored regularly.

Use during pregnancy and breastfeeding

Pregnancy. Taking Co-Perineva® is contraindicated during pregnancy. If you are planning pregnancy or if it occurs while taking Co-Perineva®, you should immediately stop taking the drug and prescribe other antihypertensive therapy. You should not use Co-Perineva® in the first trimester of pregnancy. There have been no controlled clinical studies on the use of ACE inhibitors in pregnant women. Limited data indicate that taking ACE inhibitors in the first trimester did not lead to fetotoxicity-related fetal malformations, but the fetotoxic effect of ACE inhibitors cannot be completely excluded. The drug Co-Perineva® is contraindicated in the second and third trimesters of pregnancy. Long-term use of ACE inhibitors in the second and third trimesters of pregnancy can lead to impaired fetal development (decreased renal function, oligohydramnios, delayed ossification of the skull bones) and the development of complications in the newborn (renal failure, arterial hypotension, hyperkalemia).

Long-term use of thiazide diuretics in the third trimester of pregnancy can cause hypovolemia in the mother and a decrease in uteroplacental blood flow, which leads to fetoplacental ischemia and fetal growth retardation. In rare cases, while taking diuretics, hypoglycemia and thrombocytopenia may develop in the fetus/newborn. If a woman took an ACE inhibitor in the second and third trimesters of pregnancy, it is recommended to conduct an ultrasound of the kidneys and skull of the fetus/newborn.

In newborns whose mothers received therapy with ACE inhibitors, hypotension may occur, so newborns should be under close medical supervision.

Breastfeeding period. The drug Co-Perineva® is contraindicated during breastfeeding.

It is not known whether perindopril is excreted in breast milk.

Indapamide is excreted in breast milk. Causes a decrease or suppression of lactation. The newborn may develop hypersensitivity to sulfonamide derivatives, hypokalemia and nuclear jaundice.

It is necessary to assess the significance of therapy for the mother and make a decision to stop breastfeeding or stop taking the drug.

Ko-Perineva price, where to buy

The cost of the drug in Russia on average is about 500 rubles per package of 1.25 mg + 4 mg 30 pcs. and 900 rubles for 1.25 mg + 4 mg 90 pcs. packaged.

• Online pharmacies in RussiaRussia

ZdravCity

• KO-Perineva tablets 8mg+2.5mg 30 pcs. Krka-Rus LLC
  486 rub. order
• KO-Perineva tablets 2mg+0.625mg 30 pcs. Krka-Rus LLC

  RUB 275 order

• KO-Perineva tablets 4mg+1.25mg 90 pcs. Krka-Rus LLC

  RUB 813 order

• KO-Perineva tablets 8mg+2.5mg 90 pcs. Krka-Rus LLC

  942 rub. order

• KO-Perineva tablets 4mg+1.25mg 30 pcs. Krka-Rus LLC

  RUR 535 order

The most dangerous combinations and consequences

The combination of alcohol and chemical-based drugs can lead to serious disorders in the body, and in some cases to fatal consequences.

List of medications and their side effects in combination with alcohol: