Parnavevel - instructions for use, dose, side effects, contraindications

Excipients: lactose (milk sugar) - 66.5 mg; cellulose microcrystalline - 19.0 mg; corn starch - 7.0 mg; Povidone (polyvinylpyrrolidone) 2.5 mg; magnesium stearate 1.0 mg.

Description:Tablets are white or almost white in color, flat-cylindrical, with a risk on one side and a facet on both sides.

Pharmacotherapeutic group:angiotensin-converting enzyme inhibitor

ATX: & nbsp

Perindopril

Pharmacodynamics:Perindopril, an angiotensin-converting enzyme (ACE) inhibitor, or kininase II, refers to oxo-peptidases. It converts angiotensin I into an angiotensin II vasoconstrictor and destroys the bradykinin vasodilator to an inactive heptapeptide. The suppression of ACE activity leads to a decrease in the level of angiotensin II and an increase in renin activity in the blood plasma (suppressing the negative feedback of the release of renin) and a decrease in the secretion of aldosterone.

Since ACE also destroys bradykinin, suppression of ACE leads to an increase in the activity of the circulating and tissue kallikrein-kinin system, with the activation of the prostaglandin system.

Perindopril renders therapeutic effect due to active metabolite perindoprilat.

Perindopril reduces both systolic and diastolic arterial pressure (BP) in the "lying" and "standing" positions. Perindopril reduces the overall peripheral vascular resistance (OPSS), which leads to a decrease in blood pressure. In this case, peripheral blood flow accelerated. However, the heart rate (heart rate) does not increase. Renal blood flow, as a rule, increases, while the rate of glomerular filtration does not change. Maximum antihypertensive Effect is reached 4-6 hours after single oral administration perindopril; the antihypertensive effect persists for 24 hours, and after 24 hours the drug still provides between 87% and 100% maximum effect. Reduction of blood pressure develops rapidly. Stabilization of antihypertensive action is observed after 1 month of therapy and persists for a long time. Termination of therapy is not accompanied by the development of the "withdrawal" syndrome. Perindopril reduces the hypertrophy of the myocardium of the left ventricle. With prolonged use reduces the the severity of interstitial fibrosis, normalizes isozyme profile of myosin. Increases concentration high-density lipoprotein (HDL), in patients with hyperuricemia reduces concentration of uric acid. Perindopril improves the elasticity of large arteries, eliminates structural changes in small arteries.

Perindopril normalizes the work heart, reducing pre- and postnagruzku.

In patients with chronic heart failure (CHF) on the background of perindopril therapy noted:

- decrease filling pressure in the left and right ventricles,

- decrease in OPSS,

- increase cardiac output and cardiac index.

Admission of the initial dose of perindopril 2 mg in patients with CHF I-II functional class for classification of NYHA not is statistically significant decrease in blood pressure compared with placebo.

Pharmacokinetics:

After oral administration perindopril quickly absorbed from the gastro-intestinal tract and reaches maximum concentrations in blood plasma for 1 hour.

Bioavailability is 65-70%.

In the process of metabolism, 20% is transformed into an active metabolite in perindoprilat. Period half-life (T) /₂) from the plasma of perindopril is 1 hour. The maximum plasma concentrations perindoprilata are reached in 3-4 hours.

Admission of the drug during meals is accompanied by a decrease in the conversion of perindopril to perindoprilat, respectively, the bioavailability of the drug decreases. The volume of distribution of free perindoprilata is 0.2 l / kg. The connection with blood plasma proteins is insignificant, communications perindoprilata with an ACE less than 30%, but depends on its concentration. Perindoprilat is excreted by the kidneys. T1/2 The free fraction is about 3-5 hours. The dissociation of perindoprilat, associated with ACE, is slow. As a consequence, the "effective" T1/2 is 25 hours. Do not cumulate. T1/₂ Perindoprilata with repeated admission corresponds to the period of its activity. In elderly patients, patients with renal and chronic heart failure the excretion of perindoprilate is slowed down. Perindoprilate is deleted when hemodialysis (rate 70 ml / min, 1.17 ml / sec) and peritoneal dialysis.

In patients with cirrhosis of the liver, the "hepatic" clearance of perindopril is changed, with the total number the Perindoprilata does not change and correction of the dosing regimen is not required.

Indications:

arterial hypertension;

chronic heart failure;

prevention of recurrent stroke (as part of complex therapy with indapamide) in patients with cerebrovascular diseases in the anamnesis (stroke or transient cerebral ischemic attack);

stable ischemic heart disease (CHD): decline

risk of developing cardiovascular complications in patients who have had previous myocardial infarction and / or hereditary lactose intolerance, lactase deficiency or impaired glucose uptake, and galactose.

Contraindications:

Hypersensitivity to perindopril or other components of the drug, as well as to other ACE inhibitors;

Pregnancy; the period of breastfeeding; angioedema in the anamnesis (hereditary, idiopathic or angioedema due to the administration of ACE inhibitors);

Age to 18 years (effectiveness and safety not established).

Lactose intolerance, lactase deficiency or glucose-galactose malabsorption syndrome.

Carefully:

Renovascular hypertension, bilateral stenosis of the renal arteries, stenosis arteries the only kidney - the risk of severe arterial hypotension and renal failure; CHF in the stage of decompensation, CHF IV of the functional class according to the classification NYHA, arterial hypotension; chronic renal failure (creatinine clearance (CK) less than 60 ml / min); hypovolaemia and hyponatremia (due to lack of salt diets and / or previous diuretic therapy, dialysis, vomiting, diarrhea), cerebrovascular diseases (including insufficiency cerebral circulation, ischemic heart disease (CHD), coronary insufficiency) - the risk of excessive blood pressure lowering;

stenosis of the aortic or mitral valve, Hypertrophic obstructive cardiomyopathy (GOKMP), hemodialysis with the use of high-flow polyacrylonitrile membranes - the risk of anaphylactoid reactions (eg, AN69®); state after kidney transplantation - there is no experience of clinical application; before the procedure apheresis of low-density lipoproteins density (LDL), simultaneous desensitizing therapy with allergens (eg, venom of Hymenoptera) - the risk of developing anaphylactoid reactions;

connective tissue diseases (including systemic lupus erythematosus (SLE), scleroderma), oppression bone marrow hematopoiesis with the use of immunosuppressants, allopurinol or procainamide - the risk of agranulocytosis and neutropenia; congenital deficiency of glucose-6-phosphate dehydrogenase - single cases of hemolytic anemia; in representatives of the Negroid race - the risk of developing anaphylactoid reactions;

surgical intervention (general anesthesia) - the risk of developing excessive blood pressure lowering; diabetes mellitus (monitoring the concentration of glucose in the blood); hyperkalemia; old age, simultaneous reception potassium-sparing diuretics, potassium preparations, potassium-containing substitutes for edible salt and lithium.

Pregnancy and lactation:

In pregnancy, the drug Perindopril it is contraindicated. Do not use the drug in the first trimester of pregnancy, so when planning pregnancy or when diagnosing it, the drug Perindopril It is necessary to cancel as soon as possible and to carry out other antihypertensive therapy.Appropriate controlled trials the use of ACE inhibitors in pregnant women has not been carried out. Available limited data on the effect of the drug in the first trimester of pregnancy suggest that the use of ACE inhibitors does not lead to fetal malformations associated with fetotoxicity. A drug Perindopril is contraindicated in the II-III trimesters of pregnancy, because it can cause fetotoxic effects in the fetus (decreased kidney function, low blood pressure, slowing ossification of the fetal bones) and neonatal toxic effects (renal failure, arterial hypotension, hyperkalemia). If nevertheless used the drug in the II-III trimesters of pregnancy, then it is necessary to perform ultrasound examination of the kidneys and bones of the fetal skull.

Application of the drug Perindopril in the period of breastfeeding is not recommended, due to the lack of data on the possibility of its isolation in breast milk. If necessary applications During this period, it is necessary to stop breastfeeding.

Dosing and Administration:

Inside. It is recommended to take once a day, before meals, preferably in the morning, without chewing.

The dose of the drug is selected individually for each patient, depending on the severity of the disease and individual response to treatment.

Arterial hypertension

A drug Perindopril can be used in monotherapy and in combination from other antihypertensive drugs. The recommended initial dose is 4 mg once a day, in the morning.

For patients with pronounced activation of renin-angiotensin-aldosterone system (for example, with renovascular hypertension, hypovolemia and / or hyponatremia, CHF in decompensation or severe degree of arterial hypertension hypertension) the recommended initial dose is 2 mg per day in a single dose. If the therapy is ineffective for a month, the dose can be increased to 8 mg once a day and with good tolerability of the previous dose.

Addition of ACE inhibitors patients, host diuretics, can cause the development of arterial hypotension. In this regard, it is recommended to carry out therapy with caution, to stop taking diuretics for 2-3 before starting treatment with the drug Perindopril or begin treatment with a drug Perindopril with an initial dose of 2 mg per day, in a single dose.Control is required: blood pressure, kidney function and potassium content in the blood serum. In the future, the dose of the drug may be increased, depending on the dynamics of blood pressure. If necessary, diuretic therapy can be resumed.

Have elderly patients the recommended initial daily dose is 2 mg, in a single dose. In the future, the dose can be gradually increased to 4 mg and, if necessary, to a maximum of 8 mg once a day, provided that the dose is well tolerated.

Chronic heart failure

The recommended initial dose is 2 mg in the morning, under medical supervision. After 2 weeks, the dose can be increased to 4 mg per day in one session, under the control of blood pressure. Treatment of CHF with clinical manifestations usually combined with potassium-sparing diuretics, beta-blockers and / or digoxin.

Have patients with CHF, with renal insufficiency and propensity to waterelectrolyte disturbances (hyponatremia), as well as patients receiving at the same time diuretics and / or vasodilators, treatment preparation under strict medical supervision.

Have patients at high risk development of clinically pronounced arterial hypotension (for example, when taking high doses of diuretics), if possible, before the reception preparation Perindopril is necessary to eliminate hypovolemia and waterelectrolyte disturbances.

Recommended before therapy and during it carefully monitor blood pressure, condition kidney function and potassium content in blood serum.

Prevention of repeated stroke in patients with cerebrovascular illnesses in the anamnesis

Drug therapy Perindopril should be started with 2 mg for first 2 weeks before admission indapamide. Treatment should be start at any time (from 2 weeks to several years) after suffered a stroke.

Stable ischemic disease heart (IHD)

In patients with stable course IHD the recommended initial dose preparation Perindopril is 4 mg per day. After 2 weeks, the dose increase to 8 mg per day, with good tolerability doses of 4 mg per day and controls kidney function.

Treatment elderly patients age of should begin with a dose of 2 mg, which in a week it is possible increase to 4 mg per day.AT further, if necessary, a week later you can increase dose up to 8 mg per day with mandatory preliminary control kidney function. Patients of the elderly can only be increased when good portability previous, lower dose.

With renal failure: the patients with kidney disease drug dose Perindopril is determined by degree of renal dysfunction.

Patient monitoring is usually includes regular determination of potassium and creatinine in serum.

Recommended doses:

Creatinine clearance (CC)

from 60 ml / min. and higher

from 30 to 60 ml / min.

from 15 to 30 ml / min.

Patients on hemodialysis * (QC

less than 15 ml / min.)

Dialysis clearance perindoprilata is 70 ml / min.

A drug Perindopril must be taken after the session dialysis.

With liver diseases correction doses are not required.

If you skip reception of one or more more doses in the next appointment the drug should be taken in the usual dose; can not be accepted higher dose.

Side effects:

The frequency of adverse reactions, below, was determined according to the following (classification of the World organization of health):

highly often - not less than 10%; often not less than 1%, but less than 10%; infrequently - not less than 0.1%, but less than 1%; rarely - not less than 0.01%, but less than 0.1%; highly rarely - less than 0.01%, including individual messages.

From the central and peripheral nervous system:

often a headache, dizziness, paresthesia; infrequently - sleep or mood disturbances; very rarely confusion.

From the side of the organ of vision: often - visual impairment.

From the organ of hearing: often - noise in ears.

From the side of cardiovascular system: often expressed a decrease in blood pressure; rarely arrhythmias, angina pectoris, myocardial infarction or stroke, possibly secondary, due to severe arterial hypotension in high-risk patients; vasculitis (frequency unknown).

On the part of the respiratory system: often - cough, shortness of breath; infrequently bronchospasm; very rarely eosinophilic pneumonia, rhinitis.

From the digestive tract: often - nausea, vomiting, abdominal pain, dysgeusia, dyspepsia, diarrhea, constipation; infrequent - dryness of the oral mucosa; rarely - pancreatitis; very rarely - cytolytic or cholestatic hepatitis (see section "Special instructions"), angioedema of the intestine.

From the skin: often - skin rash, itching; infrequently - angioedema, swelling of the face, extremities, urticaria; very rarely - erythema multiforme.

From the musculoskeletal system: often - muscular convulsions.

From the genitourinary system: impotence; very rarely acute renal failure.

Common violations: often - asthenia; infrequently - increased sweating.

From the organs of hematopoiesis and lymphatic system: highly rarely - with prolonged use in high doses, it is possible to reduce hemoglobin and hematocrit, thrombocytopenia, leukopenia / neutropenia, agranulocytosis, pancytopenia; very rarely - hemolytic anemia (in patients with congenital deficiency of glucose-6-phosphate dehydrogenase).

Laboratory indicators: increased urea concentration in blood serum and plasma creatinine, and hyperkalemia reversible after discontinuation of the drug (especially in patients with renal insufficiency, severe CHF and renovascular hypertension); rarely - increased activity of "liver" transaminases and bilirubin in the blood serum; hypoglycemia.

Overdose:

Symptoms: marked decrease in blood pressure, shock, stupor, bradycardia, violation of water-electrolyte balance (hyperkalemia, hyponatremia), renal failure, hyperventilation, tachycardia, palpitations, dizziness, anxiety, cough. Treatment: measures of emergency help are reduced to removing the drug from the body: gastric lavage and / or reception of activated carbon, followed by restoration of the water-electrolyte balance.

At a pronounced decrease in blood pressure - to give the patient a horizontal position with raised legs and carry out measures for replenishment volume of circulating blood (BCC). With the development of severe bradycardia, which is not amenable to drug therapy (including atropine), an artificial pacemaker is shown. It is necessary to monitor the vital functions and concentrations of creatinine and electrolytes in the blood serum.

Perindoprilat, an active metabolite of perindopril, can be removed from the systemic blood flow by hemodialysis. It is necessary to avoid the use of high-flow polyacrylic nitrile membranes.

Interaction:

Diuretics

In patients taking diuretics, especially with excessive excretion of fluid and / or sodium, at the beginning of therapy with ACE inhibitors, severe arterial hypotension may develop.The risk of developing excessive arterial hypotension can be reduced by abolishing the diuretic, intravenously administering a 0.9% solution of sodium chloride, and by prescribing an ACE inhibitor at lower doses. Further increase in the dose of the drug Perindopril should be carried out with care.

Potassium-sparing diuretics, potassium preparations, potassium-containing foods and food additives

Usually, against the background of therapy with ACE inhibitors, the content potassium in the serum remains within normal limits, but in some patients develop hyperkalemia.

Combined application ACE inhibitors potassium-sparing diuretics (eg, triamterene or amiloride), preparations potassium or Potassium-containing foods and nutritional supplements can cause hyperkalemia. Therefore, it is not recommended combine a drug Perindopril with these drugs. Assign these The combination should only be in case of hypokalemia, respecting measures precautions and regularly monitoring the potassium content in the blood serum.

Lithium

With simultaneous use of lithium drugs and ACE inhibitors, it is possible to develop a reversible increase in lithium serum and lithium toxicity. Simultaneous use of ACE inhibitors with thiazide diuretics can additionally increase the lithium content of serum and increase the risk of developing its toxic effects. Simultaneous drug administration Perindopril and lithium preparations are not recommended. If necessary Such a combination therapy is carried out under regular monitoring of lithium content in serum.

Non-steroidal anti-inflammatory drugs (NSAIDs), including acetylsalicylic acid in doses from 3 g / day and above Therapy of NSAIDs may relax the antihypertensive Effect ACE inhibitors. In addition, NSAIDs and ACE inhibitors have an additive effect on the increase in potassium in the blood serum, which can lead to impaired renal function. This effect is usually reversible. In rare cases can develop acute renal failure, especially in patients with an existing renal dysfunction, for example, in elderly patients or with dehydration.

Other antihypertensives and vasodilators

Simultaneous drug administration Perindopril with other antihypertensive drugs can enhance the antihypertensive effect of perindopril. Simultaneous use of nitroglycerin, other nitrates or vasodilators can lead to an additional hypotensive effect. Hypoglycemic agents Simultaneous application of inhibitors ACE and hypoglycemic means (insulin or hypoglycemic agents for oral administration) can increase the hypoglycemic effect, up to the development of hypoglycemia. As a rule, this phenomenon occurs in the first weeks of combined therapy in patients from renal insufficiency.

Acetylsalicylic acid, Thrombolytic agents, beta-blockers and nitrates A drug Perindopril can be combined with acetylsalicylic acid (at antiaggregant agents), thrombolytic agents and beta-blockers and / or nitrates.

Tricyclic antidepressants / antipsychotic means (antipsychotics) / agents for general anesthesia (general anesthetics)

A joint application from ACE inhibitors can lead to an increased antihypertensive effect.

Sympathomimetics Sympathomimetics can weaken the antihypertensive action of ACE inhibitors.When this combination is prescribed, the effectiveness of ACE inhibitors should be evaluated regularly.

Myelotoxic agents - gain myelotoxic actions.

Special instructions:

Stable ischemic heart disease

When the episode of unstable angina develops (significant or not) during the first month of therapy with the drug Perindopril needs to assess the benefit / risk ratio for therapy with this drug.

Arterial hypotension ACE inhibitors can cause a sharp decrease in blood pressure. Have patients with uncomplicated arterial hypertension, symptomatic arterial hypotension rarely occurs after taking the first dose. The risk of excessive reduction in blood pressure is increased in patients with reduced circulating blood volume (BCC) against diuretic therapy, with a strict salt-free diet, hemodialysis, as well as with diarrhea or vomiting, or with severe renin-dependent arterial hypertension.

Severe arterial hypotension was observed in patients with severe CHF, as in the presence of concomitant renal insufficiency, and in its absence. The most common arterial hypotension can develop in patients with more severe heart failure,taking "loop" diuretics in high doses, as well as against hyponatremia or renal insufficiency. These patients are recommended careful medical observation at the beginning of therapy and when titrating the doses of the drug. The same applies to patients with IHD or cerebrovascular disease, in whom excessive reduction of blood pressure can lead to myocardial infarction or cerebrovascular complications.

In the case of arterial hypotension necessary to give a patient a horizontal position with the raised feet, and if necessary to administer intravenously to increase the 0.9% sodium chloride solution was bcc. Transient arterial hypotension is not a contraindication for further therapy. After the recovery of the bcc and AD treatment can be continued under the condition of careful selection of the dose of the drug. In some patients with CHF and normal or low blood pressure during drug therapy Perindopril there may be an additional reduction in blood pressure. This effect is expected and usually not is the basis for drug cancellation. If arterial hypotension accompanied by clinical manifestations, a dose reduction or drug cancellation may be required Perindopril. Impaired renal function In patients with renal insufficiency (KC less than 60 ml / min) the initial dose of the drug Perindopril should be selected in accordance with the QC (see section "Method of administration and dose") and then - depending on the therapeutic response. For such patients, regular monitoring of serum potassium and serum creatinine is necessary.

Patients with symptomatic cardiac insufficiency arterial hypotension, developing in the initial period of therapy with ACE inhibitors, can lead to impaired renal function. In these patients, sometimes there were cases of acute renal failure, usually reversible. In some patients with bilateral stenosis of the renal arteries or stenosis of the renal artery of a single kidney (especially in the presence of kidney failure) against the background of therapy with ACE inhibitors there was an increase serum concentrations of urea and creatinine, reversible after the abolition of therapy.

In patients with renovascular hypertension with ACE inhibitor therapy, there is an increased risk of developing severe arterial hypotension and renal insufficiency.Treatment of such patients should begin under careful medical observation, with small doses of the drug and with further adequate dose selection. During the first weeks of therapy drug Perindopril needs to abolish diuretics and regularly monitor kidney function.

In some patients with hypertension, in the presence of previously not revealed renal failure, especially with concomitant therapy with diuretics, there was a small and a temporary increase in the concentration of urea and creatinine in the blood serum. In this case, a dose reduction preparation Perindopril and / or cancellation of a diuretic.

Patients on hemodialysis

In patients on dialysis using high-flow membranes and receiving concurrent with ACE inhibitors, several cases of persistent, menacing life of anaphylactic reactions. If necessary of hemodialysis is necessary use a different type of membrane.

Kidney Transplantation

Experience of application preparation Perindopril In patients with recent renal transplantation there is no kidney.

Hypersensitivity, angioedema Rarely in patients taking ACE inhibitors, in t.ch. perindopril, angioneurotic edema of the face, limbs, lips, tongue, vocal cords and / or larynx developed. This condition can develop at any time of treatment. When The development of angioedema be discontinued immediately, patient must be under medical supervision before complete extinction symptoms.

Angioedema of the lips and face usually does not require treatment; for decreasing severity of symptoms can apply antihistamines facilities.

Angioedema, swelling of the tongue, vocal cords or larynx can lead to death. With the development of angioedema, immediately subcutaneously epinephrine (adrenalin) and ensure airway patency. ACE inhibitors often cause angioedema in the Negro race. Patients with an angioneurotic edema in a history not associated with the use of ACE inhibitors may be prone to high risk development of angioedema, with an ACE inhibitor.

Anaphylactoid reactions during the procedure of apheresis of low-density lipoproteins (LDL-apheresis)

In patients with the appointment of inhibitors ACE on the background of the procedure of LDL-apheresis with dextran-sulfate absorption, in rare cases, the development of anaphylactic reaction.

A temporary withdrawal of an ACE inhibitor is recommended before each apheresis procedure. Anaphylactic reactions at desensitization In patients receiving ACE inhibitors during the course of desensitization (for example, the venom of Hymenoptera), in very rare cases development of menacing life of anaphylactic reactions.

It is recommended that the ACE inhibitor be temporarily withdrawn before each desensitization procedure begins. Liver failure During therapy with ACE inhibitors, it is sometimes possible to develop a syndrome that starts with cholestatic jaundice and then progresses to fulminant liver necrosis, sometimes with a fatal outcome. The mechanism of development of this syndrome is unclear. If there is jaundice during an ACE inhibitor or if there is an increase in activity "hepatic" enzymes, the ACE inhibitor should be immediately discontinued, and the patient should be carefully monitored. It is also necessary to conduct the corresponding examination.

Neutropenia, agranulocytosis, thrombocytopenia, anemia In patients on the background of therapy with ACE inhibitors, cases of development of neutropenia, agranulocytosis, thrombocytopenia and anemia were noted. With normal kidney function, in the absence of other complications, neutropenia develops rarely. A drug Perindopril it is necessary to use with great care in patients with systemic diseases of connective tissue (eg, SLE, scleroderma), simultaneously receiving immunosuppressive therapy, allopurinol or procainamide, as well as when combining all of these factors, especially if there is an existing impairment of kidney function. Such patients may develop severe infections that do not respond to intensive antibiotic therapy. When the drug is administered Perindopril in patients with the above factors, it is recommended that periodically control the number of white blood cells in the blood and warn the patient about the need to inform the doctor about the appearance of any symptoms of infection.

In patients with congenital deficiency glucose-6-phosphate dehydrogenase, isolated cases of development of hemolytic anemia were noted.

Negroid race

The risk of angioedema development in patients of the Negroid race is higher. Like other ACE inhibitors, perindopril less effective in reducing blood pressure in patients of the Negroid race, possibly because of the greater prevalence of low-grade conditions in the population of this group of patients with hypertension.

Cough

Against the background of therapy with ACE inhibitors, a persistent, unproductive cough may develop which stops after the drug is discontinued. This should be taken into account in differential diagnosis cough.

Surgery and general anesthesia

In patients whose condition requires extensive surgery or general anesthesia with drugs that cause Arterial hypotension, ACE inhibitors, including perindopril, can block the formation of angiotensin II with compensatory release of renin. The day before the surgical intervention therapy inhibitors ACE must be canceled. If the ACE inhibitor can not be canceled, then the arterial hypotension, which develops according to the described mechanism,can be corrected by increasing the BCC.

Hyperkalemia

Against the background of therapy with ACE inhibitors, including perindopril, in some patients the potassium content in the blood can increase. The risk of hyperkalemia is elevated in patients with renal and / or heart failure, decompensated diabetes mellitus and in patients using potassium-sparing diuretics, potassium preparations or other drugs that cause hyperkalemia (eg, heparin). If it is necessary to simultaneously prescribe these drugs, it is recommended that regularly monitor the potassium content in the blood serum.

Diabetes

In patients with diabetes mellitus taking hypoglycemic agents for ingestion or insulin, in the first few months of therapy with ACE inhibitors it is necessary closely monitor concentration of glucose in the blood.

Effect on the ability to drive transp. cf. and fur:

It should be used with caution in patients, manager motor vehicles and engaged in activities requiring increased concentration of attention and quick reaction, due to the danger of developing arterial hypotension and dizziness.

Form release / dosage:

Tablets 4 mg.

Packaging:

For 10, 30 tablets are placed in a contour mesh box made of a polyvinylchloride film and aluminum foil printed lacquered.

For 30, 50 or 100 tablets are placed in a polymer container for medicines.

One container or 1 or 3 contour mesh packages together with the instruction for use are placed in a pack of cardboard.

Storage conditions:

List B. Store in a dry, the dark place at a temperature of no higher than 25 ° C. Keep out of the reach of children.

Shelf life:3 years. Do not use after the expiration date.

Terms of leave from pharmacies:On prescription

Registration number:LSR-009398/09

Date of registration:23.11.2009

The owner of the registration certificate:OZONE, LLC OZONE, LLC Russia

Manufacturer: & nbsp

OZONE, LLC Russia

Information update date: & nbsp28.08.2015

Illustrated instructions

Instructions

Parnavel (Parnavel)