Perindopril erbumine

Perindopril tert-butylamine salt

Contraindications 1. Potassium-sparing diuretics (amiloride, potassium canrenoate, spironolactone, triamterene, alone or in combination), except for the treatment of heart failure (low-dose ACE inhibitors and low-dose thiazide diuretics), potassium salts. Hyperkalemia (can be fatal, especially in cases of renal failure, the drugs have a synergistic effect on the increase in blood potassium). Except for patients with hypokalemia, do not use potassium supplements or potassium-sparing diuretics with ACE inhibitors. 2. Lithium ACE inhibitors increase blood lithium concentrations and even reach toxic levels (reduce renal excretion of lithium). If ACE inhibitors must be used, blood lithium levels must be closely monitored and the dose adjusted. 3. Estramustine increases the risk of angioedema. 1. Nonsteroidal anti-inflammatory drugs and acetylsalicylic acid (aspirin) ge; 3 g/day In high-risk patients (elderly and/or dehydrated patients), the combination of ACE inhibitors and nonsteroidal anti-inflammatory drugs can cause acute renal failure by reducing glomerular filtration and inhibiting the synthesis of vasodilator prostaglandins, while the hypotensive effect is weakened. Therefore, appropriate fluid replacement should be given at the beginning of treatment, and renal function should be monitored. 2. Antidiabetic preparations (insulin, sulfonylureas) Capture of captopril and enalapril In patients receiving insulin and sulfonylurea hypoglycemic drugs, ACE inhibitors can enhance the effect of lowering blood sugar. However, symptoms of hypoglycemia rarely occur (improving glucose tolerance and reducing the need for insulin). Strengthen self-monitoring of blood sugar. 3. Baclofen increases the antihypertensive effect. Monitor blood pressure and adjust the dose of antihypertensive drugs when necessary. 4. Thiazide diuretics have the risk of causing sudden hypotension and/or acute renal failure when starting ACE inhibitor treatment in cases of water and sodium loss. In patients with hypertension, if the previous diuretic treatment has caused water and sodium loss (especially patients who have recently received diuretic treatment, low-salt diet, and hemodialysis). Recommendations: 1. Stop using diuretics before starting ACE inhibitor treatment, and if necessary, use non-potassium-sparing diuretics again. Or start ACE inhibitor treatment with a low dose and gradually increase the dose. 2. For patients with congestive heart failure who are taking diuretics, if necessary, start ACE inhibitor treatment with a low dose after reducing the dose of non-potassium-sparing diuretics. 2.1 In all cases, renal function (serum creatinine) should be monitored in the first few weeks of ACE inhibitor treatment. 2.2 Potassium-sparing diuretics: They can be used alone (amiloride, potassium canrenoate, spironolactone, triamterene), or in combination with New York Heart Association class III or IV patients with an ejection fraction of 35% who have already used ACEI and loop diuretics. If the prescription principles of combined medication are not followed, the combination of ACE inhibitors and potassium-sparing diuretics may cause hyperkalemia, which may even be fatal. Therefore, hyperkalemia and renal insufficiency should be excluded before medication, and serum potassium and serum creatinine should be closely monitored (measured once a week in the first month after treatment, and once a month thereafter). Possible combinations 2.3 Amifostine enhances the hypotensive effect. 3. Tricyclic antidepressants and neuroleptics increase the risk of antihypertensive effects and orthostatic hypotension (synergistic effect) 4. Cortisone, tecositide (oral) (except corticosteroids used as replacement therapy for Addison's disease) weaken the antihypertensive effect (corticosteroids cause water and sodium retention) 5. Alpha-receptor blockers used in the urinary tract: alfuzosin, prazosin, terazosin, tamsulosin will enhance the antihypertensive effect and increase the risk of orthostatic hypotension.