Prestanc is a drug containing a combination of two active substances (perindopril + amlodipine), which are used to treat essential hypertension and other cardiovascular disorders.
The active ingredients of the drug have two effects on the human body - antianginal and antihypertensive. The therapeutic effect of Prestanza comes less than a month after the start of medication.
The combined effect of the two active components with regular use reduces mortality from cardiovascular diseases, the frequency of strokes and the risk of heart attack.
Clinical and pharmacological group
Combined antihypertensive drug (ACE inhibitor + slow calcium channel blocker).
Pharmacy sales terms
It is released on prescription.
How much is Prestanz in pharmacies? The average price is at 650 rubles.
Release form and composition
This drug is available in the form of tablets:
- 5 + 5 mg, which are white, oblong;
- 5 + 10 mg, which are white, square;
- 10 + 10 mg, which are white, round;
- 10 + 5 mg, which are white, triangular.
1 tablet contains the main substances perindopril, amorlipine, as well as cellulose, magnesium stearate, lactose monohydrate.
The use of Prestanza with arterial hypertension can significantly reduce blood pressure for 24 hours. This drug consists of two active ingredients that act in two directions - antihypertensive and antianginal. Perindopril in Prestanza inhibits kininase II - an enzyme that converts angiotensin I to angiotensin II. It destroys bradykinin, which has a vasodilating effect to heptapeptide - an inactive substance. Therapeutic effect of perindopril is due to the fact that its active metabolite, perindoprilat, is able to inhibit ACE.
Prestanz is used to treat hypertension of any degree of complexity. Its use helps to reduce systolic and diastolic blood pressure. Prestanz reduces OPSS, which significantly improves peripheral blood flow, and also reduces blood pressure, without affecting the heart rate. The renal blood flow also increases, but the glomerular filtration rate does not change.
The substance perindopril in Prestansa is able to dilate vessels and restore the elasticity of large arteries and the structure of the walls of small arteries. It reduces left ventricular hypertrophy. The maximum antihypertensive effect of the drug appears already after 4-6 hours after application and lasts 24 hours. The therapeutic effect of Prestanza comes in less than a month.
This drug is not addictive, and stopping it is not accompanied by withdrawal syndrome. Reduced mortality and a significant reduction in the number of complications after taking perindopril confirmed by serious studies.
Amlodipine in Prestanz is engaged in blocking calcium channels of groups of dihydropyridine derivatives. It prevents the entry of calcium ions to the cells of the myocardium and blood vessels at the level of dihydropyridine receptors. Amlodipine has a prolonged and dose-dependent antihypertensive effect. The relaxation of vascular smooth muscle, achieved with this substance, helps to expand the main coronary arteries and arterioles, as well as peripheral arterioles. This reduces platelet aggregation, which leads to an increase in glomerular filtration rate, accelerated excretion of sodium and diuresis.
The prolonged effect of the use of amplodipine leads to a smooth decrease in blood pressure. In hypertension, the degree of hypertrophic changes in the myocardium of the left ventricle decreases significantly. Good results are obtained by the use of Prestanza and analogs for stenocardia, the daily dose of amlodipine in it allows to increase the total time of physical exertion, as well as to delay the onset of attacks of angina pectoris, significantly reduce their frequency and reduce the dose of nitroglycerin used.
Prestanc, as a combination of amlodipine and perindopril, significantly reduces strokes, the risk of heart attack and cardiovascular mortality.
Indications for use
Prestanz is prescribed for such diseases as:
- Arterial hypertension.
- Stable exertional angina in patients who need amlodipine as well as perindopril.
According to the instructions, Prestanz is not appointed in the case of:
- Obstruction of the exit path of the left ventricle (aortic stenosis or other);
- Unstable angina pectoris (excluding Prinzmetal stenocardia);
- Heart failure after acute myocardial infarction (first 28 days);
- Pregnancy and the entire period of lactation;
- Angioedema (angioedema), triggered by a previous history of taking ACE inhibitors;
- Hereditary or idiopathic angioedema;
- Severe hypotension (diabetes less than 90 mm Hg);
- Shock, including cardiogenic;
- Hereditary intolerance to lactose, lactase deficiency, glucose-galactose malabsorption;
- Renal failure (CC less than 60 ml / min);
- The age of 18 years (safety and efficacy have not been studied);
According to the instructions, Prestanc is not prescribed for hypersensitivity to amlodipine (other dihydroperidine derivatives), to perindopril (other ACE inhibitors), to the excipients included in the preparation.
Use during pregnancy and lactation
It is forbidden to take Prestanz during pregnancy and during breastfeeding due to the lack of clinical experience with the use of amlodipine and perindopril.
Dosage and method of use
The instructions for use indicate that Prestanz is prescribed by mouth, 1 tab. 1 time / day, preferably in the morning before meals.
The dose of the drug Prestants is selected after a previously conducted titration of doses of individual components of the drug: perindopril and amlodipine in patients with arterial hypertension and / or ischemic heart disease.
When therapeutic is necessary, the dose of the drug can be changed or an individual selection of the doses of the individual components can be carried out:
- 5 mg perindopril + 5 mg amlodipine or
- 5 mg perindopril + 10 mg amlodipine or
- 10 mg perindopril + 5 mg amlodipine or
- 10 mg perindopril + 10 mg amlodipine.
Patients with hepatic insufficiency:
- For patients with mild or moderate liver failure, dose selection should be carried out with caution. It is recommended to start taking the drug with low doses. The search for the optimal initial and maintenance dose for patients with hepatic insufficiency should be carried out individually, using the drugs amlodipine and perindopril in monotherapy. The pharmacokinetics of amlodipine in patients with severe hepatic insufficiency has not been studied. For such patients, amlodipine should be started with the lowest dose and increased gradually.
Patients - elderly - and - patients - with - renal - insufficiency:
- Removal of perindoprilat in elderly patients and patients with renal insufficiency is slow. Therefore, in these patients it is necessary to regularly monitor the concentration of creatinine and potassium in the blood plasma. Prestanz may be administered to patients with a CC ≥ 60 mL / min. Prestanc is contraindicated in patients with CC <60 ml / min. Such patients are recommended individual selection of doses of perindopril and amlodipine. Amlodipine, used in equivalent doses, is equally well tolerated by patients, both elderly and younger patients. It is not required to change the dosage regimen in elderly patients, however, the dose increase should be carried out with caution, which is associated with age-related changes and an increase in T1 / 2. Changes in the concentration of amlodipine in the blood plasma do not correlate with the severity of renal failure. Amlodipine is not excreted through dialysis.
Prestanza should not be prescribed to children and adolescents under 18 years of age due to the lack of data on the efficacy and safety of perindopril and amlodipine in these groups of patients, both as monotherapy and as combination therapy.
Prestanz tablets can lead to the development of negative reactions from various organs and systems of the patient:
- Sense organs - visual impairment, including double vision (diplopia), tinnitus.
- The reproductive system - erectile dysfunction, gynecomastia (breast enlargement) in men.
- Nervous system - dizziness, drowsiness (most often manifested at the beginning of the Prestan's course), headache, loss of skin sensitivity (paresthesia), insomnia, tremors (hand tremors), depression, intermittent fainting, confusion.
- The digestive system - nausea, vomiting, abdominal pain, diarrhea (diarrhea), more rarely, dryness of the oral mucosa, inflammation of the stomach (gastritis) and pancreas (pancreatitis).
- Respiratory system - cough (dry, can be paroxysmal), shortness of breath, less often - bronchospasm (narrowing of the lumen of the bronchi), inflammation of the nasal mucosa (rhinitis), very rarely eosinophilic pneumonia develops.
- Cardiovascular system - a feeling of palpitations in the chest, "flushes" of blood to the face, a significant reduction in blood pressure, less often - angina, myocardial infarction (due to a sharp decrease in blood pressure and a decrease in blood flow to the myocardium), cerebral stroke.
- Liver and biliary tract - toxic hepatitis, jaundice, increased activity of liver enzymes (ALT, AST) in the blood, which indicates damage to liver cells, these phenomena develop very rarely.
- Skin and subcutaneous tissue - itchy skin, rash, less often develop angioedema of soft tissues with a predominant localization in the face and genitals, hemorrhagic rash.
- The urinary system - a violation of urination, the prevalence of nocturnal diuresis over the day (nocturia), increased urination, less often - the development of renal failure, acute urinary retention.
- Musculoskeletal system - spasms of striated skeletal muscles, swelling of the tissues of the legs, less often - pain in the joints (arthralgia), muscles (myalgia), in the back.
- Laboratory tests - an increase in the concentration of bilirubin, urea, creatinine, indicating a violation of the functional activity of the kidneys and liver.
There may also be general weakness, malaise of the patient, edema of the peripheral tissues, chest pain. When symptoms of adverse reactions appear, the doctor individually decides the issue of drug withdrawal or dose reduction.
There is no data on overdose by Prestanz.
Amlodipine overdose causes: a strong decrease in blood pressure with the possible development of tachycardia and peripheral vasodilation.
Treatment: it is necessary to make a gastric lavage, receive activated charcoal, maintain cardiac and respiratory system indicators, control the volume of circulating blood and diuresis, symptomatic therapy, intravenous administration of calcium gluconate and dopamine.
Symptoms of an overdose with perindopril: pronounced decrease in blood pressure, electrolyte disturbances, shock, renal failure, tachycardia, dizziness, anxiety.
Treatment: gastric lavage and reception of activated carbon, correction of hypovolemia, intravenous catecholamine, hemodialysis.
- Functional disorders of the kidneys: it is necessary to monitor the state;
- Hypertensive crisis: safety profile is not investigated;
- Hepatic impairment: with functional disorders of the liver, amlodipine intake should be started with the lowest doses, taking precautions at the beginning of treatment and increasing the dose. In severe hepatic insufficiency, it is necessary to increase the dose gradually, carefully controlling the clinical condition;
- Heart Failure: The therapy requires caution, and when used in patients with chronic heart failure of the third and fourth functional class according to the NYHA classification, pulmonary edema may occur. Because of the possible increase in the risk of adverse events from the cardiovascular system and mortality, amlodipine is prescribed with caution in patients with chronic heart failure;
- Elderly patients: due to the increased half-life and reduced clearance of amlodipine, careful monitoring of this category of patients is necessary.
- Ethnic differences: angioedema develops more often in patients of the Negroid race;
- Cough: possible development of dry cough (it is necessary to remember about the possible iatrogenic nature of this symptom);
- Anaphylactoid reactions during low density lipoprotein apheresis: in rare cases when using dextran sulfate, life threatening anaphylactoid reactions may develop (temporary discontinuation of therapy is indicated before each procedure);
- Neutropenia, thrombocytopenia, agranulocytosis, anemia: because of the likelihood of these disorders, special caution should be exercised in patients with systemic connective tissue diseases, when used in combination with immunosuppressants, allopurinol or procainamide, especially in functional disorders of the kidneys;
- Hypersensitivity / angioedema: in some cases it is possible to develop angioedema of the face, lips, limbs, tongue, mucous membranes, larynx and / or vocal folds (immediate cancellation of therapy is required, if necessary, Kwinke swelling (especially when indicated in history), angioedema of the intestines (symptoms: abdominal pain in isolation or in combination with nausea and vomiting; diagnosed by ultrasound, computed tomography of the abdomen th field or at the time of surgery);
- Anaphylactoid reactions during desensitization (for example, with the use of hymenoptera venom): during the development of these reactions, a temporary withdrawal of angiotensin-converting enzyme inhibitors is shown;
- Severe infections, which in some cases show resistance to intensive antibiotic therapy: such patients are recommended to periodically monitor the number of leukocytes in the blood;
- General anesthesia / surgery: extensive surgical interventions and / or general anesthesia with the use of general anesthesia drugs with hypotensive action can lead to a pronounced decrease in blood pressure (it is recommended to warn the anesthesiologist / surgeon about taking the drug and cancel therapy 24 hours before the surgery;
- Mitral and aortic stenosis, hypertrophic obstructive cardiomyopathy: special care is required when prescribing the drug for obstruction of the left ventricular output tract (hypertrophic obstructive cardiomyopathy, aortic stenosis) and mitral stenosis;
- Hepatic insufficiency: in some cases, cholestatic jaundice develops (cancellation of therapy is required);
- Functional disorders of the kidneys: when creatinine clearance is less than 60 ml / min, individual selection of doses of perindopril and amlodipine is recommended;
- Patients with diabetes mellitus: against the background of the use of oral hypoglycemic agents or insulin during the first month of treatment, the concentration of glucose in the blood should be carefully monitored;
- Hyperkalemia: hyperkalemia may develop during therapy (the use of potassium-saving diuretics, potassium preparations, and potassium-containing food salt substitutes may lead to a significant increase in blood potassium, especially with reduced kidney function);
- Hypotension: there is a probability of a sharp decrease in blood pressure (rarely in the absence of concomitant diseases; the risk of development is increased with a reduced volume of circulating blood (associated with diuretic therapy, adherence to a strict salt-free diet, hemodialysis, diarrhea and vomiting) and severe arterial hypertension with high activity renin. With the development of arterial hypotension, the patient must be transferred to a horizontal position with his legs elevated, if necessary, After the improvement (replenishment of the circulating blood volume and blood pressure), the therapy can be continued.
Due to the likelihood of excessive lowering of blood pressure, drowsiness, dizziness and other adverse reactions, caution is recommended when driving and other complex mechanisms, especially at the beginning of therapy and with increasing doses.
Interaction with amlodipine:
- Amlodipine activates the hypotensive effect of other pills on pressure.
- The simultaneous use of CYP3A4 isoenzyme inducers (rifampicin, Hypericum preparations) leads to a decrease in the concentration of amlodipine in the blood.
- Drinking grapefruit juice or grapefruit increases the bioavailability of amlodipine in a number of patients, which can lead to a strong reduction in blood pressure.
- In the course of the study, Prestanz tablets did not affect the pharmacokinetics of digoxin, atorvastatin, warfarin, and cyclosporine.
- Tricyclic antidepressants, antipsychotics, amifostine, baclofen, antihypertensive drugs, vasodilators enhance the antihypertensive effect of perindopril and amlodipine.
Interaction with Perindopril:
- Sympathomimetics weaken the hypotensive effect of ACE inhibitors.
- The simultaneous use of ACE inhibitors with non-steroidal anti-inflammatory drugs leads to a weakening of the antihypertensive effect, and can also lead to impaired renal function, an increase in the concentration of potassium in the blood.
- When taken together with potassium and lithium preparations, potassium-sparing diuretics, hyperkalemia and an increase in the lithium content in the blood may develop in some individuals.
- In patients using diuretics at the beginning of therapy with ACE inhibitors, a significant reduction in blood pressure is likely.
- Hypoglycemic agents interacting with ACE inhibitors increase the hypoglycemic effect of insulin and sulfonylurea metabolites in people with diabetes.
- The combined use of ACE inhibitors and drugs for general anesthesia leads to the activation of the antihypertensive effect.
We picked up some reviews of people using the drug Prestans:
- Victor. The doctor prescribed the drug Prestans 10 10, the feedback from me is negative. The tool almost did not reduce the pressure. In addition, severe headaches, dizziness, edema appeared. Decided to refuse admission.
- Tatyana. I have a hypertensive experience. Many drugs tried on myself. On a recent visit to the doctor, he prescribed this medication at a dosage of 5/5. For the price, of course, a little expensive, but the doctor advised to buy 10/10 and divide in half. Packing lasts for 2 months. In the morning I drink half a pill and I feel like a man for a day. And the heart rhythm returned to normal. Wonderful drug!
- Nastya. Prestan's well reduced pressure, but the doctor forbade his further admission due to kidney disease. Now I am on hemodialysis. Other drugs do not help to effectively reduce the pressure, so the state of health worsened, appetite was gone.
In terms of active ingredients, Prestan's analogue is the drug Dalneva.
By the mechanism of action and by belonging to the same pharmacological group, the analogues of Prestanza are the following agents: Coriprene, Equacard, Equator, Triapin and Enanorm.
Before using analogues consult your doctor.
Storage conditions and shelf life
This drug should be stored at room temperature, not exceeding the mark of 30 ° C, in a place where little children do not have access, as well as pets.
It is necessary to store medicine no more than 2 years.