Perindopril + Indapamide

It is indicated in the treatment of essential hypertension where blood pressure is not adequately controlled on perindopril alone.

Perindopril is a nonsulphydryl ACE inhibitor used in the treatment of hypertension. Following oral administration, perindopril is rapidly hydrolysed to perindoprilat, its principal active metabolite. ACE catalyses the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II. Angiotensin II also stimulates aldosterone secretion by the adrenal cortex. Inhibition of ACE activity leads to decreased levels of angiotensin II, thereby resulting in decreased vasoconstriction and decreased aldosterone secretion. The latter change may result in a small increase in serum potassium. Decreased levels of angiotensin II and the accompanying lack of negative feedback on renal renin secretion results in increases in plasma renin activity. Perindopril administration may interfere with the degradation of the vasodepressor peptide bradykinin. It is not known whether this effect contributes to the therapeutic activity of perindopril. The mechanism through which perindopril lowers BP appears to result primarily from suppression of the RAAS.

Indapamide is a sulphonamide derivative with an indole ring, pharmacologically related to the thiazide group of diuretics. Indapamide inhibits the reabsorption of sodium in the cortical diluting segment. It increases the urinary excretion of sodium and chlorides and, to a lesser extent, the excretion of potassium and magnesium, thereby increasing urine output and having an antihypertensive action.

1-2 tablets per day preferably taken in the morning before a meal. In case of renal insufficiency, treatment should start with an adequate dose.

Concomitant use of antihypertensive & antipsychotic drug may potentiate hypotensive effects and NSAIDs may reduce the antihypertensive effect. ARB and Potassium Sparing diuretics may cause hyperkalemia.

This fixed combination is contraindicated in following situations. Hypersensitivity to perindopril/ indapamide or to any other angiotensin-converting enzyme (ACE) inhibitor.

Side-effects include nausea, vomiting, dyspepsia, diarrhea, constipation, headache, dizziness, sleep disturbance, asthenia, dry mouth, hypotension, persistent dry cough, angioedema, rash.

There are no adequate and well-controlled studies on pregnant women. So in pregnancy, this is not recommended. Mothers taking Indapa- plus should not breastfeed.

The drug should be used cautiously in the following situations- in renal impairment, renal artery stenosis, heart failure, gout, diabetes, liver cirrhosis, in elderly patient, atherosclerosis, idiopathic or hereditary angioedema.

Symptoms include hypotension, nausea, vomiting, cramps, dizziness, sleepiness mental confusion, oliguria which may progress to anuria. Salt and water disturbances (low sodium levels, low potassium levels) may also occur. Gastric lavage or administration of activated charcoal may be used to remove the ingested drug. Monitor and maintain fluid and electrolyte balance.

Combined antihypertensive preparations

Store below 30° C.