Description
Release form
Tablets.
Packing
30 pcs.
Pharmacological action
PRESTARIUM A – antihypertensive drug, ACE inhibitor. ACE, or kininase, is an exopeptidase that 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.
Suppression of ACE leads to a decrease in the content of angiotensin II in blood plasma, resulting in increased plasma renin activity (due to inhibition of negative feedback, which prevents the release of renin) and decreased aldosterone secretion. Since ACE inactivates bradykinin, ACE suppression is accompanied by an increase in the activity of both the circulating and tissue kallikrein-kinin systems, and the prostaglandin system is activated. Perindopril reduces OPSS, which leads to a decrease in blood pressure. At the same time, peripheral blood flow accelerates, but heart rate does not increase.
Perindopril has a therapeutic effect due to the active metabolite, perindoprilat. Other metabolites of the drug do not have an inhibitory effect on ACE in vitro.
Arterial hypertension
With arterial hypertension, with the use of the drug, there is a decrease in both systolic and diastolic blood pressure in the supine and standing position. Lowering blood pressure is achieved quite quickly. In patients with a positive response to treatment, normalization of blood pressure occurs within a month. In this case, the effect of addiction is not observed.
Discontinuation of treatment is not accompanied by the development of withdrawal syndrome. Perindopril has a vasodilating effect, helps to restore the elasticity of large arteries and the structure of the vascular wall of small arteries, and also reduces left ventricular hypertrophy. Concomitant administration of thiazide diuretics enhances the hypotensive effect. Besides, the combination of an ACE inhibitor and a thiazide diuretic also reduces the risk of hypokalemia with diuretics.
Heart failure
Perindopril normalizes heart function, reducing preload and afterload. In patients with chronic heart failure receiving perindopril, there was a decrease in filling pressure in the left and right ventricles of the heart, a decrease in heart rate, an increase in cardiac output and an increase in cardiac index. A study of the drug compared with placebo showed that changes in blood pressure after the first administration of Prestarium A at a dose of 2.5 mg in patients with mild to moderate heart failure did not statistically significantly differ from changes in blood pressure observed after taking placebo.
Cerebrovascular disease
An international multicenter study (PROGRESS) evaluated the effect of active perindopril therapy (monotherapy or in combination with indapamide) for 4 years on the risk of recurrent stroke in patients with a history of cerebrovascular disease. After the introductory period of perindopril tertbutylamine use, 2 mg (equivalent to perindopril arginine 2.5 mg) 1 time / day for 2 weeks and then 4 mg (equivalent to perindopril arginine 5 mg) 1 time / day for the next two weeks, 6105 patients were randomized into two groups: placebo (n = 3054) and perindopril tertbutylamine 4 mg each (corresponding to 5 mg perindopril arginine) (monotherapy) or in combination with indapamide (n = 3051). Indapamide was additionally prescribed to patients not having direct indications or contraindications for the use of diuretics. This therapy was prescribed in addition to standard therapy for stroke and / or arterial hypertension or other pathological conditions. All randomized patients had a history of cerebrovascular disease (stroke or transient ischemic attack) over the past 5 years. The value of blood pressure was not an inclusion criterion: 2916 patients had arterial hypertension and 3189 had normal blood pressure. After 3.9 years of therapy, blood pressure (systolic / diastolic) decreased by an average of 9/4 mm Hg. A significant reduction in the risk of recurrent stroke (both ischemic and hemorrhagic in nature) was also shown to be of the order of 28% (95% CI (17 38), p <0.0001) compared with placebo (10.1% vs13.8%). Additionally, a significant reduction in the risk of fatal or disability-related strokes of major cardiovascular complications, including myocardial infarction, including fatal dementia associated with stroke severe deterioration in cognitive function. These therapeutic benefits are observed both in patients with arterial hypertension and in normal blood pressure, regardless of age, gender, presence or absence of diabetes mellitus and the type of stroke. Stable CHD A 4-year, international, multicenter, randomized, double-blind, placebo-controlled EUROPA study examined the efficacy of perindopril in patients with stable CHD. The clinical trial involved 12218 patients over 18 years of age: 6110 patients took 8 mg perindopril tertbutylamine (equivalent to 10 mg perindopril arginine) and 6108 patients took placebo. The main evaluation criteria were cardiovascular mortality, nonfatal myocardial infarction and / or cardiac arrest followed by successful resuscitation. Patients with coronary artery disease with established myocardial infarction at least 3 months prior to screening, who underwent coronary revascularization at least 6 months prior to screening, angiographically detected stenosis (at least 70% narrowing of one or more major coronary arteries) or positive were selected to participate in the study. stress test if there is a history of chest pain. The drug was prescribed in addition to the standard therapy used for hyperlipidemia, arterial hypertension and diabetes mellitus. Most patients took antiplatelet agents, lipid-lowering drugs and beta-blockers. By the end of the study, the ratio of the number of patients taking these groups of drugs was 91%, 69% and 63%, respectively. After 4.2 years, the result of therapy with perindopril tertbutylamine at a dose of 8 mg 1 time / day was a significant reduction in the relative risk by 20% (95% CI) of the development of predefined complications: in 488 (8%) patients from the group taking perindopril tertbutylamine (9.9%) patients from the placebo group (p = 0.0003). The result was not dependent on gender, age, blood pressure or a history of myocardial infarction. Indications arterial hypertension chronic heart failure prophylaxis of re-stroke (combination therapy with indapamide) in patients who have had a stroke or transient cerebrovascular accident by type of stable IHD: to reduce the risk of cardiovascular complications. Contraindications history of angioedema (congenital / idiopathic or associated with previous treatment with an ACE inhibitor) pregnancy lactation period (breastfeeding) hypersensitivity to other components of the drug hypersensitivity to other components of the drug glucose / galactose malabsorption (due to the fact that the composition of the excipients of the drug includes lactose monohydrate). Use during pregnancy and lactation Contraindicated. Special instructions Diuretic agents In the initial period of treatment, some patients treated with diuretic drugs, especially with excessive excretion of fluid and / or salts, may have an excessive decrease in blood pressure at the very beginning of perindopril therapy, the risk of which can be reduced by canceling diuretic means, introducing an increased amount of water and / or sodium chloride, as well as prescribing an ACE inhibitor in lower doses. A further increase in the dose of perindopril should be carried out with caution. Potassium-sparing diuretics or potassium preparations, potassium-containing products and food additives In the presence of ACE inhibitor therapy, as a rule, the serum potassium content remains within the normal range, but hyperkalemia can sometimes develop. The combined use of ACE inhibitors and potassium-sparing diuretics (spironolactone, triamteren and amiloride) and potassium preparations, potassium-containing products and food additives can lead to a significant increase in the concentration of potassium in the blood serum. In this regard, their joint appointment with ACE inhibitors is not recommended. These combinations should be prescribed only in case of hypokalemia, observing safety precautions and constantly monitoring the serum potassium content. Lithium Co-administration of ACE inhibitors and lithium preparations can lead to a reversible increase in serum lithium concentration and the development of lithium toxicity. The additional use of thiazide diuretics in combination with lithium and ACE inhibitors increases the existing risk of lithium toxicity. Co-administration of ACE inhibitors and lithium is not recommended. If it is impossible to avoid this combination, it is necessary to regularly monitor the content of lithium in the blood serum. Nonsteroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid (aspirin) 3 g / day. NSAIDs may be associated with a weakening of the antihypertensive effect of ACE inhibitors. Moreover, it was found that NSAIDs and ACE inhibitors have an additive effect on the increase in serum potassium levels, while impaired renal function is also possible. As a rule, these effects are reversible. In rare cases, acute renal failure may develop, which occurs, as a rule, with an already existing impaired renal function in elderly patients or against the background of dehydration. Antihypertensive and vasodilators The antihypertensive effect of drugs may be enhanced by the combined use with ACE inhibitors. The use of nitroglycerin and / or other vasodilators may lead to an additional hypotensive effect. Allopurinol, immunosuppressants, including cytotoxic drugs and systemic glucocorticosteroids, procainamide Joint use with ACE inhibitors may increase the risk of leukopenia. Hypoglycemic agents Prescription of ACE inhibitors can enhance the hypoglycemic effect of insulin and oral hypoglycemic agents, up to the development of hypoglycemia. As a rule, this phenomenon is observed in the first weeks of the combined use of these drugs and in patients with renal failure. Tricyclic antidepressants / Antipsychotics (antipsychotics) / General anesthesia Co-administration with ACE inhibitors can lead to an increase in the hypotensive effect. Sympathomimetics May weaken the antihypertensive effect of ACE inhibitors. In the appointment of such a combination should regularly evaluate the effectiveness of ACE inhibitors. Antacids Reduce the bioavailability of ACE inhibitors. Acetylsalicylic acid, thrombolytic agents, beta-blockers, nitrates Perindopril can be prescribed together with acetylsalicylic acid (as a thrombolytic), thrombolytic agents, beta-blockers and / or nitrates. Alcohol enhances the hypotensive effect of ACE inhibitors. Composition The active substance of Prestarium A tablets contains: – perindopril arginine 10 mg. Excipients: Lactose monohydrate, magnesium stearate, maltodextrin, colloidal hydrophobic silicon dioxide, sodium carboxymethyl starch, glycerol, hypromellose, macrogol 6000, titanium dioxide. Dosage and administration The drug is prescribed orally 1 time / day in the morning, before meals. Side effects of Frequent side effects> 1/100, <1/10 Rare side effects> 1/1000, <1/100 Extremely rare side effects <1 / 10,000 Urinary system: rare – Decreased kidney function, extremely rare – Acute renal failure Respiratory system: often – Cough, shortness of breath, rarely – Bronchospasm, angioedema edema, extremely rare – Eosinophilic pneumonia, rhinitis Digestive system: often – Nausea, vomiting, abdominal pain, taste disorder diarrhea, constipation, decreased appetite, rarely – Dry mouth, extremely rare – Cholestatic or cytolytic jaundice, pancreatitis Allergic reactions : h hundred – Skin rash, pruritus, rarely – urticaria, very rare – Erythema multiforme nervous system: often – headache, fatigue, dizziness, ringing in the ears, blurred vision, muscle cramps, paresthesia, rarely – mood Reduction, sleep disorders, extremely rare – Confusion Others: rarely – Sweating. Sexual dysfunction Cardiovascular disorders: excessive decrease in blood pressure and related symptoms. It is extremely rare: arrhythmia, angina pectoris, myocardial infarction and stroke, the development of secondary severe arterial hypotension in patients at risk is possible. Laboratory findings: extremely rare: decreased hemoglobin and hematocrit concentrations, thrombocytopenia, leukopenia / neutropenia, isolated cases of agranulocytosis or pancytopenia. The possibility of developing hemolytic anemia against a background of deficiency of glucose-6-phosphate dehydrogenase. Rarely: increased levels of urea and creatinine in blood plasma, passing hyperkalemia, especially against the background of renal failure, increased activity of “liver” enzymes and liver bilirubin. Drug interaction In the initial period of treatment, some patients treated with diuretics, especially with excessive excretion of fluid and / or salts, may experience an excessive decrease in blood pressure, the risk of which can be reduced by canceling the diuretic, introducing an increased amount of water and / or chloride sodium, as well as prescribing an ACE inhibitor in lower doses. A further increase in the dose of perindopril should be carried out with caution. During therapy with ACE inhibitors, as a rule, the potassium content in the blood serum remains within the normal range, but hyperkalemia can sometimes develop. The combined use of ACE inhibitors and potassium-sparing diuretics (spironolactone, triamteren and amiloride) and potassium preparations, potassium-containing products and food additives can lead to a significant increase in the concentration of potassium in the blood serum. In this regard, their joint appointment with ACE inhibitors is not recommended. These combinations should be used only in case of hypokalemia, taking precautions and constantly monitoring the content of potassium in the blood serum. Co-administration of ACE inhibitors and lithium preparations can lead to a reversible increase in serum lithium concentration and the development of lithium toxicity. The additional use of thiazide diuretics against the background of the combined use of lithium and ACE inhibitors increases the already existing risk of lithium toxicity. Co-administration of ACE inhibitors and lithium is not recommended. If this combination cannot be avoided, then it is necessary to regularly monitor the serum lithium content. NSAIDs may be associated with a weakening of the antihypertensive effect of ACE inhibitors. Moreover, it was found that NSAIDs and ACE inhibitors have an additive effect on the increase in potassium in the blood serum, while it is also possible deterioration of renal function. As a rule, these effects are reversible. In rare cases, acute renal failure may develop, which occurs, as a rule, with an already existing impaired renal function in elderly patients or against the background of dehydration. The antihypertensive effect of drugs may be enhanced by the combined use with ACE inhibitors. The use of nitroglycerin and / or other vasodilators may lead to an additional hypotensive effect. With simultaneous use with ACE inhibitors, allopurinol, immunosuppressants, including cytostatic agents and systemic corticosteroids, procainamide may increase the risk of developing leukopenia. Prescription of ACE inhibitors can enhance the hypoglycemic effect of insulin and oral hypoglycemic agents, up to the development of hypoglycemia. As a rule, this phenomenon is observed in the first weeks of the combined use of these drugs and in patients with renal failure. Co-administration with ACE inhibitors of tricyclic antidepressants, antipsychotics (antipsychotics), general anesthesia drugs can lead to an increase in the hypotensive effect. Sympathomimetics may attenuate the antihypertensive effect of ACE inhibitors. In the appointment of such a combination should regularly evaluate the effectiveness of ACE inhibitors. Antacids reduce the bioavailability of ACE inhibitors. Perindopril can be prescribed together with acetylsalicylic acid (as a thrombolytic), thrombolytic agents, beta-blockers and / or nitrates. Ethanol enhances the hypotensive effect of ACE inhibitors. Overdose Symptoms: severe BP, shock, electrolyte balance disorders (such as increased potassium ion concentration, sodium reduction) renal failure, hyperventilation, tachycardia, dizziness, bradycardia, anxiety. Treatment: with a significant decrease in blood pressure, the patient should be placed in a supine position and immediately filled with BCC, preferably infused with angiotensin II and / or injected into / into catecholamines. The development of sustained pronounced bradycardia may require the use of an artificial rhythm driver. Continuous monitoring of vital functions of the body, serum electrolytes and QC is required. Perindopril can be removed from the systemic circulation by hemodialysis. The use of high-throughput polyacrylonitrile membranes should be avoided during dialysis. Storage conditions Keep out of the reach and sight of children. Shelf life 3 years. Deystvuyushtee substance Perindopril dosage form lozenges Possible product names PRESTARIUM A 0.01 N30 TABLE DISPERS IN THE MOUTH CENTRAL PRESTRUST. No. 30 TAB.DISPERG. PRESTARIUM A TAB DISP 10MG No. 30 Prestarium A tab dispersion in the oral cavity 10mg N30 fl polymer dose ind pack Prestarium A tab dispersion in the oral cavity 10mg N30 fl polymer dose ind pack * power steering, Ireland, Russia
