Bi-prestarium

Bi-Prestarium is a complex medication with hypotensive properties.

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Indications B-prestarium

It is used for the treatment of people with coronary heart disease and high blood pressure who require combination therapy using perindopril and amlodipine.

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Release form

The drug is released in tablet form, in the amount of 30 pieces inside a container; 1 such container is contained inside the box of the medicinal product.

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Pharmacodynamics

The medicine contains 2 active ingredients – perindopril with amlodipine. The therapeutic effect of the medicine is based on the medicinal properties of these substances.

Perindopril is an ACE inhibitor. It reduces the conversion of angiotensin I to form II, which results in a decrease in vasoconstriction. At the same time, the drug increases plasma renin activity and bradykinin breakdown processes; in addition, it reduces the release of aldosterone.

Perindopril rapidly reduces blood pressure values without affecting the heart rate level, and also potentiates peripheral circulation and slightly increases blood flow inside the kidneys without affecting the glomerular filtration values. At the same time, perindopril reduces left ventricular hypertrophy and increases the elasticity of large arteries. Peak therapeutic effect is recorded after 4-6 hours from the moment of drug use and lasts for at least 24 hours. The substance does not cause withdrawal syndrome.

Amlodipine helps block the activity of slow Ca channels. Inhibition of the flow of calcium ions passing through membranes in relation to smooth muscle vascular cells with the myocardium leads to the fact that amlodipine expands the vascular lumen, reduces the afterload relative to the myocardium, and at the same time improves blood circulation inside the vessels, which are coronary, and in addition, peripheral.

Amlodipine helps improve the condition of people with spontaneous angina by having a positive effect on the blood flow processes inside the coronary vessels.

A single use of the drug helps maintain the hypotensive effect for 24 hours. The substance amlodipine does not lead to a sharp drop in blood pressure. In people with angina, it increases adaptability to physical activity, and at the same time reduces the frequency of developing attacks and the need to receive nitrates.

The component amlodipine does not lead to changes in plasma lipid parameters, and in addition does not cause the development of negative metabolic symptoms.

It is reliably known that Bi-Prestarium reduces the likelihood of coronary complications, as well as myocardial infarction with stroke and mortality associated with cardiovascular function.

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Pharmacokinetics

When taken orally, the active ingredients of the medication are well absorbed through the intestines.

Perindopril is a prodrug with the active metabolic product perindoprilat. Its plasma Cmax values are observed after approximately 60 minutes, amlodipine - after 6-12 hours, and perindoprilat - 3-4 hours. In addition to perindoprilat, the perindopril element also forms 5 therapeutically inactive metabolic products. The half-life of perindopril is 60 minutes, and that of amlodipine is within 35-50 hours. About 20% of perindoprilat undergoes protein synthesis in plasma; for amlodipine, these values are higher - approximately 97-98%.

Equilibrium plasma values of perindoprilat are observed on the 4th day of treatment.

Amlodipine and perindopril are excreted mainly through the kidneys, both unchanged and in the form of metabolic products.

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Dosing and administration

Bi-Prestarium is taken orally. It is forbidden to divide or crush the tablet. To get the maximum medicinal effect, the medicine should be taken in the morning, before eating. The size of the portion of the medicine is selected by the attending physician - for each patient individually.

Often, you need to take 1 tablet per day. The maximum adult daily dose is 1 tablet of 10 mg/10 mg.

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Use B-prestarium during pregnancy

Bi-Prestarium is contraindicated for use during pregnancy. If pregnancy occurs during treatment with the drug, you should consult your doctor to prescribe an alternative course.

It is forbidden to use the medicine during lactation. If it is necessary to take the medicine during this period, it is necessary to stop breastfeeding for the duration of treatment.

Contraindications

Main contraindications:

• use in people with hypersensitivity to amlodipine with perindopril, other dihydropyridines and drugs from the ACE inhibitor category;
• appointment for people with lactose intolerance, glucose-galactose malabsorption, and galactosemia;
• idiopathic or congenital form of Quincke's edema;
• significantly reduced blood pressure values;
• aortic stenosis;
• unstable angina (excluding Prinzmetal's angina);
• a state of shock of various origins;
• heart failure in people who have a history of acute myocardial infarction (the interval between the time of infarction and the start of taking the drug should be at least 28 days).

Caution when administering Bi-Prestarium is required in the following cases:

• increased likelihood of decreased blood pressure (this includes conditions such as coronary heart disease, hypovolemia, and cerebral vascular diseases);
• mitral stenosis;
• cardiomyopathy of a hypertrophic nature;
• disorders of hematopoiesis;
• appointment to people using procainamide, immunosuppressants and allopurinol;
• liver or kidney problems;
• stenosis in the area of the renal artery (or arteries of both kidneys);
• combination with medicinal substances containing bee venom;
• when performing LDL apheresis using dextran sulfate.

Before the administration of anesthesia, you must stop using the medication - at least 24 hours before the start of the planned operation.

Side effects B-prestarium

During a therapeutic course using a drug, side effects caused by its active ingredients may appear. Among the disorders:

• problems with the digestive system: discomfort and pain in the epigastric region, nausea with dysgeusia and dry mouth, dyspepsia and vomiting, as well as gastritis or pancreatitis, cholestasis with jaundice, hyperbilirubinemia, hepatitis and increased liver enzyme levels;
• disorders associated with the function of the PNS and CNS: headaches, tinnitus, increased fatigue, dizziness, deterioration of visual acuity, as well as emotional instability, paresthesia, polyneuropathy, convulsions or tremors in the limbs and circadian rhythm disorders;
• disorders in the cardiovascular system and hematopoietic system: myocardial infarction, thrombocyto-, leuko- or neutropenia, angina attack, decreased blood pressure and heart rhythm disorder;
• signs of allergy: itching in the epidermis, erythema multiforme, urticaria, Stevens-Johnson syndrome, angioedema and allergic rhinitis;
• other manifestations: alopecia, hyperhidrosis, dyspnea, edema, impotence, asthenia, renal dysfunction and weight change. In addition, arthralgia or myalgia, hyperglycemia, gynecomastia, dysuria, hyperkalemia and pneumonia of eosinophilic genesis may develop, as well as a change in the shade of the epidermis.

Overdose

There is no information on intoxication with Bi-Prestarium. The use of large doses of the drug may lead to an overdose of perindopril or amlodipine. Among the manifestations of amlodipine poisoning is a pronounced drop in blood pressure, which occurs due to increased dilation of peripheral vessels.

There is little information on perindopril intoxication, but there is information on decreased blood pressure, circulatory shock, EBV disorders, renal function and heart rhythm, as well as the appearance of cough, anxiety and dizziness.

Amlodipine is not excreted during hemodialysis sessions, but plasma levels of perindopril are significantly reduced during this procedure.

In case of poisoning, it is necessary to stop taking the drug and perform symptomatic measures and procedures designed to support the functioning of the heart and kidneys (if perindopril intoxication has occurred).

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Interactions with other drugs

The combination of Bi-Prestarium with potassium-sparing diuretics and potassium-containing drugs significantly increases the likelihood of hyperkalemia.

Perindopril increases the toxic effect of lithium.

The combination of perindopril and estramustine increases the risk of angioedema.

The use of the drug simultaneously with NSAIDs can provoke the occurrence of renal failure in the acute stage. Therefore, such a combination should be prescribed with great caution.

Perindopril may increase the hypoglycemic effect of insulin and oral hypoglycemic agents.

The medication should not be used together with diuretic drugs, because with such a combination there is a high probability of a decrease in blood pressure readings.

Sympathomimetics, when used simultaneously with the drug, slightly weaken the therapeutic effect of perindopril.

The use of perindopril together with gold preparations (administered parenterally) may provoke symptoms characteristic of the action of nitrates (vomiting, facial hyperemia and a decrease in blood pressure).

The combination of amlodipine with dantrolene may lead to the development of ventricular fibrillation.

Caution is required when using amlodipine and inducers of CYP 3A4 activity, because these drugs reduce plasma levels of amlodipine; in addition, the substance should be combined with caution with agents that inhibit CYP 3A4 activity, because they can increase the level of amlodipine in plasma.

The combination of amlodipine with β-blockers used to treat patients with heart failure may result in the development of cardiac weakness and a marked decrease in blood pressure.

The antihypertensive effect of the drug is potentiated when combined with vasodilators, baclofen, tricyclics, other antihypertensive drugs, anesthetics, amifostine, as well as α-blockers and antipsychotics.

Tetracosactide and GCS, when used simultaneously with the drug, weaken its therapeutic properties.

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Storage conditions

Bi-Prestarium should be kept in a place protected from moisture, at temperatures between 15-25°C.

Shelf life

Bi-Prestarium can be used for 24 months from the date of manufacture of the pharmaceutical product.

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Application for children

The drug is not used in pediatrics.

Analogues

The analogs of the drug are Amapin, Eneas, Bi-ramag with Enap combi, Ekvator with Gipril, and also Enadipine and Rami-azomex.

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Reviews

Bi-Prestarium mostly receives positive reviews on forums, although there are also negative opinions. They often talk about the development of side effects from taking the drug - most often this is a suffocating cough. Some commentators also note the appearance of itching and rashes.

Cardiologists are also not very optimistic about the drug - almost all say that it has a weak medicinal effect, and also that it cannot be used for severe primary hypertension.