Triplixam tablets p/o 5mg/1.25mg/5mg №30

Name Triplixam tab. p / captive ob. 5mg/1.25mg/5mg per vial No. 30 in the pack. No. 1 Main active ingredient Perindopril + indapamide + amlodipine Release form tablets Dosage 5 mg / 1.25 mg / 5 mg Pharmacological properties Triplixam is a combined antihypertensive agent, which includes 3 components. Perindopril arginine – an angiotensin-converting enzyme inhibitor, inhibits the effect of angiotensin-converting enzyme, which catalyzes the conversion of angiotensin-I to angiotensin-II peptide, which has vasoconstrictive activity. Helps restore the elasticity of large arterial vessels, reduces left ventricular hypertrophy, reduces pressure in the pulmonary capillaries. Reduces myocardial hypertrophy, normalizes the isoenzyme profile of myosin; normalizes the work of the heart. Indopamide is a diuretic that has an antihypertensive effect. It acts at the level of blood vessels and kidneys, reduces peripheral total vascular resistance and the tone of smooth arterial muscles. Minimizes left ventricular hypertrophy. Amlodipine is an L-type calcium channel blocker. It blocks the flow of calcium ions through the membranes into the smooth muscle cells of the myocardium and blood vessels. The mechanism of hypotensive action is due to a decrease in the tone of the vascular wall. Indications for use Triplixam is indicated for the treatment of arterial hypertension in patients who require treatment with perindopril, indapamide and amlodipine at a dose available in a fixed combination Dosage and Administration For oral administration. 1 tablet Triplixam once a day, preferably in the morning before meals. The use of a fixed combination is not intended for initial therapy. If necessary, the dose of a fixed combination of Triplixam can be changed or an individual selection of doses separately for each component can be recommended. Patients with impaired renal function. In severe renal failure (creatinine clearance below 30 ml / min), treatment with the drug is contraindicated. In patients with moderate renal insufficiency (creatinine clearance – 30-60 ml / min), the appointment of Triplixam at a dose of 10 mg / 2.5 mg / 5 mg and 10 mg / 2.5 mg / 10 mg is contraindicated. Routine medical supervision should include frequent monitoring of blood creatinine and potassium levels. Elderly patients. It should be borne in mind that the withdrawal of perindoprilat in elderly patients is reduced. Appointment of the drug Triplixam to elderly patients is possible taking into account the function of the kidneys. Patients with impaired liver function. Triplixam is contraindicated in patients with severe hepatic impairment. Triplixam should be used with caution in patients with mild to moderate hepatic impairment due to the lack of dosage recommendations for amlodipine. Use during pregnancy and lactation Pregnancy. Triplixam is contraindicated in pregnancy. Perindopril. The use of ACE inhibitors is contraindicated during pregnancy. Epidemiological data on the risk of a teratogenic effect due to the use of ACE inhibitors during the first trimester of pregnancy are inconclusive, so a slight increase in risk cannot be ruled out. The drug should not be used by pregnant women or women who plan to become pregnant. If pregnancy is confirmed during treatment with the drug, its use must be immediately discontinued and replaced with another drug approved for use in pregnant women. It is known that the use of ACE inhibitors during the II and III trimesters of pregnancy leads to fetotoxicity and neonatal toxicity. If a woman has been taking ACE inhibitors with an II trimester of pregnancy, the child is recommended to have an ultrasound examination of the function of the kidneys and bones of the skull. Children whose mothers have taken ACE inhibitors during pregnancy should be carefully monitored for hypotension. Indapamide. Data on the use of indapamide during pregnancy are limited (less than 300 cases). With prolonged use of thiazide diuretics in the third trimester of pregnancy, a possible decrease in circulating blood volume and uteroplacental blood supply, which can lead to fetoplacental ischemia and fetal growth retardation. In addition, occasionally in newborns, hypoglycemia and thrombocytopenia were observed. Animal studies have shown no direct or indirect toxic effects on reproduction. Amlodipine. The safety of amlodipine in pregnant women has not been established. In animal studies, toxic effects on reproduction have been found at high doses. Breastfeeding. Triplixam is contraindicated during breastfeeding. Perindopril. The use of perindopril during lactation is not recommended due to lack of data. In particular, during the period of breastfeeding a newborn or premature infant, treatment with a proven safety profile should be prescribed. Indapamide. The available information on the penetration of indapamide / metabolites into breast milk is not enough. A risk to neonates/infants cannot be ruled out. Indapamide is a thiazide-like diuretic, the use of which during lactation has been associated with a decrease and suppression of lactation. Hypersensitivity to sulfonamide derivatives, hypokalemia may also develop. Amlodipine. There is no data on whether amlodipine passes into breast milk. Fertility. perindopril and indapamide. Reproductive toxicity studies have not shown an effect on the fertility of female and male animals. No effect on human fertility is expected. Amlodipine. Reversible biochemical changes in the sperm head have been reported in some patients treated with calcium channel blockers. Clinical data regarding the potential effect of amlodipine on fertility is not enough. It is known that when conducting an animal study, a side effect of the drug on the fertility of males was revealed. Interaction with other drugs Lithium. The simultaneous use of lithium and the combination of perindopril / indapamide is usually not recommended. Double blockade of renin-angiotensin-(RAAS). There is evidence that the simultaneous use of ACE inhibitors, angiotensin II receptor blockers or aliskiren increases the risk of hypotension, hyperkalemia and decreased renal function (including acute renal failure). Therefore, dual blockade of the RAAS by concomitant administration of ACE inhibitors, angiotensin II receptor blockers, or aliskiren is not recommended. If treatment with simultaneous use of two RAAS blockers is considered absolutely necessary, it can only occur under the supervision of a specialist and with frequent close monitoring of kidney function, electrolyte levels and blood pressure. ACE inhibitors and angiotensin II receptor blockers should not be co-administered in patients with diabetic nephropathy. Potassium-sparing drugs, dietary supplements containing potassium, or salt substitutes with potassium. The simultaneous use of perindopril with potassium-sparing drugs or dietary supplements containing potassium is not recommended. Neutropenia / agranulocytosis / thrombocytopenia / anemia. Neutropenia/agranulocytosis, thrombocytopenia, and anemia have been reported among patients taking ACE inhibitors. In patients with normal renal function and in the absence of other risk factors, neutropenia rarely occurs. Perindopril should be used very carefully in patients with collagenoses, during therapy with immunosuppressants, allopurinol, procainamide, or a combination of these factors, especially if there is impaired renal function. In some of these patients, the development of serious infectious diseases was noted, in several cases resistant to intensive antibiotic therapy. In the case of prescribing perindopril to such patients, it is recommended to periodically monitor the number of leukocytes in the blood. They also report any manifestation of an infectious disease (sore throat, fever). Hypersensitivity / angioedema. Rare cases of angioedema of the face, extremities, lips, tongue, glottis and/or larynx have been reported with the use of ACE inhibitors, including perindopril. This can happen at any time during treatment. In such cases, it is necessary to urgently stop taking perindopril and establish the necessary control over the patient’s condition until the symptoms disappear completely. In the case of swelling only in the area of the face and lips, the patient’s condition usually improves without therapy, and antihistamines may be useful to relieve symptoms. Angioedema, accompanied by swelling of the larynx, can be fatal. In cases where swelling extends to the tongue, glottis, or larynx with a possibility of airway obstruction, urgent therapy is urgently needed, which may include subcutaneous administration of a 1:1000 solution of epinephrine (0.3-0.5 ml) and / or securing a patency respiratory tract. It has been reported that ACE inhibitors are more likely to cause angioedema in blacks compared to patients of other races. Patients with a history of angioedema that has not been associated with the use of ACE inhibitors have an increased risk of its occurrence when taking ACE inhibitors. Rare cases of intestinal angioedema have occurred in patients treated with ACE inhibitors. These patients developed abdominal pain (with or without nausea and vomiting); in some cases, there was no prior angioedema of the face, and the level of C-1 esterase was normal. The diagnosis of intestinal angioedema was established during computed tomography, ultrasound, or surgery. After discontinuation of the ACE inhibitor, the symptoms of angioedema disappeared. When conducting a differential diagnosis of abdominal pain that occurs in patients while taking ACE inhibitors, it is necessary to take into account the likelihood of intestinal angioedema. Anaphylactoid reactions during desensitizing therapy. Isolated cases of prolonged life-threatening anaphylactoid reactions have been reported in patients receiving ACE inhibitors during desensitizing treatment with drugs containing bee venom, wasps. ACE inhibitors should be used with caution in allergic patients after desensitization and should be avoided during immunotherapy with agents containing toxic substances of animal origin. However, in patients requiring both ACE inhibitors and desensitizing therapy, such reactions can be avoided by temporarily stopping the use of the ACE inhibitor at least 24 hours before desensitization. Anaphylactoid reactions during low-density lipoprotein (LDL) plasmapheresis. Occasionally, life-threatening anaphylactoid reactions have been observed in patients taking ACE inhibitors during LDL plasmapheresis using dextran sulfate. The development of the latter can be avoided if, before each plasmapheresis, treatment with ACE inhibitors is temporarily stopped. Patients on hemodialysis. Cases of anaphylactoid reactions have been reported in patients taking ACE inhibitors while on hemodialysis using high-flow polyacrylic membranes (eg AN 69). Such patients should be treated with a different type of dialysis membrane or a different class of antihypertensive drugs. Hepatic encephalopathy. In patients with impaired liver function, the use of thiazide and thiazide-like diuretics can cause hepatic encephalopathy. In this case, the use of diuretics should be stopped immediately. Photosensitization. Cases of photosensitivity reactions have been reported in patients taking thiazide and thiazide-like diuretics. In the event of such reactions, treatment with diuretics is recommended to be discontinued. If it is necessary to resume taking diuretics, protect vulnerable areas from the sun or sources of artificial ultraviolet radiation. Kidney function. Patients with severe renal insufficiency (creatinine clearance containing a combination of perindopril/indapamide at a dose of 10 mg/2.5 mg (i.e. Triplixam 10 mg/2.5 mg/5 mg and 10 mg/2.5 mg/10 mg) If a patient with hypertension without obvious signs of impaired renal function has laboratory signs of renal failure, the drug should be discontinued, it is possible to resume treatment with a lower dose or one of the components of the drug.Such patients should be regularly monitored for potassium and creatinine: after 2 weeks from the start of treatment and thereafter every two months during the period of therapeutic stabilization.Renal failure has been observed predominantly in patients with severe heart failure or impaired renal function, including renal artery stenosis.This combination is not recommended for patients with bilateral renal artery stenosis or arterial stenosis of a solitary kidney.Risk of arterial hypotension and/or renal insufficiency (in cases of heart failure, water and electrolyte deficiency): significant stimulation of renin-angiotensin-was observed during a pronounced deficiency of water and electrolytes (strict salt-free diet or long-term diuretic treatment) in patients with low blood pressure, in cases of renal artery stenosis , congestive heart failure or in patients with cirrhosis of the liver with edema and ascites. Blocking this system with an ACE inhibitor, especially during the first dose and during the first two weeks of treatment, can lead to a sharp decrease in blood pressure and / or an increase in plasma creatinine, which confirms the presence of functional renal failure. Sometimes it can have an acute onset and appear at any moment. In such cases, treatment should be started at a lower dose and gradually increased. In patients with ischemic heart disease or cerebrovascular disease, a significant decrease in blood pressure can lead to myocardial infarction or stroke. Thiazide and thiazide-like diuretics are most effective if there is no or minor impairment of renal function (creatinine levels are approximately below 25 mg/l, i.e. 220 µmol/l in adults). In elderly patients, plasma creatinine levels should be appropriate for age, weight and sex. Hypovolemia caused by loss of water and sodium due to diuretics at the beginning of treatment leads to a decrease in glomerular filtration rate. As a result, there may be an increase in the level of urea and creatinine in the blood. This transient functional renal failure has no consequences in patients with normal renal function, but may exacerbate existing renal failure. Patients with renal insufficiency can use amlodipine in normal doses. Fluctuations in the concentration of amlodipine in plasma do not depend on the degree of renal failure. Triplixam fixed combination studies have not been conducted in patients with impaired renal function. For patients with renal insufficiency, the dose of the fixed combination of Triplixam should correspond to the individually selected doses of the monocomponents. Hypotension, deficiency of water and electrolytes. There is a risk of a sudden decrease in blood pressure in patients with sodium deficiency (in particular in patients with renal artery stenosis). Therefore, it is necessary to systematically check for symptoms of water and electrolyte deficiency, which may occur with vomiting or diarrhea. In such patients, it is necessary to regularly monitor the level of electrolytes in the blood plasma. If severe hypotension occurs, intravenous administration of isotonic sodium chloride solution may be required. Transient arterial hypotension is not a contraindication for further administration of the drug. After restoration of circulating blood volume (CBV) and normalization of blood pressure, treatment can be started with a low dose or one of the components of the drug. Treatment with any diuretic can lead to a decrease in plasma sodium levels, which is likely to lead to serious consequences. At first, a decrease in sodium concentration may be asymptomatic, so laboratory monitoring of this indicator should be carried out regularly. More frequent monitoring is necessary for elderly patients and patients with cirrhosis of the liver. potassium level. Treatment with a combination of indapamide with perindopril and amlodipine does not exclude the possibility of hypokalemia, in particular in patients with diabetes mellitus or renal insufficiency. As with the use of any antihypertensive drug together with a diuretic, regular monitoring of plasma potassium levels should be carried out. In some patients, while taking ACE inhibitors, including perindopril, there was an increase in the concentration of potassium in the blood plasma. Risk factors for hyperkalemia include renal insufficiency, impaired renal function, age over 70 years, diabetes mellitus, intercurrent conditions such as dehydration, acute cardiac decompensation, metabolic acidosis, and concomitant use of potassium-sparing diuretics (eg, spironolactone, eplerenone, triamterene, or amiloride) , food supplements containing potassium, or its salts with potassium; taking other drugs that cause an increase in the concentration of potassium in the blood plasma (for example, heparin). The use of potassium supplements, potassium-sparing diuretics or salt substitutes with potassium, especially in patients with impaired renal function, can lead to a significant increase in plasma potassium levels. Hyperkalemia can lead to serious, sometimes fatal, arrhythmias. If the concomitant use of perindopril and any of the above substances is considered appropriate, they should be used with caution, often monitoring serum potassium levels. A decrease in plasma potassium levels and hypokalemia is the main risk with the use of thiazide and thiazide-like diuretics. In high-risk patients (elderly and/or malnourished patients, patients who take a lot of medications, patients with cirrhosis of the liver accompanied by edema and ascites, patients with coronary heart disease and patients with heart failure), it is necessary to prevent the occurrence of hypokalemia (<3.4 mmol/l). In the event of hypokalemia, the cardiotoxicity of cardiac glycosides and the risk of rhythm disturbances increase. Patients who have a prolonged QT interval of congenital or iatrogenic origin are also at risk. Hypokalemia, as well as bradycardia, can contribute to the development of severe cardiac arrhythmias, including torsades de pointes, which can be fatal. Contraindications Use in patients on hemodialysis; use in patients with untreated decompensated heart failure, severe renal failure (creatinine clearance below 30 ml / min); moderate renal failure (creatinine clearance below 60 ml/min) when taking Triplixam containing a combination of active ingredients in doses of 10 mg/2.5 mg/5 mg or 10 mg/2.5 mg/10 mg hypersensitivity to active ingredients , other sulfonamide drugs, dihydropyridine derivatives, any other ACE inhibitor or any excipients; pregnant women or women planning to become pregnant; the period of breastfeeding; angioedema (Quincke's edema) in history associated with previous treatment with ACE inhibitors; congenital or idiopathic angioedema; hepatic encephalopathy; severe liver dysfunction; hypokalemia; severe arterial hypotension; shock, including cardiogenic shock; obstruction of the exit from the left ventricle (for example, severe aortic stenosis); heart failure with unstable hemodynamics after acute myocardial infarction; simultaneous use with drugs containing the active substance aliskiren in patients with diabetes mellitus or renal insufficiency (glomerular filtration rate 2). children. There are no data on the safety and efficacy of Triplixam in children, so it is used in this age group. Composition of TRIPLIXAM 2.5 mg / 0.625 mg / 5 mg Active ingredients: 1 tablet contains perindopril arginine 2.5 mg (corresponding to 1.6975 mg of perindopril), indapamide 0.625 mg and amlodipine besylate 6.935 mg (corresponding to 5 mg of amlodipine) TRIPLIXAM 5 mg / 1.25 mg / 5 mg Active ingredients: 1 tablet contains perindopril arginine 5 mg (corresponding to 3.395 mg perindopril), indapamide 1.25 mg and amlodipine besilate 6.935 mg (corresponding to 5 mg amlodipine) TRIPLIXAM 5 mg / 1, 25 mg / 10 mg Active ingredients: 1 tablet contains perindopril arginine 5 mg (corresponding to 3.395 mg perindopril), indapamide 1.25 mg and amlodipine besilate 13.870 mg (corresponding to 10 mg amlodipine) TRIPLIXAM 10 mg / 2.5 mg / 5 mg Active ingredients: 1 tablet contains perindopril arginine 10 mg (corresponding to 6.790 mg perindopril), indapamide 2.5 mg and amlodipine besylate 6.935 mg (corresponding to 5 mg amlodipine) TRIPLIXAM 10 mg / 2.5 mg / 10 mg Active ingredients: 1 tablet ka contains perindopril arginine 10 mg (corresponding to 6.790 mg of perindopril), indapamide 2.5 mg and amlodipine besilate 13.870 mg (corresponding to 10 mg of amlodipine) Excipients: tablet: a mixture of calcium carbonate and starch, microcrystalline cellulose, croscarmellose sodium, magnesium stearate , colloidal silicon dioxide, corn starch; film coat: glycerin, hypromellose, macrogol 6000, magnesium stearate, titanium dioxide (E 171). Overdose For the combination of perindopril / indapamide, a common adverse reaction in case of overdose is arterial hypotension, which can sometimes be accompanied by nausea, vomiting, convulsions, dizziness, drowsiness, confusion, oliguria, which can progress to anuria (due to hypovolemia). There may be disturbances in the water and electrolyte balance (decrease in the level of potassium and sodium in the blood plasma). First aid measures include the rapid elimination of the drug from the body: gastric lavage and / or the appointment of activated charcoal, and then the restoration of water and electrolyte balance in a hospital until these indicators return to normal. In the event of significant hypotension, the patient should be given a horizontal position with a low headboard. If necessary, an isotonic solution is administered intravenously or any other method of restoring blood volume is used. Perindoprilat, the active form of perindopril, can be removed from the body by hemodialysis. Data on conscious overdose of amlodipine are limited. Available data suggest that very large doses will result in excessive peripheral vasodilation and reflex tachycardia. Severe, probably long-term systemic hypotheses and fatal shock have been reported. Clinically significant hypotension caused by overdose of amlodipine requires active cardiovascular care, in particular frequent monitoring of cardiac and respiratory function, elevation of the limbs, as well as monitoring of circulating blood volume and urination. The appointment of a vasoconstrictor may be useful to restore vascular tone and blood pressure, if there are no contraindications. The introduction of calcium gluconate can help eliminate the effects of calcium channel blockade. In some cases, gastric lavage is advisable. A study involving healthy volunteers showed that as a result of the use of activated charcoal 2:00 after taking 10 mg of amlodipine, the rate of absorption of amlodipine in the body decreases. Since amlodipine has a high level of binding to blood proteins, hemodialysis is considered ineffective. Side effects The most common adverse reactions observed with the use of perindopril, indapamide and amlodipine alone are: dizziness, headache, paresthesia, vertigo, drowsiness, blurred vision, tinnitus, palpitation, hot flashes, arterial hypotension (and related symptoms) , cough, shortness of breath, gastrointestinal disorders (abdominal pain, constipation, diarrhea, taste perversion (dysgeusia), dyspepsia, nausea, vomiting), itching, skin rashes, maculopapular rashes, muscle spasms, asthenia, swelling of the ankles, swelling and fatigue. Infections and invasions. Rhinitis: perindopril - very rarely, amlodipine - infrequently. From the circulatory and lymphatic systems. Agranulocytosis: perindopril and indapamide - very rare; aplastic anemia: indapamide - very rarely; pancytopenia: perindopril - very rarely; leukopenia: perindopril, indapamide, amlodipine - very rarely; neutropenia: perindopril - very rarely; hemolytic anemia: perindopril, indapamide - very rarely; thrombocytopenia: perindopril, indapamide, amlodipine - very rarely; eosinophilia: perindopril - infrequently. From the immune system. Hypersensitivity reactions: amlodipine - very rarely, indapamide - infrequently. From the side of metabolism and metabolism. Hyperkalemia, which disappears after discontinuation of the drug: perindopril - infrequently; hyperglycemia: amlodipine - very rarely; hypercalcemia: indapamide - very rarely; hypoglycemia: perindopril - infrequently; decrease in potassium levels with hypokalemia, particularly severe in high-risk patients: indapamide - frequency unknown; hyponatremia: perindopril - infrequently indapamide - the frequency is unknown. From the side of the psyche. Confusion: perindopril - very rarely, amlodipine - rarely; insomnia: amlodipine - infrequently; mood changes (including anxiety): amlodipine - infrequently, perindopril - infrequently; depression: amlodipine - infrequently; sleep disorders: perindopril - infrequently. From the side of the nervous system. Dizziness: perindopril and amlodipine - often; headache: perindopril and amlodipine - often, indapamide - rarely; paresthesia: perindopril - often, indapamide - rarely, amlodipine - infrequently; vertigo: perindopril - often, indapamide - rarely; confusion: perindopril - very rarely; hypertension: amlodipine - very rarely; peripheral neuropathy: amlodipine - very rarely; hypesthesia: amlodipine - infrequently; taste perversion (dysgeusia): perindopril - often, amlodipine - infrequently; tremor: amlodipine - infrequently; syncope: perindopril - infrequently indapamide - frequency unknown, amlodipine - infrequently; drowsiness: perindopril - infrequently amlodipine - often, extrapyramidal disorders (extrapyramidal symptoms): amlodipine - frequency unknown; stroke, possibly due to excessive lowering of blood pressure in high-risk patients: perindopril - very rare. From the organs of vision. Visual impairment: perindopril - often, indapamide - the frequency is unknown, amlodipine - infrequently; double vision: amlodipine - infrequently; myopia: indapamide - the frequency is unknown; blurred vision: indapamide - frequency unknown. From the side of the hearing organs and the labyrinth of the ear. Ringing in the ears: perindopril - often, amlodipine - infrequently. From the side of the heart. Angina pectoris: perindopril - very rarely; arrhythmia (including bradycardia, ventricular tachycardia and atrial fibrillation): perindopril, indapamide, amlodipine - very rarely; myocardial infarction may occur due to an excessive decrease in blood pressure in high-risk patients: perindopril and amlodipine - very rarely; palpitation: perindopril - infrequently; amlodipine - often; paroxysmal ventricular tachycardia of the "pirouette" type (torsade de pointes), which can be fatal: indapamide - the frequency is unknown; tachycardia: perindopril - infrequently. From the vascular system. Hot flashes: amlodipine - often; hypotension (and related symptoms): perindopril - often, indapamide - very rarely, amlodipine - infrequently; vasculitis: perindopril - infrequently; amlodipine - very rarely. From the respiratory system, chest organs and mediastinum. Cough: perindopril - often, amlodipine - very rarely; shortness of breath: perindopril - often, amlodipine - infrequently; bronchospasm: perindopril - infrequently; eosinophilic pneumonia: perindopril - very rare. From the digestive system. Pain in the abdominal region of the abdomen: perindopril and amlodipine - often; constipation: perindopril - often, indapamide - rarely, amlodipine - infrequently; diarrhea: perindopril - often, amlodipine - infrequently; dyspepsia: perindopril - often, amlodipine - infrequently; nausea: perindopril and amlodipine - often, indapamide - rarely; vomiting: perindopril - often, indapamide and amlodipine - infrequently; dry mouth: perindopril and amlodipine - infrequently, indapamide - rarely; change in the rhythm of defecation: amlodipine - infrequently; gum hyperplasia: amlodipine - very rare; pancreatitis perindopril, indapamide and amlodipine - very rare; gastritis: amlodipine - very rarely. From the digestive system. Hepatitis: perindopril and amlodipine - very rarely, indapamide - the frequency is unknown; jaundice: amlodipine - very rarely; liver dysfunction indapamide - very rare; in the presence of liver failure, hepatic encephalopathy may occur: indapamide - the frequency is unknown. From the skin and subcutaneous tissue. Quincke's edema: amlodipine - very rarely; itching: perindopril - often, amlodipine - infrequently; rash: perindopril - often, amlodipine - infrequently; maculopapular rashes: indapamide - often; urticaria: perindopril - infrequently, indapamide and amlodipine - very rarely; angioedema: perindopril - infrequently, indapamide and amlodipine - very rarely; alopecia: amlodipine - infrequently; purpura: indapamide and amlodipine - infrequently; skin discoloration: amlodipine - infrequently; hyperhidrosis: perindopril and amlodipine - infrequently; exanthema: amlodipine - infrequently; erythema multiforme: perindopril and amlodipine - very rarely; Stevens-Johnson syndrome: indapamide and amlodipine - very rare; exfoliative dermatitis: amlodipine - very rarely; toxic epidermal necrolysis: indapamide - very rarely; reaction and photosensitization: perindopril - infrequently; indapamide - frequency unknown, amlodipine - very rare; it is possible to increase the manifestation of existing systemic lupus erythematosus: indapamide - the frequency is unknown; pemphigoid: perindopril - infrequently. From the musculoskeletal system and connective tissue. Muscle spasms: perindopril - often, amlodipine - infrequently; swelling of the ankles: amlodipine - often; arthralgia: perindopril - infrequently; amlodipine - infrequently; myalgia: perindopril - infrequently, amlodipine - infrequently; back pain: amlodipine - infrequently. From the side of the kidneys and urinary. Violation of urination, nocturia, frequent urination: amlodipine - infrequently; acute renal failure: perindopril - very rarely; renal failure: perindopril - infrequently, indapamide - very rarely. From the reproductive system and mammary glands. Erectile dysfunction: perindopril and amlodipine - infrequently; gynecomastia: amlodipine - infrequently. General disorders. Asthenia: perindopril - often, amlodipine - infrequently; increased fatigue: indapamide - rarely, amlodipine - often; edema amlodipine - often; chest pain: perindopril - infrequently, amlodipine - infrequently; pain: amlodipine - infrequently; ailments: perindopril - infrequently, amlodipine - infrequently; peripheral edema perindopril - infrequently; hyperthermia: perindopril - infrequently. Research. Increase / decrease in body weight: amlodipine - infrequently; increase in the level of bilirubin in the blood: perindopril - rarely; increased levels of liver enzymes: perindopril - rarely, indapamide - the frequency is unknown, amlodipine - very rarely; increase in the level of creatinine in the blood: perindopril - infrequently; increase in the level of urea in the blood: perindopril - infrequently; decrease in hemoglobin and hematocrit: perindopril - very rarely; prolongation of the QT interval on the electrocardiogram: indapamide - the frequency is unknown; increased blood glucose levels: indapamide - the frequency is unknown; increase in the level of uric acid in the blood: indapamide - the frequency is unknown. Injury, poisoning and complications of ingestion. Fall: perindopril - infrequently. Storage conditions The drug should be stored out of the reach of children at a temperature not exceeding 25°C. Shelf life 2 years. Conditions for the implementation of the prescription. Buy Triplixam tablets p/o 5mg/1.25mg/5mg №30 5mg #30