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Tablets 1. Tablets 2. Combined use of perindopril and indapamide does not change their pharmacokinetic parameters in comparison with separate administration of these drugs. Perindopril after ingestion is quickly absorbed from the gastrointestinal tract. Eating reduces the conversion of perindopril to perindoprilat. C max in blood plasma is reached hours after ingestion. Since taking with food reduces the conversion of perindopril to perindoprilat and the bioavailability of the drug, perindopril should be taken 1 time a day in the morning, before Breakfast. Taking perindopril 1 time a day, the equilibrium concentration is achieved within 4 days. In the liver, it undergoes metabolism with the formation of an active metabolite-perindoprilat. In addition to the active metabolite perindoprilat, perindopril forms 5 more inactive metabolites. Perindoprilat easily passes through histogematic barriers, excluding BBB, a small amount penetrates through the placenta and into breast milk. It does not accumulate. In elderly patients, in patients with renal and heart failure, the excretion of perindoprilat is delayed. In renal failure, it is recommended to reduce the dose of perindopril depending on the severity of renal failure creatinine clearance. The kinetics of perindopril was changed in patients with liver cirrhosis: hepatic clearance was reduced by half. However, the amount of perindoprilat formed does not decrease, which does not require dose adjustment. Quickly and almost completely absorbed into the digestive tract. Food intake slows down absorption somewhat, but does not significantly affect the amount of indapamide absorbed. C max in blood plasma is achieved 1 hour after ingestion of a single dose. Does not accumulate. It is metabolized in the liver. In patients with renal insufficiency, the pharmacokinetic parameters of indapamide do not change significantly. Co -Perineva is a combined drug containing the ACE inhibitor perindopril and the thiazide-like diuretic indapamide. The drug has antihypertensive, diuretic and vasodilating effects. Reduces the risk of hypokalemia caused by diuretic monotherapy. Discontinuation of treatment does not lead to the development of withdrawal syndrome. Perindopril-an ACE inhibitor, the mechanism of action of which is associated with inhibition of the activity of ACE, leading to a decrease in the formation of angiotensin II — eliminates the vasoconstrictor effect of angiotensin II, reduces the secretion of aldosterone. The use of perindopril does not lead to sodium and fluid retention, and does not cause reflex tachycardia during long-term treatment. The antihypertensive effect of perindopril develops in patients with low or normal plasma renin activity. Perindopril acts through its main active metabolite, perindoprilate. Its other metabolites are inactive. The effect of drug Co-Perinea leads to:. Perindopril is effective for hypertension of any severity: mild, moderate and severe. The maximum antihypertensive effect develops after hours after a single oral administration and persists for a day. Discontinuation of therapy does not lead to the development of withdrawal syndrome. It has vasodilating properties and restores the elasticity of large arteries. The addition of a thiazide-like diuretic increases the antihypertensive effect of perindopril. Indapamide is a derivative of sulfonamide and is a diuretic. Inhibits sodium reabsorption in the cortical segment of the renal tubules, increasing the excretion of sodium and chlorine by the kidneys, thus leading to increased diuresis. To a lesser extent, it increases the excretion of potassium and magnesium. Having the ability to selectively block slow calcium channels, indapamide increases the elasticity of the artery walls and reduces OPSS. It has a hypotensive effect in doses that do not have a pronounced diuretic effect. Increasing the dose of indapamide does not increase the antihypertensive effect, but increases the risk of adverse events. Indapamide in patients with hypertension has no effect on lipid metabolism: TG, LDL and HDL and carbohydrate metabolism, even in patients with diabetes mellitus and hypertension. Caution: systemic connective tissue diseases including systemic lupus erythematosus SLE , scleroderma and therapy with immunosuppressive agents risk of neutropenia, agranulocytosis , oppression kostnomozgovy blood, a decrease in BCC reception dioretikov, salt-free diet, vomiting, diarrhea , angina, cerebrovascular disease, renovascular hypertension, diabetes mellitus, chronic heart failure IV functional class NYHA classification , hyperuricemia especially accompanied by gout and urate nephrolithiasis a , the labile blood pressure, elderly patients, hemodialysis using a high-flow polyacrylnitrile membranes; before the procedure, LDL apheresis, simultaneous desensitizing treatment with allergen e. The drug Co-Perinea contraindicated in pregnancy. When planning a pregnancy or when it occurs against the background of taking the drug Ko-Perineva, you should immediately stop taking the drug and prescribe another hypotensive therapy. You should not use the drug Co-Perinea in the first trimester of pregnancy. Controlled clinical studies on the use of ACE inhibitors in pregnant women have not been conducted. Limited data indicate that taking ACE inhibitors in the first trimester did not lead to fetal malformations associated with fetotoxicity, but it is impossible to completely exclude the fetotoxic effect of ACE inhibitors. Long-term use of ACE inhibitors in the second and third trimesters of pregnancy can lead to impaired fetal development decreased kidney function, oligohydramnion, slowing of ossification of the skull bones and the development of complications in the newborn renal failure, hypotension, hyperkalemia. Long-term use of thiazide diuretics in the third trimester of pregnancy can cause hypovolemia in the mother and a decrease in utero-placental blood flow, which leads to fetoplacental ischemia and fetal development delay. Newborns whose mothers received ACE inhibitor therapy may experience hypotension, so newborns should be under close medical supervision. The period of breastfeeding. The drug Co-Perinea is contraindicated during breastfeeding. Indapamide is excreted in breast milk. Causes reduction or suppression of lactation. A 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 about stopping breastfeeding or stopping taking the drug. Inside, 1 time a day, preferably in the morning before Breakfast, with a sufficient amount of liquid. If possible, the drug should be started with the selection of doses of single-component drugs. In the case of clinical need may prescription combination drug therapy Co-Perinea immediately after monotherapy. The initial dose is 1 table. If after 1 month of taking the drug it is not possible to achieve adequate blood PRESSURE control, the dose of the drug should be increased to 1 table. If necessary, to achieve a more pronounced hypotensive effect, it is possible to increase the dose of the drug to the maximum daily dose of the drug Ko-Perineva - 1 table. Patients of advanced age. Patients with impaired renal function. During therapy, it is necessary to regularly monitor the concentration of creatinine and the content of potassium in the blood serum. Patients with impaired liver function. The drug is contraindicated in patients with severe liver failure see Contraindications. In moderate liver failure, dose adjustment is not required. Children and teenagers. The drug Ko-Perineva should not be used in children and adolescents under 18 years of age, because data on the effectiveness and safety are insufficient. Perindopril has an inhibitory effect on RAAS and reduces the excretion of potassium ions by the kidneys while taking indapamide. The risk of hypokalemia serum potassium content less than 3. In each group, undesirable effects are presented in order of decreasing severity. In certain clinical situations conditions after kidney transplantation or in patients undergoing hemodialysis or peritoneal dialysis , ACE inhibitors can cause anemia. From the Central and peripheral nervous system: often-paresthesia, headache, dizziness, vertigo; infrequently-mood lability, sleep disorders; very rarely-confusion. From the sensory organs: often — blurred vision, ringing in the ears. From the side of cardiovascular system: often — expressed lower AD, including orthostatic hypotension; very rarely — arrhythmia, including bradycardia, ventricular tachycardia, atrial fibrillation, and angina, myocardial infarction, possibly secondary due to blood pressure reduction in patients at high risk; frequency is unknown — ventricular tachycardia type pirouette possibly fatal. On the part of the respiratory system: often-dry, long-lasting cough that persists against the background of ACE inhibitors and disappears after their cancellation; shortness of breath; rarely — bronchospasm; very rarely — eosinophilic pneumonia, rhinitis. From the digestive system: often — constipation, dryness of the mucous membrane of the mouth, loss of appetite, nausea, epigastric pain, pain in the abdomen, breach of taste perception, vomiting, dyspepsia, diarrhea, very rarely pancreatitis, intestinal angioedema, hepatitis; frequency not installed — in case of hepatic insufficiency, there is a probability of developing hepatic encephalopathy. From the urinary system: infrequently-renal failure; very rarely-acute renal failure. Laboratory tests: rarely — hypercalcemia; frequency is unknown — increase in the QT on ECG; elevated concentrations of uric acid and glucose in serum during administration of the drug; increased liver enzymes ; and a slight increase in creatinine concentration in blood plasma, reversible upon discontinuation of therapy, which often develops on the background of renal artery stenosis or stenosis of artery only kidneys, arterial hypertension during therapy with diuretics, in renal failure; hypokalemia, especially important for patients at risk; gipohloremia can lead to compensatory metabolic alkalosis probability and severity of effect — low ; often reversible hyperkalemia; hyponatremia with hypovolemia, leading to the decrease in BCC and orthostatic hypotension. According to clinical studies, side effects correspond to the previously established safety profile of the combination of perindopril and indapamide. In rare cases, the following serious adverse events developed: hyperkalemia, acute renal failure, hypotension and cough, and angioedema may develop. Lithium preparations. With simultaneous use of lithium preparations and ACE inhibitors, cases of a reversible increase in the concentration of lithium in the blood serum have been reported. Simultaneous administration of thiazide diuretics may increase the concentration of lithium in the blood plasma and the risk of its toxic effect against the background of taking an ACE inhibitor. The simultaneous use of drug Co-Perinea the drug lithium is not recommended. If simultaneous use is necessary, serum lithium concentrations should be carefully monitored. Baclofen -potentiation of the hypotensive effect. The simultaneous use of ACE inhibitors with NSAIDs including acetylsalicylic acid at doses providing anti-inflammatory, COX-2 inhibitors and nonselective NSAIDs reduces hypotensive effect of ACE inhibitors increases the risk of development of impaired renal function, until the development of acute renal failure, increases the content of potassium in serum, especially in patients with existing impaired renal function. This combination is recommended to be used with caution, especially in elderly patients. Before starting treatment, patients need to compensate for fluid loss, as well as regularly monitor kidney function both at the beginning of therapy and during treatment. Tricyclic antidepressants, antipsychotic agents neuroleptics. They increase the hypotensive effect and increase the risk of orthostatic hypotension additive effect. GCS, tetracosactide. Reducing the hypotensive effect retention of liquid and sodium ions as a result of the action of GCS. Other antihypertensive agents: it is possible to increase the antihypertensive effect of the drug Ko-Perineva. Potassium- sparing diuretics spironolactone, triamterene, amiloride, eplerenone and potassium preparations: ACE inhibitors reduce kidney potassium loss caused by the diuretic. When used together with ACE inhibitors, it is possible to increase the potassium content in the blood serum up to a fatal outcome. If simultaneous use of an ACE inhibitor and the above drugs is necessary in the case of confirmed hypokalemia , caution should be exercised and regular monitoring of the potassium content in the blood plasma and ECG parameters should be performed. Hypoglycemic drugs for oral administration sulfonylureas and insulin : use of ACE inhibitors described for captopril and enalapril in very rare cases may increase hypoglycemic effect of sulfonylureas and insulin in patients with diabetes mellitus; in case of their simultaneous application may increase glucose tolerance and reduce insulin requirements, which may require correction doses of hypoglycemic agents for oral administration and insulin. Allopurinol, cytostatic immunosuppressants, GCS in systemic use , and procainamide : concomitant use of these drugs with ACE inhibitors may increase the risk of developing leukopenia. General anaesthetic agents: ACE inhibitors may increase the hypotensive effect of certain General anaesthetic agents. Simultaneous use with the above-mentioned drugs should be avoided. It is necessary to monitor the potassium content in the blood serum in order to avoid hypokalemia, with the development of which it is necessary to carry out its correction, to monitor THE Qt interval on the ECG. Drugs that can cause hypokalemia: amphotericin B with intravenous administration, gluco-and mineralocorticoids with systemic administration , laxatives that stimulate intestinal motility you should use laxatives that do not stimulate intestinal motility , tetracosactide — increasing the risk of hypokalemia additive effect. It is necessary to control the content of potassium in the blood plasma, if necessary, its correction. Special attention should be paid to patients receiving cardiac glycosides at the same time. Cardiac glycosides: hypokalemia increases the toxic effect of cardiac glycosides. With simultaneous use of indapamide and cardiac glycosides, the potassium content in the blood plasma, ECG parameters should be monitored and, if necessary, the dose of cardiac glycosides should be adjusted. Metformin: functional renal failure on the background of taking diuretics, especially loop, when used simultaneously with Metformin increases the risk of lactic acidosis. Iodine-containing contrast agents: in patients with hypovolemia, there is an increased risk of developing acute renal failure, especially when using contrast agents containing high doses of iodine. Before using iodine-containing contrast agents, the BCC should be filled in. Preparations containing calcium salts: with simultaneous use, hypercalcemia may develop due to a decrease in the excretion of calcium by the kidneys. Cyclosporine: it is possible to increase the concentration of creatinine in the blood plasma without changing the concentration of cyclosporine in the blood plasma, even in the absence of severe loss of sodium ions and dehydration. Symptoms: a marked decrease in blood PRESSURE, nausea, vomiting, muscle cramps, dizziness, drowsiness, confusion, oliguria up to anuria due to a decrease in BCC ; possible violations of the water-electrolyte balance low content of sodium and potassium in blood plasma. If there is a marked decrease in blood PRESSURE, the patient must be moved to the supine position with his legs raised upside down; further, measures should be taken to increase the BCC introduction of 0. Perindoprilat, the active metabolite of perindopril, can be removed from the body by dialysis. Not recommended simultaneous application of the drug Co-Perinea the drug lithium. Impaired kidney function. Some patients with hypertension without previous renal dysfunction during therapy with the drug Co-Perinea may be signs of acute renal failure. In this case, treatment with Co-Perinea should be discontinued. In the future, you can resume combination therapy using low doses of the drug Co-Perineva , or use the drugs perindopril and indapamide in monotherapy. These patients need regular monitoring of potassium and creatinine in the blood serum every 2 weeks after the start of therapy and every subsequent 2 months of therapy with Ko-Perineva. Acute renal failure often develops in patients with severe CHF or initial renal dysfunction, including bilateral stenosis of the renal arteries or stenosis of the artery of the only functioning kidney. Co-Perineva is not recommended for patients with bilateral renal artery stenosis or stenosis of the artery of the only functioning kidney. Hyponatremia is associated with the risk of a sudden decrease in blood PRESSURE especially in patients with bilateral stenosis of the renal arteries or stenosis of the artery of the only functioning kidney. Therefore, when dynamic monitoring of patients should pay attention to possible symptoms of dehydration and a decrease in the content of electrolytes in the blood plasma, for example, after prolonged diarrhea or vomiting. These patients need regular monitoring of electrolytes in the blood plasma. Transient arterial hypotension is not a contraindication for further continuation of therapy. Potassium content. Combined use of perindopril and indapamide does not prevent the development of hypokalemia, especially in patients with diabetes mellitus or renal failure. As in the case of combined use of hypotensive agents and diuretics, regular monitoring of the potassium content in the blood plasma is necessary. Auxiliary substance. It should be borne in mind that the composition of the excipients of the drug Ko-Perineva includes lactose monohydrate, so the drug is contraindicated in patients with hereditary galactosemia, lactase deficiency, glucose-galactose malabsorption see the section Contraindications. In patients with normal kidney function in the absence of other complications, neutropenia rarely develops and passes independently after the withdrawal of ACE inhibitors. Perindopril should be used with great caution in patients with connective tissue diseases and simultaneously receiving immunosuppressive therapy, allopurinol or procainamide, especially in existing renal disorders. 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 white blood cells in the blood. The patient should be warned that in case of any signs of an infectious disease sore throat, fever , it is necessary to immediately consult a doctor. When these symptoms appear, the drug should be stopped immediately, and the patient should be observed until the signs of edema disappear completely. If angioedema affects only the face and lips, its manifestations usually go away on their own, or antihistamines can be used to treat its symptoms. Angioedema, accompanied by swelling of the tongue or larynx, can lead to airway obstruction and death. If such symptoms occur, immediately administer epinephrine epinephrine in a dilution of 1: 0. Patients with a history of Quincke edema that is not associated with ACE inhibitors may have an increased risk of developing it when taking drugs in this group. In rare cases, angioedema of the intestine develops during treatment with ACE inhibitors. In this case, patients have 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 C1-esterase levels. The diagnosis is made using computed tomography of the abdominal cavity, ultrasound, or at the time of surgery. Symptoms disappear after stopping taking ACE inhibitors. In patients with abdominal pain receiving ACE inhibitors, the differential diagnosis should take into account the possibility of developing angioedema of the intestine. Anaphylactoid reactions during desensitization procedures. There are some reports of the development of long-term, life-threatening anaphylactoid reactions in patients receiving ACE inhibitors during desensitizing therapy with hymenopteran insect venom bees, wasps. Avoid prescribing an ACE inhibitor to patients receiving immunotherapy with hymenopteran insect venom. The development of anaphylactoid reactions can be avoided by temporarily canceling the ACE inhibitor at least 24 hours before the start of the desensitization procedure. Anaphylactoid reactions during LDL apheresis. In rare cases, patients receiving ACE inhibitors may develop life-threatening anaphylactoid reactions during LDL apheresis using dextran sulfate. To prevent anaphylactoid reaction, ACE inhibitor therapy should be discontinued before each LDL apheresis procedure using high-flow membranes. Anaphylactoid reactions were observed in patients receiving ACE inhibitors during hemodialysis using high-flow membranes for example, AN Therefore, it is advisable to use a different type of membrane or use a hypotensive drug of a different pharmacotherapeutic group see the section with caution. Potassium-sparing diuretics and potassium preparations. The combined use of perindopril and potassium-sparing diuretics, as well as preparations of potassium and potassium-containing food salt substitutes is not recommended. Against the background of ACE inhibitor therapy, a dry cough may occur, which disappears after the withdrawal of drugs from this group. If a dry cough appears, keep in mind that this symptom may be associated with taking an ACE inhibitor. If the doctor thinks that treatment with ACE inhibitor is necessary for the patient, the drug Co-Perinea can be continued. Children and adolescents under 18 years of age. The drug Ko-Perineva is contraindicated in children and adolescents under 18 years of age due to the lack of data on the effectiveness and safety of use. In cirrhosis of the liver, accompanied by edema and ascites, arterial hypotension, CHF, there may be significant activation of the renin-angiotensin-aldosterone system RAAS , especially with severe hypovolemia and a decrease in the content of electrolytes in the blood plasma against the background of a salt-free diet or long-term diuretics. Before taking of the drug Co-Perinea should assess renal function and potassium content in blood plasma. The risk of hypotension exists in all patients, but special care should be taken when using the drug Ko-Perineva in patients with coronary heart disease and cerebral circulatory insufficiency. In such patients, treatment should begin with a dose of 0. Patients with renovascular hypertension. Treatment with Co-Perineva for patients with diagnosed or suspected renal artery stenosis should be started in a hospital setting with a dose of Co-Perineva 0. Some patients may develop acute renal failure, which is reversible after discontinuation of the drug. Other risk groups. In patients with CHF functional class IV according to the NYHA classification and patients with type 1 diabetes mellitus risk of spontaneous increase in potassium content , treatment should be started with an initial dose of 0. Patients with diabetes mellitus. When prescribing the drug Ko-Perineva to patients with diabetes mellitus receiving hypoglycemic agents for oral administration or insulin, during the first month of therapy, it is necessary to regularly monitor the concentration of glucose in the blood. Ethnic features. Perindopril as well as other ACE inhibitors , has a less pronounced hypotensive effect in patients of the Negroid race compared to representatives of other races. It is recommended to stop taking ACE inhibitors, including perindopril, 12 hours before surgery, warning the anesthesiologist about the use of ACE inhibitors. Liver failure. In rare cases, cholestatic jaundice occurs against the background of ACE inhibitors, with the progression of which fulminant liver necrosis develops, sometimes with a fatal outcome. When the jaundice or a significant increase in liver transaminases in patients receiving ACE inhibitors the drug of the Co-Perinea should be discontinued. It may develop in patients after kidney transplantation or in patients undergoing hemodialysis. It may develop during treatment with ACE inhibitors, including perindopril. Risk factors for hyperkalemia are renal failure, advanced age, diabetes, and some related condition a decrease in the BCC, cardiac decompensation, metabolic acidosis , concomitant use of potassium-sparing diuretics such as spironolactone, eplerenone, triamterene, amiloride and potassium supplements or potassium-containing substitutes of salt and the use of other drugs that increase potassium levels in the blood plasma e. Hyperkalemia can lead to serious cardiac arrhythmias, sometimes fatal. The combined use of the above drugs should be carried out with caution. There are reports of cases of increased photosensitivity when taking thiazide and thiazide-like diuretics. With the development of photosensitivity reactions in patients receiving the drug Co-Perinea the treatment should be stopped. If it is necessary to resume the use of the drug Ko-Perineva , you should protect the exposed skin from direct exposure to solar and artificial UV rays. Water-electrolyte balance. The content of sodium in the blood plasma. Before starting treatment with Ko- Perineva, it is necessary to determine the sodium content in the blood plasma and to conduct regular monitoring of electrolytes in the blood plasma while taking the drug. All diuretics can cause hyponatremia, leading to serious complications. Potassium content in blood plasma. Therapy with thiazide and thiazide-like diuretics is associated with the risk of hypokalemia less than 3. Hypokalemia in these patients increases the toxic effect of cardiac glycosides and increases the risk of arrhythmia. Hypokalemia, like bradycardia, contributes to the development of severe heart rhythm disorders, especially pirouette-type arrhythmias, which can be fatal. In all these cases, regular monitoring of the potassium content in the blood plasma is necessary. The first determination of the potassium content in the blood plasma should be carried out within the first week from the beginning of therapy with Ko-Perineva. The content of calcium in the blood plasma. Thiazide and thiazide-like diuretics reduce the excretion of calcium by the kidneys, leading to a slight and temporary increase in the content of calcium in the blood plasma. Severe hypercalcemia may be a consequence of latent hyperparathyroidism. Before investigating the function of the parathyroid glands, you should stop taking the drug Ko-Perineva. The concentration of glucose in the blood plasma. Glucose concentration should be monitored in patients with diabetes mellitus. Uric acid. In patients with an increased concentration of uric acid in the blood plasma, the frequency of exacerbation of gout may increase during treatment with Ko-Perineva. Diuretics and kidney function. Hypovolemia as a result of lower volume or hyponatremia caused by diuretics, in the beginning of treatment with the drug Co-Perinea can lead to a decrease in glomerular filtration rate and increase in the concentration of creatinine and urea in plasma. Indapamide can give a false positive reaction during doping control. Influence on the ability to drive a car or perform work that requires increased speed of physical and mental reactions. Care must be taken when driving vehicles and working with technical devices that require increased attention and speed of psychomotor reactions. Tablets, 0. A statistically significant decrease in sad and DAP was observed after four months of treatment. The average decrease in sad was Treatment with Perineva and Co-Perineva was characterized by a high level of compliance with the treatment regimen, since Only Perinea and Co-Perinea are available for 30 and 90 table. Hribar V. Krka Med. Napalkov D. Information about prescription drugs is for professionals only. The information provided should not be used by patients to make an independent decision on the use of the presented drugs and cannot serve as a substitute for a full-time consultation with a doctor. A description of the active substances of the drug is provided. The scientific information provided is generalized and cannot be used to decide on the possibility of using a specific drug. The appearance of the product may differ from the photos on the site. Рецептурный препарат. Product is available in pharmacies:. Add to cart. All products in the order are reserved for 24 hours, after that the order is automatically canceled. Composition Pills 1 table. Pharmacokinetics Combined use of perindopril and indapamide does not change their pharmacokinetic parameters in comparison with separate administration of these drugs. Pharmacodynamics Co -Perineva is a combined drug containing the ACE inhibitor perindopril and the thiazide-like diuretic indapamide. The antihypertensive effect persists for 24 hours. The effect of drug Co-Perinea leads to: - venous dilation reduced preload on the heart due to changes in PG metabolism; the decrease in systemic vascular resistance decrease postnagruzki on the heart. In patients with heart failure, perindopril promotes: - reducing the filling pressure of the left and right ventricles; - increase in cardiac output and heart index; - increased regional blood flow in the muscles. Indications of the drug Essential hypertension. Contraindications hypersensitivity to the active substance, any ACE inhibitor, sulfonamide derivatives, or any excipients of the drug; angioedema hereditary, idiopathic or angioedema with other ACE inhibitors history ; severe renal failure; bilateral renal artery stenosis, stenosis of artery only kidneys; refractory hyperkalemia; lactose intolerance, lactase deficiency, or glucose-galactose malabsorption; simultaneous administration of drugs that lengthen THE QT interval on the ECG, simultaneous administration with antiarrhythmic drugs that can cause ventricular tachycardia in the pirouette type see Interaction ; severe liver failure including encephalopathy ; pregnancy, breast-feeding period, age under 18 efficacy and safety not established ; given the lack of sufficient experience of use, the drug Co-Perineva should not be taken in patients on dialysis, and in patients with untreated decompensated heart failure. Use during pregnancy and lactation Pregnancy. It is not known whether perindopril is excreted in breast milk. Dosage and administration Inside, 1 time a day, preferably in the morning before Breakfast, with a sufficient amount of liquid. Side effect Perindopril has an inhibitory effect on RAAS and reduces the excretion of potassium ions by the kidneys while taking indapamide. From the musculoskeletal system: often-muscle spasms. From the reproductive system: infrequently-impotence. Other: often-asthenia; infrequently-increased sweating. Interaction Simultaneous use is not recommended Lithium preparations. Simultaneous use requiring special care Baclofen -potentiation of the hypotensive effect. Simultaneous use requiring caution Tricyclic antidepressants, antipsychotic agents neuroleptics. Perindopril Simultaneous use is not recommended Potassium- sparing diuretics spironolactone, triamterene, amiloride, eplerenone and potassium preparations: ACE inhibitors reduce kidney potassium loss caused by the diuretic. Simultaneous use requiring special care Hypoglycemic drugs for oral administration sulfonylureas and insulin : use of ACE inhibitors described for captopril and enalapril in very rare cases may increase hypoglycemic effect of sulfonylureas and insulin in patients with diabetes mellitus; in case of their simultaneous application may increase glucose tolerance and reduce insulin requirements, which may require correction doses of hypoglycemic agents for oral administration and insulin. Simultaneous use requiring caution Allopurinol, cytostatic immunosuppressants, GCS in systemic use , and procainamide : concomitant use of these drugs with ACE inhibitors may increase the risk of developing leukopenia. Simultaneous use requiring caution Metformin: functional renal failure on the background of taking diuretics, especially loop, when used simultaneously with Metformin increases the risk of lactic acidosis. Overdose Symptoms: a marked decrease in blood PRESSURE, nausea, vomiting, muscle cramps, dizziness, drowsiness, confusion, oliguria up to anuria due to a decrease in BCC ; possible violations of the water-electrolyte balance low content of sodium and potassium in blood plasma. Special instruction Lithium preparations. Indapamid Photosensitivity. Form release Tablets, 0. Conditions of supply of pharmacies By prescription. Literature 1. Производитель КРКА. Prescription drug. Ignatievskoe, Social pharmacy 17 pom Sh. Town Pharmacy Catalog Basket 0. All pharmacies 1 Kantemirova Street Ajbolit с 8. Chigiri Social pharmacy с 8. Novotroitskoe Perekrestok pharmacy с 9. Ignatievskoe Tvoyaapteka с 8. Ignatievskoe Social pharmacy с 8.

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