Coversyl Plus
Generic Name
Perindopril Arginine 4 mg + Indapamide 1.25 mg Tablet
Manufacturer
Servier
Country
France
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| coversyl plus 4 mg tablet | ৳ 23.00 | ৳ 230.00 |
Description
Overview of the medicine
Coversyl Plus 4 mg tablet is a combination medication containing an ACE inhibitor (Perindopril Arginine) and a thiazide-like diuretic (Indapamide). It is primarily used to treat essential hypertension in adults.
Uses & Indications
Dosage
Adults
Usually one tablet (Perindopril 4 mg / Indapamide 1.25 mg) once daily, preferably in the morning before a meal.
Elderly
Initiate treatment with caution. Renal function and potassium levels should be monitored. No dose adjustment is generally required in elderly patients with normal renal function.
Renal_impairment
Contraindicated in severe renal impairment (creatinine clearance < 30 ml/min). In moderate renal impairment (CrCl 30-60 ml/min), the combination may be initiated if previous monotherapy with perindopril 2 mg was well tolerated. Regular monitoring of creatinine and potassium is essential.
How to Take
Orally, once daily in the morning before a meal. Swallow the tablet whole with a glass of water.
Mechanism of Action
Perindopril inhibits Angiotensin-Converting Enzyme (ACE), reducing angiotensin II formation, leading to vasodilation, decreased aldosterone secretion, and reduced sodium/water retention. Indapamide increases the excretion of sodium, chloride, and water by inhibiting reabsorption at the cortical diluting segment of the nephron, leading to decreased blood volume and peripheral resistance.
Pharmacokinetics
Onset
Perindopril: 1 hour, peak effect 4-6 hours. Indapamide: 1-2 hours, peak effect 2 hours.
Excretion
Perindoprilat: Primarily renal. Indapamide: Primarily renal (70%) and fecal (22%).
Half life
Perindoprilat: ~17 hours (effective half-life). Indapamide: ~14-24 hours.
Absorption
Perindopril is rapidly absorbed and extensively metabolized to perindoprilat, its active metabolite. Indapamide is rapidly and completely absorbed.
Metabolism
Perindopril: Hepatic (to perindoprilat). Indapamide: Hepatic.
Side Effects
Contraindications
- Hypersensitivity to perindopril, indapamide, other ACE inhibitors, sulfonamides, or any excipients.
- History of angioedema associated with previous ACE inhibitor therapy.
- Hereditary or idiopathic angioedema.
- Severe renal impairment (creatinine clearance < 30 ml/min).
- Severe hepatic impairment or hepatic encephalopathy.
- Hypokalemia.
- Concomitant use with aliskiren-containing products in patients with diabetes mellitus or renal impairment.
- Pregnancy (second and third trimesters).
- Lactation.
Drug Interactions
Lithium
Increased serum lithium levels and toxicity.
Aliskiren
Contraindicated in diabetic or renally impaired patients due to increased risk of hyperkalemia, hypotension, and renal impairment.
Corticosteroids
Decreased antihypertensive effect.
Diuretics (e.g., furosemide)
Enhanced hypotensive effect, risk of dehydration.
NSAIDs (e.g., ibuprofen, indomethacin)
Reduced antihypertensive effect, risk of renal function deterioration.
Tricyclic antidepressants/antipsychotics
Enhanced hypotensive effect.
Antidiabetic agents (e.g., insulin, oral hypoglycemics)
Enhanced hypoglycemic effect, risk of hypoglycemia.
Potassium-sparing diuretics (e.g., spironolactone, amiloride, triamterene)
Risk of hyperkalemia.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms include hypotension, electrolyte disturbances (hyponatremia, hypokalemia), nausea, vomiting, dizziness. Management involves symptomatic and supportive measures, including intravenous saline, correction of electrolyte imbalances. Perindoprilat can be removed by hemodialysis.
Pregnancy & Lactation
Contraindicated during the second and third trimesters of pregnancy due to risk of fetal toxicity. Not recommended during the first trimester. Indapamide is excreted in breast milk; therefore, not recommended during lactation.
Side Effects
Contraindications
- Hypersensitivity to perindopril, indapamide, other ACE inhibitors, sulfonamides, or any excipients.
- History of angioedema associated with previous ACE inhibitor therapy.
- Hereditary or idiopathic angioedema.
- Severe renal impairment (creatinine clearance < 30 ml/min).
- Severe hepatic impairment or hepatic encephalopathy.
- Hypokalemia.
- Concomitant use with aliskiren-containing products in patients with diabetes mellitus or renal impairment.
- Pregnancy (second and third trimesters).
- Lactation.
Drug Interactions
Lithium
Increased serum lithium levels and toxicity.
Aliskiren
Contraindicated in diabetic or renally impaired patients due to increased risk of hyperkalemia, hypotension, and renal impairment.
Corticosteroids
Decreased antihypertensive effect.
Diuretics (e.g., furosemide)
Enhanced hypotensive effect, risk of dehydration.
NSAIDs (e.g., ibuprofen, indomethacin)
Reduced antihypertensive effect, risk of renal function deterioration.
Tricyclic antidepressants/antipsychotics
Enhanced hypotensive effect.
Antidiabetic agents (e.g., insulin, oral hypoglycemics)
Enhanced hypoglycemic effect, risk of hypoglycemia.
Potassium-sparing diuretics (e.g., spironolactone, amiloride, triamterene)
Risk of hyperkalemia.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms include hypotension, electrolyte disturbances (hyponatremia, hypokalemia), nausea, vomiting, dizziness. Management involves symptomatic and supportive measures, including intravenous saline, correction of electrolyte imbalances. Perindoprilat can be removed by hemodialysis.
Pregnancy & Lactation
Contraindicated during the second and third trimesters of pregnancy due to risk of fetal toxicity. Not recommended during the first trimester. Indapamide is excreted in breast milk; therefore, not recommended during lactation.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
36 months
Availability
Pharmacies, Hospitals
Approval Status
Approved
Patent Status
Generic versions available, original patent expired
WHO Essential Medicine
YesClinical Trials
The combination of perindopril and indapamide has been extensively studied in clinical trials, notably in trials like EUROPA, ADVANCE, and HYVET, demonstrating significant cardiovascular benefits and blood pressure reduction.
Lab Monitoring
- Serum electrolytes (potassium, sodium)
- Renal function (creatinine, BUN)
- Liver function tests
- Blood pressure
Doctor Notes
- Monitor blood pressure, renal function, and serum electrolytes (especially potassium) regularly.
- Counsel patients on the risk of angioedema and symptoms requiring immediate medical attention.
- Advise patients to take the medication consistently and not to stop abruptly.
Patient Guidelines
- Take as directed by your doctor, usually once daily in the morning before food.
- Do not stop taking the medicine abruptly without consulting your doctor.
- Report any unusual side effects, especially swelling of the face, lips, tongue, or throat.
- Avoid potassium-rich foods or supplements unless advised by your doctor.
- Stay hydrated, but avoid excessive fluid intake that could lead to electrolyte imbalance.
Missed Dose Advice
If you miss a dose, take it as soon as you remember, unless it is almost time for your next dose. Do not take a double dose to make up for a missed one.
Driving Precautions
May cause dizziness, fatigue, or lightheadedness, especially at the start of treatment or when the dose is increased. Exercise caution when driving or operating machinery.
Lifestyle Advice
- Adopt a low-sodium diet.
- Engage in regular physical activity.
- Maintain a healthy weight.
- Limit alcohol consumption.
- Quit smoking.
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