Usage
- Indapamide + Perindopril erbumine is primarily prescribed for the treatment of mild to moderate essential hypertension (high blood pressure) in adults. It is used when monotherapy (treatment with a single drug) is insufficient to control blood pressure.
- Pharmacological classification: This combination drug belongs to two classes: ACE (Angiotensin-Converting Enzyme) inhibitors and thiazide-like diuretics.
- Mechanism of Action: Perindopril, the ACE inhibitor, blocks the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This leads to vasodilation, reducing blood pressure. Indapamide, the diuretic, increases the excretion of sodium and water by the kidneys, further contributing to blood pressure reduction.
Alternate Names
- The combination itself doesn’t have a distinct international nonproprietary name (INN), but its components do: Perindopril erbumine and Indapamide.
- Brand Names: Coversyl Plus, Preterax, Noliprel, pms-PERINDOPRIL-INDAPAMIDE, APO-Perindopril/Indapamide.
How It Works
- Pharmacodynamics: Perindopril’s primary effect is vasodilation, achieved by inhibiting the renin-angiotensin-aldosterone system (RAAS). Indapamide increases sodium and chloride excretion, leading to diuresis and a decrease in blood volume, further lowering blood pressure.
- Pharmacokinetics: Perindopril is rapidly absorbed orally and metabolized to perindoprilat, its active form. Indapamide is well-absorbed and has a long half-life, allowing for once-daily dosing. Both drugs are primarily eliminated by the kidneys.
- Mode of Action: Perindopril inhibits ACE, which is responsible for converting angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor and also stimulates aldosterone release, which causes sodium and water retention. By blocking ACE, perindopril reduces vasoconstriction and promotes sodium and water excretion. Indapamide acts on the distal convoluted tubule in the kidney, inhibiting sodium reabsorption, which leads to increased water excretion.
- Elimination pathways: Perindopril is primarily excreted via the kidneys, with a small amount excreted in the feces. Indapamide is mainly excreted unchanged in the urine.
Dosage
Standard Dosage
Adults:
- The usual starting dose is one tablet of Perindopril 2 mg/Indapamide 0.625 mg or 4 mg/1.25 mg once daily, taken in the morning before a meal.
- Depending on the individual patient’s response, the dose can be increased to a maximum of Perindopril 8 mg/Indapamide 2.5 mg once daily.
Children:
- The safety and efficacy of Indapamide + Perindopril erbumine have not been established in children. Use in this age group is not recommended.
Special Cases:
- Elderly Patients: Start with a lower dose (Perindopril 2 mg/Indapamide 0.625 mg) and monitor renal function.
- Patients with Renal Impairment: Dose adjustment is necessary based on creatinine clearance. The combination is contraindicated in severe renal impairment (creatinine clearance < 30 mL/min) and in moderate renal impairment when using the 8mg/2.5mg strength.
- Patients with Hepatic Dysfunction: Contraindicated in severe hepatic impairment. No dose modification is required in moderate hepatic impairment.
- Patients with Comorbid Conditions: Use with caution in patients with diabetes, heart failure, or electrolyte imbalances. Monitor potassium levels closely.
Clinical Use Cases
- The use of Indapamide + Perindopril erbumine is not specifically indicated for intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. Its primary indication is chronic hypertension management.
Dosage Adjustments
- Dosage adjustments should be made based on renal function, hepatic function, and individual patient response to therapy.
Side Effects
Common Side Effects
- Dizziness, headache, fatigue, cough, low blood pressure (hypotension), changes in taste, gastrointestinal disturbances (nausea, vomiting, diarrhea, constipation).
Rare but Serious Side Effects
- Angioedema (swelling of the face, lips, tongue, throat), severe allergic reactions, kidney problems (decreased urine output, changes in blood creatinine), liver dysfunction, low blood potassium (hypokalemia), low blood sugar (hypoglycemia), blood disorders (decreased white blood cells, red blood cells, or platelets).
Long-Term Effects
- Long-term side effects can include electrolyte imbalances and kidney problems.
Adverse Drug Reactions (ADR)
- Angioedema, severe allergic reactions, acute renal failure, significant hypotension.
Contraindications
- Hypersensitivity to perindopril, indapamide, or sulfonamides.
- History of angioedema related to ACE inhibitor use.
- Hereditary or idiopathic angioedema.
- Pregnancy.
- Breastfeeding.
- Severe renal impairment (creatinine clearance < 30 mL/min).
- Severe hepatic impairment.
- Concomitant use of sacubitril/valsartan or aliskiren (in patients with diabetes or kidney disease).
Drug Interactions
- Other antihypertensive medications (additive hypotensive effect).
- Potassium-sparing diuretics, potassium supplements (increased risk of hyperkalemia).
- Lithium (increased lithium levels).
- Nonsteroidal anti-inflammatory drugs (NSAIDs) (reduced antihypertensive effect, risk of kidney problems).
- Certain immunosuppressants (e.g., sirolimus, everolimus).
- Certain medications for heart rhythm problems.
Pregnancy and Breastfeeding
- Pregnancy Safety Category: Indapamide + Perindopril erbumine is contraindicated during pregnancy. ACE inhibitors can cause fetal harm or death, especially during the second and third trimesters.
- Breastfeeding: This combination is contraindicated during breastfeeding. Perindopril and indapamide can pass into breast milk and potentially affect the infant.
Drug Profile Summary
- Mechanism of Action: ACE inhibition (perindopril) and thiazide-like diuretic action (indapamide), leading to vasodilation and reduced blood volume.
- Side Effects: Dizziness, headache, cough, hypotension, angioedema, kidney problems, electrolyte imbalances.
- Contraindications: Hypersensitivity, history of angioedema with ACE inhibitors, pregnancy, breastfeeding, severe renal/hepatic impairment.
- Drug Interactions: Other antihypertensives, potassium supplements, lithium, NSAIDs, some immunosuppressants.
- Pregnancy & Breastfeeding: Contraindicated.
- Dosage: Starting dose: Perindopril 2mg/Indapamide 0.625mg or 4mg/1.25mg once daily; maximum dose: Perindopril 8 mg/Indapamide 2.5 mg once daily.
- Monitoring Parameters: Blood pressure, heart rate, serum electrolytes (sodium, potassium, calcium), creatinine, blood urea nitrogen (BUN), liver function tests, uric acid.
Popular Combinations
- Indapamide + Perindopril is often used alone, but other antihypertensive medications may be added if blood pressure control is inadequate.
Precautions
- General Precautions: Monitor renal function, electrolytes, and blood pressure regularly.
- Pregnant Women: Contraindicated.
- Breastfeeding Mothers: Contraindicated.
- Children & Elderly: Not recommended for children. Start with a lower dose in elderly patients.
- Lifestyle Considerations: Encourage lifestyle modifications, including a low-sodium diet, regular exercise, and smoking cessation.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Indapamide + Perindopril erbumine?
A: The usual starting dose is Perindopril 2 mg/Indapamide 0.625mg or 4mg/1.25mg once daily. The dose may be increased based on the patient’s response up to a maximum of Perindopril 8 mg/Indapamide 2.5 mg once daily.
Q2: What are the common side effects?
A: Common side effects include dizziness, headache, cough, fatigue, and low blood pressure.
Q3: Is this medication safe during pregnancy?
A: No, Indapamide + Perindopril erbumine is contraindicated during pregnancy due to the risk of fetal harm.
Q4: Can I take this medication while breastfeeding?
A: No, this medication is contraindicated while breastfeeding as it can pass into breast milk.
Q5: How does this medication affect potassium levels?
A: It can cause low blood potassium (hypokalemia), so monitoring potassium levels is important.
Q6: What should I do if I experience swelling of the face, lips, or tongue?
A: Immediately discontinue the medication and seek medical attention, as this could be a sign of angioedema, a serious allergic reaction.
Q7: Can this medication be used in patients with kidney disease?
A: Dose adjustment is required in patients with renal impairment. It is contraindicated in severe renal impairment.
Q8: What other medications should I avoid while taking this drug?
A: Avoid potassium supplements, potassium-sparing diuretics, lithium, aliskiren, and sacubitril/valsartan. Discuss all other medications with your doctor, including NSAIDs and certain immunosuppressants.
Q9: How long does it take for this medication to work?
A: It may take several weeks to achieve optimal blood pressure control.
Q10: Can I stop taking this medication once my blood pressure is normal?
A: Do not stop taking this medication without consulting your doctor. Even if your blood pressure is controlled, stopping the medication can lead to a rebound increase in blood pressure.
