Description overdue on 07/03/2014

• Composition
• Product form
• Pharmacological action
• Pharmacodynamics and pharmacokinetics
• Indications
• Contraindications
• Side effects
• Prestancia, instructions for use
• Overdose
• Cooperation
• Terms of sale
• Storage conditions
• Shelf life
• Cautions
• Analogs
• Babies
• During pregnancy (and lactation)
• Reviews
• Price, where to buy

Composition

Prestancia is available in 4 different variants of the ratio of active ingredients: perindopril arginine   - 5 mg / 10 mg (equivalent to 3,395 mg / 6.79 mg perindopril ) amlodipine besylate - 6,935 mg / 13.87 mg (equivalent to 5 mg / 10 mg amlodipine ).

Excipients: lactose monohydrate, microcrystalline cellulose   magnesium stearate   colloidal silica .

Product form

The drug is a biconvex white tablets engraved on one edge and logo - on the other. 30 of such tablets in a polypropylene vial, a bottle in a paper stack with the control opening.

Pharmacological action

The drug has hypotensive   action, but also inhibits angiotensin-converting enzyme   and Calcium channels .

Pharmacodynamics and pharmacokinetics

Pharmacodynamics

Perindopril   inhibits an enzyme that transforms angiotensin I   at   Angiotensin II . Kininaza II Or angiotensin-converting enzyme Performs as a transformation Angiotensin I   in vazaokonstrikter Angiotensin II And inactivation bradykinin Which has a vasodilator effect.

Perindopril   It has a therapeutic effect due to its metabolite - perindoprilat . Other derivatives have no effect. Perindopril - a drug for the treatment of hypertension of any form and severity. It reduces the systolic and diastolic blood pressure in the vertical and horizontal position.

The drug reduces peripheral vascular resistance, leading to a decrease in increased blood pressure and increased peripheral circulation without increasing heart rate.

Effect of the drug reaches a maximum 5-6 hours after administration and persists for days. Pressure reduction is achieved quickly. Therapeutic effect occurs within 1 month after initiation of therapy. After termination of the treatment does not develop the syndrome.

Perindopril also increases the elasticity of the large vessels, the restoration of the wall structure of smaller arteries and reduce LVH .

Amlodipine   - Blocker calcium channel . It inhibits the transmembrane movement of calcium ions in the tissue infarction   and vascular smooth muscle cells.

It is known that Amlodipine :

• expands arterioles Reducing peripheral resistance, heart rate, however, remains the same, but a necessity infarction oxygen is reduced;
• expands heart arteries   and arterioles . Individuals with Prinzmetal angina   in this case, the coronary blood flow is enhanced.

Amlodipine   It does not affect lipidnoy profile   and lipid-lowering blood parameters. The drug can be used in patients with diabetes . asthma   and gout .

Pharmacokinetics

When taken orally perindopril   rapidly adsorbed, the maximum blood concentration occurs within 1 hour. The half-life from the blood is also 1 hour.

Perindopril   pharmacologically inactive. 27% of the material falls into the bloodstream in the form of perindoprilat   (active metabolite). Besides perindoprilat   5 already known metabolites are pharmacologically inactive. The maximum concentration perindoprilat   It appears in the blood at 3 hours after administration. Receiving food slows conversion to perindoprilat Influencing the bioavailability. Consequently, the drug should be used one time per day, before breakfast.

Binding perindoprilat   with proteins of the blood is about 20% and is dose dependent.

Perindoprilat   excreted through the kidneys. Terminal half-life is 17 hours, however, the equilibrium concentration is reached within four days.

Upon receiving Amlodipine   absorbed from the digestive tract slowly perindaprila . Food intake does not alter the bioavailability of the substance. The maximum concentration amlodipine   Blood comes in 7-11 hours. Bioavailability is in the range 64-80%.

Approximately 97% of circulating blood amlodipine   blood is bound.

The final half-life amlodipine   blood - 37-50 hours. This allows reception of the drug once a day. It is metabolized in the liver, with 10% of the dose is excreted in the original form and 60% is excreted in the urine as metabolites. Not output means Dialysis .

Indications

• Stable angina   stress in people who need treatment amlodipine   and perindopril .
• Arterial hypertension .

Contraindications

Contraindications to receive perindopril :

• angioedema ;
• allergy perindopril   or other drugs from the group of ACE inhibitors;
• age less than 18 years.

Contraindications to receive amlodipine :

• allergy   to amlodipine ;
• shock , including cardiogenic ;
• expressed hypotension ;
• obstruction of the outflow path of the left ventricle;
• heart failure   hemodynamically unstable after myocardial infarction ;
• age less than 18 years.

Contraindications to receive Prestancia:

• allergy   to any component of the formulation;
• renal failure ;
• age less than 18 years;
• intolerance lactose , Failure Lactase   and galactose malabsorption glucose .

Use with caution in: one kidney, renal artery stenosis . hepatic   or renal failure Therapy allopurinol , Immunosuppressants, procainamide,   systemic connective tissue disease, cerebrovascular   violations atherosclerosis . diabetes . renovascular hypertension . heart failure , Simultaneous estramustine , Potassium-sparing diuretics, dantrolene , Drugs, potassium, lithium preparations, hyperkalemia , Surgery, advanced age, desensitizing therapy, aortic   or mitral stenosis .

Side effects

• On the side blood : leukopenia, agranulocytosis, pancytopenia, neutropenia, thrombocytopenia , Reduction hematocrit   and Hemoglobin .
• On the side metabolism :   hyperglycemia, hypoglycemia .
• On the side immunity : Allergic reaction .
• On the side Otolaryngology : Blurred vision, tinnitus.
• On the side Nervous System : Headache, dizziness, mood lability, drowsiness, insomnia, tremor . depression . peripheral neuropathy .
• On the side Cardiovascular : Strong pressure reduction,   heart attack . angina . stroke . vasculitis .
• On the side Respiratory system : Cough, eosinophilic pneumonia . bronchospasm .
• On the side digestive system : Abdominal pain, nausea, diarrhea . dyspepsia . constipation , Dry mucous membranes of the mouth.
  On the side hepatobiliary system : jaundice, hepatitis,   increased concentration of liver enzymes.
• On the side skin : Itching, rash, angioedema , Purpura, alopecia, skin discoloration, sweating, hives . Stevens-Johnson syndrome, erythema multiforme, exfoliative dermatitis .
• On the side musculoskeletal system : Swelling of lower legs, muscle spasms, myalgia, arthralgia .
• On the side genitourinary system : nocturia,   impaired renal function, impaired urination, impotence . gynecomastia .
• Disorders of a general nature: asthenia , Swelling, fatigue, chest pain, changes in body weight.

Also registered sporadic cases of extrapyramidal syndrome .

Prestancia, instructions for use

Instructions for use Prestancia recommends taking pills inside, one time a day before breakfast. The dose of medication is chosen individually on the basis of four possible ratios of doses perindopril   and amlodipine   in the preparation: Prestancia 5 mg + 5 mg + 5 mg Prestancia 10mg Prestancia 10 mg + 5 mg + 10 mg Prestancia 10 mg.

In elderly patients and patients with renal impairment should be continuous monitoring creatinine   and potassium levels, since this group excretion perindoprilat   delayed.

In individuals with hepatic insufficiency   you need to spend with caution, dose selection. It is best to start with the drug use small doses.

Overdose

Data on overdose Prestancia absent.

Overdose amlodipine   It causes: severe reduction in blood pressure with possible development tachycardia   and peripheral vasodilatation .

Treatment: gastric lavage is necessary to make, to carry out reception Activated Carbon Maintaining indicators of heart and respiratory system, control blood volume and diuresis, symptomatic therapy , Intravenous calcium gluconate   and Dopamine .

Symptoms of overdose perindopril : Marked reduction of blood pressure, electrolyte disturbances, shock, kidney failure, tachycardia . dizziness . anxiety .

Treatment: gastric lavage, and receive Activated Carbon Correction hypovolemia , Intravenous catecholamines . hemodialysis .

Cooperation

Interaction with Perindopril

When co-administered with preparations Potassium   and lithium . potassium-sparing diuretics some individuals may develop hyperkalemia   and increase in lithium   in blood.

Simultaneous reception ACE inhibitors   from NSAIDs   weakens antihypertensive action And can also lead to renal dysfunction, increased concentrations Potassium   in blood.

Hypoglycemics   interacting with ACE inhibitors   increase the hypoglycemic effect insulin   and metabolites sulfonylureas   in patients with diabetes .

Patients using diuretics   at the beginning of therapy ACE inhibitors   probably a strong drop in blood pressure.

Sympathomimetics   weaken hypotensive effect ACE inhibitors .

Joint use ACE inhibitors   and preparations for general anesthesia leads to activation of the antihypertensive effect.

Interaction with Amlodhi ping .

Simultaneous use of inductors of CYP3A4   ( rifampicin . St. John's wort preparations ) Reduces the concentration amlodipine   in blood.

Amlodipine   activates hypotensive effect other tablets pressure.

Studies Prestancia pills had no effect on the pharmacokinetics digoxin, atorvastatin, warfarin   and cyclosporine .

Drinking grapefruit juice or grapefruit increases the bioavailability   amlodipine   in some patients, which may lead to a strong reduction in blood pressure.

Tricyclic antidepressants, antipsychotics . Amifostine, baclofen,   antihypertensives vasodilators   enhance the antihypertensive effect perindopril   and amlodipine .

Terms of sale

It sold strictly on prescription.

Storage conditions

The preparation does not require special storage conditions. The bottle should be stored in closed original packaging. Keep away from children.

Shelf life

Two years.

Cautions

Withdrawal perindopril   It slowed down in the elderly and in patients with kidney   and Heart Failure , So they should be checked regularly concentration Potassium   and   creatinine in blood plasma.

Because of the possible severe reduction in blood pressure of drowsiness, dizziness and other side effects, you should be careful when driving, especially at the start of therapy and at higher dose consumed.

Analogs Prestancia

Analogs Prestancia 5/5 mg   ( 5/10 mg , 10/5 mg, 10/10 mg): BBC Prestarium   5/5 mg (5/10 mg, 10/5 mg, 10/10 mg) Amlessa   4/5 mg (4/10 mg 8/5 mg, 8/10 mg).

Babies

Banned for use to persons under 18 years of age.

During pregnancy and lactation

It is forbidden to take Prestancia during pregnancy and breastfeeding due to lack of clinical experience with amlodipine   and perindopril .

Reviews Prestancia

Reviews Prestancia 5.5 mg, 5.10 mg, 5.10 mg and reviews of Prestancia 10/10 mg are not fundamentally different, and are characterized by frequent reports of the occurrence of edema shins. Reviews of physicians in general well-evaluate the drug, but indicate the need for an individual approach to the treatment of drug and dose selection. Forums also report frequent occurrence of headaches and swelling on the background of an effective reduction in blood pressure after using Prestancia.

Price Prestancia

Cost Prestancia 5/5 mg   in Russia is 517-603 rubles, Ukraine is in the range 390-437 hryvnia; price Prestancia 5/10 mg   in Russia and Ukraine - 663-747 and 580-591 rubles hryvnia, respectively; price Prestancia 10/10 mg   - 747-839 and 605-645 rubles hryvnia and buy Prestancia 5/10 mg   It will cost 685-793 rubles or 590-612 hryvnia depending on the location.