Product Overview
[Drug Name]
Generic Name: Perindopril and Indapamide Tablets
Trade Name: Biprel forte
English Name: Perindopril and Indapamide Tablets
Chinese Pinyin: Peiduopuli Yindapa’an Pian
[Ingredients]
This product is a combination preparation consisting of: Perindopril tert-butylamine salt 4,000 mg, Indapamide 1.25 mg, Excipients (as needed for one 90 mg tablet)
[Appearance]
White stick-shaped tablets.
[Indications]
Essential hypertension.
[Dosage and Administration]
Oral administration. Take one tablet once daily, preferably in the morning before meals. Where possible, gradual dosage adjustment based on individual patient needs is recommended. In appropriate clinical cases, direct conversion from monotherapy to this product may be considered. Patients with renal impairment (see [Precautions]): This product is contraindicated in patients with severe renal impairment (creatinine clearance less than 30 ml/min). For patients with creatinine clearance greater than or equal to 30 ml/min and less than 30 ml/min, initiating treatment with an appropriate dose of a combination of drugs is recommended. For patients with creatinine clearance greater than 60 ml/min, no dose adjustment is required. Routine medical examinations should include regular monitoring of creatinine and serum potassium levels. Children: This product should not be used in children as the efficacy and tolerability of perindopril alone or in combination with other drugs have not been established in children.
[Adverse Reactions]
Related to this product: Perindopril inhibits the renin-angiotensin-aldosterone axis, potentially reducing indapamide-induced potassium loss. Hypokalemia (potassium levels 1/100, 1/100, 1/1,000, 1/1,000, 1/1,000, <1/100) occurred in 4% of patients taking this product: cramps, paresthesias. Hematologic System: - Extremely rare (<1/10,000): - Thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia, hemolytic anemia. - Anemia may occur in patients taking ACE inhibitors in special circumstances (renal transplant recipients or patients undergoing hemodialysis) (see [Precautions]). Laboratory Parameters: - Potassium depletion, particularly in high-risk groups, can be more severe (see [Precautions]). - Hyponatremia with hypovolemia can cause dehydration and orthostatic hypotension. - Increased uric acid and blood glucose levels during treatment. - Mild increases in urea and plasma creatinine levels, which return to normal after treatment discontinuation. These increases are more common in patients with renal artery stenosis, hypertension on diuretic therapy, and renal insufficiency. - Hyperkalemia is usually transient. - Rare (>1/10,000, <1/1,000): Increased plasma calcium levels.
[Contraindications]
Perindopril-related: This product is not used in the following situations: - Hypersensitivity to perindopril or any other ACE inhibitor; - A history of angioedema (Quigant's edema) associated with ACE inhibitor use; - Hereditary or idiopathic angioedema; - Pregnancy; - Breastfeeding. Generally, this product is not recommended for: - Concomitant use of potassium-sparing diuretics, potassium salts, or lithium (see [Drug Interactions]); - Bilateral renal artery stenosis or unilateral renal artery stenosis; - Hyperkalemia. Indapamide-related: This product is not used in the following situations: - Hypersensitivity to sulfonamides; - Severe renal failure (creatinine clearance less than 30 ml/min); - Hepatic encephalopathy; - Severe liver impairment; - Hypokalemia. Generally, this product is not recommended for concomitant use with non-antiarrhythmic drugs that can induce torsades de pointes (see [Drug Interactions]). Related to this product: - Allergic to any excipients; Due to lack of relevant data, this product cannot be used for: - Dialysis patients; - Patients with untreated decompensated heart failure.
[Precautions]
Special Warnings: Perindopril-associated: ● Risk of neutropenia/agranulocytosis in immunocompromised patients. The risk of neutropenia is dose- and patient-specific, depending on the patient's clinical condition. It rarely occurs in uncomplicated patients but may occur in patients with renal impairment associated with collagen vascular diseases, such as systemic lupus erythematosus or scleroderma, and in patients receiving immunosuppressive therapy. The risk resolves with discontinuation of ACE inhibitor therapy. Strict adherence to pre-specified dosing is likely the best way to prevent this event. However, if ACE inhibitors are necessary for these patients, the risk/benefit ratio should be carefully assessed. ● Angioneurotic edema (Quigant's edema): Rare cases of angioneurotic edema involving the face, extremities, lips, tongue, glottis, and/or larynx have been reported in patients taking ACE inhibitors, including perindopril. If this occurs, perindopril should be discontinued immediately, and the patient should be monitored until the edema resolves. When edema is limited to the face and lips, it generally resolves without treatment, but antihistamines can be used to relieve symptoms. Angioneurotic edema with laryngeal edema can be fatal. Edema of the tongue, glottis, or larynx can cause airway obstruction and should be treated immediately with a subcutaneous injection of 1/1000 epinephrine (0.3 to 0.5 ml) and other appropriate treatments. Angiotensin-converting enzyme inhibitors should subsequently be discontinued in these patients (see Contraindications). Patients with a history of quaggae edema unrelated to ACE inhibitor use are at increased risk of developing quaggae edema when taking ACE inhibitors. Anaphylactoid Reactions During Desensitization: Rare cases of delayed, life-threatening anaphylactoid reactions have been reported in patients undergoing desensitization to hymenopteran insect (bee, wasp) venom when using ACE inhibitors. Caution should be exercised during the initial phase of desensitization when using ACE inhibitors in patients with allergies, and ACE inhibitors must be avoided in patients undergoing venom immunotherapy. Patients requiring concomitant use of ACE inhibitors and desensitization therapy should temporarily discontinue ACE inhibitors for at least 24 hours to avoid these adverse reactions. ●Anaphylactoid Reactions in Patients Using Dialysis Membranes: Delayed, life-threatening anaphylactoid reactions have been reported in patients undergoing dialysis with hypertonic membranes or plasma LDL apheresis using glycosylated sulfate adsorption while receiving ACE inhibitors. ACE inhibitors should be avoided in patients undergoing dialysis with hypertonic membranes or plasma LDL apheresis using glycosylated sulfate adsorption. Patients requiring concomitant ACE inhibitor therapy and plasma LDL apheresis should temporarily discontinue ACE inhibitors for at least 24 hours to avoid these adverse reactions. Related to Indapamide: In the setting of impaired liver function, thiazide diuretics and thiazide-related diuretics can cause hepatic encephalopathy. If this occurs, the diuretic should be discontinued immediately. Special Precautions for Use Related to this Product: Renal Impairment: Severe renal impairment (creatinine clearance less than 30 ml/min) is a contraindication for this product. For certain hypertensive patients without prior overt renal impairment who demonstrate functional renal impairment on biological testing, this product should be discontinued and treatment restarted at a lower dose or with the single agent. Routine medical evaluation for these patients should include regular monitoring of serum potassium and creatinine levels after two weeks of treatment and every two months thereafter during stable treatment. Renal impairment has been reported primarily in patients with severe cardiac impairment or renal impairment associated with renal artery stenosis. Hypotension and Salt and Water Depletion: Patients with preexisting hyponatremia (especially those with renal artery stenosis) are at risk for a sudden drop in blood pressure. Therefore, patients who develop clinical signs of salt and water depletion accompanied by intermittent diarrhea and vomiting should undergo systematic evaluation. Routine plasma electrolyte monitoring should be performed in such patients. Patients with significant symptomatic hypotension require intravenous administration of isotonic saline. Transient hypotension is not a contraindication to continued treatment with this product. After normalization of blood volume and blood pressure, treatment can be resumed at a lower dose or with either component alone. Potassium Levels: Combining perindopril and indapamide does not prevent the development of hypokalemia, particularly in patients with diabetes or renal failure. Routine potassium monitoring should be performed when using any antihypertensive medication containing a diuretic. Related to Perindopril: Cough: A dry cough has been reported with ACE inhibitors. It is characterized by persistent cough that resolves upon discontinuation of the drug. Iatrogenic causes should be considered for this symptom. If ACE inhibitor use is necessary, continued treatment may be considered. Children: The efficacy and tolerability of perindopril, alone or in combination, in children have not been established. Risk of hypotension and/or renal insufficiency (in conditions such as cardiac insufficiency and salt and water depletion): In patients with initially low blood pressure due to renal artery stenosis, congestive heart failure, or cirrhosis with edema and ascites, the renin-angiotensin-aldosterone system can be significantly stimulated, especially in the presence of significant salt and water depletion (such as a strict sodium-free diet or chronic diuretic use). Therefore, antagonizing this system with angiotensin-converting enzyme inhibitors can cause a sudden drop in blood pressure, especially during the first dose and the first two weeks of treatment, and/or an increase in plasma creatinine levels, suggesting functional renal insufficiency. This can sometimes manifest as an acute onset, but is rare and occurs at an irregular pace. For such patients, treatment should be initiated with a low dose and gradually increased. Elderly patients: Renal function and serum potassium levels should be measured before treatment. The initial dose should be adjusted based on changes in blood pressure, particularly in patients with salt and water depletion, to avoid sudden hypotension. ● Patients with arteriosclerosis: Because all patients are at risk for hypotension, patients with ischemic heart disease and cerebral ischemia should be carefully monitored and treatment initiated at a lower dose. ● Renovascular hypertension: The treatment for renovascular hypertension is revascularization. However, for patients with renovascular hypertension awaiting corrective surgery or those who are unable to undergo surgery, ACE inhibitors may benefit. These patients should be initiated at a lower dose in the hospital, and renal function and serum potassium levels should be monitored, as some patients may develop functional renal insufficiency during treatment, which may be reversible upon discontinuation of the drug. ● Other risk groups: For patients with severe cardiac insufficiency (grade IV) or insulin-dependent diabetes mellitus (who have a tendency for spontaneous increases in serum potassium), treatment should be initiated at a low dose under close medical supervision. Beta-blocker therapy should not be discontinued in patients with hypertension and coronary artery insufficiency; ACE inhibitors should be used in combination with beta-blockers. ● Anemia: Anemia, manifested as a decrease in hemoglobin, may occur in patients who have undergone kidney transplantation or are undergoing dialysis. Because hemoglobin levels are initially high, their decrease is more pronounced. This effect does not appear dose-dependent but appears to be related to the mechanism of action of ACE inhibitors. Mild decreases in hemoglobin occur within 1-6 months of treatment and remain stable thereafter. Anemia is reversible when treatment is discontinued. Routine hematologic monitoring is recommended for such patients, and treatment can continue. ● Surgery: Under anesthesia, especially with anesthetics that tend to lower blood pressure, ACE inhibitors can cause hypotension. Therefore, for patients taking long-acting ACE inhibitors such as perindopril, discontinuation of these medications is recommended two days before surgery. ● Aortic stenosis/hypertrophic cardiomyopathy: ACE inhibitors must be used with caution in patients with left ventricular obstruction. Regarding indapamide: ● Salt and water balance: - Sodium levels: Serum sodium levels must be measured before treatment begins and periodically thereafter. All diuretics can decrease sodium levels, which can have serious consequences. Initial decreases in sodium levels may not be asymptomatic, so regular monitoring is crucial. More frequent monitoring is recommended for high-risk groups, such as the elderly and those with cirrhosis (see Adverse Reactions and Overdosage). - Potassium Level: Hypokalemia and potassium depletion are the major risks of using thiazide diuretics and thiazide-related diuretics. Precautions should be taken to avoid the risk of hypokalemia (less than 3.4 mmol/L) in high-risk groups, such as the elderly and/or malnourished patients (regardless of whether they are on polypharmacy), patients with cirrhosis and edema and ascites, and patients with coronary artery disease and heart failure. In these situations, hypokalemia can increase the cardiotoxicity of cardiac glycosides and the risk of arrhythmias. Patients with a long QT interval on the electrocardiogram (ECG), whether congenital or iatrogenic, are at risk for this drug. Both hypokalemia and bradycardia can be predisposing factors for serious arrhythmias, particularly the potentially life-threatening torsade de pointes. More frequent potassium monitoring is necessary in such patients. The initial potassium measurement should be performed during the first week of treatment. If hypokalemia is detected, it should be corrected. Calcium levels: Use of thiazide and related diuretics can reduce urinary calcium excretion and cause mild, transient hypercalcemia. A significant increase in serum calcium may be associated with undiagnosed hyperparathyroidism. In such cases, treatment should be discontinued before parathyroid function is tested. Blood glucose: Monitoring blood glucose is crucial for patients with diabetes, especially those with hypokalemia. Uric acid: Patients with elevated uric acid levels are more susceptible to gout. Renal function and diuretics: Thiazide and related diuretics are effective only when renal function is normal or mildly impaired (creatinine level in adults less than approximately 25 mg/L, or 220 μmol/L). For elderly individuals, serum creatinine values should be adjusted based on age, weight, and sex. The adjustment can be made according to the Cockroft formula: C creatinine = (140 - age) × weight / 0.814 × plasma creatinine level. Note: Age is expressed in years, weight is expressed in kilograms, and plasma creatinine level is expressed in micromoles/liter. This formula is applicable to elderly men; for women, the result should be multiplied by 0.85. Initially, diuretic therapy reduces glomerular filtration rate due to hypovolemia caused by water and sodium loss. This can lead to elevated blood urea and creatinine levels. This transient functional renal insufficiency is not a problem in patients with normal renal function, but may worsen the condition in those with pre-existing renal insufficiency. ● Athletes: The active substance contained in this product may result in a positive doping test; athletes should be aware of this. Use with caution. ● Lactose: This product contains lactose and is therefore contraindicated in patients with congenital galactosemia, glucose and galactose malabsorption, or lactase deficiency syndrome (rare metabolic disorders). Effects on the ability to use machines and drive: Related to perindopril, indapamide and tadalafil: Neither the two active ingredients nor tadalafil impairs alertness, but individual drug reactions related to hypotension may occur in a small number of patients, especially when starting treatment or when used in combination with other antihypertensive drugs. Therefore, the ability to use machines and drive may be affected.
[Use in Special Populations]
Precautions for children: See [Dosage and Administration] and [Precautions].
Precautions for pregnancy and lactation:
The presence of angiotensin-converting enzyme (ACE) inhibitors contraindicates the use of this combination product during pregnancy and lactation. Regarding perindopril: *Pregnancy: No controlled studies have been conducted in humans. When used by pregnant women, ACE inhibitors can cross the placenta and cause fetal or neonatal malformations and death. Neonatal hypotension, renal insufficiency, facial and cranial vault malformations, and/or death have been reported with this product during 4-9 months of gestation. Cases of fetal renal impairment due to oligohydramnios have been observed. Cases of oligohydramnios causing limb shortening, craniofacial malformations, pulmonary hypoplasia, and intrauterine growth retardation have also been reported. Infants exposed to ACE inhibitors in utero must be closely monitored for hypotension, oliguria, and hyperkalemia. Oliguria can be treated by regulating blood pressure and renal blood flow. There have been reports of intrauterine growth retardation, precocious puberty, ductus arteriosus occlusion, and fetal death; however, whether this is related to ACE inhibitor use or any preexisting maternal medical conditions is unclear. There are no data regarding the effects of limited drug exposure during the first three months of pregnancy on the fetus. If a patient becomes pregnant while taking ACE inhibitors, she must be informed of the potential risks to the fetus. *Breastfeeding: ACE inhibitors are excreted in breast milk, and their effects on nursing infants are unknown. Therefore, mothers taking ACE inhibitors should not breastfeed. Regarding indapamide: *Pregnancy: Diuretics are generally contraindicated in pregnant women and should not be used to treat physiologic edema during pregnancy (which does not require treatment). Diuretics can cause fetoplacental ischemia and may impair fetal growth. However, diuretics remain an important treatment option for pregnant women with edema due to cardiac, hepatic, or renal insufficiency. *Breastfeeding: Only a small amount of indapamide is excreted in breast milk. However, this medication should be avoided during breastfeeding for the following reasons: - Reduced or even suppressed lactation; - Reported adverse reactions, particularly biochemical (blood potassium levels); - Because this drug is a sulfonamide, there is a risk of allergic reactions and kernicterus.
Precautions for Elderly Patients:
See [Dosage and Administration] and [Precautions].
[Drug Interactions]
Related to this product: Medications not recommended for concomitant use: + Lithium. Increased lithium levels in the presence of a sodium-free diet (which reduces renal lithium excretion) can produce symptoms of overdose. If combined use of angiotensin-converting enzyme inhibitors and potassium-sparing diuretics is necessary, lithium levels should be carefully monitored and dosages adjusted. Medications requiring special caution when used in combination: + Antidiabetic drugs (insulin, sulfonylureas). Concomitant use with captopril and enalapril has been reported. Angiotensin-converting enzyme inhibitors may enhance the glucose-lowering effect in diabetic patients currently receiving insulin or sulfonylureas. Hypoglycemic episodes are extremely rare (improved glucose tolerance reduces insulin requirements). + Baclofen: Has potential antihypertensive effects. Monitor blood pressure and renal function, and adjust antihypertensive drug doses as necessary. + NSAIDs (systemic route), high-dose salicylates: Dehydrated patients may develop acute renal insufficiency (decreased glomerular filtration rate). Patients should be adequately hydrated; renal function should be monitored from the start of treatment. Drugs requiring caution when used in combination: + Imipramine-type antidepressants (tricyclics), neuroleptics: May enhance the effects of antihypertensive drugs and increase the risk of orthostatic hypotension (additive effect). + Corticosteroids, tecocticoids: Reduced efficacy of antihypertensive drugs (corticosteroids cause water and salt retention). Related to perindopril: Drugs not recommended for concomitant use: + Potassium-sparing diuretics (alone or in combination with spironolactone, triamterene): Potassium (salts) may increase potassium levels (potentially fatal), especially in patients with renal impairment (additive potassium sparing). Potassium-sparing drugs should not be used in combination with angiotensin-converting enzyme inhibitors unless potassium levels are low. + Anesthetics: Angiotensin-converting enzyme inhibitors may enhance the hypotensive effects of certain anesthetics. + Concomitant administration of allopurinol, cell proliferation inhibitors or immunosuppressants, corticosteroids (systemic), or procainamide with angiotensin-converting enzyme inhibitors may increase the risk of leukopenia. + Antihypertensive drugs: Potentiate the hypotensive effect of angiotensin-converting enzyme inhibitors. Related to indapamide: Drugs not recommended for concomitant use: + Non-antiarrhythmic drugs that can cause QT prolongation or torsades de pointes (astemizole, bepridil, erythromycin IV, halofantrine, pentamidine, sultopride, terfenadine, vincamine). Torsades de pointes (hypokalemia, bradycardia, and pre-existing QT prolongation are risk factors). If hypokalemia occurs, medications that do not cause torsades de pointes can be used. Drugs requiring special caution when used concomitantly: + NSAIDs (systemic route). High-dose salicylates may reduce the antihypertensive effect of indapamide. Dehydrated patients may develop acute renal insufficiency (decreased glomerular filtration rate). Patients should be adequately hydrated; renal function should be monitored from the start of treatment. + Medications that lower potassium levels: amphotericin B (intravenous), glucocorticoids and mineralocorticoids (systemic), teicosin, and stimulant laxatives. These increase the risk of hypokalemia (synergistic effects). Monitor serum potassium and correct as necessary; caution is required when using cardiac glycosides. Use non-stimulant laxatives. + Cardiac glycosides: Hypokalemia can cause toxic effects of cardiac glycosides. Monitor serum potassium and electrocardiograms, and adjust treatment if necessary. Medications to be used with caution: + Potassium-sparing diuretics (amiloride, spironolactone, triamterene). This combination can be beneficial in some patients, but it does not rule out the development of hypokalemia or, particularly in patients with renal insufficiency or diabetes, hyperkalemia. Monitor serum potassium and electrocardiograms, and adjust treatment if necessary. + Antiarrhythmic drugs that can cause torsades de pointes: Class IA antiarrhythmic drugs (quinidine, dihydroquinidine, disopyramide), amiodarone, bretylamide, sotalol. Torsades de pointes (hypokalemia, bradycardia, and pre-existing QT prolongation are risk factors). Prevent hypokalemia and correct it if necessary: Monitor the QT interval. During a torsades de pointes episode, do not use antiarrhythmic drugs (use a pacemaker instead). + Metformin. In patients with underlying functional renal insufficiency associated with diuretics, particularly loop diuretics, metformin may cause lactic acidosis. Contraindicate use of metformin in patients with creatinine levels exceeding 15 mg/L (135 μmol/L) in men and 12 mg/L (110 μmol/L) in women. + Iodinated contrast media: For patients dehydrated by diuretic use, iodinated contrast media increase the risk of acute renal failure, especially when large doses are used. Fluid repletion is essential before administering iodinated compounds. + Imipramine-type antidepressants (tricyclics) and neuroleptics: They can enhance the effects of antihypertensive drugs and increase the risk of orthostatic hypotension (additive effect). + Calcium (salt): Reduced urinary calcium excretion leads to the risk of hypercalcemia. + Cyclosporine: Even without altering circulating cyclosporine levels, there is a risk of elevated creatinine levels, even in the absence of water or sodium depletion. + Corticosteroids, tecocticoid (systemic route): Reduced efficacy of antihypertensive drugs (salt and water retention caused by corticosteroids).
[Pharmacological Action]
This product is a combination of perindopril tert-butylamine salt, an angiotensin-converting enzyme inhibitor, and indapamide, a chlorosulfamoyl diuretic. Its pharmacological properties are derived from the individual pharmacological properties of the two components and the positive synergistic effect of their combined use. Pharmacological Mechanism of Action: This product exhibits a positive synergistic antihypertensive effect from the two components. Related to Perindopril: Perindopril is an angiotensin-converting enzyme (ACE) inhibitor. ACE converts angiotensin I to angiotensin II, a vasoconstrictor. This enzyme also stimulates aldosterone secretion from the renal cortex and degrades bradykinin, a vasodilator, into an inactive heptapeptide. Perindopril exerts its effects through its active metabolite, perindoprilat. Other metabolites are inactive. Therefore, this drug can cause: - a decrease in aldosterone secretion; - an increase in plasma renin activity due to the inability of aldosterone to generate negative feedback; - long-term treatment can reduce total peripheral vascular resistance through preferential effects on muscle and renal vascular beds, without associated salt and water retention or reflex tachycardia. Perindopril can also produce antihypertensive effects in patients with low or normal renin levels. Perindopril can reduce cardiac workload: - by altering prostaglandin metabolism, resulting in venous dilation, thus reducing preload; - by reducing total peripheral vascular resistance, thus reducing afterload. Studies in patients with cardiac insufficiency have demonstrated: - a decrease in left and right ventricular filling pressures; - a decrease in total peripheral vascular resistance; - an increase in cardiac output and improved cardiac index; - an increase in regional muscle blood flow. Exercise testing results are also improved. Related to indapamide: Indapamide is a sulfonamide derivative with an indole ring, and its pharmacological activity is similar to that of thiazide diuretics. Indapamide inhibits sodium reabsorption in the diluent segment of the renal cortex. It increases urinary excretion of sodium and chloride, and slightly increases potassium and magnesium excretion, thereby increasing urine volume and exerting an antihypertensive effect. Characteristics of the Antihypertensive Effect Related to This Product: In hypertensive patients of all ages, this product dose-dependently lowers both systolic and diastolic blood pressure, whether supine or standing. This antihypertensive effect persists for 24 hours. Blood pressure decreases within a month, without acute antihypertensive effects; there is no rebound effect after discontinuation of the drug. In clinical trials, coadministration of perindopril and indapamide produced a synergistic antihypertensive effect compared to either drug alone. Related to Perindopril: Perindopril can treat a wide range of hypertension: mild to moderate, or severe. It lowers both systolic and diastolic blood pressure in both supine and standing positions. Maximum antihypertensive effect occurs 4-6 hours after a single dose and persists for more than 24 hours. A high degree of inhibition of angiotensin-converting enzyme activity, approximately 80%, is still maintained 24 hours later. For patients who respond to treatment, blood pressure returns to normal after one month and remains normal, without acute drug resistance. Discontinuation of treatment does not cause rebound blood pressure. Perindopril has vasodilatory properties, restoring the elasticity of large arteries, correcting histomorphological changes in resistance vessels, and reducing left ventricular hypertrophy. Combination with thiazide diuretics, if necessary, can produce a synergistic effect. Combining angiotensin-converting enzyme inhibitors with thiazide diuretics can reduce the risk of hypokalemia caused by diuretic use alone. Related to indapamide: Indapamide therapy alone has a 24-hour sustained antihypertensive effect. This effect occurs at doses where its diuretic effect is minimal. Its antihypertensive effect is paralleled by improvements in arterial compliance and reductions in total arterial and peripheral vascular resistance. Indapamide can reduce left ventricular hypertrophy. When thiazide diuretics and thiazide-related diuretics are used above a certain dose, the antihypertensive effect reaches a plateau, while adverse reactions continue to increase. Therefore, if treatment is ineffective, the dose should not be increased. Furthermore, in the short-, medium-, and long-term treatment of hypertension, indapamide: - Does not affect lipid metabolism, including triglycerides, LDL cholesterol, and HD cholesterol; - Does not affect total carbohydrate metabolism, even in diabetic hypertensive patients. Toxicity: The toxicity of Perindopril is slightly greater than that of its constituent components. No potential renal changes were observed in rats. However, combined use may cause gastrointestinal toxicity in dogs and increased toxicity in female rats (compared to perindopril). Nevertheless, the doses at which these adverse effects occur are significantly below the therapeutic dose.
[Storage] Store below 30°C.
[Strength] 4mg: 1.25mg x 20 tablets
[Packaging] Box
[Expiration Period] 24 months
[Approval Number] National Medicine Standard H20051756
[Manufacturer] Company Name: Servier (Tianjin) Pharmaceutical Co., Ltd.
