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|Coversyl 4 mg|
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Pharmacodynamics of Coversyl
Promotes the restoration of the elasticity of large arterial vessels, reduces left ventricular hypertrophy, reduces the pressure in the pulmonary capillaries. Reduces myocardial hypertrophy, normalizes myosin isozyme profile; normalizes heart function. Reduces preload and afterload, filling pressure of the left and right ventricles, systemic vascular resistance, moderately decreases heart rate, increases regional blood flow in muscles. Discontinuation of treatment is not accompanied by the development of withdrawal syndrome.
Cmax in blood plasma is achieved after 1 hour.
Approximately 20% of the total absorbed perindopril is converted to perindoprilat, an active metabolite.
T1/ 2 perindopril 1 hour
Cmax perindoprilat is achieved in 3-4 hours Perindoprilat is excreted through the kidneys. T1/2 of the metabolite - 3-5 hours. The equilibrium state is reached after 4 days.
Therapeutic indications of Coversyl
- arterial hypertension;
- chronic heart failure.
- prevention of recurrent stroke (combination therapy with indapamide) in patients who have suffered a stroke or transient ischemic cerebrovascular accident.
Route of administration and dosage
Inside, before meals.
Treatment of essential hypertension: the initial dose is 4 mg once a day, in the morning. If therapy is ineffective within a month, the dose may be increased to 8 mg once a day.
When prescribing ACE inhibitors to patients receiving diuretic therapy, there may be a sharp drop in blood pressure, for the prevention of which it is recommended to stop taking diuretics 2-3 days before the intended start of therapy with Coversyl 5 mg® or to prescribe the drug in lower doses - 2 mg 1 time day.
In patients with renovascular arterial hypertension, the recommended starting dose is 2 mg once a day. Subsequently, if necessary, the dose may be increased.
In elderly patients, treatment should be started with a dose of 2 mg / day, and then, if necessary, gradually increase it, up to a maximum of 8 mg / day.
Treatment of patients with heart failure with Coversyl 5 mg® in combination with a non-potassium-sparing diuretic and / or digoxin is recommended to start under close medical supervision, prescribing the drug in an initial dose of 2 mg once a day, in the morning. Subsequently, after 1–2 weeks of treatment, the dose of the drug can be increased to 4 mg once a day.
Prevention of recurrent stroke. In patients with a history of cerebrovascular disease, therapy with Coversyl 5 mg® should be started with 2 mg during the first 2 weeks before indapamide is administered. Therapy should be started at any (from 2 weeks to several years) time after a stroke.
Renal failure: It is necessary to regularly monitor the level of potassium and creatinine. The following dosing regimen is recommended: at Cl creatinine 30-60 ml / min - 2 mg / day; at Cl creatinine 15-30 ml / min - 2 mg every other day; in patients on hemodialysis (with Cl creatinine <15 ml / min) - 2 mg per day of dialysis. In patients with Cl creatinine more than 60 ml / min or with hepatic insufficiency, correction of the regimen is not required.
If you miss one or more doses, take one tablet before your next meal.
Hypersensitivity to perindopril and other components of the drug, as well as a history of drugs of this group.
- a history of angioedema;
- period of breastfeeding.
- lowering the BCC (taking diuretics, salt-free diet, vomiting, diarrhea, hemodialysis), hyponatremia, cerebrovascular diseases, angina pectoris - the risk of a sharp drop in blood pressure;
- renovascular hypertension;
- bilateral stenosis of the renal arteries or the presence of only one functioning kidney - the risk of developing severe arterial hypotension and renal failure;
- chronic renal and heart failure (risk of hypokalemia);
- systemic connective tissue diseases (systemic lupus erythematosus, scleroderma) and immunosuppressive therapy (including kidney transplantation) - the risk of agranulocytosis and neutropenia;
- hyperkalemia (see Interaction);
- aortic valve stenosis, hypertrophic obstructive cardiomyopathy;
- therapy with hypoglycemic agents in patients with diabetes mellitus - the risk of developing hypoglycemia;
- hemodialysis procedure using high-flow polyacrylonitrile membranes, desensitizing therapy with allergens - the risk of allergic reactions;
- surgical intervention / general anesthesia - the possibility of developing arterial hypotension;
- the presence of lactase deficiency, galactosemia or glucose / galactose malabsorption syndrome;
- old age (treatment should be started with low doses);
- age up to 18 years (efficacy and safety of use have not been studied).
In case of an overdose of the drug, you should immediately consult a doctor.
Symptoms are a marked decrease in blood pressure, shock, stupor, bradycardia, electrolyte imbalance, renal failure.
Combined therapy with Coversyl 5 mgshould be carried out with caution® with lithium preparations, antidiabetic agents, anesthetics, narcotic analgesics, antipsychotic, antihypertensive agents, allopurinol, cytostatic agents, immunosuppressants, systemic corticosteroids, procainamide.
Combined administration with potassium salts and potassium-sparing diuretics such as spironolactone, triamterene and amiloride is not recommended.
Often - more than 1/10 or less than 1/100; rarely - more than 1/100 - less than 1/1000; very rarely - more than 1/1000 - less than 1/10000; extremely rare - less than 1/10000.
From the side of the cardiovascular system: often - excessive decrease in blood pressure and associated symptoms; extremely rare - arrhythmia, angina pectoris, myocardial infarction, stroke.
From the urinary system: rarely - decreased renal function, extremely rarely - acute renal failure.
On the part of the respiratory system: often - "dry" cough, difficulty breathing; rarely - bronchospasm, extremely rarely - rhinorrhea.
From the digestive system: often - nausea, vomiting, abdominal pain, diarrhea, constipation, taste disturbance. Rarely - dry mouth. It is extremely rare - cholestatic jaundice, pancreatitis.
From the nervous system: often - headache, asthenia, dizziness, ringing in the ears, blurred vision, muscle cramps, paresthesia. Rarely - decreased mood, sleep disturbance. It is extremely rare - confusion.
Allergic reactions: often - skin rashes, itching; rarely - urticaria, angioedema; extremely rare - erythema multiforme.
Others: rarely - sweating, impaired sexual function.
Laboratory indicators: while taking the drug, a slight increase in the concentration of creatinine in urine and blood plasma is possible, reversible after discontinuation of the drug - most likely with stenosis of the renal arteries, treatment of arterial hypertension with diuretic drugs, the presence of renal failure. An increase in the concentration of potassium ions, usually temporary. The use of ACE inhibitors in patients with glomerular nephropathy can lead to the development of proteinuria. In some patients (after kidney transplantation, hemodialysis) while taking ACE inhibitors, anemia may develop. Rarely - thrombocytopenia, decreased hemoglobin, hematocrit. Extremely rare - agranulocytosis, pancytopenia, increased activity of hepatic transaminases, hyperbilirubinemia. Possibility of developing hemolytic anemia against the background of glucose-6-phosphate dehydrogenase deficiency.
In case of development of suffocation and swelling of the face or tongue, you should immediately consult a doctor and stop taking the drug.