Product Description:

• Perindopril is an ACE inhibitor. It works by blocking the action of angiotensin converting enzyme (ACE). ACE produces angiotensin II, as part of the body's natural control of blood pressure. Angiotensin II causes blood vessels to constrict and narrow, which increases the pressure within the blood vessels. Perindopril blocks the action of ACE, it reduces the production of angiotensin II, thus allows the blood vessels to relax and widen. The overall effect of this is a drop in blood pressure.


• During sympathetic stimulation or when renal blood pressure or blood flow is reduced, renin is released from the granular cells of the juxtaglomerular apparatus in the kidneys. In the blood stream, renin cleaves circulating angiotensinogen to ATI, which is subsequently cleaved to ATII by ACE. ATII increases blood pressure using a number of mechanisms. First, it stimulates the secretion of aldosterone from the adrenal cortex. Aldosterone travels to the distal convoluted tubule (DCT) and collecting tubule of nephrons where it increases sodium and water reabsorption by increasing the number of sodium channels and sodium-potassium ATPases on cell membranes. Second, ATII stimulates the secretion of vasopressin (also known as antidiuretic hormone or ADH) from the posterior pituitary gland. 

Uses:

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  Perindopril is a long-acting ACE (Angiotensin Converting Enzyme) inhibitor and is used for Essential hypertension, Stable coronary artery disease, Congestive heart failure.

  
  


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  Perindopril Arginine is also used to associated treatment for these conditions: Cardiovascular Events, Diabetic Nephropathy, High Blood Pressure (Hypertension), Hypertension,Essential, Myocardial Infarction, NYHA Class I Congestive heart failure, Stroke, Chronic heart failure with reduced ejection fraction (NYHA Class II), Chronic heart failure with reduced ejection fraction (NYHA Class III)

  
  

How Perindopril Arginine Works:

• There are two isoforms of ACE: the somatic isoform, which exists as a glycoprotein comprised of a single polypeptide chain of 1277; and the testicular isoform, which has a lower molecular mass and is thought to play a role in sperm maturation and binding of sperm to the oviduct epithelium. Somatic ACE has two functionally active domains, N and C, which arise from tandem gene duplication. Although the two domains have high sequence similarity, they play distinct physiological roles.

Dosage:

• Hypertension: One Perindopril 4 tablet once daily preferably in the morning. If necessary, the dose may be increased to 8 mg after 1 month of treatment. Perindopril should be taken before food.


• Stable coronary artery disease: Perindopril 4 once daily for two weeks, then increased to 8 mg once daily, depending on renal function and provided that the 4 mg dose is well tolerated. Elderly patients should receive Perindopril 2 mg once daily for one week, then Perindopril 4 once daily the next week, before increasing the dose up to 8 mg once daily, depending on renal, function. The dose should be increased only if the previous lower dose is well tolerated.


• Congestive heart failure: Perindopril should be started under close medical supervision at a starting dose of 2 mg in the morning. If necessary dose may be increased to 4 mg.


• Elderly patients: Start treatment at Perindopril 2 mg daily.

Toxicity:

• The most likely symptom of overdose is severe hypotension. The most common adverse effects observed in controlled clinical trials include cough, digestive symptoms, fatigue, headache, and dizziness.

Precautions:

• Renovascular hypertension


• Surgery/Anesthesia


• Renal failure: The dose should be cautiously adjusted in accordance with the creatinine clearance


• Symptomatic hypotension is rarely seen, but is more likely in volume-depleted patients, those receiving diuretics, or with the first two doses


• In diuretic-treated patients: stop the diuretic 3 days before starting Perindopril. A diuretic may later be given in combination if necessary; potassium-sparing diuretics are not recommended


• Combination with neuroleptics or imipramine-type drugs may increase the hypotensive effect. Serum lithium concentrations may rise during lithium therapy