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Viacoram

(amlodipine - perindopril)

How does this medication work? What will it do for me?

This is a combination medication that contains amlodipine and perindopril. Amlodipine belongs to the group of medications called calcium channel blockers. Perindopril belongs to the group of medications called angiotensin converting enzyme inhibitors (ACEIs).

This medication is used to treat mild-to-moderate high blood pressure when a combination medication is considered appropriate. Both medications relax the walls of blood vessels, but they work in different ways. This helps to reduce the workload for the heart and decrease the pressure needed to pump blood through the body.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

How should I use this medication?

The recommended starting dose of amlodipine - perindopril is one tablet containing 3.5 mg of perindopril and 2.5 mg of amlodipine, once daily. After 4 weeks, your doctor may increase your dose if your blood pressure has not been lowered enough. An additional increase in dose may be necessary 8 weeks after starting this medication if your blood pressure is still high. The maximum daily dose is 14 mg perindopril and 10 mg amlodipine.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Amlodipine - perindopril should be taken at the same time each day, preferably in the morning before breakfast.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

What form(s) does this medication come in?

3.5 mg/2.5 mg
Each white, round tablet 5 mm in diameter contains 3.5 mg of perindopril arginine and 2.5 mg of amlodipine. Nonmedicinal ingredients: lactose monohydrate, magnesium stearate, cellulose microcrystalline, and colloidal anhydrous silica.

7 mg/5 mg
Each white, round tablet, 6 mm in diameter, engraved with a version of the Servier logo on one face, contains 7 mg of perindopril arginine and 5 mg of amlodipine. Nonmedicinal ingredients: lactose monohydrate, magnesium stearate, cellulose microcrystalline, and colloidal anhydrous silica.

14 mg/10 mg
Each white, round tablet, 8 mm in diameter, engraved with 14/10 on one face and  a version of the Servier logo on the other face, contains 14 mg of perindopril arginine and 10 mg of amlodipine. Nonmedicinal ingredients: lactose monohydrate, magnesium stearate, cellulose microcrystalline, and colloidal anhydrous silica.

Who should NOT take this medication?

Do not take this medication if you:

  • are allergic to perindopril, amlodipine, or any ingredients of the medication
  • are allergic to other ACEIs (e.g., captopril, ramipril)
  • are allergic to other calcium channel blockers
  • are pregnant or planning to get pregnant
  • are breast-feeding
  • are taking aliskiren and have diabetes or moderately to severely decreased kidney function
  • are receiving certain blood treatments such as dialysis or apherisis
  • have reduced kidney function
  • have had angioedema (a serious allergic reaction that causes the area around the throat and tongue to swell) after taking any angiotensin II receptor blockers (ARBs; e.g., candesartan, losartan) or angiotensin converting enzyme inhibitors (ACEIs)
  • have been diagnosed with hereditaryor idiopathic angioedema
  • have poor heart output because of a serious heart problem (e.g., mitral valve stenosis)
  • have heart failure
  • have galactose intolerance, glucose-galactose malabsorption, or the Lapp lactase deficiency (hereditary problems with digesting and absorbing lactose)
  • have narrowing of the arteries in the kidneys

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • cough (dry, persistent)
  • diarrhea
  • dizziness
  • headache
  • itchiness
  • nausea
  • swelling of the hands, feet, or ankles
  • unusual tiredness

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • abnormal heartbeat (e.g., pounding heartbeat, slow heartbeat, fast heartbeat)         
  • signs of low blood pressure (e.g., dizziness, lightheadedness, fainting)
  • signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
  • signs of too much potassium in the body (e.g., confusion, irregular heartbeat; nervousness; numbness or tingling in hands, feet, or lips; shortness of breath or difficulty breathing; weakness or heaviness of legs)

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • signs of angioedema (e.g., swollen mouth, lips, tongue, difficulty swallowing or breathing)
  • signs of a serious allergic reaction (i.e., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
  • signs of heart attack (e.g., sudden chest pain or pain radiating to back, down arm, jaw; sensation of fullness of the chest; nausea; vomiting; sweating; anxiety)
  • signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
  • signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort
  • symptoms of angina (e.g., chest pain, sudden wheeziness, difficulty breathing or shortness of breath)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Are there any other precautions or warnings for this medication?

 Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Angioedema: Although not common, angioedema (a serious allergic reaction that causes the area around the throat and tongue to swell) may occur with ACE inhibitors, including perindopril. If you experience swelling of the face, tongue, or glottis, stop taking amlodipine - perindopril at once and seek immediate medical attention. People who have had angioedema caused by other substances may be at increased risk of angioedema while taking an ACE inhibitor such as perindopril.

Blood counts: This medication can decrease the number of neutrophils (a type of white blood cell that helps fight infection), red blood cells (which carry oxygen), and platelets (which help your blood to clot). Your doctor will do blood tests to monitor this. If you notice more frequent signs of infection (e.g., fever, chills, or sore throat) or unusual bleeding or bruising, contact your doctor.

Cough: People taking perindopril may develop a dry, persistent cough that usually disappears only after stopping or lowering the perindopril dose. Be sure to tell your doctor of any cough that does not seem to be related to a usual cause.

Diabetes: Perindopril may affect blood sugar control. If you have diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. You may need to test your blood sugar more often when you first start taking this medication.

Drowsiness/dizziness: Amlodipine - perindopril may cause drowsiness or dizziness, affecting the mental or physical abilities needed to drive or operate machinery. Avoid driving, operating machinery, or performing other hazardous tasks until you have determined how this medication affects you.

Fluid and electrolyte balance: Increases in levels of potassium in the blood may occur as a result of taking amlodipine - perindopril. This is more likely to occur if you are using certain other medications, have kidney problems or diabetes, or are taking potassium supplements or salt substitutes that contain potassium. Although this doesn’t usually cause problems, your doctor will probably want to monitor your potassium levels regularly with blood tests.

Grapefruit juice: Grapefruit juice may increase the effects of amlodipine. Avoid grapefruit juice while taking this medication.

Kidney function: Changes in kidney function have been seen in certain people who take this medication. The use of diuretics (water pills) or aliskiren may further increase the risk of kidney problems for those already at risk for this problem. If you have kidney disease or renal artery stenosis (narrowing of blood vessels in the kidneys), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Rarely, people taking this medication experience decreases in liver function, possibly leading to liver failure. Your doctor will do blood tests to monitor this. If you notice any signs of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Amlodipine is removed from the body by the liver. Reduced liver function or liver disease may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

Low blood pressure: Occasionally, blood pressure drops too low after amlodipine - perindopril is taken. This usually happens after the first or second dose or when the dose is increased. It is more likely to occur if you take aliskiren, water pills, have a salt-restricted diet, are on dialysis, are suffering from diarrhea or vomiting, or have been sweating excessively and not taking in enough fluids. If low blood pressure causes you to faint or feel lightheaded, contact your doctor.

Surgery: Certain anaesthetics (medications to put you to sleep) used during surgery cause decreased blood pressure. Perindopril blocks the body’s natural response to these sudden reductions in blood pressure, which may be dangerous during surgery. If you are scheduled to have surgery and are taking perindopril - amlodipine, talk to your doctors about stopping the medications for surgery.

Pregnancy: ACE inhibitors such as perindopril may cause severe harm or death to a developing baby if taken by the mother during pregnancy. This medication should not be used during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: Medications in the ACEI family have been reported to pass into breast milk. If you are a breast-feeding mother and are taking amlodipine - perindopril, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

Seniors: Amlodipine - perindopril has not been studied for use by seniors and should not be prescribed for seniors.

What other drugs could interact with this medication?

There may be an interaction between amlodipine - perindopril and any of the following:

  • abiraterone acetate
  • acetylsalicylic acid (ASA)
  • alpha blockers (e.g., alfuzosin, doxazosin, tamsulosin)
  • aliskiren
  • allopurinol
  • amifostine
  • amiodarone
  • amphetamines (e.g., dextroamphetamine, lisdexamphetamine)
  • other angiotensin converting enzyme inhibitors (ACEIs; captopril, ramipril)
  • angiotensin receptor blockers (ARBs; e.g., candasartan, irbesartan, losartan)
  • antipsychotics (e.g., clozapine, olanzapine, quetiapine, risperidone)
  • aprepitant
  • azathioprine
  • “azole” antifungals (e.g., itraconazole, ketoconazole, voriconazole)
  • baclofen
  • barbiturates (e.g., butalbital, pentobarbital, phenobarbital)
  • beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
  • bicalutamide
  • boceprevir
  • bosentan
  • brimonidine
  • other calcium channel blockers (e.g., diltiazem, nifedipine, verapamil)
  • calcium supplements (e.g., calcium carbonate, calcium citrate)
  • carbamazepine
  • ciprofloxacin
  • clopidogrel
  • cobicistat
  • conivaptan
  • crizotinib
  • cyclosporine
  • dabrafenib
  • dasatinib
  • deferasirox
  • desipramine
  • dexamethasone
  • diabetes medications (e.g., chlorpropamide, glipizide, glyburide, insulin, metformin, nateglinide, rosiglitazone)
  • diuretics (water pills; e.g., furosemide, hydrochlorothiazide, triamterene)
  • dronedarone
  • duloxetine
  • enzalutamide
  • eplerenone
  • everolimus
  • ferric gluconate
  • gold salts
  • grapefruit juice
  • grass pollen allergen extract
  • heparin
  • hepatitis C antiviral combinations (e.g., ombitasvir - paritaprevir - ritonavir - dasabuvir, ombitasvir - paritaprevir - ritonavir)
  • HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delaviridine, efavirenz, etravirine, nevirapine)
  • HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
  • hydrocodone
  • imatinib
  • ivacaftor
  • levodopa
  • lithium
  • lomitapide
  • low-molecular-weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
  • macrolide antibiotics (e.g., clarithromycin, erythromycin)
  • magnesium supplements (magnesium hydroxide, magnesium-containing antacids)
  • medications that increase the level of potassium in the blood (e.g., spironolactone, amiloride, triamterene, or salt substitutes that contain potassium)
  • mifepristone
  • mitotane
  • melatonin
  • methylphenidate
  • metronidazole
  • modafinil
  • nefazodone
  • nitrates (isosorbide dinitrate, nitroglycerin)
  • non-steroidal anti-inflammatory medications (NSAIDs; e.g., diclofenac, ibuprofen, naproxen)
  • norfloxacin
  • pentoxifylline
  • phenobarbital
  • phenytoin
  • phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
  • pregabalin
  • primidone
  • quinidine
  • quinine
  • rasagiline
  • rifabutin
  • rifampin
  • ropinirole
  • sacubitril
  • St. John's wort
  • selegiline
  • sertraline
  • siltuximab
  • simeprevir
  • simvastatin
  • sirolimus
  • sodium phosphates
  • stiripentol
  • tacrolimus
  • temsirolimus
  • tizanidine
  • tocilizumab
  • tolvaptan
  • trimethoprim
  • yohimbine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2017. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Viacoram

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