Several drugs which include lithium, potassium sparing diuretics, anaesthetics, cytostatic and immunosuppressants and antiarrhythmic drugs should not be coadministered with perindopril/indapamide because of the potential for significant drug interactions with either component of the combined dose.

Hypertension

Cough, headache, bradycardia, dizziness, asthenia, hypokalemia and orthostatic hypotension

Avoid in patients with renal failure, hypokalemia, severe hepatic impairment or hepatic encephalopathy, a history of angioedema linked with treatment with an ACE inhbitor. Pregnant and lactating women and children.

Special precautions:

Caution should be observed when the drug is administered in patients with impaired renal function and the risk of hypotension and electrolyte imbalance should be borne in mind. Regular monitoring of plasma levels of potassium should be carried out.

Indication:

Essential hypertension

Dosage:

Perindopril/Indapamide 1/0.625mg is recommended to be administered once daily in the morning for adult and elderly patients and should be preferably administerd before the meal.

Pharmacology:

Perindopril is an ACE inhibitor, which acts by inhibiting the conversion of antigiotensin I to angiotension II, reducing the activity of the sympathetic system and inhibiting enzyme kinase, which is involved in the conversion of bradykinin and other substances. Moreover, due to the long acting property, it has the convenience of once daily administration.

Pharmacokinetics:

The combined formulation demonstrated bioequivalance with its individual components. The drugs are mainly excreted by renal route. Elimination half-life of perindopril and indapamide is 50.7 and 14.6 hours respy. The renal clearance of the combination is significantly lower when compared to that of the monotherapy. The pharmacokinetics of the combined perindopril/ indapamide in patients with renal failure or elderly patients was consistent with those reported for its individual components.

Rationale for the combination-

Combination acts by combining the agents with complimentary mechanisms of action to provide equivalent or gretarer overall efficiency than either of the individual drugs. It offers increased protection against hypertension related organ damage and minimizes adverse effects and hemodynamic and humoral efects. Perinodpril conteracts the reduction in serum potassium levels induced by indapamide therapy. The combinatiuon decreased supine systolic blood pressure and isolated systolic hypertension..

Should be preferably administerd before the meal.

Contra-indicated for use during pregnancy and/ or lactating women and children