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In the initial period of treatment, some patients with diuretic therapy, especially with excessive excretion of fluid and / or salts, may experience an excessive decrease in blood pressure, the risk of which can be reduced by discontinuing the diuretic, introducing an increased amount of water and / or sodium chloride, as well as prescribing an ACE inhibitor in lower doses. Further increase in the dose of perindopril should be carried out with caution. Against the background of therapy with ACE inhibitors, as a rule, the potassium content in the blood serum remains within the normal range, but sometimes hyperkalemia may develop. The combined use of ACE inhibitors and potassium-sparing diuretics (spironolactone, triamterene and amiloride) and potassium preparations, potassium-containing products and dietary supplements can lead to a significant increase in the concentration of potassium in the blood serum. In this regard, their co-administration with ACE inhibitors is not recommended. These combinations should be used only in case of hypokalemia, taking precautions and constantly monitoring the potassium content in the blood serum. The combined administration of ACE inhibitors and lithium preparations can lead to a reversible increase in the concentration of lithium in the blood serum and the development of lithium toxicity. The additional administration of thiazide diuretics against the background of the combined use of lithium and ACE inhibitors increases the already existing risk of lithium toxicity. Joint administration of ACE inhibitors and lithium is not recommended. If this combination cannot be avoided, then it is necessary to regularly monitor the lithium content in the blood serum. The administration of NSAIDs may be accompanied by a weakening of the antihypertensive effect of ACE inhibitors. Moreover, it has been established that NSAIDs and ACE inhibitors have an additive effect on increasing the potassium content in the blood serum, while it is also possible to worsen kidney function. As a rule, these effects are reversible. In rare cases, acute renal failure may develop, which occurs, as a rule, with an already existing violation of kidney function in elderly patients or against the background of dehydration of the body. The antihypertensive effect of the drugs may increase against the background of combined use with ACE inhibitors. The use of nitroglycerin and/ or other vasodilators may lead to an additional hypotensive effect. Concomitant use with ACE inhibitors of allopurinol, immunosuppressants, including cytostatic agents and systemic GCS, procainamide may increase the risk of leukopenia. The administration of ACE inhibitors may enhance the hypoglycemic effect of insulin and oral hypoglycemic agents until the development of hypoglycemia. As a rule, this phenomenon is observed in the first weeks of combined use of these drugs and in patients with renal insufficiency. Concomitant administration with ACE inhibitors of tricyclic antidepressants, antipsychotics (neuroleptics), and general anesthesia agents may lead to an increased hypotensive effect. Sympathomimetics can weaken the antihypertensive effect of ACE inhibitors. When prescribing such a combination, the effectiveness of ACE inhibitors should be regularly evaluated. Antacids reduce the bioavailability of ACE inhibitors. Perindopril can be prescribed together with acetylsalicylic acid (as a thrombolytic), thrombolytic agents, beta-blockers and / or nitrates. Ethanol enhances the hypotensive effect of ACE inhibitors. How to take, course of administration and dosage The drug is prescribed orally 1 time / day in the morning, before meals.
Symptoms: marked decrease in blood pressure, shock, electrolyte imbalance (such as increased concentration of potassium ions, decreased sodium); renal failure, hyperventilation, tachycardia, dizziness, bradycardia, anxiety and cough. Treatment: with a significant decrease in blood pressure, the patient should be transferred to the supine position and immediately replenish the BCC, if possible, an infusion of angiotensin II and / or inject catecholamines. With the development of stable pronounced bradycardia, the use of an artificial pacemaker may be required. Constant monitoring of vital body functions, serum electrolytes and QC is necessary. Perindopril can be removed from the systemic circulation by hemodialysis. During dialysis, it is necessary to avoid the use of high-flow polyacrylonitrile membranes.