Perindopril Arginine + Amlodipine: Brands, Price & Uses in Bangladesh

Perindopril Arginine + Amlodipine is a fixed-dose combination of an ACE inhibitor (perindopril arginine) and a dihydropyridine calcium channel blocker (amlodipine), indicated for:

• Substitution/maintenance therapy for hypertension: Perindopril Arginine + Amlodipine is indicated in patients whose blood pressure is already adequately controlled with perindopril and amlodipine given concurrently as separate tablets at the same dose levels, to simplify their treatment regimen. It is not intended as initial (first-line) therapy.
• Stable coronary heart disease: Perindopril Arginine + Amlodipine is also used as substitution therapy in patients with stable coronary artery disease who are already stabilized on perindopril and amlodipine at equivalent doses, to reduce the risk of cardiovascular events.
• Hypertension not adequately controlled on monotherapy (in formulations/markets where Perindopril Arginine + Amlodipine is approved for initiation): to lower blood pressure in patients who require more than one agent to achieve blood pressure goals.

Perindopril Arginine + Amlodipine lowers blood pressure and, by extension, reduces the risk of stroke and myocardial infarction associated with uncontrolled hypertension. It is not indicated for the initial (first-time) treatment of hypertension in patients not already on both individual components.

General principles

Perindopril Arginine + Amlodipine is generally used as substitution/maintenance therapy in patients already controlled on perindopril and amlodipine given concurrently as separate products at matching doses. It should be taken once daily, preferably in the morning, before a meal, with a glass of water.

Renal impairment

Use with caution. Perindopril Arginine + Amlodipine is generally not recommended when creatinine clearance is less than 30 mL/min; dose should not exceed the lowest combined strength in mild-to-moderate renal impairment. Individual-component dose titration is preferred when renal function is reduced.

Hepatic impairment

Amlodipine clearance is reduced in hepatic impairment; lower doses and close monitoring are advised. Perindopril Arginine + Amlodipine should be used cautiously, generally starting at the lowest available strength.

Elderly

No initial dose adjustment is usually required, but blood pressure should be monitored closely, especially during dose increases, due to increased sensitivity to blood-pressure-lowering effects.

Side effects of Perindopril Arginine + Amlodipine arise from both its ACE-inhibitor and calcium-channel-blocker components.

Common side effects

• Peripheral edema (swelling of the ankles/feet), the most common adverse effect, related to amlodipine
• Dizziness or lightheadedness
• Headache
• Persistent dry cough (class effect of ACE inhibitors)
• Flushing and palpitations
• Fatigue or tiredness
• Altered taste (dysgeusia)
• Nausea
• Muscle cramps

Less common but serious side effects

• Angioedema of the face, lips, tongue, glottis, or larynx — requires immediate discontinuation and emergency medical attention, especially if there is airway swelling or difficulty breathing (see Precautions and Warnings)
• Significant hypotension, particularly after the first dose or in volume-depleted patients
• Hyperkalemia
• Deterioration of renal function
• Rare hepatic reactions, including cholestatic jaundice
• Rare blood disorders (neutropenia, agranulocytosis)

Patients should seek prompt medical attention for facial/throat swelling, difficulty breathing or swallowing, fainting, or signs of an allergic reaction.