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Bi-prestarium
Last reviewed: 23.04.2024
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Bi-Prestarium is a complex medication with antihypertensive properties.
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Indications Bi-prestarium
It is used to treat people with coronary artery disease and elevated blood pressure, who need complex therapy with perindopril and amlodipine.
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Pharmacodynamics
The drug contains 2 active elements - perindopril with amlodipine. The therapeutic effect of drugs is based on the medicinal properties of these substances.
Perindopril is an ACE inhibitor. It weakens the conversion of angiotensin I to form II, due to which vasoconstriction decreases. At the same time, the drug increases the plasma activity of renin and the processes of the breakdown of bradykinin; in addition, it weakens the release of aldosterone.
Perindopril rapidly decreases the blood pressure values without affecting the heart rate, and in addition it potentiates the peripheral blood circulation and slightly increases the 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. The peak therapeutic effect is recorded after 4-6 hours from the moment of use of the drug and lasts at least 24 hours. Substance does not cause withdrawal syndrome.
Amlodipine helps block the activity of slow Ca channels. Inhibition of calcium ion flow through the membrane in relation to smooth muscle vascular cells with myocardium leads to the fact that amlodipine expands the vascular lumen, reduces afterload relative to the myocardium, and at the same time improves blood circulation inside the vessels that are coronary, and in addition peripheral.
Amlodipine helps to improve the condition of people with spontaneous angina by providing a positive effect on the blood flow processes inside the coronary vessels.
A single use of the medication helps maintain the hypotensive effect in the span of 24 hours. Substance amlodipine does not lead to a sharp drop in blood pressure levels. In individuals with angina pectoris, it increases adaptability in terms of physical activity, and at the same time reduces the incidence of developing seizures and the need for obtaining nitrates.
Component amlodipine does not lead to changes in plasma lipid parameters, and besides this does not cause the development of negative metabolic symptoms.
It is reliably known that the Bi-Prestarium reduces the likelihood of the occurrence of coronary complications, and in addition to this myocardial infarction with stroke and mortality associated with the CVS function.
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Pharmacokinetics
When consumed inside the active elements of the drug are well absorbed through the intestines.
Perindopril is a prodrug with an active metabolic product, perindoprilat. Its plasma Cmax values are observed approximately after 60 minutes, amlodipine - after 6-12 hours, and perindoprilat - 3-4 hours. In addition to perindoprilat, the element perindopril also forms 5 therapeutically inactive metabolic products. The half-life of perindopril is 60 minutes, amlodipine is within 35-50 hours. Approximately 20% of perindoprilat undergoes protein synthesis within the plasma; for amlodipine, these values are higher - approximately 97-98%.
Equilibrium plasma values of perindoprilat are observed on the 4th day of treatment.
Amlodipine with perindopril is excreted mainly through the kidneys, both in unchanged condition 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 somehow grind the pill taken. To get the maximum medicinal effect, the medication should be applied in the morning, before eating food. The size of the dose of drugs is selected by the attending doctor - each patient separately.
Often for the day you need to take the 1st tablet. At the same time, the maximum adult daily dose is 1-well pill with a volume of 10 mg / 10 mg.
Use Bi-prestarium during pregnancy
Bi-Prestarium contraindicated during pregnancy. In case of its occurrence at the stage of treatment with the use of drugs, it is necessary to consult with your doctor for the appointment of an alternative course.
Do not use the drug during lactation. If it is necessary to take an agent during this period, it is required to refuse 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;
- administration to people with lactose intolerance, glucose-galactose absorption disorder, as well as with galactosemia;
- idiopathic or congenital form of angioedema;
- low blood pressure in severe degree;
- aortic stenosis;
- angina of unstable nature (excluding Prinzmetal stenocardia);
- shock state having a different nature;
- heart failure in people who have a history of myocardial infarction in the acute stage (the gap between the time of development of a heart attack and the start of taking the drug should be at least 28 days).
Caution in administering Bi-Prestarium is required in the following cases:
- increased likelihood of decreased blood pressure (this includes conditions in coronary artery disease, hypovolemia and cerebral vascular disease);
- mitral stenosis;
- hypertrophic cardiomyopathy;
- disorders of hematopoietic activity;
- administration to people using procainamide, immunosuppressants, and allopurinol;
- disorders of the liver or kidneys;
- stenosis in the renal artery (or arteries of both kidneys);
- combination with medicinal substances, which contain bee venom;
- when performing apheresis of LDL using dextran sulfate.
Before the introduction of anesthesia, the use of the drug must be discontinued - at least 24 hours before the start of the planned operation.
Side effects Bi-prestarium
With a therapeutic course with the use of drugs, side effects may appear, provoked by its active elements. Among the violations:
- problems with the work of the digestive system: discomfort and pain in the epigastric zone, nausea with dysgeusia and dry oral mucosa, dyspepsia and vomiting, and in addition, gastritis or pancreatitis, cholestasis with jaundice, hyperbilirubinemia, hepatitis and an increase in the values of liver enzymes;
- disorders associated with PNS and CNS function: headaches, ear ringing, increased fatigue, dizziness, worsening of visual acuity, and also emotional instability, paresthesias, polyneuropathy, convulsions or tremors in the limbs and a disorder of the daily regimen;
- disorders of the cardiovascular system and the hematopoietic system: myocardial infarction, platelet, leuco-or neutropenia, angina pectoris, lower blood pressure and heart rhythm disorder;
- signs of allergy: itching in the epidermis, erythema multiforme, urticaria, Stevens-Johnson syndrome, angioedema, and a runny nose of allergic origin;
- other manifestations: alopecia, hyperhidrosis, dyspnea, edema, impotence, asthenia, renal dysfunction and weight change. In addition, arthralgia or myalgia, hyperglycemia, gynecomastia, dysuria, hyperkalemia and pneumonia, which has eosinophilic genesis, can develop, as well as change the shade of the epidermis.
Overdose
There is no information regarding the intoxication of the Bi-Prestarium. The use of large portions of drugs can lead to an overdose of perindopril or amlodipine. Among the manifestations of amlodipine poisoning is a pronounced drop in blood pressure levels, which occurs due to increased expansion of peripheral vessels.
There is little information regarding perindopril intoxication, but there is information about a decrease in blood pressure values, circulatory shock, EBV disorders, kidney activity and heart rate, and in addition, the appearance of cough, anxiety and dizziness.
Amlodipine does not undergo excretion during hemodialysis sessions, but the plasma values of perindopril are significantly reduced when performing this procedure.
In case of poisoning, you must stop taking the drug and perform symptomatic measures and procedures designed to support the work of the heart and kidneys (if perindopril is intoxicated).
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Interactions with other drugs
The combination of Bi-Prestarium with potassium-sparing diuretic drugs and potassium drugs significantly increases the likelihood of hyperkalemia.
Perindopril increases the toxic effect of lithium.
The combination of perindopril with estramustine increases the likelihood of angioedema.
The use of the drug at the same time as NSAIDs can trigger the appearance of kidney failure in the acute stage. Therefore, this combination should be appointed very carefully.
Perindopril is able to increase the hypoglycemic effect of insulin, as well as the hypoglycemic agents used internally.
You can not use the drug together with diuretic drugs - because with such a combination there is a high probability of a decrease in blood pressure.
Sympathomimetics in the case of simultaneous use with the drug slightly weaken the therapeutic effect of perindopril.
The use of perindopril with gold medications (administered parenterally) can provoke symptoms characteristic of the action of nitrates (vomiting, facial hyperemia and a decrease in blood pressure values).
The combination of amlodipine with dantrolene can cause ventricular fibrillation.
Caution is needed when using amlodipine and inductors of the activity of the element CYP 3A4 - due to the fact that these drugs reduce the plasma values of amlodipine; In addition, the substance is carefully combined with agents that slow down the activity of CYP 3A4 - because they are able to increase the level of amlodipine inside the plasma.
Combining amlodipine with β-blockers used to treat people with heart failure can cause the development of weak heart function and a pronounced decrease in blood pressure values.
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.
Tetrakozaktid and GKS with simultaneous use with the drug weaken its therapeutic properties.
Storage conditions
Bi-Prestarium must be kept in a place protected from moisture, with temperature values in the range of 15-25 ° C.
Shelf life
Bi-Prestarium can be used within 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.
Analogs
Analogues of drugs are drugs Amapin, Eneas, Bi-Ramag with Enap kombi, Equator with Gipril, and besides this Enadipine and Rami-azomex.
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Reviews
The Bi-Prestarium generally receives positive reviews on the forums, although there are also negative opinions. They often talk about the development of adverse symptoms from taking drugs - most often it becomes choking cough. Some commentators also note the appearance of itching and rashes.
Cardiologists are also not very optimistic about the medicine - almost everyone says that it has a weak medicinal effect, and also that it cannot be used for severe primary hypertension.
Attention!
To simplify the perception of information, this instruction for use of the drug "Bi-prestarium" translated and presented in a special form on the basis of the official instructions for medical use of the drug. Before use read the annotation that came directly to medicines.
Description provided for informational purposes and is not a guide to self-healing. The need for this drug, the purpose of the treatment regimen, methods and dose of the drug is determined solely by the attending physician. Self-medication is dangerous for your health.