According to the instructions for use, Prestarium belongs to the category of ACE inhibitors. The drug is available in tablet form in two dosage forms - 5 and 10 mg of the active component in one capsule. Also on sale there are similar medicines “Prestarium A”, “Bi Prestarium”. The optimal option, suitable for a particular patient, will be chosen by the doctor based on the results of studies of the patient's condition.
What is made of?
Instructions for use "Prestarium" (5 mg) contains an indication of the active component - arginine perindopril. In terms of pure perindopril, this is 3.395 mg. The tablets are administered in the form of green-coated capsules. Each instance has an elongated shape, both sides are equipped with a division line. One of the sides is complemented by the manufacturer's logo.
In addition to the active substance, in the manufacture of the drug used lactose, starch, colloidal magnesium dioxide, maltodextrin and magnesium stearate. The tablet shell is made from chlorophyll, macrogol, mellose, glycerol, titanium dioxide and E470B.
The instructions for use "Prestarium" (10 mg) indicates a brighter green color of the shell of the drug. In other nuances, this issue outwardly coincides with a less concentrated one. Each capsule contains 10 mg of perindopril arginine, which in terms of perindopril is 6.79 mg. The manufacturer used additional components - the list almost matches the ones listed above. All possible differences from it are indicated in the accompanying documentation. In particular, sodium glycolate may be added to the tablets.
Features release and release
The tablets in question are packed in polypropylene containers. In one container - 30 doses. The bottle is packaged in a cardboard box indicating all the nuances of release (number of tablets, concentration of the active substance). Tablets must be completed with instructions for use. “Bi Prestarium”, “Prestarium A”, “Prestarium” are issued in card boxes that indicate the name of the drug, the name of the manufacturer, production date, and shelf life of the product.
The medicine is allowed to be sold only if the buyer has a prescription. Particular attention is paid to this in the instructions for the use of Prestarium tablets. The drug shows a pronounced effect on the heart, so its unreasonable use can be dangerous to human health and life. On the outside of the packaging, the manufacturer always notes that only prescription leave is possible.
How it works?
All features of the use of the composition are indicated in the accompanying instructions for use. At what pressure does Prestarium help? The annotation is not indicated. The manufacturer only mentions the effectiveness of the drug for hypertension. The doctor, prescribing the drug, will explain when and how to use it. The product belongs to the category of medicines of long-term effect and is applied by the course. One of the goals pursued by therapy is the prevention of high pressure episodes. This is achievable due to the inhibition of the transformation reactions of angiotensin-1 into angiotensin-2, which could narrow the blood vessels. ACE, inhibited by the active compounds of the drug, activates the production of aldosterone, the reaction of the breakdown of bradykinin with the formation of a heptapeptide.
Very often, many positive reviews by cardiologists can be heard about the drug. The instructions for use of Prestarium specify that a decrease in the activity of the formation of angiotensin-2 leads to a secondary growth of renin, since the negative back reaction is inhibited. At the same time, aldosterone production is directly reduced. The drug affects the kinin-kallikrein system, prevents the breakdown of bradykinin.
The medication belongs to the category of prodrugs. After the compound enters the body, perindoprilat is formed in metabolic reactions - it is this that causes the described effect.
Diagnoses and application. Pressure
Although the manufacturer does not specify in the instructions for use "Prestarium" at what pressure the agent is effective, the accompanying documentation indicates the effectiveness of the composition for hypertension in various forms: soft, medium, severe. Under the influence of active components, diastole and systole pressure decrease. The drug shows the result, regardless of the position of the patient. The pressure decreases with a sitting position and lying down.
The drug dilates blood vessels, thereby reducing peripheral vascular resistance. This helps to normalize pathologically elevated blood pressure. The rheological qualities of blood are getting better. The drug does not adjust the frequency, the rate of contraction of the heart muscle. In most cases, blood flow in the kidneys is activated. The instructions for use "Prestarium A" (10 mg or 5 mg), "Prestarium", "Bi Prestarium" states that the substance does not affect glomerular filtration.
Performance Features
The use of tablets inside at the dose recommended by the doctor allows you to get the most pronounced effect on average five hours after administration (with an hourly deviation up and down). The instructions for use of Prestarium A (10 mg, 5 mg, as well as related release forms) specify that the effectiveness of a single dose lasts one full day.
If the patient’s response to the drug is satisfactory, the pressure returns to normal after a month of regular intake. Subsequently, the effect persists, while the medication, as studies have shown, does not provoke tachyphylaxis. Stopping the course does not lead to withdrawal.
In the instructions for use with Prestarium tablets, the manufacturer draws attention to the ability of the drug to normalize the elasticity of arteries with prolonged use. The main components of the drug affect histomorphological processes in the persistent arteries. Consequently, regression in the left heart ventricle is activated, which helps get rid of organ hypertrophy.
CHF. Nuances
Following the instructions for use with the Prestarium medicine, the drug can be prescribed for heart failure in a chronic form. Active components stabilize the functioning of the body, reduce post-, preload. Regular use in accordance with the instructions of the doctor helps to achieve stabilization, lower blood pressure. The work of both ventricles improves, OPSS decreases.
As tests have shown, in case of chronic heart failure, observing the optimal dosage, Prestarium does not lead to a strong change in pressure. This applies both to the period after the first dose, and to a long therapeutic course.
Pharmacokinetics of the drug
As indicated in the instructions for use, the medicine “Prestarium” is rapidly absorbed when it enters the digestive tract. The maximum concentration of the active substance in the circulatory system is observed approximately an hour after taking the tablets. Bioavailability is estimated at an average of 70%.
The transformation of the compound leads to the formation of perindoprilat, which accounts for about 27% of metabolic projects, as well as five other compounds that do not have pharmacological effectiveness. The highest concentration of perindoprilat in the circulatory system is achievable on average 4 hours after taking the pill. Entry into strong bonds with plasma beks is estimated at 20%, mainly due to the possibility of ACE. Specific indicators are determined by dosage, concentration. The volume of free distribution is about 0.2 l / kg.
Accumulation and elimination
In the instructions for use of Prestarium, the manufacturer indicates the absence of a cumulative effect. Repeated use does not cause the accumulation of drug components in the body. The half-lives and activities correspond to each other. The use of the drug at the time of the meal leads to a decrease in the metabolic rate.
The manufacturer in the instructions for use "Prestarium A" (5 mg, 10 mg), "Prestarium" and "Bi Prestarium" specifies that the half-life is about one hour. Perindoprilat is predominantly eliminated by the kidneys. The half-life of free fractions is estimated at 17 hours on average. An equilibrium concentration is achievable in about four days of regular use of the drug.
Special occasion
Instructions for use "Prestarium" draws attention to the slowdown of elimination processes in the presence of insufficient liver or kidney function, as well as when using the composition in old age.
With cirrhosis, the clearance of the parent molecule in the kidneys is twice as slow as normal. The volumes of perindoprilat produced are similar to those typical of the usual case. Therefore, there is no need to change the dosage.
When will it help?
All possible diagnoses in which it is allowed to prescribe a remedy are listed in the instructions for use accompanying the pill. "Prestarium" is effective for high blood pressure, as well as heart failure in a chronic form, it is prescribed for cardiac ischemia. The tool helps to reduce the likelihood of a cardiac event with a heart attack in the past or at the stage of revascularization.
Application rules
Although the instructions for use tell you how to take Prestarium in sufficient detail, at the reception the doctor will certainly explain to the patient personally all the nuances and features of the case. As a rule, tablets are taken orally once a day. It is necessary to take the drug before a meal, preferably in the morning.
If Prestarium is prescribed to correct high blood pressure, it can be used both as an independent tool and in combination with other medicines to control blood pressure. Instructions for the use of Prestarium A (5 mg) recommend the use of one tablet as the optimal starting dose. If such a program does not show effectiveness, the doctor may recommend doubling the volume.
Dosage Nuances
Some categories of patients have an increased risk of over-activation of the renin-angiotensin-aldosterone system. This is possible with renovascular hypertension, an imbalance in the electrolyte balance, and a decrease in circulating blood volumes. Certain risks are associated with severe hypertension and a lack of cardiac activity in a decompensated form. It is clarified that after using the first dose of the drug there is a risk of a sharp decrease in pressure. According to the instructions for use, Prestarium A (5 mg) or Prestarium (5 mg), tablets, can be used in a reduced dosage of 2.5 mg per day. The patient's condition should be carefully monitored. After a month of regular use with an adequate response of the body, the dose is gradually increased. The maximum allowable is 10 mg per day.
Special conditions are indicated in the instructions for use of Prestarium A (5 mg, 10 mg), as well as other release options (Prestarium, Bee Prestarium), if necessary, to adjust the condition of the elderly. The optimal starting dose in this case is 2.5 mg. Gradually, an increase is possible until a pronounced therapeutic effect is achieved. A month after the start of the course, the dose is doubled, a month later they are raised to 10 mg. Next, they focus on renal functionality, individually for each case, making a decision on the continuation of the course and the format for using the tablets.
In case of chronic insufficiency of the functioning of the heart muscle, Prestarium is recommended in an amount of 2.5 mg daily.
Subtleties of use
A combination of Prestarium and diuretics is possible (except for those leading to the accumulation of potassium in the body). You can combine the substance with beta-blockers, digoxin. If necessary, such a course at first regularly monitor the patient's condition. Start using Prestarium with half a tablet (2.5 mg) in the morning. If tolerance is satisfactory, volumes may be gradually increased. The increment is 2.5 mg, the frequency of increasing the dose is once every two weeks or less. Course correction is carried out only if there is a clinical individual reaction that requires this.
In the treatment of cardiac ischemia, “Prestarium” is first used in an amount of 5 mg once a day. In this format, the medicine is taken for two weeks, after which the dose is doubled.
In old age, the first week of Prestarium is used in an amount of 2.5 mg once a day, the second week - 5 mg daily, then 10 mg every day. Focus on kidney functionality. It is possible to increase the dose only if the drug is well tolerated.
Negative consequences: what is possible?
Instructions for use contain a complete list of side effects that can lead to the use of the drug. It is known that quite often patients experience coughing, shortness of breath, and malfunctioning of taste buds. May be sick and dizzy. There is a risk of asthenia, tinnitus, convulsions, vomiting, and nausea. Some have pain in the abdomen, stool is broken, a rash and itching of the skin, dyspepsia are disturbing. There is a likelihood of disruption of the visual system.
Much less often, patients experience bronchospasm, increased activity of liver enzymes, and an increase in plasma bilirubin concentration. There is a likelihood of kidney failure, malfunctioning of the reproductive system, increased sweat production, and angioedema.
Extremely rarely, “Prestarium” provoked hepatitis, heart attack, angina pectoris, arrhythmia, anemia, neutro-, pancyto-, thrombocyto-, leukopenia and a decrease in the concentration of hematocrit, hemoglobin.
Categorically not
It is forbidden to use “Prestarium” with increased sensitivity or intolerance to perindopril, other components of the medication. You can not use the drug if such a reaction is detected with respect to any ACE inhibitor. It is not allowed to use the composition with idiopathic, hereditary angioedema, which previously occurred during the use of ACE inhibitors.
The drug is not used to treat children, adolescents. There is no exact information about the safety of such practices and the effectiveness of the product for persons under the age of eighteen. Prestarium is not suitable for the treatment of pregnant women and breast-feeding mothers.
Possible analogues
Instructions for use "Prestarium" contains a reference to the active substance that ensures the effectiveness of the composition - this is perindopril. Other medicines are based on it:
- Perindopril.
- "Perineva."
- "Parnawel."
The choice of replacement should be agreed with the doctor. Self-adjustment of the therapeutic course can cause its inefficiency.
Is it worth trusting? Reviews
In the instructions for use of Prestarium (5 mg, 10 mg), the manufacturer indicates the effectiveness of the medication with proper use and strict adherence to the recommendations of the doctor. Patients who used the drug under the supervision of a doctor confirm that the tablets are effective, rarely provoke side effects, and can stabilize the condition. Doctors using Prestarium in clinical practice also confirm that this tool is safe, reliable, affordable for the general population.
At the same time, it is noted that with the unauthorized use of the composition, there is a high probability of colliding with side effects. As a rule, it is the people who themselves have prescribed such treatment who face the negative consequences of taking the pills.
Violations of the liver, kidneys and heart. The nuances of using
Against the background of the use of inhibitory ACF drugs, there is a risk of jaundice or a significant increase in the activity of liver enzymes in the circulatory system. When identifying such features, it is necessary to abandon the medication and undergo additional diagnostics to determine the causes of the phenomenon.
When creatinine clearance is less than 60 ml / min, it is recommended to use Prestarium first in a minimum amount, and the dosage is selected based on specific clearance indicators. Further, the accepted volumes of the drug are changed based on the individual reaction of the body. With reduced creatinine clearance, the use of Prestarium is possible only under conditions of regular monitoring of creatinine and potassium in the circulatory system.
In heart failure, the first step in taking the drug described is usually accompanied by hypotension. In the presence of severe clinical manifestations, it may be suspected that renal function will subsequently weaken. . .