Arterial hypertension currently suffers from a fairly wide section of the population of different social foundations, wealth, and educational level. It cannot be said that this disease is only overtaken by the elderly, as it was, say, in the last century. Modern life is swift, global challenges, high technology, the desire to do as much as possible today, to do more tomorrow, do not allow the body to fully relax. Under conditions of constant stress and work at the limit of physical capabilities, arterial hypertension develops . Who of modern people pays attention to the fact that often a headache? It hurts a day, two, a week, a month, and when, finally, a person goes to the doctor, it becomes clear that hypertension already has a place to be.
Modern medicine is ready to offer hypertensive patients a lot of drugs to stabilize blood pressure, one of which is Ko-Perineva. Instructions for use contain complete information about the possibilities, contraindications and side effects.
Composition and form of release
The main active components of the drug are indapamide and perindoprilerbumin. In addition, the pellets additionally contain prefabricated granules (in the form of crospovidone, lactose monohydrate and calcium chloride hexahydrate) and a number of excipients.
The form of the drug is round biconvex tablets of white color. Available in several dosages. The buyer can purchase medicine in pharmacies with a dose of active substances of 0.625 + 2 mg, respectively, 1.25 + 4 or 2.5 + 8 mg.
In general, it must be said that the French doctors developed and successfully used the drug Noliprel A, and its Russian counterpart, Ko-Perineva.
Pharmacodynamics
Perindopril is an ACE inhibitor, it contributes to the expansion of blood vessels, as a result of which blood pressure decreases and, accordingly, the non-heart load decreases. After 4-6 hours after taking the medication, the maximum effect develops, which can be maintained during the day. Indapamide belongs to the group of diuretic thiazide-like diuretics. In addition, this substance is able to improve the elasticity of the vascular walls, which also helps to lower blood pressure.
Like far from any of its counterparts, Ko-Perineva does not affect the processes of fat and carbohydrate metabolism. In addition, the presence of indapamide does not cause much harm to the water-salt balance of the body, which cannot be said about other diuretic medicines. Treatment with this combination agent (“Ko-Perineva”) does not contribute to the development of tachycardia, the state of the heart muscle is stabilized, and its ability to carry loads is improved.
Who should refrain from using?
The medication is very effective for the treatment of hypertension, however, it also has a list of contraindications. "Co-Perineva", analogues containing the same active ingredients, can not be taken by people with hypersensitivity to any components of the drug. Also, a drug is not prescribed for those who suffer from intolerance or deficiency of lactose, glucose-galactose malabsorption, stenosis of the renal arteries, liver or kidney failure. A contraindication for the use of “Co-Perinev” is the presence of refractory hyperkalemia in the patient (excess potassium in the body), a predisposition to the development of angioedema (the body's reaction to the effects of chemical and biological factors, very often has an allergic nature).
Do not prescribe "Ko-Perineva" to those patients who suffer from azotemia (blood contains nitrous metabolic products that must be excreted by the kidneys above the acceptable limits) and anuria (urine does not enter the bladder). The effectiveness and safety of “Ko-Perinev” (similar drugs can be used if clinical results are available) has not been established for patients under 18 years of age, pregnant and lactating women. Therefore, for these groups of people, taking the medication is prohibited.
Feasible side effects
Most often, the negative effects that the medication itself or a cheap analogue of “Co-Perinev” - tablets “Perindopril plus Indapamide” - can cause certain side effects from various organs and body systems. The most common reactions from the central nervous system are headaches, dizziness, weakness, and sensitivity disorders. From the senses, you can hear about tinnitus, visual impairment. A marked decrease in blood pressure is a possible reaction of the cardiovascular system.
A dry, annoying, unproductive cough signals a respiratory reaction. A sufficiently large list of deviations can be observed from the gastrointestinal tract. Here, regarding the reaction to the Ko-Perinev remedy (analogues), patient reviews speak of nausea, vomiting, diarrhea, frequent constipation, abdominal pain and epigastric pain, a change in taste, and loss of appetite. The musculoskeletal system can remind yourself of spasms.
Various side effects are possible in the form of skin rashes of different intensities, itching, swelling of the face, oral mucosa, tongue of the upper palate or larynx.
Dosage regimen
Dosage of the medication (any analogue of “Ko-Perinev” can be taken according to another scheme) - 1 tablet per day. This is best done in the morning, before breakfast, with water. Most often, the scheme is developed based on the ratio of indapamide / perindopril. First, tablets with a dosage of 0.625 / 2 mg are prescribed to the patient. If after one month it was not possible to achieve control over blood pressure, the dose is increased to one tablet at a dose of 1.25 / 4 mg. To achieve an effective result, the dosage can be increased to a maximum daily dose of 2.5 / 8 mg.
Elderly patients begin treatment with one tablet at a dosage of 0.625 / 2 mg. Therapy begins and is carried out under the constant control of blood pressure and kidney function.
If the patient suffers from moderate renal failure, therapy also begins with a dosage of 0.625 / 2 mg, however, the maximum dose allowed during the day should not exceed 1.25 / 4 mg.
Exceeding the permissible dose: symptoms, treatment
Symptoms of a drug overdose are the presence of nausea, vomiting, the development of muscle cramps. Drowsiness, dizziness, confusion, oliguria (a decrease in the volume of urine excreted by the kidneys), a decrease in water-electrolyte balance, and a drop in blood pressure are possible. Any analogue of "Co-Perinev" may have different symptoms in case of an overdose.
To eliminate the consequences, gastric lavage and the use of absorbent drugs are recommended. It is also necessary to restore the water-electrolyte balance. If there is a strong drop in blood pressure, the patient needs to lie on his back and raise his legs. The attending physician may consider it necessary to introduce a 0.9% sodium chloride solution. There is information about the effectiveness of hemodialysis.
Pregnant and lactating women
"Ko-Perineva" instructions for use prohibit taking pregnant women and nursing mothers. The use of this medication during the period of bearing a child can provoke the development of placental ischemia, and, as a result, increase the risk of slowing the development of the fetus. If we are talking about a nursing mother, then we must keep in mind that indapamide is excreted in breast milk. If, however, the use of "Ko-Perineva" during lactation is an urgent need, you will have to abandon breastfeeding.
Special instructions
The use of "Co-Perinev" in parallel with any lithium preparations is unacceptable . In case of impaired kidney function, the medication should also not be taken. If a patient with a diagnosis of arterial hypertension has developed symptoms of renal failure while using Co-Perineva, treatment should be stopped immediately. A little later, you can try to resume taking the medication in minimal doses or switch to monotherapy with indapamide and perindopril. In such patients, the level of potassium and creatine in the blood should be monitored every 2 weeks.
In patients with diabetes mellitus or renal failure, Co-Perineva (including analogues) can provoke the development of hypokalemia. Therefore, such people require constant monitoring of potassium levels in the blood.
Interaction with other substances
You can not use perindopril in conjunction with potassium-sparing diuretics and potassium preparations. Also, with great caution, the medication itself (and any analogue of the Co-Perinev medication) is prescribed together with insulin and other hypoglycemic agents. Combined medication with cytostatic immunosuppressants can cause leukopenia. When using the drug and medications for general anesthesia, there is a chance of an increase in the hypotensive effect.
Indapamide-containing medicines are prescribed with caution in parallel with antipsychotics and antiarrhythmic drugs, benzamides, buterophenones. Also, "Co-Pyrenev" is not prescribed in conjunction with drugs that can trigger the development of hypokalemia, with laxatives that stimulate the intestines.
The use of contrast agents with a high iodine content can be an impetus for the development of renal failure.
Analog medicines
The most commonly used and known to a wide range of consumers analogue of “Ko-Perinev” - “Noliprel A”. The dosage (perindopril / indapamide ratio from the original manufacturer Servier France) can be 2.5 / 0.625 mg, 10 / 2.5 mg, 5 / 1.25 mg. Also, this drug is produced in the Russian Federation ("Serdix") in the same dosage as the original.
Another well-known similar medication is Perindopril Plus Indapamide from a Russian manufacturer. For the above ratio, dosages of 1.25 / 4 mg, 2.5 / 0.008 mg, 0.625 / 0.002 mg, 8 / 2.5 mg are possible.
Price range
The dosage and number of tablets in the package are the main factors affecting the price of the medicine “Ko-Perineva”. The instruction (analogues may vary slightly in dosage) describes possible options for the ratios of two main components - perindopril and indapamide. For example, 30 tablets with a ratio of 0.625 / 2 mg will cost the buyer 350 rubles. A medicine with a dosage of 1.25 / 4 mg will cost 390-440 rubles. The largest ratio of 2.5 / 8 mg is from 470 to 510 rubles per 30 tablets. Naturally, packages of 90 tablets will cost customers a much larger amount.
The French original Noliprel A will cost consumers much more.
Consumer opinion
Medication "Ko-Perineva" instructions for use, patient reviews in most cases are characterized as a modern and very effective drug to normalize blood pressure. The drug is convenient to use: took one tablet in the morning, and is free until the next day. In addition, at the cost of “Ko-Perinev” is available to a wide range of consumers with different financial capabilities, which cannot be said about “Noliprel A” from the French manufacturer.
However, negative reviews are not uncommon, which are most often associated with the manifestation of side effects in the form of headaches, swelling of the face and limbs, and reactions from the gastrointestinal tract. In such cases, it is required to discontinue treatment and seek medical advice. After examining and assessing the situation, the specialist will decide whether to resume taking the “Co-Perineva” drug with a reduced dosage, or whether it is better to pay attention to other medicines with similar characteristics and expected treatment results.