Aortic stenosis, hypertrophic obstructive cardiomyopathy, cerebrovascular and cardiovascular diseases (including cerebrovascular insufficiency, coronary heart disease, coronary insufficiency – a risk of excessive blood pressure lowering and concomitant ischemia).
Severe autoimmune systemic connective tissue disease (including systemic lupus erythematosus, scleroderma), inhibition of bone marrow hematopoiesis in patients receiving immunosuppressive drugs (increasing the likelihood of neutropenia).
Renovascular trenbolone enanthate side effects hypertension, a bilateral renal artery stenosis, stenosis of the artery only kidney condition after kidney transplantation (risk of renal dysfunction and agranulocytosis), chronic renal failure (especially accompanied by hyperkalemia), hyperkalemia, diet sodium restriction, a condition associated with decreased blood volume (including diarrhea, vomiting, diuretics), diabetes, advanced age, surgery (general anesthesia).
Dosing and Administration
Inside, in the morning before eating.
The initial dose for the treatment of hypertension is 4 mg / day, if necessary (after 1 month.) Dose may be increased to 8 mg / day in one portion.
In the appointment of ACE patients receiving diuretic therapy inhibitors, there may be a sharp decrease in blood pressure, which is recommended for the prevention stop taking diuretics 2-3 days before the expected start of therapy with perindopril or to prescribe a drug at lower doses – 1 mg 2 times a day.
In patients with renovascular hypertension initial dose of 1 mg 2 times a day. If necessary, the dose may subsequently be increased.
In elderly patients, therapy should be initiated with a dose of 2 mg per day, and thereafter, if necessary, to gradually increase it up to a maximum dose of 8 mg per day.
Treatment of patients with chronic heart failure in combination with nekaliysberegayuschim diuretic and / or digoxin is recommended to start under close medical supervision, Perindopril administered in an initial dose of 1 mg 2 times a day, in the morning.
Subsequently, after 1-2 weeks of therapy, the dose may be increased to 4 mg 1 time per day.
In patients with renal impairment, the dose should be adjusted according to the degree of renal failure: depending on the creatinine clearance.
When a creatinine trenbolone enanthate side effects clearance of 60 ml / min – 4 mg perindopril per day. When creatinine clearance 30-60 ml / min – 1 mg 2 times a day; with creatinine clearance 15-30 ml / min-2 mg every other day; patients on hemodialysis (creatinine clearance less than 15 ml / min.) – 2 mg per day of dialysis.
Patients with hepatic impairment, dose change is required.
The frequency of side effects is estimated on the basis of: often – 1-10%; rarely – 0.1-1%; very rare, including isolated reports – less than 0.1%.
From the cardiovascular system: often – an excessive fall in blood pressure and related symptoms, rarely – arrhythmias, angina, myocardial infarction and stroke.
From the urinary system: decrease in renal function, acute renal failure.
From the respiratory system: often – “dry” cough, shortness of breath; rarely -bronhospazm, rhinorrhea.
From the digestive system: often – nausea, vomiting, abdominal pain, change in taste, diarrhea or constipation, dry mouth, decreased appetite, cholestatic jaundice, pancreatitis, intestinal swelling.
On the part of the central nervous system: often – headache, asthenia, fatigue, dizziness, ringing in the ears, blurred vision, muscle cramps, paresthesias; rarely – depressed mood, insomnia; extremely rare – confusion.
Allergic reactions: often – skin rash, itching; rarely – urticaria, angioedema; rarely – exudative erythema multiforme.
Laboratory tests: often – hypercreatininemia, proteinuria, hyperkalemia; hyperuricemia; rarely (with prolonged use at high doses) – neutropenia, leukopenia, gipogemoglobinemiya, thrombocytopenia, decreased hematocrit; very rarely – agranulocytosis, pancytopenia, increased activity of “liver” enzymes, hyperbilirubinemia, haemolytic anemia (compared to glucose-6-phosphate dehydrogenase deficiency).
Other: increased trenbolone enanthate side effects sweating, sexual dysfunction.
Overdose Symptoms: reduced blood pressure, shock, stupor, bradycardia, electrolyte disturbances, renal failure. Treatment: gastric lavage, the use enterosorbents, restoring fluid and electrolyte balance, intravenous administration of 0.9% sodium chloride solution. In the case of significant decrease in blood pressure patient should be given a horizontal position with raised legs. Effective hemodialysis (not use highly permeable membrane nitron polyacrylic). With the development of bradycardia -atropin. In severe cases, a timing implantation of pacemaker. It is necessary to monitor and correct the vital functions of the body.
Interaction with other drugs
increases the severity of hypoglycemic action of insulin and sulfonylureas.
Baclofen, tricyclic antidepressants, antipsychotic drugs (neuroleptics) saluretiki enhance the hypotensive effect and increases the risk of development of orthostatic hypotension (additive effect).