perindopril erbumine
CLINICAL USE
Angiotensin-converting enzyme inhibitor:Hypertension Heart failure
DOSE IN NORMAL RENAL FUNCTION
2–8 mg daily
PHARMACOKINETICS
Molecular weight                           :441.6 %Protein binding                           :60 ( 10 to 20 as perindoprilat)
%Excreted unchanged in urine     : 4–12 Volume of distribution (L/kg)       :0.2half-life – normal/ESRD (hrs)      :1/27 DOSE IN RENAL IMPAIRMENT
GFR (mL/MIN)
20 to 50     : Initially 2 mg daily, adjust according to response 10 to 20     : Initially 2 mg daily, adjust according to response <10           : Initially 2 mg daily, adjust according to response DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
CAPD                :Unknown dialysability. Dose as in GFR <10 mL/min HD                     :Dialysed. Dose as in GFR <10           : mL/min HDF/high flux   :Dialysed. Dose as in GFR <10           : mL/min CAV/VVHD      :Dialysed. Dose as in GFR=10–20 mL/min IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugs Anaesthetics: enhanced hypotensive effect Analgesics: antagonism of hypotensive effect and increased risk of renal impairment with NSAIDs; hyperkalaemia with ketorolac and other NSAIDsCiclosporin: increased risk of hyperkalaemia and nephrotoxicity Diuretics: enhanced hypotensive effect; hyperkalaemia with potassium-sparing diuretics Epoetin: increased risk of hyperkalaemia; antagonism of hypotensive effect Lithium: reduced excretion (possibility of enhanced lithium toxicity) Potassium salts: increased risk of hyperkalaemia Tacrolimus: increased risk of hyperkalaemia and nephrotoxicity ADMINISTRATION
Reconstition
– Route
Oral Rate of Administration
–Comments
– OTHER INFORMATION
Active metabolite perindoprilat has a half- life of 25–30 hoursTitrate dose according to response; normal doses have been used in CKD 5Small volume of distribution due to low lipophilicity. Close monitoring of renal function during therapy is necessary in those with renal insufficiency
Renal failure has been reported in association with ACE inhibitors in patients with renal artery stenosis, post renal transplant and those with severe congestive heart failureHigh incidence of anaphylactoid reactions has been reported in patients dialysed with high-flux polyacrylonitrile membranes and treated concomitantly with an ACE inhibitor – this combination should therefore be avoidedHyperkalaemia and other side-effects are more common in patients with renal impairment
See how to identify renal failure stages according to GFR calculation
See how to diagnose irreversible renal disease
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