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Active Ingredient: Perindopril Erbumine.

💚Aceon is used for treating high blood pressure.

Other names for this medication:
Acertil, Acerycal, Agulan, Aldoc, Apo-perindox, Armix, Asyntilsan, Bionoliprel, Biprel, Bipreterax, Cardipen, Co-prenessa, Co-prestarium, Cobathrow, Coveram, Coverene, Coverex, Coverex-as, Coversum, Covinace, Domanion, Dorover, Indapril, Inopil, Midopril, Noliprel, Pendoril, Pendrex, Percarnil, Perindal, Perindan, Perindo, Perindox, Prenessa, Prenix n, Prestance, Prestarium, Preterax, Prexanil, Prexanil a, Prexum, Prindace, Procaptan, Provinace, Reaptan, Repres plus, Spopress, Stopress, Teraxans, Tertensif kombi, Vectoryl, Vidotin.

👉Indications for use
Indications for use are narrow-profile for a therapeutic hospital due to the specificity of the therapeutic effect of the drug Perindopril:

☞arterial hypertension;
☞chronic heart failure;
☞hypertension of renovascular etiology;
☞prevention of recurrent stroke or stroke after a transient ischemic attack;
☞stable ischemic heart disease.

👉Indications for useComposition

Perindopril in the form of tablets contains:
☞perindopril erbumin (acts as the main active ingredient) – 4 mg;
☞milk sugar (lactose);
☞microcrystalline cellulose (MCC);
☞croscarmellose or primellose sodium;
☞magnesium stearate.

👉Pharmachologic effect
Perindopril is a pharmaceutical product that belongs to the group of angiotensin-converting enzyme inhibitors. Due to the chemical interaction of this catalyst with zinc ions, it is completely inactivated. As a result of such influences, the conversion of angiotensin I to angiotensin II, which has a vasoconstrictor effect, is inhibited (due to the narrowing of the vascular bed, blood pressure rises). Suppression of ACE is accompanied by effects on the kallikrein-kinin system and prostaglandins – their circulating and tissue concentrations increase.

Active metabolites of Perindopril affect the natural hormones of the human body. The production of aldosterone (the result of interaction with the renin-angiotensin-aldosterone system of the kidneys) decreases, the release of norepinephrine from sympathetic nerve endings and the formation of endothelin by the inner layer of the vascular wall are suppressed. All these changes strengthen the hypotensive effect of the pharmaceutical preparation, allowing, as they say, “to attack on all fronts”, which entails a steady decrease in blood pressure.

The drug to some extent has protective properties – Perindopril contributes to the regenerative restoration of the elasticity of large blood vessels of the arterial bed. The mechanism of this pharmaceutical effect lies in reducing the excess amount of collagen occupying the subendothelial layer of the structure. Thus, the great vessels become stronger in the physiological sense and can respond more actively to changes in blood pressure.

The cardiac effects of an ACE inhibitor consist in reducing the pre and post load on the myocardium (the total peripheral vascular resistance and the volume of blood flow decrease), thereby normalizing the work of the muscular organ, increasing its efficiency – the minute volume of blood increases without increasing the heart rate. Peripheral tissues and organs improve their trophism and regional blood flow, which is reflected in the condition of the patient’s entire body undergoing conservative therapy.

If the muscular pump is subject to such pathology as chronic heart failure, then the degree of clinical signs of this nosological unit decreases. Exercise tolerance, on the contrary, is growing rapidly. Clinical studies were conducted using a bicycle ergometric test, which confirmed the reliability of therapeutic effects in the treatment of chronic heart diseases.

👉Pharmacodynamics and pharmacokinetics
The drug is used orally, after which 25 percent of the constituent components are absorbed from the cavity of the gastrointestinal tract. Bioavailability of the drug is 65-70 percent. Interesting and even somewhat unusual is the time to reach maximum plasma concentration. The largest number of inactive substances reaches 1 hour, and the biologically active perindoprilat, the product of the active ingredient exchange in the internal environment of the body (about 20 percent of Perindopril is metabolized to this form), manifests its extreme abilities only 3-4 hours after taking the medicine.

Perindoprilat is able to bind to plasma proteins to an insignificant degree and with angiotensin-converting enzyme (slightly less than 30 percent of the active fraction). The volume of distribution of the free metabolite is 0.2 l / kg. The product exchanges mainly kidneys with a half-life of 3-5 hours. The same part, which is associated with ACE, is deploying extremely slowly, which prolongs the effective half-life to 25 hours. The cumulation of the active substance is not observed (the amount of perindoprilat and its half-life does not change in any way when the drug is taken again).

Active excretion of the active product of metabolism can be slowed down by physiological deterioration of the renal apparatus in elderly people or in chronic heart and kidney failure, therefore strict dose adjustment is required based on the creatine kinase level (constant diagnostic examinations are required during the course of treatment if the patient is in this risk group ). Dialysis clearance is 70 ml per minute.

👉Contraindications
☞increased individual sensitivity, acquired or inherited intolerance to the constituent components of a pharmaceutical preparation or the whole group of angiotensin-converting enzyme inhibitors;
☞gestation period;
☞lactation or breastfeeding;
☞angioedema of hereditary or idiopathic origin;
☞the drug is not used in pediatric practice (until the age of 18).

Separately, it is worth noting that there are a number of pathological conditions when the use of the drug Perindopril is not completely safe and requires constant diagnostic monitoring of various indicators of the body with the conditions of the hospital. The list consists of such diseases:
☞aortic or mitral stenosis;
☞constrictive pericarditis;
☞leukopenia;
☞severe autoimmune nosological units of the connective tissue (in particular, systemic lupus erythematosus or scleroderma);
☞hyponatremia;
☞the presence of a transplanted donor kidney;
☞hypertrophic cardiomyopathy;
☞thrombocytopenia;
☞cerebrovascular diseases;
☞obliterating atherosclerosis or narrowing of the lumen of vessels of other origin (especially the channel feeding the heart muscle);
☞bilateral stenosis of the renal arterioles;
☞hyperkalemia;
☞moderate or severe renal failure;
☞dehydration and exsiccosis.

👉Side effects
Perindopril is an extremely active pharmaceutical drug, which, in addition to therapeutic effects, is indicated by the frequency of adverse reactions during treatment. It makes up 1-10 percent of all cases of conservative therapy. The side effect of the constituent components can manifest itself in the form of a violation of various body systems:

Digestive tract: nausea, vomiting, indigestion, dry mouth, diarrhea, loss of appetite, cholestatic jaundice, inflammation of the pancreas, intestinal edema.
Since the cardiovascular system: excessive reduction in blood pressure with the development of orthostatic hypotension, arrhythmia, angina, stroke and myocardial infarction.
On the part of the urinary system: reduced functional ability of the kidneys, acute renal failure.
Respiratory organs: dry cough, rhinorrhea, difficulty in inhaling and exhaling, eosinophilic pneumonia, bronchospasm.
On the part of the central nervous system: headache, asthenia, dizziness, fatigue, imbalance of sleep and wakefulness, decreased mood, periodic tinnitus, disorders of the visual apparatus, muscle cramps and paresthesia.
Allergic reactions: pruritus or rash, urticaria, angioedema, erythema multiforme.
From other systems: increased sweating, impaired sexual function.
Changes in laboratory parameters – hypercreatininemia, hypohemoglobinemia, thrombocytopenia, proteinuria, hyperkalemia, hyperuricemia, neutropenia, leukopenia (agranulocytosis), pancytopenia, increased percentage and activity of liver enzymes, hemolytic anemia in the presence of glucose-6-phosphate-6-phospholiphoma-6-phosphorus, and hemolytic anemia, an increase in the percentage ratio and activity of liver enzymes.

👉Perindopril, instructions for use (method and dosage)
Pharmaceutical drug is used orally at a time (once a day). Treatment usually starts with a starting dosage of 1-2 mg per day. Further, depending on the indications for therapy, the instructions for use of Perindopril are somewhat different:

✧in case of congestive heart failure, conservative readjustment is continued with an optimal dosage of 2-4 mg per day;
✧arterial hypertension can be treated with higher amounts of the medication taken, with this pathology 4-8 mg per day is used, the dosage should be increased gradually, within 3-4 weeks;
✧renovascular hypertension is treatable at 2 mg per day;
✧prevention of stroke is carried out according to a special scheme: first, 2 mg per knock for 2 weeks, and then 4 mg per day for the same length of time;
✧therapy of stable coronary heart disease begins with a starting dose of 4 mg per day for 2 weeks, and then the amount of the drug taken increases to 8 mg per day.

👉Overdose

There are significant clinical cases of overdose with a pharmaceutical product, which, as a rule, manifests itself in the following list of symptoms:
☞excessive lowering of blood pressure;
☞shock;
☞stupor;
☞bradycardia;
☞electrolyte imbalance;
☞renal failure.

There is no specific antagonist for the drug. With this complex of adverse effects of treatment, which accompanies increased plasma concentrations of active components, symptomatic therapy is used. The following medical actions are effective:
☞gastric lavage;
☞horizontal position with a raised lower end to restore blood pressure;
☞the use of enterosorbents;
☞correction of water and electrolyte balance isotonic solution of sodium chloride;
☞atropine in the development of bradycardia;
☞effectively using hemodialysis (use of highly permeable polyacrylonitrile membranes is not recommended);
☞in a particularly severe pathological picture of overdose, implantation of an artificial pacemaker can be used.

👉Interaction

Perindopril is an extremely active pharmaceutical product (in this parameter it is even listed in the B list of the International Drug Registry), therefore, it has a long list of interactions of different nature. First of all, it should be noted products that enhance the hypotensive effect of an ACE inhibitor (excessive lowering of blood pressure can lead to orthostatic hypotension or acute cerebrovascular insufficiency):
☞agents used for anesthesia;
☞muscle relaxants;
☞anti hypertensive drugs of any mechanism of action;
☞loop and thiazide diuretics;
☞tricyclic antidepressants;
☞antipsychotic drug group;
☞organic nitrates;
☞non-selective monoamine reuptake inhibitors.
☞Indomethacin may have the opposite effect, that is, a decrease in the hypotensive effect.

Combined use of Perindopril with pharmaceuticals such as potassium-sparing diuretics, digitalis glycosides and potassium-based products (for example, active biological additives) increases the risk of hyperkalemia and all symptoms resulting from this pathological condition.

Separately, it is worth noting the interaction with Nimodipine, since a cardiac rhythm disturbance and an increase in myocardial insufficiency with the combined use of drugs in conservative therapy is clinically important.

Also, patients with diabetes should be cautious, because Perindopril increases the manifestations of the sugar-reducing effect of antidiabetic drugs. Accordingly, there is a risk of hypoglycemia and coma, as its consequences.

👉Storage conditions
Conserve Perindopril should be dry, out of the reach of children, and protected from direct sunlight. The temperature regime of optimal storage should not exceed 25 degrees Celsius.

👉Shelf life
2 years.

👉Special instructions
When using ACE inhibitors and Perindopril in particular, there is a risk of arterial hypotension, headache, dizziness and visual impairment, therefore during the period of conservative treatment it is worth refusing to independently control vehicles or other activities that require increased attention, speed and clarity of motor reactions.

The drug belongs to the pharmaceutical group of angiotensin-converting enzyme inhibitors, so technically all the drugs in this subunit of the classification of antihypertensive drugs can be used as analogues of Perindopril. Most often, with individual contraindications, the therapeutic effect is replaced by the following drugs: Hypernik, Stopress, Noliprel, Prestarium A, Perineva, Prestans.

Separately, it should be noted that Perindopril, due to its breadth of therapeutic effects and pharmacological action, is abundantly used to create combined pharmaceutical preparations. The most popular among this series are:

Perindopril PLUS Indapamide is a drug in which the therapeutic effects of Perindopril are complemented by the diuretic component. The new active component blocks the reabsorption of sodium, chlorine and water ions, selectively suppresses the activity of calcium channels and reduces the total peripheral resistance of blood vessels. A positive feature of this combination of pharmaceutical substances is a well-pronounced hypotensive effect, independent of the position of the body in space and the age of the patient. Also, the action of this drug is not accompanied by reflex tachycardia.
Perindopril Indapamide Richter is an enhanced form of the previous analog. The effect of the drug lasts for 24 hours, and persistent therapeutic effects develop in less than a month of conservative treatment. It should be emphasized that the termination of drug rehabilitation when using this form of medication is not accompanied by withdrawal syndrome, which is sometimes extremely difficult.
Perindopril Arginine is a unique medicine of its kind, because the constituent components of the antihypertensive agent are supplemented with conditionally essential amino acid, the main role of which is to be a source of NO synthase in the process of producing endogenous nitric oxide. The latter is an extremely active mediator of the organism in the pathophysiological sense. In this context, the most important are its vasodilation abilities and the regulating effects on smooth muscle tone. Thus, the hypotensive effect of the drug covers a much wider mechanism of action than Perindopril in its pure form. It should be noted that this drug combination does not prolong the list of side effects of use, since arginine is part of the natural metabolism of the human body.
Amlodipine Perindopril is a pharmaceutical product that includes another slow calcium channel blocker, a dihydropyridine derivative. In addition to the antihypertensive effect, Amlodipine also has an antianginal effect, since, by binding to the dihydropyridine receptors, it reduces the transmembrane current of calcium in smooth muscle cells of the coronary and peripheral beds. This mechanism of action and the consequences of its use put this drug in the first place among the analogues of Perindopril for indications for the treatment of coronary heart disease and angina in particular.
Perindopril-Mik is a Belarusian equivalent of a domestic pharmaceutical product. A key feature of it is the use of Perindopril t-butylamine salt (in the traditional form of the drug, a compound with erbumin is used). Due to this fact, the drug reduces pressor effects on the vascular wall (including adrenergic), which manifests itself as an angioprotective effect. It should also be noted that the therapeutic effects of this combination extend to peripheral tissues to a greater extent – they are sensitized to insulin, and therefore glucose metabolism proceeds with greater intensity.

👉For children
The drug is not used in pediatric practice until the age of 18.

👉With alcohol
While undergoing a course of conservative drug therapy, alcoholic beverages should be completely excluded, since alcohol increases the hypotensive effect of the drug, which can adversely affect the body and lead to serious consequences (sudden loss of consciousness, acute cerebral or coronary circulation insufficiency, and so on).

👉During pregnancy and lactation
Perindopril is contraindicated for use during periods of pregnancy, lactation or breastfeeding.

👉Perindopril Reviews
Messages on pharmaceutical forums unanimously reiterate the positive effect of the drug on blood pressure parameters and the work of the heart as a whole. Such an active active ingredient of Perindopril can cope with serious pathology in a relatively short course of conservative therapy. People who took a pharmaceutical drug speak very well about it, because in addition to the main therapeutic effects, it improves trophism and the delivery of beneficial nutrients to all peripheral tissues and organs, cleans the macro circulatory bed, which can not but affect the overall well-being .

Reviews of doctors about Perindopril confirm the opinion of grateful patients from a professional point of view. However, there are several points that somewhat cloud the opinion of qualified specialists. First of all, this is the frequent development of side effects during the course of Aceondrug treatment, because the incidence of adverse reactions is a catastrophic large 1-10 percent. Of course, the overwhelming majority of adverse effects is stopped quite easily, but this creates an additional burden on the patient’s body and does not always pass without a trace.

Therefore, in therapeutic hospitals, Perindopril is increasingly being replaced by combined pharmaceutical ingredients. So, for example, in combination with argininin, the number of adverse effects of conservative treatment does not increase, and the therapeutic effect, on the contrary, is growing irresistibly.

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