Angioneurotic edema of the lips and face usually does not require treatment; Antihistamines can be applied trenbolone enanthate gains to reduce the severity of symptoms. Angioneurotic swelling of the tongue, glottis or larynx may be fatal. With the development of angioedema should immediately enter subcutaneous epinephrine (adrenaline) and secure the airway.
Inhibitors are more likely to cause angioedema in blacks patients. Patients with angioedema in history, is not associated with the use of inhibitors may be at high risk of angioedema while receiving an inhibitor. Anaphylactoid reactions during the procedure apheresis low density lipoprotein (LDL -afereza) patients in the appointment of ACE inhibitors on the background of the procedure apheresis of low density lipoprotein (LDL) using dextran-sulfate absorption in rare cases can develop an anaphylactic reaction.Recommended temporary cancellation of inhibitors before each apheresis procedure.
Anaphylactic reactions during desensitisation Patients receiving inhibitors during the course of desensitization (eg, poison Gimenoptera (Hymenoptera venom)), in very rare cases may develop life-threatening anaphylactic reactions. Recommended temporary cancellation of trenbolone enanthate gainsinhibitor prior to each desensitisation procedures. Liver failure during therapy with inhibitors may sometimes develop a syndrome that starts with cholestatic jaundice and progresses to fulminant then necrosis of the liver, sometimes with fatal consequences. The mechanism of this syndrome is unclear.
When you are receiving an ACE inhibitor appears jaundice or observed increased activity of “liver” enzymes, ACE inhibitor should be lifted immediately and the patient should be monitored carefully. It is also necessary to carry out appropriate patients during therapy with inhibitors cases of neutropenia / agranulocytosis, thrombocytopenia and anemia have been observed. With normal kidney function in the absence of other complications of neutropenia is rare. The drug Perineva must be very great caution used in patients with connective tissue diseases (eg, lupus, scleroderma) while receiving immunosuppressive therapy, allopurinol or procainamide, and by combining all these factors, particularly when existing impaired renal function. These patients may develop severe infections that can not be intensive antibiotic therapy.
During the therapy with Perineva patients with the above factors, it is recommended to periodically monitor white blood cell count, and warn the patient of the need to inform the doctor about trenbolone enanthate gains any symptoms of infection. In patients with a congenital deficiency of glucose-6-phosphate dehydrogenase observed isolated cases of hemolytic anemia. Negroid Risk development of angioedema in patients blacks is higher. Like other ACE inhibitors, perindopril is less effective in reducing blood pressure in patients blacks, possibly because of higher prevalence of low-renin states in the population of this group of patients with hypertension. Cough Against the background of ACE inhibitor therapy may develop a persistent, non-productive cough, which stops after discontinuation of the drug. This should be considered in the differential diagnosis of cough. Surgery / general anesthesia In patients whose condition requires major surgery or anesthesia drugs that cause hypotension, ACE inhibitors, including perindopril, can block the formation of angiotensin II during compensatory renin release. The day before surgery, therapy with ACE inhibitors should be abolished.
If an inhibitor can not be undone, the hypotension, developing according to the described mechanism can be adjusted to increase BCC. Hyperkalaemia The therapy with ACE inhibitors, including perindopril, the concentration of potassium ions in the blood may rise in some patients. Increased risk of hyperkalemia in patients with kidney and / or heart failure, diabetes and decompensated patients applying sparing diuretics, potassium supplements or other drugs that cause hyperkalemia (e.g., heparin). If necessary, the simultaneous administration of said drugs to regularly monitor the content of potassium in serum. Diabetes mellitus Patients with diabetes taking hypoglycemic agents for oral or insulin, in the first few months of therapy with ACE inhibitors must be carefully controlled concentration of glucose in the blood. Lithium Not recommended that co-administration of drugs lithium and perindopril. potassium-sparing diuretics, drugs containing potassium kalisodergaszczye products and food supplements is not recommended with concomitant use of ACE inhibitors. lactose The trenbolone enanthate gains tablets contain lactose Perineva. Therefore, patients with hereditary galactose intolerance, Lapp lactase deficiency or malabsorption of glucose-galactose should not take this drug.