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What is Prestalia, and how does it work?
- when one medicine to lower your high blood pressure is not enough
- as the first medicine to lower your high blood pressure if your doctor decides you are likely to need more than one medicine
It is not known if Prestalia is safe and effective in children.
What are the side effects of Prestalia?
- When pregnancy is detected, discontinue Prestalia as soon as possible.
- Drugs that act directly on the renin-angiotens in system can cause injury and death to the developing fetus
Prestalia can cause serious side effects, including:
- Serious allergic reactions that can be life threatening. Stop taking Prestalia and get emergency medical help right away if you get any of these symptoms of a serious allergic reaction:
People who are black and take Prestalia have a greater risk of having a serious allergic reaction than people who are not black and take Prestalia.
- Worsening of chest pain (angina) or a heart attack (myocardial infarction) can happen after you start taking or increase your dose of Prestalia. Get emergency help if you get worse chest pain or chest pain that does not go away.
- Low blood pressure (hypotension) is most likely to happen if you also:
If you feel faint or dizzy, lie down and call your doctor right away.
- Increased amount of potassium in the blood. Your doctor will check your potassium blood level during your treatment with Prestalia.
- Kidney problems. Some people with certain conditions may develop kidney problems and may need to stop treatment with Prestalia. Call your doctor if you get swelling in your feet, ankles, or hands, or unexplained weight gain.
The most common side effects of Prestalia include:
Tell your doctor if you have any side effect that bothers you or that does not go away.
These are not all the possible side effects of Prestalia. For more information, ask your doctor or pharmacist.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800- FDA-1088.
What is the dosage for Prestalia?
- The recommended starting dose of Prestalia is 3.5/2.5 mg once daily.
- Adjust dosage according to blood pressure goals. In general, wait 7 to 14 days between titration steps.
- The maximum recommended dose is 14/10 mg once daily.
- Prestalia may be used as initial therapy if a patient is likely to need multiple drugs to achieve blood pressure goals.
- Consider use in patients unable to achieve adequate antihypertensive effect with amlodipine monotherapy because of dose-limiting peripheral edema caused by amlodipine.
- Administered as monotherapy, perindopril erbumine is an effective treatment for hypertension in oncedaily doses ranging from 4 mg to 16 mg daily.
- Amlodipine is effective in once-daily doses of 5 mg and 10 mg.
- Adverse reactions related to perindopril are generally uncommon and independent of dose, while those related to amlodipine are a mixture of dose-dependent phenomena (primarily peripheral edema) and dose-independent phenomena, the former much more common than the latter.
Dosage Adjustment In Renal Impairment
- Prestalia is not recommended in patients with creatinine clearances <30 mL/min.
- For patients with creatinine clearance between 30 and 80 mL/min (mild or moderate renal impairment), do not exceed 7/5 mg.
Monitoring In Elderly Patients (Over 65 Years Of Age)
- Monitor blood pressure for up to two weeks following titrations at dosages above 7/5 mg in patients over 65 years of age.
What drugs interact with Prestalia?
- The pharmacokinetics of perindopril and amlodipine are not altered when the drugs are co-administered.
- No drug interaction studies have been conducted with Prestalia, although studies have been conducted with perindopril and amlodipine.
- Patients taking concomitant mTOR inhibitor (e.g. temsirolimus) therapy may be at increased risk for angioedema.
- Patients taking concomitant neprilysin inhibitors may be at increased risk for angioedema.
- Patients on diuretics, especially those in whom diuretic therapy was recently instituted, may occasionally experience an excessive reduction of blood pressure after initiation of therapy with Prestalia.
- Provide close medical supervision with the first dose of Prestalia, for at least two hours and until blood pressure has stabilized for another hour.
- Perindopril can attenuate potassium loss caused by thiazide diuretics.
Potassium Supplements And Potassium-Sparing Diuretics
- Potassium-sparing diuretics (spironolactone, amiloride, triamterene, and others) or potassium supplements, or other drugs capable of increasing serum potassium (indomethacin, heparin, cyclosporine and others) can increase the risk of hyperkalemia.
- If concomitant use of such agents is indicated, the patient's serum potassium should be monitored frequently.
- Increased serum lithium levels and symptoms of lithium toxicity have been reported in patients receiving ACE inhibitors during therapy with lithium.
- When co-administering Prestalia and lithium, frequent monitoring of serum lithium levels is recommended.
- Use of a diuretic may further increase the risk of lithium toxicity.
- Nitritoid reactions (symptoms include facial flushing, nausea, vomiting, and hypotension) have been reported rarely in patients on therapy with injectable gold (sodium aurothiomalate) and concomitant ACE inhibitor therapy.
Non-Steroidal Anti-Inflammatory Agents (NSAIDS) Including Selective Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors)
- In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, co-administration of NSAIDS, including selective COX-2 inhibitors, with ACE inhibitors, including perindopril, may result in deterioration of renal function, including possible acute renal failure. These effects are usually reversible.
- Monitor renal function periodically in patients receiving perindopril and NSAID therapy.
- The antihypertensive effects of ACE inhibitors, including perindopril, may be attenuated by NSAIDS, including selective COX-2 inhibitors.
Dual Blockade Of The Renin-Angiotensin System (RAS)
- Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren is associated with increased risks of hypotension, hyperkalemia, and changes in renal function (including acute renal failure) compared to monotherapy.
- In most patients no benefit has been associated with using two RAS inhibitors concomitantly.
- In general, avoid combined use of RAS inhibitors. Closely monitor blood pressure, renal function, and electrolytes in patients on Prestalia and other agents that affect the RAS.
- Do not co-administer aliskiren with Prestalia in patients with diabetes. Avoid use of aliskiren with Prestalia in patients with renal impairment (GFR <60 mL/min).
- Co-administration of multiple doses of 10 mg of amlodipine with 80 mg simvastatin resulted in a 77% increase in exposure to simvastatin compared to simvastatin administered alone.
- Limit the dose of simvastatin in patients on amlodipine to 20 mg daily.
- A prospective study in renal transplant patients showed an average 40% increase in trough cyclosporin levels during concomitant treatment with amlodipine. Frequent monitoring of trough blood levels of cyclosporine is recommended.
- Co-administration of the moderate CYP3A inhibitor diltiazem increases the exposure to amlodipine by 60%.
- Co-administered erythromycin, also a moderate CYP3A inhibitor, does not impact the exposure to amlodipine.
- Strong CYP3A inhibitors (e.g., itraconazole) may increase the plasma concentrations of the CYP3A substrate amlodipine to a greater extent.
- Monitor for symptoms of hypotension and edema when amlodipine is co-administered with moderate or strong CYP3A inhibitors to determine the need for dose adjustment.
- No information is available on the quantitative effects of CYP3A inducers on amlodipine.
- Blood pressure should be monitored when amlodipine is co-administered with CYP3A inducers.
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Is Prestalia safe to use while pregnant or breastfeeding?
- Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death.
- Resulting oligohydramnios can be associated with fetal lung hypoplasia and skeletal deformations.
- Potential neonatal adverse effects include skull hypoplasia, anuria, hypotension, renal failure, and death.
- When pregnancy is detected, discontinue Prestalia as soon as possible.
- These adverse outcomes are usually associated with use of these drugs in the second and third trimester of pregnancy.
- Most epidemiologic studies examining fetal abnormalities after exposure to antihypertensive use in the first trimester have not distinguished drugs affecting the renin-angiotensin system from other antihypertensive agents.
- Appropriate management of maternal hypertension during pregnancy is important to optimize outcomes for both mother and fetus.
- It is not known whether perindopril or amlodipine is excreted in human milk, but radioactivity was detected in the milk of lactating rats following administration of 14C-perindopril.
- Because of the potential for adverse effects on the nursing infant, decide whether to discontinue nursing or discontinue Prestalia.
Prestalia is a prescription medicine that contains perindopril arginine, an angiotensin converting enzyme inhibitor (ACE inhibitor), and amlodipine, a calcium channel blocker. Prestalia is used to treat high blood pressure (hypertension) when one medicine to lower your high blood pressure is not enough or as the first medicine to lower your high blood pressure if your doctor decides you are likely to need more than one medicine.
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Second Source WebMD Medical Reference
High Blood Pressure (Hypertension)
High blood pressure (hypertension) is a disease in which pressure within the arteries of the body is elevated. About 75 million people in the US have hypertension (1 in 3 adults), and only half of them are able to manage it. Many people do not know that they have high blood pressure because it often has no has no warning signs or symptoms. Systolic and diastolic are the two readings in which blood pressure is measured. The American College of Cardiology released new guidelines for high blood pressure in 2017. The guidelines now state that blood normal blood pressure is 120/80 mmHg. If either one of those numbers is higher, you have high blood pressure. The American Academy of Cardiology defines high blood pressure slightly differently. The AAC considers 130/80 mm Hg. or greater (either number) stage 1 hypertension. Stage 2 hypertension is considered 140/90 mm Hg. or greater. If you have high blood pressure you are at risk of developing life threatening diseases like stroke and heart attack.REFERENCE: CDC. High Blood Pressure. Updated: Nov 13, 2017.
Pulmonary hypertension is elevated pressure in the pulmonary arteries that carry blood from the lungs to the heart. The most common symptoms are fatigue and difficulty breathing. If the condition goes undiagnosed, more severe symptoms may occur. As pulmonary hypertension worsens, some people with the condition have difficulty performing any activities that require physical exertion. While there is no cure for pulmonary hypertension, it can be managed and treated with medications and supplemental oxygen to increase blood oxygen levels.
Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)
Pseudotumor Cerebri (intracranial hypertension) is a condition where there is an increase in pressure of fluid surrounding the brain and spinal cord (cerebrospinal fluid or CSF) mimicing a brain tumor. The cause is unknown. The most common symptom is headache but also include eye-pain, vision loss and double vision. Pseudotumor cerebri is diagnosed with MRI or CAT scans and treated by discontinuing offending medications (if applicable), weight loss and diuretic medications. The condition can also be helped by repeated drainage of spinal fluid using the lumbar puncture.
Preeclampsia (Pregnancy Induced Hypertension)
Preeclampsia is related to increased blood pressure and protein in the mother's urine. Preeclampsia typically begins after the 20th week of pregnancy. When preeclampsia causes seizures, it is termed "eclampsia" and is the second leading cause of maternal death of in the US. Preeclampsia is the leading cause of fetal complications. Risk factors for preeclampsia include high blood pressure, obesity, multiple births, and women with preexisting medical conditions such as diabetes, kidney disease, rheumatoid arthritis, lupus, or scleroderma. Pregnancy planning and lifestyle changes may reduce the risk of preeclampsia during pregnancy.
Portal hypertension is most commonly caused by cirrhosis, a disease that results from scarring of the liver. Other causes of portal hypertension include blood clots in the portal vein, blockages of the veins that carry the blood from the liver to the heart, and a parasitic infection called schistosomiasis. Symptoms of portal hypertension include varices (enlarged veins), vomiting blood, blood in the stool, black and tarry stool, ascites (abnormal fluid collection within the peritoneum, the sac that contains the intestines within the abdominal cavity), confusion and lethargy, splenomegaly or enlargement of the spleen, and decreased white blood cell counts.
Hypertensive Kidney Disease
High blood pressure can damage the kidneys and is one of the leading causes of kidney failure (end-stage renal kidney disease). Kidney damage, like hypertension, can be unnoticeable and detected only through medical tests. If you have kidney disease, you should control your blood pressure. Other treatment options include prescription medications.
High Blood Pressure Treatment (Natural Home Remedies, Diet, Medications)
High blood pressure (hypertension) means high pressure (tension) in the arteries. Treatment for high blood pressure include lifestyle modifications (alcohol, smoking, coffee, salt, diet, exercise), drugs and medications such as ACE inhibitors, angiotensin receptor blockers, beta blockers, diuretics, calcium channel blockers (CCBs), alpha blockers, clonidine, minoxidil, and Exforge.
What Is High Blood Pressure (Hypertension)?
High blood pressure or hypertension is when the blood pressure readings consistently range from 140 or higher for systolic or 90 or higher for diastolic. Blood pressure readings above 180/120 mmHg are dangerously high and require immediate medical attention.
High Blood Pressure Symptoms
Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels. In some patients, symptoms may include fatigue, headaches, dizziness, confusion, sweating, chest pain and vision problems.
Treatment & Diagnosis
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