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Composition:


active ingredients: perindopril, indapamide;


1 tablet contains 2 mg of perindopril TERT-butylamine, which is equivalent to 1.669 mg of perindopril and 0.625 mg of indapamide,


or 4 mg of perindopril TERT-butylamine, which is equivalent to 3,338 mg of perindopril and 1.25 mg of indapamide,


or 8 mg of perindopril TERT-butylamine, which is equivalent to 6.676 mg of perindopril and 2.5 mg of indapamide;


excipients: lactose, monohydrate; microcrystalline cellulose; crospovidone; sodium bicarbonate; colloidal anhydrous Silicon Dioxide; Magnesium Stearate.


Dosage form. Pills.


Basic physical and chemical properties: round biconvex tablets from white to almost white in color.


Pharmacotherapeutic group.


Combined preparations of angiotensin-converting enzyme (ACE) inhibitors. Perindopril and diuretics. ATX code C09B A04.


Pharmacological properties.


Pharmacodynamics.


In-ALLITER is a combination of the ACE inhibitor perindopril TERT-butylamine and the sulfonamide diuretic indapamide. Its pharmacological action is due to the properties of each component (perindopril and indapamide) and their additive synergy.


Pharmacological mechanism of action.


Mechanism of action associated with perindopril.


Perindopril is an ACE inhibitor that converts angiotensin I to angiotensin II (vasoconstrictor substance), additionally stimulates the secretion of aldosterone by the adrenal cortex and the breakdown of bradykinin (vasodilator substance) to inactive heptapeptides.


Ace inhibition leads to:


- reduced aldosterone secretion;


- increased activity of renin in blood plasma, while aldosterone does not have a negative effect;


- reduction of total peripheral vascular resistance due to the predominant effect on the vessels of muscles and kidneys; at the same time, there is no water and salt retention or reflex tachycardia, even in the case of long-term treatment.


In addition, perindopril reduces blood pressure in patients with normal and low plasma renin levels.


Perindopril acts through its active metabolite perindoprilate. Other metabolites are inactive.


Perindopril reduces heart function due to:


- vasodilator effect on the veins (possibly due to changes in prostaglandin metabolism) - reduced preload;


- reduction of the total resistance of peripheral vessels ‒ reduction of afterload on the heart.


Studies conducted with patients with heart failure have shown that the use of perindopril leads to:


- reducing the filling pressure of the left and right ventricles;


- reduction of total peripheral vascular resistance;


- increased cardiac output and improved cardiac index;


- increased regional blood flow in the muscles.


The performance of physical activity tests is significantly improved.


Mechanism of action associated with indapamide.


Indapamide is a sulfonamide derivative with an indole ring, pharmacologically related to thiazide diuretics, which acts by inhibiting sodium reabsorption in the cortical segment of the kidneys. This increases the excretion of sodium and chlorides in the urine and, to a lesser extent, potassium and magnesium, thus increasing urination and providing an antihypertensive effect.


Characteristics of antihypertensive action.


In-ALLITER reduces systolic blood pressure (SAT) and diastolic blood pressure (Dat) in patients with arterial hypertension of any age, both in the supine and standing positions. The antihypertensive effect of the drug is dose-dependent. The antihypertensive effect lasts 24 hours. A decrease in blood pressure is achieved in less than one month without the occurrence of tachyphylaxis; discontinuation of treatment has no withdrawal effect.


Antihypertensive effect associated with perindopril.


Perindopril effectively reduces blood pressure in all degrees of arterial hypertension: mild, moderate and severe. A decrease in SAT and dat is observed both in the supine and standing positions.


The maximum antihypertensive effect develops 4-6 hours after taking a single dose and persists for 24 hours.


Perindopril has a high level of final ACE inhibitor blocking (approximately 80 %) 24 hours after administration.


In patients who responded to treatment, normalization of blood pressure occurs within a month and persists without the occurrence of tachyphylaxis.


Discontinuation of therapy is not accompanied by a withdrawal effect.


Perindopril has vasodilating properties, restores the elasticity of large arteries, corrects histomorphometric changes in arterial resistance and reduces left ventricular hypertrophy. The addition of a thiazide diuretic, if necessary, leads to additional synergy.


The combination of an ACE inhibitor and a thiazide diuretic reduces the risk of hypokalemia that may occur when a diuretic is prescribed in monotherapy.


Antihypertensive effect associated with indapamide.


The antihypertensive effect of indapamide in monotherapy lasts 24 hours. This effect is manifested in doses in which the diuretic properties are minimal.


The antihypertensive effect of indapamide is associated with an improvement in arterial elasticity and a decrease in arteriole resistance and total peripheral vascular resistance.


Indapamide reduces left ventricular hypertrophy.


If the recommended dose is exceeded, the therapeutic effect of thiazide and thiazide-like diuretics does not increase, while the number of undesirable effects increases. If the treatment is not effective enough, it is not recommended to increase the dose.


In addition, as has been shown in studies of various durations (short, medium and long) involving patients with arterial hypertension, indapamide:


- does not affect the metabolism of lipids (triglycerides, low-and high-density lipoproteins);


- does not affect the metabolism of carbohydrates, even in patients with arterial hypertension and diabetes mellitus.


Children.


There are no data on the use of the drug in children.


Pharmacokinetics.


The pharmacokinetic properties of perindopril and indapamide in the composition of the drug in-ALLITER do not differ from the properties when they are used separately.


Pharmacokinetic properties associated with perindopril.


Absorption and bioavailability.


After oral administration, perindopril is rapidly absorbed, the maximum concentration is reached in 1 hour. The plasma half-life of perindopril is 1 hour.


Since food intake reduces the conversion of perindopril to perindoprilate, and therefore reduces its bioavailability, perindopril is recommended to be taken orally in a single daily dose in the morning before meals.


Distribution.


The volume of distribution of Unbound perindoprilate is approximately 0.2 L/kg. Binding of perindoprilate to plasma proteins is 20 %, mainly to ace, and is dose-dependent.


Biotransformation.


Perindopril is a prodrug. Thus, 27% of the dose of perindopril taken enters the bloodstream as the active metabolite of perindoprilate. In addition to active perindoprilate, perindopril Forms 5 other inactive metabolites. The maximum concentration of perindoprilate in blood plasma is reached in 3-4 hours.

Output.


Perindoprilate is excreted in the urine, and the final half-life of the unbound fraction is approximately 17 hours. The state of equilibrium is reached after 4 days.


Linearity.


There is a linear relationship between the dose of perindopril and its plasma concentration.


Special groups of patients.


Elderly patients.


Excretion of perindoprilat decreases in elderly patients and in individuals with heart or renal insufficiency.


Patients with renal insufficiency.


For patients with renal insufficiency, the dose should be adapted depending on the degree of impaired renal function (creatinine clearance).


Patients on dialysis.


The dialysis clearance of perindoprilate is 70 ml/min.


Patients with cirrhosis of the liver.


The kinetics of perindopril changes in patients with cirrhosis of the liver: the hepatic clearance of the main molecule is halved. However, the amount of perindoprilate produced does not decrease. Therefore, such patients do not need to select the dose (see the sections "dosage and administration" and "application features").


Pharmacokinetic properties associated with indapamide.


Absorption.


Indapamide is rapidly and completely absorbed in the digestive tract.


The maximum concentration in blood plasma is reached approximately 1 hour after oral administration.


Distribution.


Binding to plasma proteins is 79 %.


Biotransformation and elimination.


The elimination Half ‒ Life is 14 to 24 hours (an average of 18 hours). Repeated administration does not lead to accumulation. Excretion mainly occurs in the urine (70% of the dose) and feces (22 %) in the form of inactive metabolites.


Special groups of patients.


Patients with renal insufficiency.


In patients with renal insufficiency, the pharmacokinetic parameters do not change.


Clinical characteristics.


Indications.


Dosage 2 mg/0.625 mg:


- essential hypertension in adult patients.


Dosage 4 mg/1.25 mg:


- essential hypertension in adult patients;


- if additional blood pressure monitoring is necessary when using perindopril as monotherapy.


Dosage 8 mg/2.5 mg:


- arterial hypertension in patients requiring the use of perindopril TERT-butylamine at a dose of 8 mg and indapamide at a dose of 2.5 mg.


Contraindications.


Contraindications for the use of perindopril:


- hypersensitivity to perindopril or any other ACE inhibitors;


- a history of angioedema (angioedema) associated with previous treatment with ACE inhibitors;


- congenital or idiopathic angioedema;


- pregnancy or pregnancy planning;


- concomitant use with drugs whose active ingredient is aliskiren, patients with diabetes mellitus or patients with renal insufficiency (glomerular filtration rate 2) (see the sections "features of Use" and "interaction with other drugs and other types of interactions");


- concomitant use with the combination of sacubitril / valsartan;


- extracorporeal methods of treatment that lead to blood contact with negatively charged surfaces (see the section "interactions with other drugs and other types of interactions");


- significant bilateral stenosis of the renal arteries or stenosis of the artery of the only functioning kidney (see the section "application features").


Contraindications for the use of indapamide:


- hypersensitivity to indapamide or any other sulfonamides;


- severe renal impairment (creatinine clearance


- hepatic encephalopathy;


- severe liver dysfunction;


- hypokalemia;


- this drug is contraindicated in combination with non-antiarrhythmic drugs, which can lead to the development of paroxysmal ventricular tachycardia of the "pirouette" Type (see the section "interactions with other drugs and other types of interactions");


- the period of breast-feeding (see the section "use during pregnancy or lactation").


Contraindications associated with the drug in-ALLITER:


- hypersensitivity to any excipient.


Due to the lack of sufficient clinical experience, in-ALLITER should not be used:


- patients undergoing hemodialysis;


- patients with untreated decompensated heart failure.


Interactions with other drugs and other types of interactions.


Interactions characteristic of perindopril and indapamide.


Not recommended combinations.

Lithium.


Reversible increases in serum lithium concentrations and increased toxicity have been reported with concomitant use of lithium and ACE inhibitors. Concomitant use with thiazide diuretics may lead to further increases in lithium levels, which increases the risk of toxicity of the combination of lithium and ACE inhibitors. Concomitant use of perindopril together with indapamide and lithium is not recommended, but if it is really necessary, the level of lithium concentration in the blood serum should be carefully monitored (see the section "special instructions for use").


Combinations that require special attention.


Baclofen.


Increases the antihypertensive effect. Blood pressure and renal function should be monitored and the dose adjusted if necessary.


Systemic nonsteroidal anti-inflammatory drugs (including acetylsalicylic acid in doses of 3 g).


Concomitant use of ACE inhibitors and nonsteroidal anti-inflammatory drugs (NSAIDs), such as acetylsalicylic acid in anti-inflammatory doses ( 3 g), COX-2 inhibitors and non-selective NSAIDs, may reduce the antihypertensive effect. Concomitant use of ACE inhibitors and NSAIDs may impair renal function (not including acute renal failure) and increase serum potassium levels, especially in patients with impaired renal function. This combination should be used with caution, especially in elderly patients. Patients should restore their water balance before starting treatment and monitor renal function at the beginning and during combination therapy.


Combinations that require attention.


Imipramine-like (tricyclic) antidepressants, neuroleptics.


Increase the antihypertensive effect and increase the risk of orthostatic hypotension (additive effect).


Interactions associated with perindopril.


Data from clinical studies have shown that double blockade of the renin-angiotensin-aldosterone system (RAAS) with combined use of ACE inhibitors, angiotensin II receptor blockers, or aliskiren is associated with a higher frequency of adverse events such as hypotension, hyperkalemia, and decreased renal function (including acute renal failure) compared to monotherapy with drugs that affect the renin-angiotensin-aldosterone system.


Medications that can cause hyperkalemia.


Certain medications or therapeutic classes of medications may cause hyperkalemia, such as aliskiren, potassium salts, potassium-sparing diuretics, ACE inhibitors, angiotensin II receptor antagonists, nonsteroidal anti-inflammatory drugs, heparins, immunosuppressants such as cyclosporine or tacrolimus, trimethoprim. The combination of these medications increases the risk of hyperkalemia.


Combinations are contraindicated.


Aliskiren.


Concomitant use of perindopril and aliskiren in patients with diabetes mellitus or patients with impaired renal function is contraindicated due to the increased risk of hyperkalemia, deterioration of renal function and cardiovascular morbidity and mortality (see the section "contraindications").


Extracorporeal methods of treatment.


Concomitant use with extracorporeal treatments that result in blood contact with negatively charged surfaces, such as dialysis or hemofiltration using certain membranes with high hydraulic permeability (for example, polyacrylonitrile) and low-density lipoprotein apheresis using dextran sulfate, may lead to an increased risk of severe anaphylactoid reactions (see Section "contraindications"). If such treatment is necessary, consideration should be given to using a different type of dialysis membrane or using a different class of antihypertensive agents.


Sacubitril / valsartan.


Concomitant use of perindopril and the sacubitril/valsartan combination is contraindicated, as the combination of a nonprolysin inhibitor and ace may increase the risk of angiodystrophy. The sacubitril / valsartan combination should be used no earlier than 36 hours after the last dose of perindopril. Perindopril should be used no earlier than 36 hours after the last dose of the sacubitril/valsartan combination.


Not recommended combinations.


Aliskiren.


Concomitant use of perindopril and aliskiren in all other groups of patients, except for patients with diabetes mellitus or patients with impaired renal function, is not recommended due to the increased risk of hyperkalemia, deterioration of renal function and cardiovascular morbidity and mortality (see the section "features of use").


Concomitant therapy with ACE inhibitors and angiotensin receptor blockers.


Concomitant use of ACE inhibitors and angiotensin receptor blockers was accompanied by an increase in the incidence of hypotension, syncope, hyperkalemia, and impaired renal function (including acute renal failure) compared to monotherapy with drugs that affect the renin-angiotensin-aldosterone system. The use of double blockade (i.e., a combination of an ACE inhibitor with angiotensin II receptor antagonists) is possible only in individual cases with careful monitoring of renal function, potassium levels and blood pressure.


Estramustine.


There is a risk of increasing the frequency of adverse reactions such as angioedema (angioedema).


Co-trimoxazole (trimethoprim/sulfamethoxazole).


Patients taking co-trimoxazole (trimethoprim/sulfamethoxazole) have an increased risk of hyperkalemia (see the section "special instructions for use").


Potassium-sparing diuretics (Triamterene, amiloride in monotherapy or in combination), potassium salts.


ACE inhibitors reduce potassium loss caused by diuretics. Potassium-sparing diuretics, such as Triamterene or amiloride, dietary supplements containing potassium, or salt substitutes with potassium can lead to a significant increase in serum potassium levels (possibly fatal). This combination should be prescribed with caution, with frequent monitoring of potassium levels and ECG in cases where simultaneous administration is indicated due to the presence of confirmed hypokalemia.


Combinations that require special attention.


Antidiabetic agents (insulin, oral hypoglycemic agents).


Epidemiological studies have shown that concomitant use of ACE inhibitors and antidiabetic drugs (insulin, oral hypoglycemic agents) can lead to a decrease in blood glucose levels and the risk of hypoglycemia. This effect is more common in the first weeks of combination treatment and in patients with impaired renal function.


Diuretics.


Patients taking diuretics (especially those with reduced fluid volume and/or salt intake) may experience an excessive decrease in blood pressure at the beginning of ACE inhibitor therapy. A decrease in the hypotensive effect may occur after discontinuation of diuretics by increasing the volume of fluid and/or taking salt before starting therapy with perindopril.


In case of arterial hypotension, when previous diuretic therapy may have caused a decrease in fluid volume and/or the amount of salts, diuretics should be discontinued before starting the use of an ACE inhibitor. After that, it is possible to re-administer diuretics or an ACE inhibitor with a gradual increase in the dosage.


Patients with congestive heart failure using diuretics should be prescribed ACE inhibitors after reducing the dose of diuretics. In this group of patients, treatment with ACE inhibitors should begin with the lowest dose.


In all cases, renal function (creatinine levels) should be monitored during the first weeks of ACE inhibitor therapy.


Potassium-sparing diuretics (eplerenone, spironolactone).


Concomitant use of eplerenone or spironolactone in doses of 12.5–50 mg per day with low-dose ACE inhibitors:


- in the treatment of patients with heart failure of functional classes II–IV according to the classification of chronic heart failure of the New York Heart Association (NYHA) and with an ejection fraction


- before prescribing this combination, make sure that there is no hyperkalemia or renal failure;


- it is recommended to carefully monitor potassium and creatinemia weekly during the first month of treatment and monthly in the future.


Application features.


Special warnings and precautions.


Special warnings and precautions for the use of perindopril and indapamide.


For the low-dose combination of in-ALLITER, no significant reduction in adverse reactions was demonstrated compared to the use of appropriate doses of its components as monopreparations, with the exception of hypokalemia (see the section "adverse reactions"). If the patient starts using two new antihypertensive active substances at once, an increase in the frequency of idiosyncratic reactions cannot be excluded. To minimize this risk, the patient's condition should be carefully monitored.


Combination with lithium.


Concomitant use of lithium and a combination of perindopril/indapamide is usually not recommended (see "interactions with other drugs and other types of interactions").


Excipients.


The composition of the drug includes lactose, so its use is contraindicated in patients with rare hereditary intolerance to galactose, glucose-galactose malabsorption syndrome, Lapp lactase deficiency.


Special warnings and precautions for the use of perindopril.


Double blockade of the renin-angiotensin-aldosterone system (RAAS).


There is evidence that concomitant use of ACE inhibitors, angiotensin II receptor blockers, or aliskiren increases the risk of hypotension, hyperkalemia, and decreased renal function (including acute renal failure). Therefore, double blockade of Raas by combined use of ACE inhibitors, angiotensin II receptor blockers, or aliskiren is not recommended.


If Raas double blockade therapy is considered absolutely necessary, it should only be performed under the supervision of specialists monitoring kidney function, electrolyte levels, and blood pressure.


Patients with diabetic nephropathy should not use ACE inhibitors and angiotensin II receptor blockers at the same time.


Potassium-sparing diuretics, dietary supplements containing potassium, or salt substitutes with potassium.


The combination of perindopril with potassium-sparing diuretics and potassium salts is usually not recommended (see the section "interactions with other drugs and other types of interactions").


Neutropenia / agranulocytosis/thrombocytopenia / anemia.


Neutropenia, agranulocytosis, thrombocytopenia, and anemia have been reported among patients taking ACE inhibitors. Neutropenia is rare in patients with normal renal function and in the absence of other risk factors. Perindopril should be administered very carefully to patients with collagenosis, during therapy with immunosuppressants, allopurinol or procainamide, or with a combination of these factors, especially against the background of impaired renal function. Sometimes the above-mentioned patients may develop serious infections, which in rare cases do not respond to intensive antibiotic therapy. When using perindopril, this group of patients should periodically monitor the number of white blood cells. Patients should be aware that they should be notified of any manifestation of an infectious disease (for example, sore throat, fever, etc.).


Renovascular hypertension.


Patients with bilateral renal artery stenosis or unilateral renal artery stenosis using ACE inhibitors have an increased risk of hypotension and renal failure, and diuretic therapy is an additional risk factor. Loss of renal function can also occur with minor changes in serum creatinine levels, even in patients with unilateral renal artery stenosis.


Hypersensitivity/angioedema.


Rare cases of angioedema of the face, extremities, lips, tongue, glottis and/or larynx have been reported in patients with ACE inhibitors, including perindopril. This can happen at any time during treatment. In such cases, it is necessary to immediately stop taking the drug and establish monitoring of the patient's condition until the symptoms completely disappear. If the swelling spreads only to the face and lips, the patient's condition usually improves without treatment, although taking antihistamines can help reduce symptoms.


Angioedema associated with laryngeal edema can be fatal. In cases where edema spreads to the tongue, glottis or larynx, which can lead to airway obstruction, urgent emergency therapy is necessary, which may include subcutaneous administration of a 1:1000 epinephrine solution (0.3–0.5 ml) and/or measures to ensure airway patency.


According to available data, ACE inhibitors are more likely to cause angioedema in black patients compared to representatives of other races.


Individuals with a history of angioedema that has not been associated with ACE inhibitors have an increased risk of angioedema while taking ACE inhibitors (see Section "contraindications").


Rare cases of intestinal angioedema have been reported in patients treated with ACE inhibitors. These patients had abdominal pain (with or without nausea and vomiting); some cases of intestinal angioedema were not accompanied by the manifestation of previous facial angioedema, the level of the C1-esterase inhibitor was normal. The diagnosis of intestinal angioedema was established by computed tomography, ultrasound, or during surgery. After discontinuation of the ACE inhibitor, the symptoms of angioedema disappeared. If abdominal pain occurs in patients taking ACE inhibitors, a differential diagnosis should be made in order to exclude intestinal angioedema.


Concomitant therapy with mTOR inhibitors.


Patients taking concomitant mTOR inhibitors (for example, sirolimus, everolimus, temsirolimus) have an increased risk of angioedema (for example, edema of the respiratory tract or tongue with or without respiratory disorders).


Sacubitril / valsartan.


Concomitant use of perindopril and the sacubitril/valsartan combination is contraindicated due to the increased risk of angioedema. The sacubitril / valsartan combination should be used no earlier than 36 hours after the last dose of perindopril. After the end of sacubitril/valsartan combination therapy, perindopril therapy can be initiated no earlier than 36 hours after the last dose of the sacubitril/valsartan combination. Concomitant use of other neutral endopeptidase inhibitors (such as racecadotril) and ACE inhibitors also increases the risk of angioedema. Therefore, if a patient is receiving perindopril, the doctor should carefully evaluate the risk/benefit ratio before treatment with neutral endopeptidase inhibitors (for example, racecadotril).


Anaphylactoid reactions during desensitizing therapy.


Isolated cases of prolonged, life-threatening anaphylactoid reactions have been reported in patients taking ACE inhibitors during desensitizing therapy with bee venom-containing drugs. ACE inhibitors should be used with caution in people with allergies who have undergone a course of desensitizing therapy, and avoid their use during immunotherapy with drugs containing bee venom. However, in patients requiring both ACE inhibitors and desensitizing therapy, such reactions can be avoided by temporarily stopping the use of an ACE inhibitor at least 24 hours before desensitization.

Dosage and administration.


For oral administration.


In-ALLITER 2 mg/0.625 mg.


Apply 1 tablet a day, preferably in the morning before meals. The tablet of the drug can be divided into equal doses. If your blood pressure does not change after a month of treatment, the dose can be doubled.


In-ALLITER 4 mg/1.25 mg.


In-ALLITER tablets 4 mg/1.25 mg are indicated for patients whose blood pressure, respectively, is not regulated by monotherapy with perindopril alone. The usual dose is 1 tablet per day at a time, preferably in the morning before meals. It may be advisable to individually select the doses of individual components. In-alliter tablets 4 mg/1.25 mg should be prescribed if blood pressure is not regulated accordingly by in-alliter tablets 2 mg/0.625 mg. If there are clinical indications, a decision is made to directly switch from monotherapy with perindopril to taking in-ALLITER 4 mg/1.25 mg tablets.


In-ALLITER 8 mg/2.5 mg.


In-ALLITER 8 mg/2.5 mg tablets are indicated for the treatment of arterial hypertension as a substitute for patients who are already taking perindopril and indapamide as separate drugs in the same doses.


The usual dose is 1 tablet of in-ALLITER 8 mg/2.5 mg per day at a time, preferably in the morning before meals. The maximum daily dose is 1 tablet of in-ALLITER 8 mg/2.5 mg.


Elderly patients (see the section "application features").


Treatment should begin with the recommended dose ‒ 1 tablet of in-ALLITER 2 mg/0.625 mg per day, taking into account the level of blood pressure and renal function.


In-ALLITER 4 mg/1.25 mg: elderly patients should be treated taking into account blood pressure and renal function.


In-ALLITER 8 mg/2.5 mg: elderly patients should determine their plasma creatinine levels based on age, body weight, and gender. Treatment of elderly patients can be initiated in the case of normal renal function and after taking into account the response of blood pressure to therapy.


Patients with impaired renal function (see the section "application features").


In the presence of severe renal impairment (creatinine clearance


Patients with creatinine clearance ≥ 60 mL/min do not require dose adjustment.


Routine medical supervision should include frequent monitoring of plasma creatinine and potassium levels.


Patients with impaired liver function (see the sections "contraindications", "application features" and "pharmacokinetics").


In the presence of severe liver function disorders, treatment with the drug is contraindicated.


Patients with moderate hepatic impairment do not require dose adjustment.


Children.


In-ALLITER should not be used for the treatment of children, as the efficacy and tolerability of perindopril in monotherapy or in combination have not been established for this group of patients.


Overdose.


Symptoms.


In case of overdose, the most common adverse reaction is hypotension, which can sometimes be accompanied by nausea, vomiting, convulsions, dizziness, drowsiness, confusion, oliguria, which can progress to anuria (due to hypovolemia), as well as circulatory shock. There may be a violation of the water-electrolyte balance (a decrease in the level of potassium and sodium in the blood plasma), renal failure, hyperventilation, tachycardia, rapid heartbeat (palpitation), bradycardia, anxiety, cough.


Treatment.


First aid measures include rapid elimination of the drug from the body ‒ gastric lavage and/or the use of activated charcoal, after which the water-electrolyte balance is normalized in a hospital setting.


In case of significant arterial hypotension, the patient should be given a horizontal position. If necessary, an isotonic sodium chloride solution should be administered intravenously or any other method of restoring blood volume should be used. Infusion treatment with angiotensin II and/or intravenous catecholamines may also be considered.


Perindoprilate, the active form of perindopril, can be removed from the body by hemodialysis (see Section "pharmacokinetics").


Tags: Indapamide, Perindopril