Triplixamamamamamamamamamamamamamamom 5mg/5mg Servier Treatment of hypertension (30 tablets)
Dosage form Box of 30 tablets
Specifications Perindopril arginine, indapamide, amlodipine
Ingredient
| Composition information | Content |
| Perindopril Arginine | 5mg |
| Indapamide | 1.25mg |
| Amlodipine | 5mg |
Uses
Indications
Triplixam drugs are indicated for replacement in the treatment of hypertension for patients who have been controlled blood pressure when combining Perindopril/indapamid and amlodipine with the same content.
Pharmacokological
Angiotensin -shifting enzyme inhibitors, combined drugs. Angiotensin -shaped enzyme inhibitors, calcium channel blockers and diuretic. Triplixam is a combination of three -component hypotension with complementary mechanisms to help control blood pressure in hypertension patients. Perindopril arginin is an angiotensin -shifting enzyme inhibitor, indapamid is a chlorosulphamoyl and amlodipine diuretic that is a calcium ion inhibitor belonging to the dihydropyrine group.
Triplixam's pharmacological characteristics are a combination of pharmacological characteristics of each separate ingredient. In addition, the combination of perindopril/ indapamid creates an effective plus effect of hypotension from these two components.
Mechanism of effect and pharmacological effect:
perindopril
Perindopril is an angiotensin -shifting enzyme inhibitor, which catalyzes Angiotensin I into angiotensin II, a vasoconstrictor. Moreover, it also stimulates the secretion of aldosteron from the adrenal shell and stimulates the regression of Bradykinin, a vasodilator, into non -active heptides.
The result is:Perindopril's hypotension effect is also shown in patients with low or normal renin concentrations.
Perindopril works through its active metabolites, Perindoprilat. Other metabolites are not active.
Perindopril reduces the burden on the heart by:
Studies performed in patients with heart failure have shown:
The test results also show this improvement.
Perindopril is effective on all levels of hypertension: mild, moderate or heavy. Reducing systolic and diastolic blood pressure is recorded in both lying or standing positions.
The maximum hypotension is between 4 and 6 hours after taking the single dose and maintained for 24 hours. The ability to inhibit enzyme is still very high in the 24th hour, about 80%. In patients with response, blood pressure returns to normal after a month of treatment and maintain a stable level without having to get used to fast drugs. When stopping the drug does not occur the phenomenon of blood pressure soar again.
Perindopril has the properties of vasodilation and restores the elasticity of large arteries, repairing hypopateral changes in the arteries that hinder and thereby reduce left ventricular hypertrophy. If necessary, the addition of thiazid diuretics will lead to the combination effect.
A combination of an angiotensin -shifting enzyme inhibitors with a thiazid diuretics reduces the risk of hypokalemia associated with the use of single diuretic.
indapamid
indapamid is a sulfonamid derivative with an indol core, related to pharmacological with thiazid diuretics. Indomamid inhibits the reabsorption of sodium in the dilution of the kidney shell. This drug increases the secretion of sodium and chloride through the urine, and also increases the excretion of a part of potassium and magnesium, thus increasing the secretion of urine and has the effect of lowering blood pressure.
Indapamid has a prolonged lowering effect of blood pressure for 24 hours similar to single therapy. This effect occurs when used alone at a dose level that diuretic effect is minimal.
The hypotension effect of the drug is proportional to the improvement of the elasticity of the artery and reducing the resistance in small arteries as well as the total barrier of the peripheral vessel.
indapamid reduces left ventricular hypertrophy.
When the dosage of thiazid diuretics and diuretic drugs with thiazid increases, the effect of lowering blood pressure will achieve ceiling effects while increasing adverse events. Therefore, additional dose should therefore be ineffective.
In addition, in patients with hypertension, taking drugs in a short, medium and long -term time, indapamid has been shown:
Amlodipin
Amlodipin is a calcium channel blocker of the dihydropyridine group (slow channel blockers or calcium ions) and inhibits the diagonal calcium that penetrates the membrane into the heart muscle and blood vessel muscle.
Amlodipine's hypotension mechanism is due to the effect of direct relaxation of blood vessel smooth muscles. The exact mechanism of relief of amlodipine angina has not been completely determined but Amlodipine reduces the whole burden of ischemic by the following two effects:
In patients with age -related hypertension, the combination of perindopril/indapamid creates hypotension effect dependent on the dosage on diastolic blood pressure and centrifugal blood pressure to collect both lying position and standing position. In clinical trials, drink simultaneously Perindopril and Indopamid to create an effective synergistic effect compared to taking each separate medicine.
pharmacokinetics
Triplixam: Drink simultaneously Perindopril/indapamid and amlodipine does not change the pharmacokinetic properties compared to each part of each component.
perindopril
absorption and bioavailability
After oral use, Perindopril is quickly absorbed and the peak concentration is within 1 hour (Perindopril is the precursor and Perindoprilat is an active metabolic substance). Perindopril's plasma sale time is 1 hour. Foods reduces convert into Perindoprilat, so to ensure bioavailability, drink Perindopril arginin once a day in the morning before meals.
Distribution
Perindoprilat's distribution volume is about 0.2L/kg. Perindoprilat's bond ratio with plasma proteins is 20%, mainly with angiotensin transfer enzymes, but the ratio of the bond depends on the dose.
Biological metabolism
Perindopril is a medication, 27% of Perindopril's oral dose absorbs in the form of a common period in the form of amplifier with Perindoprilat activity. In addition to Perindoprilat activity, Perindopril also converts into 5 non -activity metabolites. Perindoprilat's top plasma concentration is achieved within 3 to 4 hours.
Elimination
Perindoprilat is eliminated through the urine and the semi -discharged time of the free form is about 17 hours, reaching a stable state within 4 days.
linear/non -linear
The correlation between Perindopril's dose and the total amount of drugs in plasma has been proven to be linear.
Special patient population
indapamid
absorption
Indapamid is absorbed quickly and completely through the digestive tract. The peak concentration of plasma is achieved in people about an hour after taking the medicine.
Distribution
The ratio of binding with plasma proteins is 79%.
Metabolism and elimination
Pharmacokinetics does not change in patients with renal failure.
amlodipin
absorption and bioavailability
After drinking at the level of treatment, Amlodipin is well absorbed with the peak concentration of 6 - 12 hours. Absolute bioavailability is about 64% and 80%. Amlodipine's bioavailability is not affected by food.
Distribution
The distribution volume is about 21L/kg. In vitro studies show that about 97.5% amlodipine in the blood binds to plasma proteins.
Metabolism
Amlodipin is strongly metabolized in the liver into non -active metabolites with 10% of the parent and 60% of metabolites excreted in the urine.
Elimination
Selling excretion time from plasma is about 35 - 50 hours and therefore can use one -time dosage of the day.
Special patient population
Use drugs for the elderly: Time to reach the peak concentration of amlodipine plasma in the elderly is similar to young people. Amlodipine clearance tends to decrease with the increase in AUC and the sale time in elderly patients. Increasing AUC and disposal time in patients with congested heart failure have been expected in research groups.
Using drugs in patients with liver function impairment: There is very little clinical data on the use of oral amlodipin in patients with liver failure. Patients with hepatic impairment will reduce Amlodipine clearance, resulting in increasing the sale time and increasing AUC by 40-60%.
Before taking Triplixamamamamamamamamamamamamamamom 5mg/5mg Servier Treatment of hypertension (30 tablets)
How to use
Oral drugs.
Dosage
A film tablet every day, it is best to drink in the morning and before meals.
Fixed dose combination is not suitable for the beginning therapy.
When you need to adjust the dose, it is necessary to adjust for each ingredient.
Special patient subjects:
kidney failure
In patients with severe renal impairment (creatinine clearance
recommendations to start treatment with appropriate doses from removable forms.
Regular medical monitoring includes regular creatinine and potassium control.
Contraindicated treatment simultaneously Perindopril with Aliskiren in patients with renal failure (glomerular filtration
Patients with liver failure
In patients with severe liver failure, contraindicated with triplixam.
In patients with mild to moderate liver failure, Triplixam should be used with carefulness due to the recommended dose of Amlodipin in these patients that have not been set up.
Older patients
Perindoprilat's clearance decreases in the elderly.
Can treat triplixam for older adults depending on the kidney function.
Pediatric population
The safety and effectiveness of Triplixams in children and minors have not been announced. There is no data.
What to do when overdose? For a combination of perindopril/indapamid
Symptoms
The most likely adverse reactions in the case of overdose are hypotension, sometimes accompanied by nausea, vomiting, abdominal pain, dizziness, drowsiness, mental disorders, urinary disorders that can lead to anuria (due to decrease in volume). Salt and water disorders (low sodium concentrations, low potassium levels) may occur.
How to handle
The first measures to be taken include quickly removing the substances that have entered the stomach by gastrointestinal or using activated carbon, then rehydration and electrolyte balance at the medical center until recovery.
If hypotension occurs, can be treated by placing patients in a lying position with lower heads. If necessary, the intravenous infusion of isometric salt solution, or use any volume increasing measure.
Perindoprilat, the activity of Perindopril, can be separated through dialysis.
For amlodipine
Experience of intentional overdose is very little.
Symptoms
The existing data indicates that the total dose of excess can lead to excessive peripheral vasodilation and may have a tachycardia reflex. Hypoglycemia of strong and prolonged systems leads to death shock. How to handle
Clinical significant hypotension due to amlodipine overdose should be supported with cardiovascular support including regular monitoring of cardiovascular and respiratory function, improving limbs and paying attention to circulating liquid and urine volume.
A vasoconstrictor may be helpful in restoring vascular tone and blood pressure, provided that there is no contraindication. Intravenous calcium gluconate intravenously may be useful in reversing the effects of calcium channel blockers.
Gastric lavage may be valid in some cases. In healthy volunteers, the use of coal up to 2 hours after using amlodipin 10mg has shown the ability to reduce the absorption of Amlodipin.
Because Amlodipin has a high ratio of binding to protein, dialysis is not able to benefit.
What to do when forgetting 1 dose? However, if the time to relax with the next dose is too short, skip the dose and continue the calendar of the drug. Do not use double doses to compensate for missed dose. Consult doctors/pharmacists.
Side Effects
Safety data summary
The most common adverse response is reported separately to Perindopril, Indopamid and Amlodipin: dizziness, headache, abnormalities, drowsiness, taste disorders, visual impairment, double view, tinnitus, dizziness, blushing, redness, hypotension (and effects related to hypotension), stomach disorders, diarrhea, diarrhea, diarrhea, diarrhea, diarrhea, diarrhea (stomach disorders, diarrhea, diarrhea, Disgusting, stomach disorders, Disrail, Disable, Disable. vomiting, vomiting, digestive disorders), itching, rash, rash with burning, cramps, swelling of the ankle, weakness, edema and fatigue.
Summary of adverse reactions
The following adverse reactions are observed and reported during treatment with Perindopril, Indopamid or Amlodipine and is assessed with the following frequency: Very popular (≥ 1/10); popular (≥ 1/100 to Classification of Agency system according to Meddra Unwanted effects Frequency Perindopril indapamid amlodipin Infection Rhinitis Very rare - Not popular Eosin leukemia Not popular * - - Very rare Very rare - - Very rare - Very rare - - Very rare Very rare Very rare Very rare - - Very rare Very rare - Very rare Very rare Very rare Too hypersensitivity - Not popular Very rare Hypoglycemia Not popular * - - Not popular * - - Not popular * Not known - - - Very rare - Very rare - Potassium impairment with hypokalemia, particularly serious in the population of patients with high risk of high risk - Not known - Insomnia - - Not popular Not popular - Not popular depression - - Not popular Not popular - - Very rare - rare Stunned Popular - Popular Headache Popular rare Popular Popular rare Not popular Not popular * - Popular - - Not popular Popular - Not popular Run - - Not popular Not popular * Not known Not universal - - Very rare - - Very rare - - Not known Very rare - - - Not known - visual impairment Popular Not known Popular - - Popular myopia - Not known - - Not known - Tinnitus Popular - Not popular Popular Rare - Not popular * - Popular Not popular * - - Very rare - - Very rare Very rare Not popular Very rare - Very rare - Not known - Flushing face - - Popular Popular Very rare Not popular Not popular * - Very rare ho Popular - Not popular Popular - Popular Not popular - - Very rare - - gut Abdominal pain Popular - Popular Popular Rare Popular Popular - Popular Popular - Popular Nausea Popular Rare Popular vomiting Popular Not popular Not popular Not popular Rare - - - Popular - - Very rare Pancreatitis Very rare Very rare Very rare Gastritis - - Very rare Hepatitis Very rare Not known Very rare - - Very rare Liver dysfunction - Very rare - Itching Popular - Not popular Popular - Not popular - Popular - Not popular Very rare Not popular Not popular Very rare Very rare Hair loss - - Not popular - Not popular Not popular - - Not popular Hepatitis Very rare Not known Very rare Increase surgery Not popular - Not popular - - Not popular Not popular * Not known Very rare Rare - - pemphigoid Not popular * - - Very rare - Very rare - Very rare Very rare Skin peeling - - Very rare - Very rare - - - Very rare Co Popular - Popular - - Popular joint pain Not popular * - Not popular Not popular * - Not popular back pain - - Not popular - Not known - urination disorders - - Not popular - - Not popular - - Not popular Very rare - - Not popular Very rare - erectile dysfunction Not popular - Not popular - - Not popular weakness Popular - Popular - Rare Fatigue - - Very popular Not popular * - Not popular - - Not popular Not popular * - Not popular Not popular * - - Not popular * - - Parameters Weight gain - - Not popular - - Not popular Not popular * - - Not popular * - - Rare - - Rare Not known Very rare Very rare - - - Not known - - Not known - - Not known - Self Not popular * - - SIADH cases (unsuitable anti -diuretic secretion syndrome) have been reported to other transferred enzyme inhibitors. Siadh can be considered rare but complications may be related to the inhibition of enzyme transfer including Perindopril. Report on adverse reactions when suspected Report adverse reactions when suspected after the drug product is licensed. It allows continuous monitoring to balance the benefits/risks of drug products. Medical experts are required to report all the adverse reactions when suspected.
Warnings
Before using the drug you need to read the instructions carefully and refer to the information below.
This drug is only used by a doctor.
Do not use overdue drugs indicated on the packaging.
Do not use the prescribed overdose.
Read the user manual carefully before use.
Notify the doctor with unwanted effects when using the drug.
If you need more information, please consult a doctor.
Contraindicated
Triplixam is contraindicated for the following cases:
Hypersensitivity to the active ingredient, or any sulfonamid derivatives, sensitive to Dihydropyridine derivatives, with any angiotensin -shaped enzyme inhibitors or any ingredients of the drug.
History of angioedema (edema) related to the previous Angiotensin enzyme inhibitors. Evaluation or idiopathic or idiopathic. breastfeeding. Hypotension. Unstable hemodynamic heart failure after acute myocardial infarction. Simultaneously used with Sacubitril/Valsartan. Serial treatments lead to blood contact with negative charge surfaces. narrowing of the kidney artery on both sides or significant artery stenosis leads to kidney function on one side. kidney failure In case of severe renal failure (creatinine clearance In patients with hypertension without the previous kidney damage and blood examination to the kidneys shows that the renal function decreases, the treatment should be stopped and may start again at low doses or monomers. In these patients, medical monitoring includes potassium and creatinine control, after 2 weeks of treatment and every 2 months during stable treatment. Renal failure is reported mainly in patients with severe heart failure or have a renal failure platform including kidney stenosis. This drug is not recommended in the case of kidney artery narrowing on both sides or only one kidney function. The risk of arterial hypotension and/or kidney failure (in case of heart failure, dehydration and electrolyte ...). The significant disorder of the Renin - Angiotensin - Aldosteron system has been observed with Perindopril when dehydrated and clearly electrolyte (salt diet or prolonged diuretic treatment), in patients with initial blood pressure, in case of kidney stenosis, congestor or cirrhosis with edema and ascites. This system inhibitors with an enzyme inhibitor in the form of angiotensin can cause sudden hypotension and/or increase plasma creatinine levels, indicating impaired renal function, during the first time of treatment and in the first 2 weeks of treatment. In some cases, this becomes acute at the beginning, although rare, and onset at different times. In these cases, treatment should be started in low doses and gradually increase the dose, in patients with heart anemia and cerebrovascular disease, excessive hypotension can cause myocardial infarction or stroke. thiazid diuretics and thiazid diuretics are only completely effective when normal kidney function or slight decline (plasma creatinine levels below 25mg/l, meaning 220µmol/l in adults). In the elderly, plasma creatinine levels should be adjusted according to age, weight and gender. Decreased secondary blood volume caused by dehydration and salt caused by diuretic at the beginning of the treatment may cause reduced filtration of glomerular filtration. This can lead to increased blood urea and plasma creatinine. This transient kidney function fails to cause consequences in individuals with normal kidney function but it can worsen the previous impaired renal function. Amlodipin can be used in patients with kidney failure in normal doses. Change plasma amlodipine concentration is not related to renal failure. The effect of combining in Triplixam has not been tested in patients with renal abnormalities, in patients with renal impairment, the dosage of Triplixam should respect the dose of ingredients when drinking individually. Hypotension and dehydration and sodium There is a surprising risk of hypotension when there is a previous sodium loss (especially in patients with kidney artery stenosis). Therefore, the whole body test should be conducted when there are clinical signs of dehydration and electrolytes, which may appear when diarrhea or vomiting. Regular monitoring of plasma electrolytes should be conducted in these patients. Significant hypotension may need an isotonic intravenous line. Hypotension is not contraindicated to continue the treatment. After re -establishing the volume of circulatory and blood pressure, treatment may start again or by reducing the dose or with only one ingredient. Sodium concentration decline may have no initial symptoms, so regular testing should be conducted. Testing should be conducted more often in elderly patients and cirrhosis. Any treatment of diuretics can cause sodium loss, sometimes very serious consequences. Hypoglycocytic hypoglycemia, accompanied by a decrease in blood volume may be the cause of dehydration and hypotension. The loss of chlorid ions can lead to metabolic alkali infection with secondary compensation: the frequency and level of this influence are light. Potassium The combination of indapamid with perindopril and amlodipine does not prevent hypokalemia triggers especially in diabetics or patients with renal impairment. Like all other antihypertensive drugs when coordinating with diuretics, plasma testing should be conducted. Increasing plasma potassium has been observed in some patients who have been treated with angiotensin -shaped enzyme inhibitors, including Perindopril. Risk factors that increase blood potassium include renal failure, reduced renal function, age (> 70 years old), diabetes, events that occur simultaneously, especially dehydration, acute cardiomy, metabolic acidosis and simultaneous use with potassium diuretics (such as spironolacton, eplerenon, triamteren or amilorid), potential supplements and containing salts containing potassium -contained salts; Or patients who use other drugs that increase serum potassium (e.g. heparin, co -trimoxazole is known as trimethoprim/sulfamethoxazole). The use of potassium supplements, potassium diuretics or alternative salts containing special potassium in patients with renal impairment may increase the meaning of serum potassium concentration. Hemoto hyperpasses can cause serious arrhythmia, sometimes 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. Potassium loss and hematuria are the main risks of thiazid diuretics and thiazid diuretics. The risk of hypokalemia ( In this case, hypokalemia increases the heart toxicity of heart glycosides and the risk of arrhythmia. Individuals with long QT distance are also at risk, whether due to congenital or drug use. Hypotension, as well as a slow heart rate, is a factor leading to serious arrhythmia, especially twisted, which can be life -threatening. Potassium control more frequently required in all of the above cases. Plasma potassium measurement should be conducted in the first week after the beginning of treatment. If the potassium level is detected, the adjustment is necessary. calcium thiazid diuretics and thiazid diuretics can reduce the amount of calcium excreted through urine and increase the amount of plasma calcium. Significant hypercalcemia may be because the thyroid gland has not been detected earlier. In this case, the treatment should be stopped before exploring the thyroid function. Aortic hypertension Treatment of kidney hypertension is rejuvenation. However, the angiotensin -shaped enzyme inhibitors may work in patients with hypertension of the kidneys that are waiting for surgery or cannot be surgery. If Triplixam is prescribed for patients who have known or suspected kidney stenosis, treatment should be started in the hospital with monitoring of kidney and potassium function, because some patients will have renal failure recovered when stopping treatment. ho atherosclerosis The risk of hypotension may occur in all patients but pay special attention to patients with myocardial oral hypotension or cerebral circulatory diseases, with low -dose treatment. acute hypertension The efficiency and safety of amlodipine in acute hypertension patients have not been established. Heart failure/heart failure Patients with heart failure should be treated with care. In a long -term study, compared to placebo in patients with severe heart failure (NYHA LLL - IV), pulmonary side effects are reported higher in the amlodipine group when compared to the placebo group. Calcium channel blockers, including amlodipine, should be used with carefulness in patients with congestive heart failure, as they can increase cardiovascular and death. thiazid diuretics and thiazid diuretics can reduce the amount of calcium excreted through urine and increase the amount of plasma calcium. Significant hypercalcemia may be because the thyroid gland has not been detected earlier. In this case, the treatment should be stopped before exploring the thyroid function. In patients with severe heart failure (degree IV), treatment should be started under medical monitoring and reduced the dose of arising. Beta blockers should not be stopped in patients with hypertension with coronary artery disease: A combination of enzyme inhibitors should inhibit the angiotensin -shaped enzyme with beta blockers. Aortic stenosis and hypertrophic cardiac/myocardial valve Angiotensin -shifting enzyme inhibitors should be used cautiously when used for patients with blood clogged out of the left ventricle. Diabeten patient In diabetes patients with insulin dependent (spontaneous trend of increased potassium), treatment should be started under medical supervision and with low doses. Hemorrhage levels should be closely monitored in previous diabetics who have been treated with oral or insulin diabetes, especially in the first month when treated with angiotensin -shaped enzyme inhibitors. Sugar control is important for diabetics, especially when the potassium level is low. Race Similar to other angiotensin -shaped enzyme inhibitors, Perindopril's hypotension can be less efficient in black skin patients, which may be due to low ratio of lenin activity in hypertension patients with higher blood pressure. surgery/anesthesia Very rarely, angiotensin -shaped enzyme inhibitors can cause hypotension in case of anesthesia, especially when anesthetic is likely to lower blood pressure. Therefore, the treatment of angiotensin -shifting enzyme inhibitors has a long -lasting effect like Perindopril is recommended to stop before surgery about a day. Hepatic failure Very rarely, the angiotensin -shifting enzyme inhibitors related to the syndrome begins to evidence of cholestasis jaundice and progresses into violent and (sometimes) deaths. The mechanism of this syndrome is not well understood. Patients using angiotensin -shifting enzyme inhibitors are increased and significantly increased liver enzyme, so they stop using angiotensin -shaped enzyme inhibitors and need appropriate medical monitoring. Amlodipine's waste time is prolonged and higher AUC value in patients with liver function impairment, recommended dose has not been set. Therefore, amlodipine should be started at low doses with carefulness, both at the beginning as well as when increasing the dose. Closely adjustable and strict dose adjustment may be required in patients with severe liver failure. The effect of combining in Triplixam has not been tested in patients with liver failure. Regarding the effectiveness of each component in this combination, Triplixam is contraindicated in patients with severe liver failure, and cautious for patients with mild to medium liver failure. Uric acid The trend of gout can increase in patients with increased blood uric acid. Elderly Should check the kidney function and potassium level before starting treatment. The first dose needs to be adjusted according to the response of blood pressure levels, especially in cases of dehydration and electrolyte to avoid the starting of sudden hypotension. In older patients should be cautious in increasing the dose of amlodipine. There has been no research on the influence of Triplixam on driving and operating machinery. Perindopril and Indopamid do not affect the ability to drive and operate machines but separate reactions related to hypotension may occur in some patients. Amlodipin may have a slight or moderate effect on the ability to drive and operate machinery. If patients have symptoms of dizziness, headache, fatigue or nausea, the ability to react may be impaired. The result is the ability to drive and operate machinery may be impaired. Precautions especially when starting. Perindopril Epidemiological evidence is related to the risk of teratogenicity after using angiotensin enzyme inhibitors during the first pregnancy that has not come to conclusions, but a slight increase in risk is not excluded. Unless the continued use of angiotensin enzyme inhibitors is considered necessary, patients who have a plan to become pregnant should be transferred to other anti -hypertension treatments that have set data safely for pregnancy. Once pregnant, treated with an angiotensin -shaped enzyme inhibitors should stop immediately, and if possible, start with another replacement therapy. The use of enzyme inhibitors is not recommended in the first pregnancy. The use of enzyme inhibitors in the form of angiotensin is contraindicated during the second and third pregnancy. The use of enzyme inhibitors in the second and third pregnancy is known to cause fetal toxicity (impaired renal function, amniotic fluid, skull slowly) and neonatal toxicity (kidney failure, hypotension, hyperkalemia). In the case of an angiotensin -shift enzyme inhibitor during pregnancy, the ultrasound recommends test kidney and skull. Infants whose mothers have used the angiotensin -shifting enzyme inhibitors that need to be closely monitored. indapamid No or limited data (less than 300 pregnant women) from the use of indapamid in pregnant women. Prolonging the use of thiazid during pregnancy can reduce the volume of the mother's plasma as well as the uterine blood flow - the placenta, which can cause local placenta anemia and growth retardation. Moreover, some rare cases of hypoglycemia and thrombocytopenia in newborns have been reported after short -term contact. Animal studies do not indicate directly and indirectly harmful effects on reproductive toxicity. amlodipin Amlodipine safety during pregnancy has not been set. In animal studies, reproductive toxicity has been observed at high doses. Triplixam is contraindicated during breastfeeding. perindopril Due to the lack of data related to the use of Perindopril during breastfeeding, Perindopril is not recommended and prioritizes alternative treatments with safety records set up during breastfeeding, especially when breastfeeding or premature babies. indapamid There is no enough information about the excretion of IndaPamid/substances that metabolize into breast milk. Hypersensitivity to sulfonamide derivatives and hypotension may occur. Can not rule out the risk for infants/young children. Indopamid is closely related to thiazid diuretics that are associated with reduction or even inhibition of milk secretion during breastfeeding. amlodipin Amlodipin is not known to be able to excrete through breast milk or not. General for perindopril and indapamid Studies on reproductive toxicity do not produce any evidence of the fertility in female and male mice. There is no effect on the fertility of the estimated person. amlodipin Change with biochemical recovery at the tip of sperm has been reported on some patients treated with calcium channel blockers. There is not enough clinical data related to amlodipine's influence on fertility. In a mouse study, adverse reactions are recorded on the fertility of male mice. Clinical data indicates that the double closing of the Renin - Angiotensin - Aldosteron system by combining Angiotensin -shifting enzyme inhibitors, Angiotensin II or Aliskiren receptor blockers related to higher frequency of disadvantages such as health pressure, hyperpoints and impairment. grant) When compared with the use of a single -renin - Angiotensin - Aldosteron inhibitor. Hemoto hyperkalus: Some medications or therapy can increase blood potassium: Aliskiren, potassium salt, potassium diuretics, angiotensin -shaped enzyme inhibitors, Angiotensin II (ARB), anti -inflammatory drugs, heparin, heparin, immunosuppressants such as ciclosporin or tacrolimus, trimethrim. The combination of these drugs increases the risk of hyperkalemia. Combining combinations: Uncounts are not recommended: Ingredients Interactive has been known to other drugs Interaction with other drugs Perindopril/ indapamid lithium Increased lithium and toxic lithium recovery has been reported in simultaneous use and lithium inhibitors and enzyme inhibitors in the form of angiotensin shifting, using a combination of Perindopril, Indopamid and Lithium are not recommended, but when needed, it is necessary to carefully monitor serum lithium concentration. Perindopril Aliskiren In patients without diabetes or renal failure, there is a risk of hyperkalemia, impaired renal function, increased cardiovascular disease and mortality. There have been reports in the literature, in patients with atherosclerosis, heart failure, or diabetes with target organs, simultaneous use of angiotensin -shaped enzyme inhibitors and angiotensin receptor blockers are associated with increased frequency of blood pressure, fainting, hyperkemia and renal impairment (including acute renal impairment) when comparison with a single -effect on use. In Renin-Anotensin-Aldosteron system. Double blockbellion (for example, an angiotensin -shifting enzyme inhibitor with an Angiotensin II anti -receptor drug) should be limited in certain cases with strict monitoring of kidney function, potassium and blood pressure levels. The risk of increasing adverse effects such as nerveema. Hemorrhage hyperka (at risk of death), especially when combined with kidney failure (the effect of hyperkalemia). Combining Perindopril with drugs mentioned is not recommended. In case of this coordination indication, be careful and regularly monitor serum potassium levels. For the use of Spironolacton in heart failure, see the "combination need special caution". Patients using Co-Trimoxazole simultaneously (trimethoprim/sulfamethoxazole) may increase the risk of hyperkalemia. dantrolen (infusion) In animals, observing death and cardiovascular collapse related to hyperkalemia after use simultaneously Verapamil and dantrolen intravenously. Due to the risk of hyperkalemia, calcium channel blockers such as Amlodipin are recommended to avoid using simultaneously in patients who are easy to increase malignant body temperature and are controlling malignant body temperature. Biochemical can increase in some patients leading to increased hypotension effect. Ingredients Interactive has been known to other drugs Interaction with other drugs Baclofen Increased anti -hypertension effect. Monitoring blood pressure and adjusting anti -hypertension dose if necessary. When an enzyme inhibitor is an angiotensin shifting, simultaneously used with an anti-inflammatory drug Non-steroids (for example, acetylsalicylic acid used anti-inflammatory doses, non-selective COX-2 and NSAID inhibitors) can reduce anti-hypertension effect. The simultaneous use of angiotensin -shaped enzyme inhibitors with NSAID may increase the risk of impaired renal function, including acute renal failure, and increase serum potassium levels, especially in patients who have poor kidney function. This combination should be used carefully, especially in the elderly. Patients should be properly rehydrated and consider monitoring of kidney function after starting this combination treatment, and periodically later. Perindopril Cure diabetes (insulin, oral hypoglycemic drugs) Epidemiological studies believe that the use of enzyme inhibitors inhibit the angiotensin -shaped enzyme and diabetic medications (insulin, oral hypoglycemic drugs) can increase the effectiveness of blood sugar, leading to the risk of hypoglycemia. This phenomenon is more likely to appear in the first weeks of combination treatment and in patients with renal failure. Patients who are using diuretics, especially patients with volume decline and/or salt can decrease in excessive blood pressure after arising with an angiotensin -shaped enzyme inhibitor. The ability to lower blood pressure can be minimized by stopping using diuretic, by compensating the volume and salt before ruling at a low dose then gradually increasing the dose of Perindopril. In arterial hypertension, when previous diuretic therapy can cause decrease in volume/salt, diuretics should be discontinued before starting with angiotensin -shifting enzyme inhibitors, in this case, a diuretic that does not hold potassium can be re -used afterwards or angiotensin -shifting enzyme inhibitors need to be used at low doses. In congestive heart failure, diuretics, enzyme inhibitors in the form of angiotensin should be started with very low doses, maybe after reducing the dose of non -potassium -keeping diuretics used. In all cases, renal function (creatinine concentration) must be monitored in the first weeks of treatment with enzyme inhibitors in the form of angiotensin. With Eplerenon or Spironolacton at a dose of 12.5 mg to 50 mg daily and the low doses of the Angiotensin -shifting enzyme inhibitors: In the treatment of heart failure LL - IV (NYHA) with blood emulsion rates Before starting combined treatment, checking the absence of hyperkalemia and kidney failure. Advice to closely monitor potassium and blood creatinine in the first month of treatment, once a week at the beginning and monthly. racecadotril Switching enzyme inhibitors (such as Perindopril) have been known to be able to cause angiography. This risk may increase when used simultaneously with racecadotril (a drug used to prevent acute diarrhea). Treated patients in combination with MTOR inhibitors may increase the risk of angioed with angiography indapamide Twisted drugs Due to the risk of hypokalemia, indapamid should be used cautiously when used with torsion -causing drugs such as: - Anti-arrhythmia IA (Quinidin, Hydroquinidin, Disopyramid); - Anti-arrhythmia group III (Amiodaron, Dofetilid, Ibutilid, Bretylium, Sotalol); - A few neuroleptics (chlorpromazin, cyamemazin, levomepromazin, thioridazin, trifluoperazin), benzamid groups (amisulprid, sulpid, sultoprid, rayprid), butyrophenone group (droperidol, haloperidol), other nervous drugs (pimozid); - Other active ingredients such as Bepridil, Cisaprid, Diphemanil, Erythromycin intravenously, Halofantrin, Mizolastin, Moxifloxacin, Pentamidin, Sparfloxacin, Vincamin intravenous, Methadon, Astemizol, Terfenadin. Prevention and adjustment of potassium reduction if needed, monitoring QT. Increased risk of potassium lowering (combined impact). Monitor potassium concentration and adjust if necessary; Especially consider in cases of treatment with heart glycosides. Do not use excited laxatives. Low potassium concentration increases the toxicity of heart glycosides. Potassium and electrocardiogram concentration should be monitored and treated should be reviewed if necessary. Collection of treatment with indapamide can increase the rate of hypersensitivity reactions with allopurinol. CYP3A4 induction drugs There is no data on the effects of CYP3A4 induction drugs on amlodipine. The simultaneous use of CYP3Y4 induction drugs (for example, rifampicin, hypericum perforatum) may reduce plasma amlodipine levels. Amlodipin should be used cautiously with CYP3A4 induction drugs. CYP3A4 inhibitors Concomitant use of amlodipine with strong and medium CYP3A4 inhibitors (protease inhibitors, Azol antifungal, broad -spectrum antibiotics such as erythromycin, verapamil or diltiazem) can significantly increase amlodipine concentration. Clinical research shows that changes in this pharmacokinetics can be more noticeable in the elderly. Clinical monitoring and dose adjustments are therefore required. There is an increase in the risk of hypotension in patients using clarithromycin with amlodipine. It is recommended to closely monitor patients when using simultaneously amlodipine with clarithromycin. Ingredients Interactive has been known to other drugs Interaction with other drugs Perindopril/ indapamid/ amlodipin Antidepressants like imipramin (three -round antidepressants), nerve drugs Increased anti -hypertension and increased the risk of hypotension (complex impact). Using other anti -hypertension drugs may increase the effect of lowering blood pressure. Reduce anti -hypertension effect (holding salt and water due to corticosteroids). Perindopril anti -hypertension and vasodilators Simultaneously used with nitroglycerin and other nitrate, or vasodilators, can increase the effect of lowering blood pressure. Simultaneously used with enzyme inhibitors that can be transferred to angiotensin may lead to the risk of leukopenia. Anesthesia Angiotensin -moving enzyme inhibitors may increase the lowering effect of certain anesthesia. Previous treatment with high doses of diuretics can lead to decline in volume and risk of hypotension when starting with Perindopril. gliptines (linagliptin, saxagliptin, sitagliptin, vilagliptin) Increased risk of angioedema, due to intravenous dipeptidyl peptidase (DPP-IV) impaired operating by gliptin, in patients with treatment in combination with angiotensin-shifting enzyme inhibitors. Sympathetic medications can reduce the anti -hypertension effect of enzyme inhibitors in the form of angiotensin. Nitrotoid reaction (symptoms including flushing, nausea, vomiting and hypotension) are reported rare in patients being injected with gold salt (sodium aurothiomalate) and simultaneous use of angiotensin enzyme inhibitors including perindopril. indapamide Metformin Lactic acidosis due to metformin can be caused by kidney failure related to diuretics and especially diuretics. Do not use metformin when plasma creatinine levels exceed 15mg/l (135micromol/l) in men and 12mg/l (110micromol/l) in women. In cases of dehydration due to diuretics, there is a risk of increasing the likelihood of acute renal failure, especially when taking high doses of contrast -containing iodine. Water compensation needs to be done before using the compound containing iodine. The risk of increasing calcium concentration due to reduced calcium excretion in urine. ciclosporin The risk of increasing creatinine concentration with circulation ciclosporin levels does not change, even without salt and water impairment Atorvastatin, Digoxin or Warfarin In clinical interactive studies, Amlodipin does not affect the kinetics of Atorvastatin, Digoxin or Warfarin. tacrolimus There is a risk of increased blood tacrolimus concentration when combined with amlodipine. To avoid the toxicity of Tacrolimus, blood concentration should be monitored and adjust the appropriate tacrolimus dose when taking amlodipine in patients treated with tacrolimus. ciclosporine There are no drug interactive studies between ciclosporine and amlodipine that are controlled & healthy volunteers or other populations except for kidney transplant patients, when the bottom level changes increasing (average of 0% - 40%) of Ciclosporine. Ciclosporine concentration should be considered in kidney transplant patients using amlodipine, and reducing ciclosporine dose if necessary. Simvastatin The simultaneous use of amlodipin 10 mg with simvastatin 80 mg leads to an increase of 77% of the concentration of simvastatin compared to simvastatin used alone. Do not use more than 20mg of simvastatin/ day in patients using amlodipin. Precautions when using
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