Description
Pharmacological action of
Perindopril is an inhibitor of the enzyme that converts angiotensin I to angiotensin II (an ACE inhibitor). Angiotensin-converting enzyme, or kininase II, is an exopeptidase, which carries out both the conversion of angiotensin I into a vasoconstrictor substance angiotensin II, and the destruction of bradykinin, which has a vasodilating effect, to an inactive heptapeptide. Since ACE inactivates bradykinin, ACE suppression is accompanied by an increase in the activity of both the circulating and tissue kallikrein-kinin systems, while the prostaglandins system is also activated. Perindopril has a therapeutic effect due to its active metabolite, perindoprilat. Other metabolites do not inhibit ACE.
Amlodipine is a “slow” calcium channel blocker (BMCC), a derivative of dihydropyridine.
Amlodipine inhibits the transmembrane transition of calcium ions to cardiomyocytes and smooth muscle cells of the vascular wall. The antihypertensive effect of amlodipine is due to a direct effect on the smooth muscle cells of the vascular wall. It has been established that amlodipine: • causes the expansion of peripheral arterioles, decreasing the total peripheral vascular resistance (afterload) since heart rate does not change, and myocardial oxygen demand decreases. • causes the expansion of coronary arteries and arterioles in both ischemic and intact zones. In patients with Prinzmetal angina, coronary blood flow improves.
Amlodipine + Perindopril The main criterion for evaluating the effectiveness of prolonged use of amlodipine in combination with perindopril is a combined indicator of the frequency of non-fatal myocardial infarction (including painless) and lethal outcomes of coronary heart disease. The complication rate decreases with the use of amlodipine in combination with perindopril.
Indications
Arterial hypertension and / or coronary heart disease (CHD): stable angina pectoris in patients who require perindopril and amlodipine therapy.
Contraindications
Perindopril
– Hypersensitivity to perindopril or other ACE inhibitors
– History of angioedema (Quincke’s edema) (including when taking other ACE inhibitors) srdlcrp – 18 years old efficacy and safety not established).
– The simultaneous use of perindopril and drugs, containing aliskiren in patients with renal failure (CC less than 60 ml / min) and patients with diabetes mellitus.
Amlodipine
– Hypersensitivity to amlodipine or other derivatives of dihydropyridine
– Severe arterial hypotension (systolic blood pressure (BP) less than 90 mmHg)
– Obstruction of the exit tract of the left ventricle (for example, severe stenocardial angina pectoris) (with the exception of Prinzmetal angina)
– Age under 18 years (effectiveness and safety have not been established).
– Shock (including cardiogenic).
– Hemodynamically unstable heart failure after acute myocardial infarction.
Amlodipine + Perindopril
– Hypersensitivity to excipients,
– Renal failure (creatinine clearance (CC) less than 60 ml / min)
– Under 18 years of age (efficacy and safety not established)
– Hereditary lactose intolerance, lactase deficiency and glucose-galactose malabsorption.
Composition
1 tablet 10 mg + 8 mg
Active ingredients: amlodipine besilate – 13.88 mg in terms of amlodipine base -10.0 mg and perindopril erbumin – 8.0 mg
Dosage and administration
Inside, 1 tablet 1 time per day, preferably in the morning before meals. The dose of Parnawel Amlo is selected after a previous titration of doses of the individual components of the drug: perindopril and amlodipine in patients with arterial hypertension and / or coronary heart disease.
With therapeutic need, the dose of Parnawel Amlo may be changed or an individual dose selection of individual components may be preliminarily performed: 4 mg of perindopril + 5 mg of amlodipine or 8 mg of perindopril + 5 mg of amlodipine or 4 mg of perindopril + 10 mg of amlodipine or 8 mg of perindopril + 10 mg of amlodipine. Parnawel Amlo in doses of 4 mg perindopril + 10 mg amlodipine and 8 mg perindopril + 10 mg amlodipine is the maximum daily dose that should not be exceeded.
active substance
Amlodipine, Perindopril
drugstore conditions for prescription
