Reducing the formation cypionate testosterone of angiotensin II is accompanied by increased activity of plasma renin activity (due to inhibition of the negative feedback). ACE Inhibition accompanied by increased activity of both circulating and tissue kallikrein-kinin system, it also activates prostaglandin system. Helps restore elasticity of large arteries (reduction in the formation of excessive amounts of subendothelial collagen), reduces the pressure in the pulmonary capillaries, with long-term administration reduces the severity hypertrophy left ventricular myocardium and interstitial fibrosis, normalizes the isoenzyme profile of myosin; It normalizes the functioning of the heart. Lowers preload and afterload (reduces systolic and diastolic blood pressure (BP) in the position of “lying” and “standing”), filling pressure of the left and right ventricles, total peripheral vascular resistance; increases blood circulation minute volume and cardiac index without changing the heart rate (in patients with chronic heart failure), at therapeutic doses does not increase the heart rate, increases regional blood flow in the muscles.
Increases concentration of high density lipoprotein in patients with hyperuricemia reduces the concentration of uric acid . Increases renal blood flow, does not change the glomerular filtration rate. In patients with chronic heart failure causes a significant reduction in the severity of clinical signs of heart failure and increases exercise tolerance (according to bicycle stress test). After ingestion average single dose maximum hypotensive effect is achieved after 4-6 h and maintained for 24 hours. The hypotensive effect of stabilization is observed after one month of therapy, and stored for a long time. Discontinuation of treatment is not accompanied by the development of the syndrome of “cancellation”. Pharmacokinetics Absorption – 25% bioavailability – 65-70%. . The time to reach maximum plasma concentration – 1 hour, perindoprilat – 4.3 h 20% metabolism is transformed into the active metabolite – perindoprilat (reception perindopril after meals reduces the proportion perindoprilat formed – has substantial clinical significance in); remainder – 5 inactive compounds. T ½ (half-life) of perindopril -1ch. Communication cypionate testosterone of distribution of free perindoprilat – 0.2 l / kg. Perindoprilat excreted by the kidneys, the T ½ free fraction metabolite -. 3-5 hours Dissociation of perindoprilat bound to ACE, slow. Because of this “efficient” T ½ is 25 hours. Reappointment of perindopril does not lead to its accumulation, and T ½ perindoprilat Repeated dose corresponds to the period of its activity. Excretion of perindoprilat is slowed in elderly patients and in patients with chronic heart failure and chronic renal failure (the latter dose adjustment should be based on creatinine clearance). Perindopril dialysis clearance is 70 ml / min. In patients with hepatic clearance perindopril cirrhosis is reduced by 2 times, while the total number remains unchanged formed perindoprilat and correct dosing regimen is not required.
Hypertension; chronic heart failure.
: Hypersensitivity to perindopril and other components of the drug or other ACE inhibitors, angioedema in history against a background of ACE inhibitor therapy, hereditary or idiopathic angioedema, pregnancy, lactation, age 18 years (effectiveness and safety have been established); Hereditary lactose intolerance, lactase deficiency or malabsorption of glucose and galactose.
aortic stenosis, hypertrophic obstructive cardiomyopathy, cerebrovascular diseases (including cerebrovascular insufficiency), ischemic heart disease, coronary insufficiency – a risk of excessive blood pressure lowering and concomitant ischemia.
Severe autoimmune systemic diseases of connective tissue (ie. h. systemic lupus cypionate testosterone erythematosus, scleroderma), inhibition of bone marrow hematopoiesis in patients receiving immunosuppressive drugs (increasing the likelihood of developing neutropenia).
renovascular hypertension, a bilateral renal artery stenosis, stenosis of the artery only kidney condition after kidney transplantation (risk of renal dysfunction and agranulocytosis) chronic renal failure (especially accompanied by hyperkalemia), hyperkalemia, diet sodium restriction, a condition associated with decreased blood volume (including diarrhea, vomiting, diuretics), diabetes, advanced age, surgery (general anesthesia).