Перинева®

General characteristics. Structure:

Perindoprila эрбумин, a semi-finished product - granules of 38,39 mg 76,78 mg 153,56 mg
Active agent of a semi-finished product granules
Perindoprila эрбумин 2 mg 4 mg 8 mg
Semi-finished product excipients - Calcii chloridum granules hexahydrate, lactoses monohydrate, кросповидон]. 
Excipients
Cellulose microcrystallic, silicon dioxide colloid, magnesium stearate.

Description
Tablets of 2 mg. Round, slightly biconvex tablets, white or almost white color with a facet.
Tablets of 4 mg. Oval, slightly biconvex tablets, white or almost white color with a facet and risky on one party.
Tablets of 8 mg. Round, a slega biconvex tablets, white or almost white color with a facet and risky on one party.

Pharmacological properties:

Pharmacodynamics. Perindopril - APF inhibitor, or a kininaza of II, treats oxopeptidases. Turns angiotensin I into a vasoconstrictor angiotensin II and bradikinin destroys a vazodilatator to an inactive gektapeptid. Suppression of activity of APF leads to decrease in level of angiotensin II and increase in activity of a renin in plasma (suppressing negative feedback of release of a renin) and to decrease in secretion of Aldosteronum. As APF is also destroyed by bradikinin, suppression of APF brings and to increase in activity of the circulating and fabric kallikrein-kinin system, at the same time the system of prostaglandins is activated.
Perindopril has therapeutic effect thanks to an active metabolite - a perindoprilat.
Perindopril reduces both the systolic, and diastolic arterial pressure (AP) in situation "lying" and "standing". Perindopril reduces the general peripheric vascular resistance (GPVR) that leads to decrease in the ABP. At the same time the peripheral blood stream accelerates. However the heart rate (HR) does not increase. The renal blood stream, as a rule, amplifies while the glomerular filtration rate does not change. The maximum anti-hypertensive effect is reached in 4-6 hours after a single dose in a perindopril; the hypotensive effect remains within 24 hours, and in 24 hours drug still provides from 87% to 100% of the maximum effect. Decrease in the ABP develops quickly. Stabilization of anti-hypertensive action is observed in 1 month of therapy and remains for a long time. The termination of therapy is not followed by a syndrome of "cancellation". Perindopril reduces a hypertrophy of a myocardium of a left ventricle. At long appointment reduces expressiveness of intersticial fibrosis, normalizes an isofermental profile of a myosin. Increases concentration of lipoproteids of the high density (LPVP), at patients with a hyperuricemia reduces concentration of uric acid.
Perindopril improves elasticity of large arteries, eliminates structural changes in small arteries.
Perindopril normalizes cardiac performance, reducing before - and an afterload.
At patients with the chronic heart failure (CHF) against the background of therapy perindoprily it is noted:
• reduction of filling pressure in the left and right ventricles,
• reduction of OPSS,
• increase in cordial emission and cardiac index.
Reception of an initial dose of a perindopril of 2 mg at patients with HSN I-II of a functional class on classification of NYHA was not followed by statistically significant decrease in the ABP in comparison with placebo.

Pharmacokinetics. After intake perindoprit quickly it is soaked up from digestive tract and reaches the maximum concentration in a blood plasma within 1 hour. Bioavailability makes 65 - 70%.
20% of all quantity of the absorbed perindopril turn in периндоприлат (an active metabolite). The elimination half-life (T1/2) makes 1 hour of a blood plasma of a perindopril. The maximum plasma concentration of a perindoprilat are reached in 3-4 hours.
Administration of drug during meal is followed by reduction of transformation of a perindopril in периндоприлат, bioavailability of drug respectively decreases. The volume of distribution of an untied perindoprilat makes 0,2 l/kg. Communication with proteins of a blood plasma insignificant, communication of a perindoprilat with APF less than 30%, but depends on its concentration.
Perindoprilat is brought by kidneys. T1/2 of untied fraction makes about 3-5 hours. Does not kumulirut. At patients of advanced age, at patients with renal and chronic heart failure removal of a perindoprilat is slowed down. Perindoprilat leaves at a hemodialysis (speed of 70 ml/min., 1,17 ml/sec.) and peritoneal dialysis.
At patients with cirrhosis the "hepatic" clearance of a perindopril changes, at the same time total quantity of the formed perindoprilat does not change and correction of the mode of dosing is not required.

Indications to use:

• Arterial hypertension;
• chronic heart failure;
• prevention of a repeated stroke (as a part of complex therapy with indapamidy) at patients with cerebrovascular diseases in the anamnesis (a stroke or the tranzitorny cerebral ischemic attack);
• stable coronary heart disease (CHD): decrease in risk of development of cardiovascular complications in the patients who earlier had a myocardial infarction and/or coronary revascularization.

Route of administration and doses:

Inside, it is recommended to accept once a day, before meal, preferably in the morning. The dose of drug is selected individually for each patient, depending on disease severity and individual reaction to treatment.
Arterial hypertension
Perinev's drug can be used in monotherapy and in a combination with other anti-hypertensive means.
The recommended initial dose makes 4 mg once a day, in the morning. For patients about the system renin-angiotensin-aldosteronovoy expressed by activation (for example, at renovascular hypertensia, a hypovolemia and/or a hyponatremia, HSN in a stage of a decompensation or heavy degree of arterial hypertension) the recommended initial dose makes 2 mg a day in one step. At inefficiency of therapy within a month the dose can be increased to 8 mg 1 times/days and at good tolerance of the previous dose.
Addition of APF inhibitors to the patients accepting diuretics can become the reason of development of arterial hypotension. In this regard it is recommended to carry out therapy with care, to cancel reception of diuretics in 2 - 3 days prior to treatment by Perinev's drug or to begin treatment with Perinev's drug with an initial dose of 2 mg a day, in one step. Control is necessary: The ABP, functions of kidneys and concentration of potassium ions in blood serum. Further the dose of drug can be increased, depending on dynamics of the ABP level. If necessary therapy can be resumed by diuretic.
Patients of advanced age have a recommended initial daily dose - 2 mg, in one step. Further it is possible to increase a dose gradually to 4 mg and, if necessary, to maximum - 8 mg once a day, on condition of good tolerance of a smaller dose.
Chronic heart failure the Recommended initial dose makes 2 mg in the morning, under medical observation. In 2 weeks the dose can be increased to 4 mg a day in one step, under control of the ABP. Treatment of HSN with clinical manifestations is usually combined with kaliynesberegayushchy diuretics, beta adrenoblockers and/or digoxin.
At patients with HSN, with a renal failure and with tendency to electrolytic disturbances (hyponatremia), and also at the patients accepting at the same time diuretics and/or vazodilatator, treatment by drug begin under strict medical observation.
At patients with high risk of development of clinically expressed arterial hypotension (for example, at reception of high doses of diuretics), whenever possible, prior to administration of drug of Perinev it is necessary to eliminate a hypovolemia and electrolytic disturbances. It is recommended before therapy and during it carefully to control the ABP level, a condition of function of kidneys and concentration of potassium ions in blood serum.
Prevention of a repeated stroke at patients with cerebrovascular diseases in the anamnesis
Therapy by Perinev's drug should be begun with 2 mg within the first 2 weeks before reception of an indapamid. Treatment should be begun at any time (from 2 weeks to several years) after the had stroke.
Stable coronary heart disease (CHD) 
At patients from a stable ischemic heart disease the recommended initial dose of drug of Perinev makes 4 mg a day. In 2 weeks the dose is increased to 8 mg a day, on condition of good tolerance of a dose of 4 mg a day and control of function of kidneys. Treatment of patients of advanced age has to begin with a dose of 2 mg which in a week can be raised to 4 mg a day. Further, if necessary, in a week it is possible to increase a dose to 8 mg a day with obligatory preliminary control of function of kidneys. At patients of advanced age the dose of drug can be increased only at good tolerance of the previous, lower dose. At a renal failure: at patients with diseases of kidneys the dose of drug of Perinev is established depending on extent of disturbances of renal function. Control of a condition of the patient usually includes regular definition of concentration of potassium ions and creatinine in blood serum.
The recommended doses: 
The Clearance of Creatinine (CC)           the Recommended dose 
from 60 ml/min. and                   it is higher than 4 mg in DAYS
from 30 to 60                       ml/min. 2 mg a day
from 15 to 30                      ml/min. 2 mg every other day
Patients on a hemodialysis

* (KK less than 15 ml/min.).             2 mg in day of dialysis

 * - The dialysis clearance of a perindoprilat makes 70 ml/min. Perinev's drug needs to be accepted after dialysis session. At liver diseases: correction of doses is not required.

Features of use:

Stable coronary heart disease (CHD) 
At development of an episode of unstable stenocardia (considerable or not) within the first month of therapy by Perinev's drug it is necessary to estimate a ratio advantage/risk at therapy by this drug.
Arterial hypotension
APF inhibitors can cause sharp decrease in the ABP. At patients with неосложненнон arterial hypertension symptomatic arterial hypotension seldom arises after reception of the first dose. The risk of excessive decrease in the ABP is increased at patients with reduced OTsK against the background of therapy by diuretics, at observance of a rigid electrolyte-deficient diet, hemodialysis, and also at diarrhea or vomiting, or at suffering heavy a renin - dependent hypertensia. The expressed arterial hypotension was observed at patients from heavy HSN, both in the presence of the accompanying renal failure, and at its absence. The most often expressed arterial hypotension can develop at the patients from heavier HSN accepting "loopback" diuretics in high doses and also against the background of a hyponatremia or a renal failure. Careful medical observation at the beginning of therapy is recommended to these patients and at titration of doses of drug. The same concerns also patients with an ischemic heart disease or cerebrovascular diseases at which excessive decrease in the ABP can lead to a myocardial infarction or cerebrovascular complications.
In case of development of arterial hypotension it is necessary to give to the patient horizontal position with the raised legs, and if necessary to enter intravenously chloride sodium solution for increase in OTsK. Tranzitorny arterial hypotension is not a contraindication for further therapy. After recovery of OTsK and the ABP treatment can be continued on condition of careful selection of a dose of drug.
Some patients to HSN and the normal or low ABP during therapy by Perinev's drug can have an additional decrease in the ABP. This effect is expected and usually is not the basis for drug withdrawal. If arterial hypotension is followed by clinical manifestations, reduction of a dose or drug withdrawal of Perinev can be required.
Stenosis of the aortal or mitral valve / hypertrophic cardiomyopathy
APF inhibitors, including also perindoprit, have to be appointed with care to patients with a stenosis of the mitral valve and obstruction of the taking-out path of a left ventricle (a stenosis of the aortal valve and a hypertrophic cardiomyopathy).
Renal failure
 At patients with a renal failure (KK less than 60 ml/min.) the initial dose of drug of Perinev has to be picked up according to KK (see the section "Route of Administration and Doses") and then - depending on the therapeutic answer. Regular control of concentration of potassium ions and creatinine in blood serum is necessary for such patients.
Patients with symptomatic heart failure have an arterial hypotension developing in an initial stage of therapy by APF inhibitors, can lead to deterioration in function of kidneys. At such patients cases of an acute renal failure, usually reversible were sometimes noted.
At some patients with a bilateral stenosis of renal arteries or a renal artery stenosis of the only kidney (especially in the presence of a renal failure) against the background of therapy APF inhibitors noted increase in serumal concentration of urea and creatinine, reversible after therapy cancellation. Patients with renovascular hypertensia against the background of therapy by APF inhibitors have an increased risk of development of heavy arterial hypotension and renal failure. Treatment of such patients has to begin under careful medical observation, with small doses of drug and at further adequate selection of a dose. Within the first weeks of therapy by Perinev's drug it is necessary to cancel diuretic means and to regularly control function of kidneys. At some patients with arterial hypertension, in the presence of earlier not revealed renal failure, especially at the accompanying therapy diuretics, noted slight and temporary increase of concentration of urea and creatinine in blood serum. In this case reduction of a dose of drug of Perinev and/or cancellation of diuretic means is recommended.
Patients on a hemodialysis
 At the patients who are on dialysis with use of high-flowing membranes, and accepting at the same time APF inhibitors several cases of development of permanent, life-threatening anaphylactic reactions were noted. In need of carrying out a hemodialysis it is necessary to use other type of membranes.
Transplantation of kidneys
 Experience of use of a perindopril for patients with recently postponed transplantation of a kidney is absent.
The increased sensitivity / a Quincke's disease
 Seldom at the patients accepting APF inhibitors including perindoprit, the Quincke's disease of the person, extremities, lips, mucous membranes, language, a glottis and/or throat developed. This state can develop at any moment of treatment. At development of a Quincke's disease treatment has to be immediately stopped, the patient has to be under medical observation before total disappearance of symptoms. The Quincke's disease of lips and the person usually does not demand treatment; it is possible to apply antihistamines to reduction of expressiveness of symptoms. The Quincke's disease of language, a glottis or throat can lead to a lethal outcome. At development of a Quincke's disease it is necessary to enter immediately subcutaneously Epinephrinum (adrenaline) and to provide passability of respiratory tracts. APF inhibitors cause a Quincke's disease in patients of negroid race more often.
Patients with the Quincke's disease in the anamnesis which is not connected using APF inhibitors can be subject to high risk of development of a Quincke's disease at APF inhibitor reception.
Anaphylactoid reactions during a procedure of an aferez of lipoproteids of the low density (LPNP-aferez)
At patients at purpose of APF inhibitors against the background of holding a procedure of an aferez of lipoproteids of the low density (LPNP) with the help a dextran - sulfate absorption, development of anaphylactic reaction is in rare instances possible. Temporary cancellation of APF inhibitor before each procedure of an aferez is recommended.
Anaphylactic reactions when performing desensitization
 At the patients receiving APF inhibitors during a desensitization course (for example, Gimenopter's poison (poison of Hymenoptera)), development of life-threatening anaphylactic reactions is seldom or never possible. Temporary cancellation of APF inhibitor prior to each procedure of desensitization is recommended.
Liver failure
 During therapy by APF inhibitors development of a syndrome which begins with cholestatic jaundice is sometimes possible and then progresses to a fulminantny necrosis of a liver, sometimes with a lethal outcome. The mechanism of development of this syndrome is not clear. If during reception of APF inhibitor there is jaundice or increase in activity of "hepatic" enzymes is observed, APF inhibitor should be cancelled immediately, and the patient has to be under careful observation. It is also necessary to conduct the corresponding examination.
Пейтропения/агранулоцитоз/тромбоцитопения/анемия
 At patients against the background of therapy APF inhibitors noted cases of development of a neutropenia/agranulocytosis, thrombocytopenia and anemia. At normal function of kidneys for lack of other complications the neutropenia develops seldom. Perinev's drug needs to be used with very big care at the patients with general diseases of connecting fabric (for example, hard currency, a scleroderma) who are at the same time receiving immunodepressive therapy, Allopyrinolum or procaineamide, and also at a combination of all listed factors, especially at the existing renal failure. At such patients development of the heavy infections which are not giving in to an intensive antibioticotherapia is possible. When performing therapy Perinev's drug at patients with above-mentioned factors recommends to control periodically quantity of leukocytes in blood and to warn the patient about need to inform the doctor on emergence of any symptoms of an infection.
At patients with inborn deficit glyukozo-6-fosfatdegidrogenazy isolated cases of development of hemolitic anemia are celebrated.
Negroid race
 The risk of development of a Quincke's disease in patients of negroid race is higher. As well as other APF inhibitors, perindoprit is less effective concerning decrease in the ABP at patients of negroid race, perhaps, because of bigger prevalence of lowrenine states in population of this group of patients with arterial hypertension.
Cough
 Against the background of therapy by APF inhibitors persistent, unproductive cough which stops after drug withdrawal can develop. It should be considered at differential diagnosis of cough.
Surgical intervention / general anesthesia
 At patients whose condition demands extensive surgical intervention or anesthesia the drugs causing arterial hypotension, APF inhibitors, including perindoprit, can block formation of angiotensin II at compensatory release of a renin. One day before surgical intervention therapy by APF inhibitors needs to be cancelled. If APF inhibitor cannot be cancelled, then the arterial hypotension developing on the described mechanism can be corrected by increase in OTsK.
Hyperpotassemia
 Against the background of therapy by APF inhibitors, including perindoprit, at some patients concentration of potassium ions in blood can increase. The risk of a hyperpotassemia is increased at patients with renal and/or heart failure, a dekompensirovanny diabetes mellitus and at the patients applying the kaliysberegayushchy diuretics, drugs of potassium or other drugs causing a hyperpotassemia (for example, heparin). In need of co-administration of the specified drugs, it is regularly recommended to control the content of potassium in blood serum.
Diabetes mellitus
 At the patients with a diabetes mellitus accepting hypoglycemic means for intake or insulin in the first several months of therapy by APF inhibitors it is necessary to control carefully concentration of glucose in blood.
Lithium
 Joint administration of drugs of lithium and perindopril is not recommended.
The Kaliysberegayushchy diuretics, drugs containing potassium, kaliysoderzhashchy products and nutritional supplements
 Combined use with APF inhibitors is not recommended.
Lactose
Perinev's tablets contain lactose. Therefore patients with hereditary intolerance of a galactose, deficit of lactase of Lapp or a sprue of glucose galactose should not accept this drug.

Influence on ability to manage motor transport and other mechanical means:
it is necessary to consider a possibility of development of arterial hypotension or dizziness which can influence control of motor transport and work with technical means.

Side effects:

very often:> 1/10,
often:> 1/100, <1/10,
sometimes:> 1/1000, <1/100,
seldom:> 1/10000, <1/1000,
very seldom: <1/10000, including separate messages.
From the central and peripheral nervous system: often - a headache, dizziness, paresthesias; sometimes - sleep disorders or moods; very seldom - confusion of consciousness.
From an organ of sight: often - vision disorders.
From an acoustic organ: often - a sonitus.
From cardiovascular system: often - the expressed decrease in the ABP; very seldom - arrhythmias, stenocardia, a myocardial infarction or a stroke, perhaps secondary, owing to the expressed arterial hypotension at patients of group of high risk; a vasculitis (frequency is unknown).
From a respiratory organs: often - cough, short wind; sometimes - a bronchospasm; very seldom - eosinophilic pneumonia, rhinitis.
From a digestive tract: often - nausea, vomiting, an abdominal pain, a dysgeusia, dyspepsia, diarrhea, a lock; sometimes - dryness of a mucous membrane of an oral cavity; seldom - pancreatitis; very seldom - cytolytic or cholestatic hepatitis (see the section "Special Instructions").
From integuments: often - skin rash, an itch; sometimes - a Quincke's disease of the person, extremities, a small tortoiseshell; very seldom - a multiformny erythema.
From a musculoskeletal system: often - muscular spasms.
From urinogenital system: sometimes - a renal failure, impotence; very seldom - an acute renal failure.
General disturbances: often - an adynamy; sometimes - the increased sweating.
From bodies of a hemopoiesis and lymphatic system: very seldom - at prolonged use in high doses decrease in concentration of hemoglobin and a hematocrit, thrombocytopenia, a leukopenia/neutropenia, an agranulocytosis, a pancytopenia is possible; very seldom - hemolitic anemia (at patients with inborn deficit glyukozo-6-fosfatdegidrogenazy).
Laboratory indicators: increase in concentration of urea in blood serum and blood plasma creatinine, and a hyperpotassemia, reversible after drug withdrawal (especially at patients with a renal failure, heavy HSN and renovascular hypertensia); seldom - increase in activity of "hepatic" enzymes and bilirubin in blood serum; hypoglycemia.

Interaction with other medicines:

Diuretic means
At the patients accepting diuretics, especially at excess removal of liquid and/or sodium at the beginning of therapy by APF inhibitors excessive arterial hypotension can develop. The risk of development of excessive arterial hypotension can be reduced by cancellation of diuretic, intravenous administration of 0,9% of solution of sodium of chloride, and also appointing APF inhibitor in lower doses. Further increase in a dose of a perindopril has to be carried out with care.
Kaliysberegayushchy diuretics, potassium drugs, kaliysoderzhashchy products and nutritional supplements
Usually against the background of therapy by APF inhibitors potassium concentration in blood serum remains within normal values, but at some patients the hyperpotassemia can develop. The combined use of APF inhibitors and kaliysberegayushchy diuretics (for example, Spironolactonum, Triamterenum or amiloride), drugs of potassium or kaliysoderzhashchy products and nutritional supplements can cause a hyperpotassemia.
Therefore it is not recommended to combine perindoprit with these drugs. It is necessary to appoint these combinations only in case of a hypopotassemia, observing precautionary measures and regularly controlling concentration of potassium ions in blood serum.
Lithium
At simultaneous use of drugs of lithium and APF inhibitors development of reversible increase in concentration of lithium in blood serum and lithium toxicity is possible. Simultaneous use of APF inhibitors with thiazide diuretics can increase in addition concentration of lithium in blood serum and increase risk of development of its toxic effects. Perindoprit simultaneous use and lithium is not recommended.
In need of such combination therapy it is carried out under regular control of concentration of lithium in blood serum.
Non-steroidal anti-inflammatory drugs (NPVP), including acetylsalicylic acid in doses from 3 g/days and above
Therapy of NPVP can weaken anti-hypertensive effect of APF inhibitors. Besides, NPVP and APF inhibitors have the additive effect concerning increase in concentration of potassium ions in blood serum that can provoke deterioration in function of kidneys. This effect is usually reversible. In rare instances the acute renal failure, especially at patients with already existing renal failure, for example, at elderly patients or against the background of organism dehydration can develop.
Other anti-hypertensive means and vazodilatator
Simultaneous use of a perindopril with other anti-hypertensive means can strengthen anti-hypertensive effect of a perindopril. Simultaneous use of nitroglycerine, other nitrates or vazodilatator can result in additional hypotensive effect.
Hypoglycemic means
Simultaneous use of APF inhibitors and hypoglycemic means (insulin or hypoglycemic means for intake) can strengthen hypoglycemic effect, up to development of a hypoglycemia. As a rule, this phenomenon arises in the first weeks of a combination therapy at patients with a renal failure.
Acetylsalicylic acid, thrombolytic means, beta adrenoblockers and nitrates
Perindopril it is possible to combine with acetylsalicylic acid (as antiagregantny means), thrombolytic means and beta adrenoblockers and/or nitrates.
Tricyclic antidepressants / antipsychotic means (neuroleptics)/means for the general anesthesia (the general anesthetics) 
Combined use with APF inhibitors can lead to strengthening of hypotensive effect.
Sympathomimetics
Sympathomimetics can weaken anti-hypertensive effect of APF inhibitors. At purpose of a similar combination it is necessary to estimate efficiency of APF inhibitors regularly.

Contraindications:

• Hypersensitivity to a perindopril or other components of drug, and also to other APF inhibitors;
• a Quincke's disease in the anamnesis (a hereditary, idiopathic or Quincke's disease owing to reception of APF inhibitors);
• age up to 18 years (efficiency and safety are not established);
• hereditary intolerance of a galactose, deficit of lactase of Lapp or sprue of glucose galactose.
With care: renovascular hypertensia, a bilateral stenosis of renal arteries, a stenosis of an artery of the only kidney - risk of development of heavy arterial hypotension and renal failure; HSN in a decompensation stage, arterial hypotension; chronic renal failure (clearance of creatinine (CC) less than 60 ml/min.); considerable hypovolemia and hyponatremia (owing to an electrolyte-deficient diet and/or the previous therapy by diuretics, dialysis, vomiting, diarrhea), cerebrovascular diseases (including insufficiency of cerebral circulation, coronary heart disease, coronary insufficiency) - risk of development of excessive decrease in the ABP; a stenosis of the aortal or mitral valve, a hypertrophic subaortic stenosis, a hemodialysis with use of high-flowing poliakrilnitrilovy membranes - risk of development of anaphylactoid reactions; the state after transplantation of a kidney - is absent experience of a clinical use; before the procedure of an aferez of lipoproteids of the low density (LPNP), simultaneous performing the desensibilizing therapy by allergens (for example, poison of Hymenoptera) - risk of development of anaphylactoid reactions; diseases of connecting fabric (including the system lupus erythematosus (SLE), a scleroderma), oppression of a marrowy hemopoiesis against the background of reception of immunodepressants, Allopyrinolum or procaineamide - risk of development of an agranulocytosis and neutropenia; inborn deficit glyukozo-6-fosfatdegidrogenazy - isolated cases of development of hemolitic anemia; representatives of negroid race have a risk of development of anaphylactoid reactions; surgical intervention (the general anesthesia) - risk of development of excessive decrease in the ABP; a diabetes mellitus (control of concentration of glucose in blood); hyperpotassemia; advanced age.

Pregnancy and period of a lactation
At pregnancy use of drug is contraindicated. It is not necessary to apply in the I trimester of pregnancy therefore at pregnancy confirmation Perinev's drug needs to be cancelled as soon as possible. Drug is contraindicated in the II-III trimesters of pregnancy as use in the II-III trimesters of pregnancy can cause fetotoksichesky effects (depression of function of kidneys, an oligoamnios, delay of ossification of bones of a skull of a fruit) and neonatal toxic effects (a renal failure, arterial hypotension, a hyperpotassemia). If nevertheless used drug in the II-III trimesters of pregnancy, then it is necessary to conduct ultrasound examination of kidneys and bones of a skull of a fruit.
Use of drug of Perinev during feeding by a breast is not recommended, due to the lack of data on a possibility of its penetration into breast milk. In need of use of drug in the period of a lactation to stop breastfeeding.

Overdose:

Symptoms: the expressed decrease in the ABP, shock, disturbances of water and electrolytic balance (a hyperpotassemia, a hyponatremia), a renal failure, a hyperventilation, tachycardia, heartbeat, bradycardia, dizziness, alarm, cough.
Treatment: at the expressed decrease in the ABP - to give to the patient horizontal position with the raised legs and to hold events for completion of the volume of the circulating blood (VCB), whenever possible - intravenous administration of angiotensin II and/or intravenous solution of catecholamines. At development of the expressed bradycardia which is not giving in to medicinal therapy (including atropine), showed installation of an artificial pacemaker (pacemaker). It is necessary to control the vital functions and concentration of creatinine and electrolytes in blood serum. Perindopril can be removed from a system blood-groove with a hemodialysis method. It is necessary to avoid use of high-flowing poliakrilnitrilovy membranes.

Storage conditions:

List B. To store at a temperature not above 30 °C. To store in the place, unavailable to children. Period of validity 2 years. Not to use drug after expiry date.

Issue conditions:

According to the recipe

Packaging:

Tablets on 2 mg, 4 mg and 8 mg. 10, 14 or 30 tablets in a blister strip packaging. 3,6 or 9 blister strip packagings on 10 tablets or 1, 2, 4, 7 blister strip packagings on 14 tablets or 1, 2, 3 blister strip packagings on 30 tablets together with the application instruction place in a pack from a cardboard.