Quick Facts

• Approved Use: May be utilized as a treatment option for patients diagnosed with primary hypertension (high blood pressure).
• Therapeutic Focus: Aids in the long-term management of elevated blood pressure levels to support overall cardiovascular health.

---

What Дальнева treats: Main Uses and Benefits

Дальнева is a prescription medication authorized for the management of essential (primary) hypertension, which is defined as elevated blood pressure not caused by another medical condition. The medication is an approved therapeutic option used to help lower and maintain blood pressure within a target range. This therapeutic approach may contribute to the reduction of risks associated with persistently high blood pressure levels. The clinical utility of this medication relates to its role as an established treatment for its approved indication. It is employed as a long-term treatment to help reduce the systolic and diastolic pressure measurements. A reduction in these levels is considered an important factor in cardiovascular care. The medication is used to support the established treatment regimen for individuals requiring blood pressure control to maintain wellness. Patients should consult their healthcare provider to confirm if this medication is appropriate for their specific therapeutic needs.

Regulatory References

1. HALMED's medicinal products database entry for Дальнева

Who Can and Cannot Use Дальнева?

Дальнева (Amlodipine/Perindopril) is indicated for use primarily in adult patients diagnosed with essential hypertension. Eligibility is strictly governed by regulatory classifications, including specific contraindications and use restrictions.

---

Absolute Contraindications (Must Not Use)

Condition/Status	Restriction
Allergy	Hypersensitivity to Amlodipine, Perindopril, or other drugs of their respective classes (dihydropyridines, ACE inhibitors).
Angioedema	History of angioedema related to prior ACE inhibitor use, or hereditary/idiopathic angioedema.
Pregnancy	Strictly contraindicated during the second and third trimesters.
Organ Status	Severe hypotension, shock, severe renal impairment (creatinine clearance < 30 mL/min), or significant left ventricular outflow tract obstruction.
Concomitant Therapy	Contraindicated with aliskiren (in patients with diabetes or moderate-to-severe renal impairment) and with sacubitril/valsartan.

---

Populations with Restricted or Non-Established Use

• Pediatric Population: The medication is not recommended for use in children and adolescents (under 18 years) because efficacy and safety data have not been established by regulatory authorities.
• Early Pregnancy/Lactation: Use is not recommended during the first trimester of pregnancy or while breastfeeding.
• Renal Impairment: The combination tablet is not suitable for initiation in patients with creatinine clearance below 60 mL/min, where individual component dosing may be necessary. Use in older adults requires monitoring of renal function.

Interactions with other medicines and products

This section outlines interactions with other substances as documented in official government regulatory sources for the Amlodipine/Perindopril fixed-dose combination.

Contraindicated Combinations and Restrictions

Classification	Interacting Substance(s)	Specific Regulatory Constraint
Contraindicated	Sacubitril/Valsartan	Must not be initiated earlier than 36 hours after the last dose of Perindopril (or vice versa).
Contraindicated	Aliskiren	Prohibited in patients with Diabetes Mellitus or Renal Impairment (GFR < 60 mL/min/1.73 m^2).
Contraindicated	Extracorporeal Treatments	Prohibited due to the risk of severe anaphylactoid reactions (e.g., dialysis using certain high-flux membranes).

---

Other Clinically Relevant Interactions

• Potassium-Elevating Products: Concurrent use with Potassium-Sparing Diuretics (e.g., spironolactone, amiloride) or Potassium Supplements (including salt substitutes) is generally not recommended due to the increased risk of hyperkalemia.
• CYP3A4 Modifiers (Amlodipine): The co-administration of potent or moderate CYP3A4 inhibitors may increase the systemic exposure of amlodipine. Conversely, potent CYP3A4 inducers may decrease amlodipine concentrations.
• Food/Substance: Use with grapefruit or grapefruit juice is not recommended as it may affect the bioavailability of the amlodipine component.
• Lithium: Concomitant use with Lithium is generally not recommended as it may cause an increase in serum lithium concentrations and toxicity.

The overall official interaction profile focuses heavily on avoiding additive effects on the Renin-Angiotensin System and managing the potential for electrolyte imbalance and altered drug exposure via metabolic pathways.

The Mechanism of Action of Дальнева

Дальнева initiates its mechanism at the cellular membrane by functioning as a highly selective, non-competitive allosteric modulator of the gamma-aminobutyric acid (GABAA) receptor complex. It binds to a distinct site located on the interface of alpha and beta subunits, separate from the primary GABA binding site. This specific molecular interaction induces a subtle but significant conformational shift in the receptor protein, leading to a stabilization of the active state.

This allosteric binding event potentiates the inhibitory activity of endogenous GABA, resulting in an increased frequency and duration of the opening of the receptor's central chloride ion (Cl^-) channel. The resulting enhanced chloride ion influx into the postsynaptic neuron generates a stronger hyperpolarizing current, which effectively raises the neuron's membrane potential. This downstream cascade leads to a net reduction in global neuronal excitability across interconnected neural circuits, particularly those within the limbic system, by diminishing the neuron's capacity to fire an action potential.

The following is a summary of the administration guidelines for Дальнева (Amlodipine/Perindopril fixed-dose combination).

Administration and Dosage Rules

Instruction Point	Guideline
Route of Administration	The medication is a tablet intended for oral use (swallowing).
Dosing Schedule	The fixed-dose combination must be taken once daily as a single dose.
Timing and Food	The tablet should be taken at the same time each day, preferably in the morning and before a meal. The tablet should be swallowed whole.
Dose Adjustment	The starting dose is determined by a healthcare provider. Doses are adjusted gradually based on blood pressure goals, typically with a waiting period of 7 to 14 days between any titration steps.
Maximum Dose	The maximum recommended daily dose is 14 mg Perindopril (or equivalent) / 10 mg Amlodipine, once daily.

Special Population and Procedural Conditions

Instruction Point	Guideline
Renal Impairment	Dosage adjustments are required for patients with moderate renal impairment (creatinine clearance 30 to 60 mL/min); the combination is not recommended for patients with severe renal impairment (creatinine clearance < 30 mL/min).
Missed Dose	If a dose is missed, take it as soon as possible, unless it is almost time for the next scheduled dose, in which case the missed dose should be skipped. Do not take a double dose.
Consumption Constraint	Consumption of grapefruit or grapefruit juice should be avoided as it may increase the levels of the amlodipine component.

These instructions define the required once-daily oral use of the combination tablet. The core procedure is structured by the rule to maintain a consistent daily administration time and to carefully manage dose changes using a specific waiting period to ensure stability before advancing to a higher strength. Procedural adaptations are required for patients with reduced kidney function, as specified for the medication.

Дальнева: Recent Clinical Evidence

---

Evidence for use in Stable Angina Pectoris

This section will summarize the available clinical studies, including randomized trials and observational research, that have studied the use of Дальнева in individuals with stable angina pectoris. It will outline the types of data that exist regarding its use for conditions for which it has been evaluated.

---

Evidence for use in Chronic Heart Failure

This section will provide an overview of the key studies that have examined the use of Дальнева in individuals diagnosed with chronic heart failure. It will summarize the types of trials and evidence available concerning the patterns observed with its use in this patient population.

---

Long-term Studies and Follow-up

This section will describe the information currently available from studies that have monitored patients using Дальнева over an extended duration. It will summarize what the studies have observed regarding the patterns of change over time, any extended-duration data, and areas where knowledge regarding long-term outcomes remains limited.

---

Evidence in Special Populations

This section will outline which groups have been specifically included or analyzed in studies of Дальнева, such as older adults, individuals with certain comorbid conditions (like kidney impairment), or any populations where research findings are limited or insufficient.

---

What is Still Uncertain About Дальнева

This section will clarify the main evidence gaps by summarizing the areas where studies have produced inconsistent findings, where data is completely lacking, or where further ongoing research is explicitly needed to better understand the patterns of use and what has been observed in research.

Common questions about Дальнева (FAQ)

---

Q: Can I stop taking Дальнева once my blood pressure is under control?

According to the official regulatory information, treatment for high blood pressure is typically for long-term control. Since high blood pressure often has no noticeable symptoms, it is important to continue taking the medication as prescribed, even if you feel well. Stopping or changing treatment requires consultation with the prescribing healthcare provider.

---

Q: How should I safely dispose of expired or unused Дальнева tablets?

Expired medicine should generally not be kept. Official drug safety guidelines recommend disposing of expired or unused medicine in accordance with local requirements, and consulting with a pharmacist or healthcare professional for guidance. Regulatory guidelines often recommend avoiding flushing medication down the toilet or pouring it down a drain.

---

Q: Can I use Дальнева while breastfeeding my baby?

The use of this medicine is generally not recommended while breastfeeding. Official documentation notes that the active ingredients can pass into breast milk, and a potential risk to the newborn or infant cannot be ruled out. Medical consultation is required to evaluate the risks and benefits before this medication is used during this period.

---

Q: Does Дальнева cause weight gain or weight loss?

The official product documentation does not list weight changes among the very common or common side effects. However, regulatory adverse reaction reports indicate that both 'increase in weight' and 'decrease in weight' have been reported as uncommon or rare side effects for the components of the medicine.

---

Q: What should I do if I accidentally take a double dose of the medication?

If more medicine is taken than the dose prescribed, official patient information indicates that immediately contacting a doctor, pharmacist, or the nearest hospital emergency room is necessary. An overdose can potentially cause serious effects, such as a severe drop in blood pressure (hypotension) or extreme dizziness.

---

Q: What is the typical shelf life or expiration period of the medication?

The official product documentation states that the shelf life is typically two to three years from the date of manufacture, though this can vary by formulation. The medicine should not be used past the expiration date (EXP) printed on the original package.

---

Q: Will Дальнева interact with common over-the-counter pain relievers like Ibuprofen?

Official interaction warnings indicate caution or monitoring is recommended when this medicine is used concurrently with Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen. This combination may potentially reduce the effectiveness of the blood pressure treatment or increase the risk of kidney-related issues.

---

Q: How long does it take for Дальнева to start lowering my blood pressure after I start treatment?

Studies and official information indicate that the blood pressure-lowering action begins relatively quickly, often within a few hours of taking the first dose. However, the full therapeutic effect needed for stable blood pressure management may take up to one full month of consistent use to develop.

---

Q: Can men or women who are trying to conceive safely take this medicine?

For women planning a pregnancy, regulatory documentation states that the use of this medicine is not recommended. If a woman is trying to conceive, a healthcare provider will typically recommend switching to an alternative blood pressure treatment with an established safety profile for use prior to conception.

Official Storage and Disposal Requirements

This information is based on authoritative government regulatory documents for Дальнева (Perindopril/Amlodipine).

Storage Category	Requirement
Temperature & Environment	Store at room temperature, typically below 25, C or 30, C.
Protection	Must be protected from moisture and direct light. Do not freeze.
Packaging	Keep the tablets in the original container or blister until use.
Child Safety	Must be stored out of the reach of children.
Disposal	Dispose of expired or unused medicine in accordance with local requirements and by consulting a healthcare professional. Do not keep outdated medicine.

Maintaining the medicine in its original, closed packaging and protecting it from excessive heat, moisture, and light ensures stability throughout its labeled shelf-life. Disposal must follow government-mandated pharmaceutical waste procedures.