Prestanza - instructions for use, analogs, reviews and release forms (5 mg + 5 mg, 5 + 10, 10 + 10, 10 + 5) medication for the treatment of hypertension and pressure reduction in adults, children and pregnancy. Composition

In this article, you can read the instructions for using the drug Prestans. Presented are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors specialists on the use of Prestans in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Prestans in the presence of existing structural analogues. Use to treat hypertension and reduce blood pressure in adults, children, as well as during pregnancy and lactation. Composition of the preparation.

Prestans - Combined antihypertensive and antianginal drug.

Perindopril

Perindopril is an inhibitor of the enzyme converting angiotensin 1 to angiotensin 2 (an ACE inhibitor). ACE, or kininase 2, is an exopeptidase that carries out both the conversion of angiotensin 1 into a vasoconstrictor substance, angiotensin 2, and the destruction of bradykinin, which has a vasodilating effect, to an inactive heptapeptide.

Since ACE inactivates bradykinin, ACE inhibition is accompanied by an increase in the activity of both the circulating and tissue kallikrein-kinin system, and the system of prostaglandins is also activated.

Perindopril has a therapeutic effect due to the active metabolite, perindoprilat. Other metabolites have no inhibitory effect on ACE.

Arterial hypertension

Perindopril is a drug for the treatment of arterial hypertension of any severity. Against the background of its use there is a decrease in both systolic and diastolic blood pressure in the supine and standing position. Perindopril reduces OPSS, which leads to a decrease in elevated blood pressure and an improvement in peripheral blood flow without a change in heart rate.

As a rule, the intake of perindopril increases the renal blood flow, the rate of glomerular filtration does not change.

Antihypertensive effect of the drug reaches a maximum after 4-6 hours after a single oral intake and is maintained for 24 hours.

Antihypertensive effect 24 hours after a single oral intake is about 87-100% of the maximum antihypertensive effect. Decrease in blood pressure is achieved quickly enough.

The therapeutic effect occurs less than 1 month after the start of therapy and is not accompanied by tachycardia. Termination of treatment does not cause withdrawal syndrome. Perindopril has vasodilating effect, contributes to the restoration of elasticity and large arteries of the vascular wall structure of small arteries and reduces left ventricular hypertrophy.

Stable ischemic heart disease

The efficacy of perindopril in patients (12,218 patients over 18 years of age) with stable coronary artery disease without clinical symptoms of chronic heart failure was studied in a 4-year study (EUROPA). 90% of study participants had previously suffered acute myocardial infarction or coronary revascularization.Therapy with perindopril tert-butylamine at a dose of 8 mg per day (equivalent to 10 mg perindopril arginine) resulted in a significant reduction in the absolute risk of complications by 1.9%, in patients who had previous myocardial infarction or coronary revascularization, the absolute risk reduction was 2.2% compared with the placebo group.

Amlodipine

Amlodipine is a blocker of slow calcium channels, a derivative of the dihydropyridine series. Amlodipine inhibits the transmembrane transition of calcium ions to cardiomyocytes and smooth muscle cells of the vascular wall.

The antihypertensive effect of amlodipine is due to direct action on the smooth muscle cells of the vascular wall. It has been established that amlodipine induces an increase in peripheral arterioles, decreasing OPSS (afterload), since heart rate does not change in this case, and myocardial oxygen demand decreases. Causes the expansion of coronary arteries and arterioles both in the ischemic and intact zones. In patients with Prinzmetal angina, coronary blood flow is improved.

In patients with hypertension, amlodipine once a day provides a clinically significant reduction in blood pressure in the standing and lying position for 24 hours.Antihypertensive action develops slowly, in connection with which the development of acute arterial hypotension is uncharacteristic.

In patients with angina, receiving amlodipine once a day increases exercise tolerance, delays the onset of angina and "ischemic" depression of the ST segment, and also reduces the incidence of angina attacks and the consumption of Nitroglycerin (short-acting forms).

Amlodipine has no effect on the lipid profile and does not cause changes in lipid-lowering plasma parameters.

The drug can be used in patients with concomitant bronchial asthma, diabetes and gout.

The efficacy and safety of the use of amlodipine in a dose of 2.5-10 mg per day, the inhibitor of ACE lisinopril at a dose of 10-40 mg per day, and the thiazide diuretic chlorthalidone at a dose of 12.5-25 mg per day as a first-line drug was studied in a 5-year study of ALLHAT with the participation of 33,357 patients aged 55 years and over) in patients with mild to moderate hypertension and at least one of the additional risk factors for coronary events such as myocardial infarction or stroke,transferred more than 6 months prior to enrollment, or other confirmed cardiovascular disease of atherosclerotic origin; diabetes; HDL cholesterol level less than 35 mg / dl; hypertrophy of the left ventricle according to ECG or echocardiography; smoking.

The main criterion for assessing efficacy is a combined index of the frequency of deaths from ischemic heart disease and the incidence of non-fatal myocardial infarction. There were no significant differences between the groups of amlodipine and chlorthalidone according to the main evaluation criterion. The incidence of heart failure in the amlodipine group was significantly higher than in the chlorthalidone group - 10.2% and 7.7%, respectively, the overall death rate in the amlodipine and chlorthalidone group did not differ significantly.

Perindopril and amlodipine

Efficacy with prolonged use of amlodipine in combination with perindopril and Atenolol in combination with bendroflumethiazide in patients aged 40 to 79 years with hypertension and at least 3 of additional risk factors such as left ventricular hypertrophy according to ECG or echocardiography; type 2 diabetes mellitus; atherosclerosisperipheral arteries; previously suffered stroke or transient ischemic attack; male; age 55 years and older; microalbuminuria or proteinuria; smoking; total cholesterol / HDL cholesterol ≥ 6; early development of IHD in close relatives, was studied in the ASCOT-BPLA study.

The main criterion for assessing efficacy is a combined indicator of the incidence of non-fatal myocardial infarction (including painless) and lethal outcomes of IHD. The incidence of complications provided by the main evaluation criterion in the amlodipine / perindopril group was 10% lower than in the atenolol / bendroflumethiazide group, but this difference was not statistically significant. In the amlodipine / perindopril group, there was a significant reduction in the incidence of complications provided for by additional efficacy criteria (except for fatal and nonfatal heart failure).

Composition

Perindopril arginine + Amlodipine besylate + auxiliary substances.

Pharmacokinetics

The amount of absorption of perindopril and amlodipine in the use of the preparation Prestanas does not differ significantly from that with monopreparations.

Perindopril

When ingestion perindopril quickly absorbed.Perindopril does not have pharmacological activity. Approximately 27% of the total amount of perindopril ingested enters the bloodstream as an active metabolite of perindoprilate. In addition to perindoprilata, another 5 metabolites are formed that do not have pharmacological activity. Eating slows the conversion of perindopril to perindoprilat, thus affecting bioavailability. Therefore, the drug should be taken 1 time per day, in the morning, before eating. Perindoprilat is excreted from the body by the kidneys.

Amlodipine

Absolute bioavailability is about 64-80%. Eating food does not affect the bioavailability of amlodipine. Amlodipine is metabolized in the liver with the formation of inactive metabolites. About 60% of the accepted dose of amlodipine is excreted by the kidneys, 10% - unchanged.

Indications

• arterial hypertension;
• IHD: Stable angina in patients who require perindopril and amlodipine therapy.

Forms of release

Tablets 5 mg + 5 mg, 5 mg + 10 mg, 10 mg + 10 mg, 10 mg + 5 mg.

Instructions for use and dosing regimen

The drug is given orally, 1 tablet once a day, preferably in the morning before eating.The dose of the drug Prestanse is selected after previous titration of the doses of individual components of the drug: perindopril and amlodipine in patients with arterial hypertension and stable angina.

For therapeutic reasons, the dose of Prestans can be changed on the basis of individual selection of individual component doses: 5 mg perindopril + 5 mg amlodipine or 5 mg perindopril + 10 mg amlodipine or 10 mg perindopril + 5 mg amlodipine or 10 mg perindopril + 10 mg amlodipine .

Prestans in doses of 10 mg perindopril + 10 mg amlodipine is the maximum daily dose of the drug, which should not be exceeded.

The excretion of perindoprilat in elderly patients and patients with renal insufficiency is slowed. Therefore, in such patients it is necessary to regularly monitor the concentration of creatinine and potassium in the blood plasma. Prestants can be given to patients with CC ≥ 60 ml / min. Pregnancy is contraindicated in patients with CC <60 mL / min. Such patients are recommended individual selection of doses of perindopril and amlodipine. The change in the concentration of amlodipine in the blood plasma does not correlate with the degree of renal insufficiency.

Caution should be exercised in prescribing Prestans to patients with hepatic impairment because of the lack of recommendations for dosing the drug in such patients.

Prestants should not be given to children and adolescents under 18 years of age because of the lack of data on the efficacy and safety of perindopril and amlodipine in these patient groups, either as monotherapy or as combination therapy.

Side effect

• leukopenia, neutropenia, agranulocytosis, pancytopenia, thrombocytopenia;
• hives;
• increase in body weight;
• decrease in body weight;
• drowsiness;
• dizziness;
• headache;
• insomnia;
• mood lability;
• sleep disturbance;
• tremor;
• peripheral neuropathy;
• confusion of consciousness;
• visual impairment;
• noise in ears;
• palpitation;
• flushes of blood to the skin of the face;
• marked decrease in blood pressure;
• fainting;
• pain behind the sternum;
• angina pectoris;
• myocardial infarction, possibly due to excess BP reduction in patients at high risk;
• arrhythmias (including bradycardia, ventricular tachycardia and atrial fibrillation);
• stroke, possibly due to excess BP reduction in patients at high risk;
• vasculitis;
• dyspnea;
• cough;
• rhinitis;
• bronchospasm;
• eosinophilic pneumonia;
• abdominal pain;
• nausea, vomiting;
• dyspepsia;
• diarrhea;
• constipation;
• dryness of the oral mucosa;
• gastritis;
• hepatitis;
• cholestatic jaundice;
• itching;
• rash;
• angioedema, swelling of the face, limbs, lips, mucous membranes, tongue, vocal cords and / or larynx;
• alopecia;
• hemorrhagic rash;
• photosensitization;
• increased sweating;
• angioedema;
• Stevens-Johnson syndrome;
• muscle spasms;
• arthralgia;
• myalgia;
• backache;
• violation of urination;
• nocturia;
• frequent urination;
• kidney failure;
• impotence;
• gynecomastia;
• peripheral edema;
• asthenia;
• increased fatigue;
• pain in the chest;
• malaise.

Contraindications

Perindopril

• angioedema (angioedema) (angioedema) in the anamnesis (including against the background of taking other ACE inhibitors);
• hereditary / idiopathic angioedema;
• age under 18 years (effectiveness and safety not established);
• hypersensitivity to perindopril or other ACE inhibitors.

Amlodipine

• severe arterial hypotension (systolic blood pressure less than 90 mm Hg);
• obstruction of the left ventricular outflow tract (eg, severe aortic stenosis);
• unstable angina (with the exception of Prinzmetal's stenocardia);
• age under 18 years (effectiveness and safety not established);
• hypersensitivity to amlodipine or other dihydropyridine derivatives.

Prestans

• renal failure (CC less than 60 ml / min);
• age under 18 years (effectiveness and safety not established);
• hereditary lactose intolerance, lactase insufficiency and glucose malabsorption / galactose syndrome;
• Hypersensitivity to the excipients included in the preparation.

Application in pregnancy and lactation

The drug is contraindicated for use in pregnancy.

With the exception of cases where Prestans is necessary for life-saving therapy, when planning pregnancy, you should cancel the drug and prescribe other antihypertensive drugs that are approved for use in pregnancy. At the onset of pregnancy should immediately stop taking Prestans and, if necessary, prescribe another antihypertensive therapy.

It is known that the effect of ACE inhibitors on the fetus in the 2nd and 3rd trimester of pregnancy can lead to disruption of its development (decreased kidney function, oligohydramnion, slowing ossification of the skull bones) and development of complications in the newborn (kidney failure, arterial hypotension, hyperkalemia). If the patient received ACE inhibitors in the 2 or 3 trimesters of pregnancy, it is recommended to perform ultrasound examination of the fetus to assess the condition of the skull and kidney function.

Newborns whose mothers received ACE inhibitors in pregnancy should be under close medical supervision because of the risk of developing arterial hypotension, oliguria, and hyperkalemia.

Available limited data on the use of amlodipine and other slow calcium channel blockers in pregnancy indicate that the drug does not adversely affect the fetus. However, there is a risk of lengthening labor.

It is not recommended to take Prestanas during lactation due to the lack of appropriate clinical experience with perindopril and amlodipine, both in monotherapy and in combination therapy.If you need to take the drug, you should stop breastfeeding.

Use in children

Contraindicated in children and adolescents under the age of 18 years.

special instructions

Special instructions relating to perindopril and amlodipine are applicable to the preparation of Prestan.

Perindopril

Hypersensitivity / angioedema

When taking ACE inhibitors, incl. and perindopril, in rare cases development of angioedema of the face, limbs, lips, mucous membranes, tongue, vocal cords and / or larynx can be observed. If symptoms appear, the drug should be stopped immediately, and the patient should be observed until the signs of edema disappear completely. If the swelling affects only the face and lips, then its manifestations usually pass on their own, although antihistamines can be used to treat the symptoms.

Angioedema, accompanied by swelling of the larynx, can lead to death. Swelling of the tongue, vocal cords, or larynx can lead to airway obstruction. If such symptoms appear, epinephrine (epinephrine) should be injected subcutaneously and / or ensure that the respiratoryways. The patient should be under medical supervision until the symptoms disappear completely and persistently.

In patients with edema of Quincke in history, not associated with the administration of ACE inhibitors, the risk of its development with the administration of drugs of this group may be increased.

In rare cases, against the background of therapy with ACE inhibitors, angioedema develops in the intestine. In this case, patients have abdominal pain as an isolated symptom or in combination with nausea and vomiting, in some cases, without a previous angioedema and at a normal level of C1-esterase. The diagnosis is established using computed tomography of the abdominal region, ultrasound or at the time of surgery. Symptoms disappear after stopping the intake of ACE inhibitors. Therefore, patients with abdominal pain receiving ACE inhibitors should take into account the possibility of developing angioedema of the intestine during differential diagnosis.

Anaphylactoid reactions during apheresis of LDL

In rare cases, patients receiving ACE inhibitors may develop life-threatening anaphylactoid reactions during LDL-apheresis with dextran sulfate.To prevent anaphylactoid reaction, therapy with an ACE inhibitor should be temporarily discontinued before each apheresis procedure.

Anaphylactoid reactions during desensitization

There are some reports of the development of anaphylactoid reactions in patients receiving ACE inhibitors during desensitizing therapy (for example, the venom of Hymenoptera insects). In the same patients, the anaphylactoid reaction could be avoided by the temporary withdrawal of ACE inhibitors, and if the drug was randomly taken, the anaphylactoid reaction occurred again.

Neutropenia, agranulocytosis, thrombocytopenia, anemia

Against the background of the administration of ACE inhibitors, neutropenia / agranulocytosis, thrombocytopenia and anemia can occur. In patients with normal renal function and in the absence of other aggravating factors, neutropenia develops rarely. With extreme caution, perindopril should be used in patients with diffuse connective tissue diseases, when immunosuppressants, Allopurinol or procainamide are used, especially in patients with impaired renal function.

Some patients experienced severe infectious lesions, in some cases, resistant to intensive antibiotic therapy.When prescribing perindopril to such patients it is recommended to periodically monitor the number of white blood cells in the blood. Patients should inform the doctor of any signs of infectious diseases (eg, sore throat, fever).

Arterial hypotension

ACE inhibitors can cause a sharp decrease in blood pressure. Symptomatic arterial hypotension rarely develops in patients without concomitant diseases. The risk of excessive reduction in blood pressure is increased in patients with reduced BCC, which can be observed against diuretic therapy, with strict salt-free diet, hemodialysis, diarrhea and vomiting, as well as in patients with severe hypertension with high renin activity. Patients with an increased risk of developing symptomatic arterial hypotension should carefully monitor blood pressure, kidney function and potassium levels in the blood serum during therapy with the drug Prestan.

This approach is also used in patients with angina and cerebrovascular diseases, in which severe arterial hypotension can lead to myocardial infarction or cerebral circulation impairment.

In the case of development of arterial hypotension, the patient should be transferred to a supine position with raised legs. If necessary, it is necessary to replenish the BCC with the help of / in the introduction of 0.9% sodium chloride solution. Transient arterial hypotension is not an obstacle for further administration of the drug. After the recovery of bcc and blood pressure, treatment can be continued.

Mitral stenosis, aortic stenosis, hypertrophic cardiomyopathy

Prestans, like other ACE inhibitors, should be administered with caution to patients with obstruction of the left ventricular outflow tract (aortic stenosis, hypertrophic cardiomyopathy), as well as to patients with mitral stenosis.

Impaired renal function

Patients with renal insufficiency (CC less than 60 ml / min) are recommended individual selection of doses of perindopril and amlodipine. Such patients need regular monitoring of potassium and creatinine in the blood serum.

In patients with bilateral stenosis of the renal artery or stenosis of the artery of a single kidney against the background of therapy with ACE inhibitors, an increase in urea and creatinine in the blood serum, usually taking place with the withdrawal of therapy, is possible.More often this effect is observed in patients with renal insufficiency. The additional presence of reninvascular hypertension causes an increased risk of severe arterial hypotension and kidney failure in these patients.

In some patients with arterial hypertension without signs of renal vascular disease, an increase in the concentration of urea and creatinine in the blood serum is possible, especially with the joint appointment of perindopril with a diuretic, usually minor and transient. More often this effect is noted in patients with a previous impairment of kidney function.

Liver failure

In rare cases, when taking ACE inhibitors, cholestatic jaundice occurs. With the progression of this syndrome, fulminant liver necrosis develops, sometimes with a fatal outcome. The mechanism of development of this syndrome is unclear. If jaundice or a significant increase in activity of liver enzymes against the background of taking ACE inhibitors should stop taking the drug and see a doctor.

Cough

Against the background of therapy with an ACE inhibitor, dry cough may occur. Cough persists for a long time against the background of taking this group's drugs and disappears after their withdrawal.When a patient has a dry cough, remember the possible iatrogenic nature of this symptom.

Surgery / general anesthesia

The use of ACE inhibitors in patients undergoing extensive surgery and / or general anesthesia can lead to a marked decrease in blood pressure if general anesthetics with hypotensive action are used. This is due to the blocking of the formation of angiotensin 2 against a background of compensatory enhancement of renin activity. If the development of arterial hypotension is associated with the described mechanism, you should increase the volume of circulating plasma. It is recommended to alert the surgeon / anesthesiologist that the patient is taking ACE inhibitors and stop taking the drug 24 hours before surgery.

Hyperkalemia

Hyperkalemia can develop during treatment with ACE inhibitors, including. and perindopril. Risk factors for hyperkalemia are renal failure, elderly age (over 70 years), diabetes mellitus, certain concomitant conditions (dehydration, acute decompensation of chronic heart failure, metabolic acidosis),simultaneous administration of potassium-sparing diuretics (such as spironolactone and its derivative eplerenone, triamterene, amiloride), as well as potassium or potassium-containing substitutes for edible salt, and the use of other drugs that increase the potassium level in the blood plasma (eg, heparin). The use of potassium, potassium-sparing diuretics, potassium-containing substitutes for edible salt can lead to a significant increase in potassium in the blood, especially in patients with reduced renal function.

Hyperkalemia can lead to serious, sometimes fatal heart rhythm disturbances. If simultaneous administration of perindopril and the above drugs is necessary, treatment should be carried out with caution in the context of regular monitoring of potassium in serum.

Patients with diabetes mellitus

When prescribing a drug for patients with diabetes mellitus receiving hypoglycemic agents for oral use or insulin, during the first month of therapy, the concentration of glucose in the blood should be carefully monitored.

Amlodipine

Chronic heart failure

Care should be taken when prescribing amlodipine in patients with chronic heart failure.

Prestans

Due to the presence of lactose in the drug should not be prescribed to patients with hereditary lactose intolerance, lactase deficiency and glucose / galactose malabsorption syndrome.

Impact on the ability to drive vehicles and manage mechanisms

In connection with the possible development of weakness and dizziness, care should be taken when driving vehicles and engaging in certain activities that require increased concentration of attention and quick motor reaction.

Drug Interactions

Perindopril

Unsuitable combinations of drugs

Despite the fact that the potassium content in the blood serum remains within normal limits, in some patients perindopril may experience hyperkalemia. Potassium-sparing diuretics (for example, spironolactone, triamterene, amiloride), potassium preparations and potassium-containing substitutes for edible salt can lead to a significant increase in potassium in the serum.Therefore, the simultaneous use of an ACE inhibitor and the above agents is not recommended. If simultaneous use is necessary (in case of confirmed hypokalemia), care should be taken and regular monitoring of potassium content in plasma and ECG parameters should be carried out.

With simultaneous use of lithium drugs and ACE inhibitors, a reversible increase in lithium levels in the blood plasma and related toxic effects can occur. Simultaneous use of perindopril and lithium preparations is not recommended. If this therapy is necessary, regular monitoring of the lithium content in the blood plasma is necessary.

The combined use of Prestans with estramustine is accompanied by an increased risk of angioedema.

Combination of medicines requiring special attention

Nonsteroidal anti-inflammatory drugs (NSAIDs), including high doses of Aspirin (more than 3 g per day): concurrent use of ACE inhibitors with NSAIDs (aspirin at a dose of exerting anti-inflammatory effects, COX-2 inhibitors and the nonselective NSAIDs) may reduce the antihypertensive effects of ACE inhibitors.

The simultaneous use of ACE inhibitors and NSAIDs may lead to a deterioration of renal function, including the development of acute renal failure and increase in the potassium content in blood serum, especially in patients with reduced kidney function. Care should be taken when prescribing this combination, especially in elderly patients. Patients should compensate for the loss of fluids and carefully monitor renal function at the beginning of treatment and during treatment.

ACE inhibitors can enhance the hypoglycemic effect of insulin and hypoglycemic agents for oral (including the sulfonylureas) in patients with diabetes. Hypoglycaemia occurs very rarely (likely due to the increase in glucose tolerance and reduce insulin requirements).

A combination of medicines requiring attention

In patients receiving diuretics (thiazide and "loop"), especially when excessive excretion of liquid and / or electrolytes in the beginning of ACE inhibitor therapy a significant reduction in blood pressure may occur, the risk of which can be reduced by eliminating a diuretic, administration of high amounts of fluid and / or salt,and also appointing perindopril in a low dose with further gradual increase.

Sympathomimetics can weaken the hypotensive effect of ACE inhibitors.

With the appointment of ACE inhibitors, incl. perindopril patients receiving I / gold preparations (sodium aurothiomalate) was described symptom, including facial flushing, nausea, vomiting, hypotension.

Simultaneous application of allopurinol with ACE inhibitors, cytostatic and immunosuppressive agents, corticosteroids (for systemic use), and procainamide may be accompanied by an increased risk of leukopenia.

The combined use of ACE inhibitors and agents for general anesthesia can lead to an increased antihypertensive effect.

Amlodipine

Unsuitable combinations of drugs

In laboratory animals, cases of fibrillation of ventricles with a lethal outcome were noted against the background of Verapamil and intravenous administration of dantrolene. Extrapolating the available data, combined use of dantrolene and amlodipine should be avoided.

Combination of medicines requiring special attention

With simultaneous use with cytochrome CYP3A4 inducers (rifampicin, preparations of St. John's wort, anticonvulsants such as carbamazepine, phenobarbital, phenytoin, phosphenytoin, primidone), a decrease in the plasma concentration of amlodipine is possible due to an increase in its metabolism in the liver. Caution should be exercised with the simultaneous use of amlodipine and inducers of microsomal oxidation and, if necessary, adjust the dose of amlodipine.

When used simultaneously with cytochrome CYP3A4 inhibitors (itraconazole, ketoconazole), an increase in plasma concentrations of amlodipine and an increased risk of side effects are possible. Caution should be exercised with the simultaneous use of amlodipine and Itraconazole or ketoconazole, if necessary adjust the dose of amlodipine.

A combination of medicines requiring attention

When used simultaneously with beta-blockers used in chronic heart failure (bisoprolol, carvedilol, metoprolol), the risk of developing arterial hypotension increases and the flow ofchronic heart failure in patients with uncontrolled or latent chronic heart failure (increased negative inotropic effect). Also beta-blockers can reduce excessive reflex cardiac sympathetic activation against the background of concomitant chronic heart failure.

Other combinations of drugs

Marked safety of amlodipine or combined with thiazide diuretics, beta-blockers, ACE inhibitors, nitrates prolonged action, nitroglycerine (sublingual), digoxin, warfarin, atorvastatin, sildenafil, antacids (algeldrat, magnesium hydroxide), simethicone, cimetidine, NSAIDs , antibiotics and hypoglycemic agents for oral administration.

In addition, special studies have shown the lack of interaction of the following drugs with amlodipine:

• with the simultaneous use of amlodipine and cimetidine pharmacokinetic parameters of amlodipine did not change;
• with the simultaneous use of amlodipine and sildenafil, there was no increase in the hypotensive effect of each drug;
• grapefruit juice: a study involving 20 healthy volunteers showed that taking 240 ml of grapefruit juice together with a single dose of amlodipine (10 mg orally) did not have a significant effect on the pharmacokinetics of amlodipine.

Amlodipine does not affect the pharmacokinetics of the following drugs:

• Atorvastatin: taking repeated doses of amlodipine 10 mg in combination with atorvastatin at a dose of 80 mg does not lead to a significant change in the equilibrium pharmacokinetic parameters of atorvastatin;
• digoxin: co-administration of amlodipine and digoxin is not accompanied by a change in serum digoxin content and renal clearance of digoxin in healthy volunteers;
• warfarin: in healthy male volunteers who received warfarin, the addition of amlodipine did not have a significant effect on the change in prothrombin time caused by warfarin;
• cyclosporine: amlodipine does not significantly affect the pharmacokinetic parameters of cyclosporine.

Combination of medicines requiring special attention

With simultaneous use with baclofen, an increase in antihypertensive action is possible.It is necessary to monitor blood pressure and kidney function, if necessary - adjust the dose of amlodipine.

A combination of drugs that requires attention

Hypotensive drugs (eg, beta-blockers) and vasodilators can enhance the antihypertensive effect of perindopril and amlodipine. Caution should be exercised when concomitant administration with nitroglycerin, other nitrates or other vasodilators, as this may further reduce blood pressure.

Corticosteroids (mineral- and glucocorticoids), tetracosactide, reduce the antihypertensive effect (fluid retention and sodium ions due to the action of corticosteroids).

Alpha-adrenoblockers (prazosin, alfuzozin, doxazosin, tamsulosin, terazosin) increase the antihypertensive effect and increase the risk of orthostatic hypotension.

Amifostin can enhance the antihypertensive effect of amlodipine.

Tricyclic antidepressants / antipsychotics / agents for general anesthesia increase the antihypertensive effect and increase the risk of orthostatic hypotension.

Analogues of the drug Prestanz

Structural analogs for the active substance:

• Dalnev.

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