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The active substance that enhances the pharmacological effect of Coversyl is perindopril. The medication is referred to a group of ACE inhibitors, has a hypotensive, vasodilatory, cardioprotective and natriuretic effect.
Coversyl pharmacological action
In the body the active ingredient is converted into its active metabolite – perindoprilat (carboxyalkyl group), which interacts with an atom of zinc per molecule of angiotensin-converting enzyme. ACE inactivates plasma vascular endothelium in the cells of the renal glomeruli and tubules, lung tissue, heart, adrenal glands and brain. Coversyl lowers the level of angiotensin II in the blood and tissues, reduces production and release of aldosterone from the adrenal gland, suppresses liberation of norepinephrine from sympathetic nerve endings of the fibers and the formation of endothelin in the vascular wall. The remedy increases the concentration of bradykinin, a vasodilatory prostaglandins (ACE converts inactive angiotensin I into angiotensin II, providing vasoconstriction action, but also causes degradation of bradykinin and prostaglandins, vasodilating activity), increases the activity of the kallikrein-kinin system, stabilizes the level of atrial natriuretic peptide, endothelin-dependent relaxing factor.
Coversyl decreases round, blood pressure (without the development of tachycardia), left ventricular filling pressure (improves diastolic relaxation). During the course arterial and venous vasodilation accompanied by weakening of the post and the preload on the myocardium, a reduction in end-diastolic pressure in the ventricles of the heart, a moderate decrease in heart rate, an increase in cardiac output are monitored. The remedy improves regional (coronary, cerebral, renal, muscular) circulation, reduces myocardial oxygen demand in ischemic heart disease. Inhibiting the tissue renin-angiotensin system the medication provides cardioprotective (reduces left ventricular hypertrophy) and angioproteguoe (hyperplasia and prevents proliferation of vascular smooth muscle cells induces regression of hypertrophy of the vascular wall elasticity recovers large vessels and endothelial function, including the ability to release nitric oxide endothelium-derived relaxing factor) effect.
Coversyl indications for use
The medication is typically prescribed in the following cases:
• Chronic heart failure;
• Prevention of recurrent stroke in patients with a history of cerebrovascular disease (in the complex therapy with indapamide).
The preparation is designed for perioral administration, as a whole, without chewing, no food, once a day at the same time (in the morning):
• in essential hypertension the initial dose is 4 mg per day, if necessary, the dose is increased to a maximum daily dosage of 8 mg every 3-4 weeks;
• in case of renovascular hypertension 2 mg of preparation are prescribed;
• in heart failure cases – 2-4 mg once each 24 hours is the recommended dosage.
In patients with renal insufficiency the dosage is determined by creatinine clearance: creatinine clearance 60 mL/min – 4 mg/day; 30-60 ml/min – 2 mg/day; 15-30 ml/min – 2 mg every other day; below 15 ml/min – 2 mg per day dialysis (dialysis clearance perindoprilat – 70 ml/min). In patients with chronic renal failure with creatinine clearance 60 mL/min or with hepatic insufficiency correction dosing regimen is not required. The maintenance dose is adjusted individually, depending on tolerability, therapeutic effect, and the patient's condition.
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