Coversyl 10mg Servier medicine for hypertension (30 tablets)

Enzyme inhibition leads to reduction of angiotensin II in plasma, which increases the activity of lenin in plasma (due to negative response in inhibition of renin release) and reduces aldosteron secretion. Because the transferred enzyme causes Bradykinin inactivity, the inhibition of the enzyme transferred also leads to the increase in the activity of the circulating and local circulating systems (and thus also activating the prostaglandin system). It is possible that this mechanism contributes to the effect of lowering blood pressure and is related to the unwanted effect of the drug (for example: cough).

pharmacokinetic

absorption

After drinking, Perindopril is quickly absorbed and the peak concentration is reached within 1 hour. Perindopril's half -life is 1 hour. Perindopril is a precursor; 27% of the dose of Perindopril is circulating blood in the form of an active Perindoprilat metabolic. Along with Perindoprilat is active, Perindopril for 5 other metabolites is not active.

Perindoprilat's peak plasma concentration is achieved within 3-4 hours. Eating foods reduces the conversion to Perindoprilat, thus reducing the bioavailability of this substance, so it is necessary to take Perindopril Arginine with a single dose of the day before meals.

Distribution

The distribution volume is about 0.2 liters/kg for non -combined Perindoprilat. The combination of Perindoprilate on plasma proteins is 20%, mainly on the enzyme that changes the angiotensin form, but depends on the concentration.

Metabolism and elimination

Perindoprilat is eliminated into urine and the half -life of non -combination segment is about 17 hours, resulting in a stable state within 4 days.

Creatinin Clcr> 15: 2.5mg on blood vessels.

* Perindoprilat's appraisal is 70 ml/min. For patients with blood accumulation, drug dose should be used after blood accumulation.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.

What to do when overdose? Symptoms related to overdose of enzyme inhibitors may include hypotension, circulatory shock, electrolyte disorders, kidney failure, breathing fast, fast heartbeat, chest drum, slow heartbeat, dizziness, anxiety and dry cough.

The recommended overdose treatment is the intravenous transmission of 9 mg/ml sodium chloride solution (0.9%). If the patient has hypotension, keep the patient in the posture. If possible, cons Perindopril may be removed from the common circulation by dialysis. The pacemaker is indicated for cases of slow resistance of treatment. Signs of life, serum electrolysis and creatinine levels should be continuously monitored.

What to do when forgetting a dose? Ignore the forgotten dose if it is close to the time for the next expected dose. Do not use more medicine to replace the forgotten dose.

Thinkle (edema) on the face, head, lips, tongue, subjects and/or larynx.

Instructions on how to handle ADR

When experiencing side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

Be cautious when using

If you have any of the following signs, notify your doctor immediately before using Coversyl:

Stable coronary artery disease

If there is an unstable angina (typical or not typical) that appears in the first month when treatment with Perindopril, should carefully assess benefits/risk before continuing treatment.

Hypotension

Angiotensin (ACEI) inhibitors can cause hypotension. Symptoms of hypotension rarely observed in patients with hypertension without complications and often appear in patients with decreased circulatory volume as being treated with diuretics, diets that limit salt, blood vessels, diarrhea or vomiting or patients with severe hypertension dependent on renin. Hypotension is accompanied by renal failure or not. These symptoms appear mostly in patients with heart failure, which is more severe due to the use of high doses of diuretics, hypoglyc sodium or functional kidney failure.

In patients who increase the risk of symptomatic hypotension, it is necessary to monitor patients at the beginning of treatment and at the dose adjustments. The same principle is also applied to patients with myocardial ischemia or cerebrovascular disease, due to excessive hypotension that can lead to myocardial infarction or stroke.

If symptoms of hypotension appear, the patient should be on the back and if necessary, the intravenous solution of 2 mg/ml sodium chloride solution (0.9%) should be transmitted. There is no contraindication to the next dose if the lower hypotension reaction, patients can usually use the next dose without any difficulty due to the increase in the volume of circulating will pull the blood pressure increases.

On some patients with congestion heart failure with normal blood pressure or low blood pressure, systemic hypotension may appear when using Coversyl 10 mg. This effect can be predicted and often not the cause of treatment. In the case of hypotension with symptoms, it may be necessary to reduce the dose or stop using coversyl 10 mg.

Aortic stenosis and hypertrophic cardiac/myocardial valve

Similar to other ACE inhibitors, should be cautious when using Coversyl 10 mg for patients with mitral stenosis and clogged blood flow from the left ventricular such as aortic stenosis or hypertrophic cardiomyopathy.

kidney failure

In the case of renal failure (Creatinine clearance

Acute renal failure, often recovered, has been recorded in this case. In some patients on both sides of the renal artery or the kidney stenosis on one side of the patient, one kidney is treated with ACE inhibitors that have recorded blood urea and serum creatinine recovery after stopping treatment. This is especially like on patients with renal impairment. If the patient has hypertension, the risk of severe hypotension and renal failure will increase. In these patients, it is advisable to start treating with low doses under strict medical supervision and caution.

Because diuretics may be a factor that contributes to these risks, it is necessary to stop diuretics and monitor kidney function in the first weeks of Coversyl 10 mg. Some patients with hypertension previously do not show signs of kidney vascular disease may appear hyperurine and serum creatinine, usually mild and transient, especially when using Coversyl 10 mg simultaneously with diuretics. The risk is more likely to occur in patients with a history of renal failure. Dosage and/or stop use of diuretics and/or coversyl 10 mg.

Patient with blood viaer

Anaphylactic reaction has been reported in patients with high -speed filters treated simultaneously with ACE inhibitors. In these patients, it is advisable to consider the use of other blood membranes or use other anti -hypertension drugs.

kidney transplant

No experience used when using CoverSyl 10 mg for new kidney transplant patients.

Hypersensitivity/eagles

Facility on the face, limb, lips, mucosa, tongue, subjects and/or larynx have been reported rare in patients treated with ACE inhibitors, including 10 mg Coversyl. This reaction may appear at any time during treatment. In such cases, it is recommended to stop using CoverSyl 10 mg and start the appropriate monitoring process, continue until the symptoms appear completely retreat. During this time, the symptoms of facial swelling and lips are usually stopped without treatment, even if antihistamine drugs can effectively reduce symptoms. Evaluation related to Thanh Mon can be fatal.

When symptoms of edema appear in the tongue, bar or larynx, it can lead to airway obstruction, so emergency treatment should be promptly treated. Adrenalin can be used in combination with respiratory ventilation for patients. Patients should be closely monitored until the whole symptoms are completely gone. Patients with a history of angioedema are not related to the treatment of ACE drugs that may increase the risk of angioedema when using ACE inhibitors.

Gastrointestinal angioedema has been recognized as rare in patients treated with ACE inhibitors. These patients appear symptoms of abdominal pain (with or without nausea or vomiting); In some cases, there is no front edema and C-1 esterase concentration is normal. The diagnosis of angioedema includes abdominal CT scan, or ultrasound, or by surgery and loss of symptoms after stopping ACE inhibitors. The gastrointestinal angioedema should include distinguished diagnosis in patients using ACE inhibitors with abdominal pain.

Anaphylactic reactions in the process of filtering low density lipoprotein (LDL)

Anaphylactic reactions that are life -threatening are rarely seen in patients using ACE inhibitors during filtering low density lipoprotein as dextran sulphat. These anaphylactic reactions can be avoided by temporarily stop taking ACE inhibitors before each filter.

Anaphylactic reactions in the sensitive process

Patients taking ACE inhibitors during sensitivity (eg, some insects) have encountered anaphylactic reactions. In these patients, anaphylactic reactions can be avoided by suspension of ACE inhibitors, but these reactions may reappear after unintentional sensitivity.

Hepatic failure

Rarely cases of ACE drugs related to the syndrome begins with jaundice and progresses into spreading liver necrosis and (sometimes) death. The mechanism of this syndrome is not well known. Patients taking ACE inhibitors with progressive jaundice or increased liver enzyme should stop taking the drug and medical monitoring.

Neutral leukemia/grain leukemia/thrombocytopenia/anemia

Neutral leukemia, grain leukemia, thrombocytopenia and anemia have been recorded in patients with ACE inhibitors. In patients with normal renal function and no other risk factors, neutropenia rarely appears. “Absolutely cautious when using Perindopril for patients with blood vessels with glue, patients treated with immunodeficiency, is being treated with Allopurinol or Procainamid, or patients with a combination of these risk factors, especially patients who have previously had a history of renal insufficiency. Some of these patients had severe infections that did not respond to antibiotics. Periodically monitor the number of white blood cells and guide the patient to report any signs of infection (for example, sore throat, fever).

Race

ACE inhibitors causing angiography in black skin patients with higher rate in other patients. Similar to other ACE inhibitors, Perindopril's hypotension can be less efficient in black skin patients, which may be due to low plasma lenam activity ratio in higher hypertension patients with hypertension patients.

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cough has been recorded when using ACE inhibitors. Cough is usually characterized by dry, persistent cough and ends after stopping treatment. ACE inhibitors cause coughs should be considered as part of cough diagnosis.

surgery/anesthesia

On patients, large surgery or anesthesia with drugs may cause hypotension, 10 mg coversyl can cause an Angiotensin II synthesis inhibitors to compensate for the release of renin. Should stop taking the medicine one day before surgery. If the blood pressure appears due to this mechanism, it can be adjusted by increasing the circulatory mass.

Increased serum potassium

High serum potassium has been recorded in some patients taking ACE inhibitors, including Perindopril. Risk factors that increase blood potassium include kidney failure, renal function, age (> 70 years old), diabetes, especially dehydration, acute cardiac loss, metabolic acidosis and simultaneous use with potassium diuretics (such as spironolacton, eplerenon, triamteren or amilorid), potassium supplements and replacement salts containing potassium; Or patients with other drugs that increase serum potassium (eg heparin). The use of potassium supplements, potassium diuretics or replacement salts containing special potassium in patients with renal impairment may increase the meaning of serum potassium concentration. Hyperboly hyperkalemia may be serious, sometimes causing arrhythmia leading to death. If the same use of the above drugs is considered necessary, it is necessary to use caution and regularly monitor serum potassium.

Patients with diabetes

On patients with diabetes using oral diabetes medications, should monitor blood sugar in the first month when treated with ACE inhibitors.

The ability to drive and operate machinery

The drug does not directly affect the ability to drive and operate machinery but some patients may have some symptoms related to reducing blood pressure, especially when newly treated or in combination with other anti -hypertension drugs. Therefore, the ability to drive or operate machines can be affected.

Pregnancy

perindopril is not used during pregnancy.

When taking the drug, if you are pregnant or pregnant, you have been determined, immediately replaced with other medications, as soon as possible. There has been evidence that if the drug is used for three months of the second and third pregnancy, there is fetal toxicity (reducing renal function, less amniotic fluid, slow chemistry), infinite poisoning (kidney failure, hypotension, hyperkalemia). If Perindopril has been used for three months of pregnancy, the kidney and skull should be made.

Breastfeeding period

Because there is no information on the use of Coversyl during breastfeeding, Coversyl is not recommended to use and should use replacement therapy with more data on safety in breastfeeding women, especially for newborn or premature babies.

Drug interaction

Diuretics

Patients are taking diuretics, especially patients who reduce the amount of circulatory or salt loss, may be excessive blood pressure when they start treatment with ACE inhibitors. The likelihood of hypotension may decrease when stopping using diuretics, or by increasing the circulating volume or increasing the amount of salt consumed before starting Perindopril treatment in low doses and gradually increasing the dose.

Potassium diuretics, potassium supplements or alternative salts containing potassium

Despite the serum potassium concentration that is usually kept within normal limits, hyperkalemia may appear in some patients treated with Perindopril. Potassium diuretics (e.g. Spironolacton, triamteren or amilorid), potassium supplements, or replacement salt containing potassium may increase the meaning of serum potassium concentration. Therefore, combining Perindopril with drugs mentioned above is not recommended. If the combination of these drugs is indicated by patients with hypokalemia, caution should be used and regularly monitor serum.

lithium

Increased lithe and toxic lithium recovery has been reported when used simultaneously with lithium with ACE inhibitors. Simultaneous use with thiazid diuretics may increase the risk of lithium toxicity and increase the risk of lithium toxicity that had existed earlier when taking ACE inhibitors. Using Perindopril with lithium is not recommended, but it is necessary to combine, careful monitoring of serum lithium concentration.

Non -steroid anti -inflammatory drugs (NSAID) include aspirin with a dosage> 3 g/day

When using ACE inhibitors simultaneously with non-steroid anti-inflammatory drugs (for example, acetylsalicylic acid in anti-inflammatory doses, unsterious COX-2 inhibitors and NSAIDs), Perindopril's hypotension can be reduced. Simultaneous use of ACE and NSAID inhibitors may increase the risk of reduced kidney function, including acute renal failure, increased serum potassium levels, especially in patients who have reduced kidney function. The combination of drugs should be carefully applied, especially in elderly patients. Patients need to be appropriate and should be monitored with kidney function when starting with coordination treatment and periodic monitoring stage.

Anti -blood pressure medications and vasoconstriction

Timeless use of these drugs may increase the risk of Perindopril's hypotension. Simultaneous use with nitroglycerin and other nitrates, or with other vasoconstrictors can cause hypotension.

Diabetes treatments

Epidemiological research has shown the simultaneous use of ACE inhibitors and diabetic medications (insulin, oral hypoglycemic drugs that can increase the effect of hypoglycemia of the drug, leading to the risk of hemorrhagic drop. This phenomenon usually appears in the first weeks of combined treatment and on patients with renal failure.

Three -round antidepressants/anti -psychotic drugs/anesthesia

Concomitance some anesthetic, three -round antidepressants and anti -psychotic drugs with ACE inhibitors can cause stronger blood pressure.

Sympathomical drugs

Sympathetic medications can reduce the effect of lowering the blood pressure of ACE inhibitors. Acetylsalicylic acid, thrombolytic drugs, beta blockers, Perindopril nitrate can be used simultaneously with acetylsalicylie acid (used with anti -platelet aggregation effect).

Gold

Nitritoid reactions (symptoms including blushing, nausea, vomiting and hypotension) have been rarely recorded in patients treated with yellow salt through injection (sodium aurothomalate) and simultaneous treatment with ACE inhibitors including Perindopril.