Dosing and Administration
Inside, testosterone cypionate price in the morning before eating.
The initial dose for treating hypertension is 4 mg / day, if necessary (1 month), the dose may be increased to 8 mg / day in one step. In the appointment of ACE patients receiving diuretic therapy inhibitors, there may be a sharp decrease in blood pressure, which is recommended for the prevention stop taking diuretics 2-3 days before the expected start of therapy with Parnavel or prescribe a drug at lower doses – 1 mg 2 times a day.
In patients with renovascular hypertension, the initial dose is 1 mg 2 times a day. If necessary, the subsequent dose may be increased.
In elderly patients, therapy should be initiated with a dose of 2 mg per day, and thereafter, if necessary, to gradually increase it up to a maximum dose of 8 mg per day.
Treatment of patients with chronic heart failure in combination kaliynesberegayuschim with a diuretic and / or digoxin is recommended to start under close medical supervision, Parnavel administered in an initial dose of 1 mg 2 times a day, in the morning.
in the future, after 1-2 weeks of therapy, the dose may be increased to 4 mg 1 time . per day
in patients with renal impairment, the dose should be adjusted according to the degree of renal failure: depending on the creatinine clearance. When creatinine clearance 30-60 ml / min. – 1 mg 2 times a day;1530 with creatinine clearance ml / min. – 2 mg every other day; patients on hemodialysis (creatinine clearance less than 15 ml / min.) – 2 mg per day of dialysis. When a creatinine clearance of 60 ml / min. – 4 mg. Patients with impaired liver function changes in dose are required.
Side effect On the part of the cardiovascular system: often – an excessive fall in blood pressure and related simshgomy, rarely – arrhythmias, angina, myocardial infarction and stroke. From the urinary system: decrease in renal function, acute renal failure. On the part of the respiratory system: often – “dry” cough, shortness of breath; redkobronhospazm, rhinorrhea, eosinophilic pneumonia. From the digestive system: often – nausea, vomiting, abdominal pain, change in taste, diarrhea or constipation, dry mouth, decreased appetite, cholestatic or cytolytic jaundice, pancreatitis, intestinal swelling. On the part of the central nervous system: often – headache, asthenia, fatigue, dizziness, ringing in the ears, blurred vision, muscle cramps, paresthesias; rarely – depressed mood, insomnia; extremely rare – confusion. Allergic reactions: often – skin rash, itching; rarely – urticaria, angioedema; rarely – exudative erythema multiforme. Laboratory tests: often – hypercreatininemia, proteinuria, hyperkalemia;hyperuricemia; rarely (with prolonged use at high doses) – neutropenia, leukopenia, gipogemoglobinemiya, thrombocytopenia, decreased hematocrit; very rarely – agranulocytosis, pancytopenia, testosterone cypionate price increased activity of “liver” enzymes, hyperbilirubinemia, haemolytic anemia (compared to glucose-6-phosphate dehydrogenase deficiency). Other: increased sweating, sexual dysfunction.
Overdose Symptoms: marked testosterone cypionate price reduction of blood pressure, shock, stupor, bradycardia, tachycardia, anxiety and cough, dizziness, electrolyte disorders (hyperkalemia, hyponatremia), renal failure. Treatment:gastric lavage, the restoration of water and electrolyte balance, intravenous administration of 0.9% sodium chloride solution . In the case of significant decrease in blood pressure should be given to the patient to a horizontal position, lifting the legs up; make up the volume of circulating blood. With the development of bradycardia – atropine, may require production of an artificial pacemaker. Control of blood electrolytes, and serum CK. Perindopril may be removed from the systemic circulation by hemodialysis. Avoid using vysokoprotochnyh nitron polyacrylic membranes.
Interaction with other drugs
increases the severity of hypoglycemic action of insulin and sulfonylureas.
Baclofen, tricyclic antidepressants, antipsychotics (neuroleptics), saluretiki enhance the hypotensive effect and increase the risk of orthostatic hypotension (additive effect), antacids reduce the bioavailability of ACE inhibitors.
Glucocorticoids, nonsteroidal anti-inflammatory drugs (NSAIDs), including selective inhibitors of cyclooxygenase 2 (COX-2), acetylsalicylic acid (more than 3 g / day) reduced the severity of hypotensive action (fluid retention and electrolytes).
Allopurinol, immunosuppressants, including cytostatics and system corticosteroids, procainamide – when combined with ACE inhibitors -. risk of leucopenia
potassium-sparing diuretics (spironolakgon, triamterene, amiloride), potassium supplements increase the risk of hyperkalemia.
not recommended simultaneous testosterone cypionate price application of drugs that may cause hyperkalemia, and ACE inhibitors, except in cases severe hypokalaemia (control of the content of potassium in the blood serum).
in an application with drugs lithium may slow its elimination from the body (requires regular monitoring of blood lithium). Diuretics, drugs for general anesthesia and muscle relaxants, ethanol increases the risk of excessive blood pressure lowering. The risk of symptomatic hypotension may be reduced by stopping the diuretic a few days prior to treatment with perindopril.
Perindopril can be administered in conjunction with acetylsalicylic acid (as an antiplatelet agent), thrombolytics, beta-blockers and / or nitrates.
Sympathomimetics may reduce the antihypertensive effect of ACE inhibitors. In the appointment of such a combination is necessary to evaluate the effectiveness of ACE inhibitors.
In an application with the preparation of gold (sodium aurothiomalate) in injectable form in patients observed adverse effects, “tides” of blood to the skin of the face, nausea, vomiting, hypotension (hypotension is seen as strengthening effect ACE inhibitors influenced gold preparation).