← Search & browse all drugs
CARDIOVASCULAR SYSTEM › AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM › ACE INHIBITORS, COMBINATIONS › ACE inhibitors, other combinations
perindopril, bisoprolol, amlodipine and indapamide
C09BX06
Forms & Strengths
- Perindopril 2.5mg + Bisoprolol 5mg + Amlodipine 5mg + Indapamide 1.25mg
- Perindopril 5mg + Bisoprolol 10mg + Amlodipine 10mg + Indapamide 2.5mg
- Perindopril 10mg + Bisoprolol 10mg + Amlodipine 5mg + Indapamide 1.25mg
- Tablets
Adult Dosing
- Hypertension: 1 tablet per day, may be increased after 4-8 weeks
- Elderly: starting dose of perindopril 2.5mg, bisoprolol 2.5mg, amlodipine 2.5mg and indapamide 1.25mg per day
- Dose adjustment based on blood pressure response, up to a maximum dose of perindopril 10mg, bisoprolol 10mg, amlodipine 10mg and indapamide 2.5mg per day
Pediatric Dosing
- Not recommended for patients under 18 years of age due to limited data
- Hypertension in children and adolescents: alternative antihypertensive therapy should be considered
Indications
- Treatment of essential hypertension
- Reduction of cardiovascular risk in patients with hypertension and additional risk factors
Mechanism of Action
- Perindopril: competitive inhibition of angiotensin-converting enzyme (ACE)
- Bisoprolol: selective beta-1 adrenergic receptor blocker, decreases heart rate and myocardial contractility
- Amlodipine: calcium channel blocker, inhibits inward calcium flux
- Indapamide: thiazide-like diuretic, increases sodium and water excretion
Contraindications
- Hypersensitivity to perindopril, bisoprolol, amlodipine, indapamide, or any excipients
- Severe hepatic impairment, cirrhosis, or liver failure
- Severe renal impairment, patients on dialysis
- Unstable or acute heart failure, cardiogenic shock, or significant left ventricular outflow obstruction
- Second or third degree atrioventricular (AV) block, or sick sinus syndrome without a functioning pacemaker
- Pregnancy and breastfeeding
Adverse Reactions
- Hypotension, dizziness, headache, asthenia, fatigue
- Cough, dyspnea, orthostatic hypotension, palpitations, cardiac arrhythmias
- Nausea, vomiting, diarrhea, abdominal pain, dyspepsia
- Renal impairment, hyperkalemia, hypokalemia, hyponatremia
- Pruritus, rash, urticaria
Drug Interactions
- Potassium supplements, potassium-sparing diuretics: increased risk of hyperkalemia
- Lithium: reduced renal clearance of lithium, increased risk of lithium toxicity
- Non-steroidal anti-inflammatory drugs (NSAIDs): reduced antihypertensive effect, increased risk of acute kidney injury
- Digoxin: increased risk of bradycardia, cardiac arrhythmias
- Beta-blockers, other antihypertensive agents: additive effect on blood pressure
Curated Content: Needs Vetting Before Put to Clinical Use