This medicine is indicated for the treatment of essential hypertension when blood pressure is not adequately controlled with perindopril alone.

Perindopril is a non-sulphydryl angiotensin-converting enzyme (ACE) inhibitor used in hypertension treatment. After oral administration, it is rapidly converted into its active metabolite, perindoprilat. ACE converts angiotensin I into angiotensin II, a potent vasoconstrictor that also stimulates aldosterone secretion from the adrenal cortex. Inhibition of ACE reduces angiotensin II levels, leading to decreased vasoconstriction and reduced aldosterone secretion. This may cause a slight increase in serum potassium. Reduced angiotensin II also increases renin release due to loss of negative feedback, resulting in higher plasma renin activity. Perindopril may also inhibit the breakdown of bradykinin, a vasodilator peptide, though its clinical significance is uncertain. The primary antihypertensive effect is due to suppression of the renin-angiotensin-aldosterone system (RAAS).

Indapamide is a sulphonamide-derived diuretic related to the thiazide group. It works by inhibiting sodium reabsorption in the cortical diluting segment of the nephron. This increases the excretion of sodium and chloride, and to a lesser extent potassium and magnesium, resulting in increased urine output and 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 drugs with antipsychotics may enhance hypotensive effects. NSAIDs may reduce the antihypertensive efficacy of the drug. Angiotensin receptor blockers (ARBs) and potassium-sparing diuretics may increase the risk of hyperkalemia.

This fixed-dose combination is contraindicated in patients with hypersensitivity to perindopril, indapamide, or any other angiotensin-converting enzyme (ACE) inhibitor.

Common side effects include nausea, vomiting, dyspepsia, diarrhea, constipation, headache, dizziness, sleep disturbances, asthenia, dry mouth, hypotension, persistent dry cough, angioedema, and skin rash.

There are no adequate and well-controlled studies in pregnant women. Therefore, this medicine is not recommended during pregnancy. Breastfeeding mothers should avoid using this medicine.

This drug should be used with caution in patients with renal impairment, renal artery stenosis, heart failure, gout, diabetes, liver cirrhosis, elderly patients, atherosclerosis, and those with idiopathic or hereditary angioedema.

Overdose may cause hypotension, nausea, vomiting, cramps, dizziness, drowsiness, mental confusion, and oliguria which may progress to anuria. Electrolyte imbalance such as hyponatremia and hypokalemia may also occur. Management includes gastric lavage or activated charcoal, along with monitoring and correction of fluid and electrolyte balance.

Combined antihypertensive preparations

Store below 30°C.