• Dosage of Prexanil in details
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Dosage of Prexanil in details

Prexanil Dosage

Generic name: Prexanil 2mg

Dosage form: tablet

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Hypertension

Use in Uncomplicated Hypertensive Patients: In patients with essential hypertension, the recommended initial dose is 4 mg once a day. The dose may be titrated, as needed to a maximum of 16 mg per day. The usual maintenance dose range is 4 mg to 8 mg administered as a single daily dose or in two divided doses.

Use in Elderly Patients: The recommended initial daily dosage of Prexanil for the elderly is 4 mg daily, given in one or two divided doses. Experience with Prexanil is limited in the elderly at doses exceeding 8 mg. Dosages above 8 mg should be administered with careful blood pressure monitoring and dose titration.

Use with Diuretics: In patients who are currently being treated with a diuretic, symptomatic hypotension can occur following the initial dose of Prexanil. Consider reducing the dose of diuretic prior to starting Prexanil.

Stable Coronary Artery Disease

In patients with stable coronary artery disease, Prexanil should be given at an initial dose of 4 mg once daily for 2 weeks, and then increased as tolerated, to a maintenance dose of 8 mg once daily. In elderly patients (greater than 70 years), Prexanil should be given as a 2 mg dose once daily in the first week, followed by 4 mg once daily in the second week and 8 mg once daily for maintenance dose if tolerated.

Dose Adjustment in Renal Impairment and Dialysis

Perindoprilat elimination is decreased in renally impaired patients. Prexanil is not recommended in patients with creatinine clearance <30 mL/min. For patients with lesser degrees of impairment, the initial dosage should be 2 mg/day and dosage should not exceed 8 mg/day. During dialysis, Prexanil is removed with the same clearance as in patients with normal renal function.

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What other drugs will affect Prexanil?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with Prexanil, especially:

• gold injections to treat arthritis;

• lithium;

• NSAIDs (non-steroidal anti-inflammatory drugs)--ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others;

• a potassium supplement;

• salt substitutes that contain potassium; or

• a diuretic or "water pill."

This list is not complete. Other drugs may interact with Prexanil, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Prexanil interactions

Diuretics: Patients on diuretics and especially those started recently, may occasionally experience an excessive reduction of blood pressure after initiation of Prexanil therapy. The possibility of hypotensive effects can be minimized by either discontinuing the diuretic or increasing the salt intake prior to initiation of treatment with Prexanil. If diuretics cannot be interrupted, close medical supervision should be provided with the 1st dose of Prexanil, for at least 2 hrs and until blood pressure has stabilized for another hour.

The rate and extent of Prexanil absorption and elimination are not affected by concomitant diuretics. The bioavailability of perindoprilat was reduced by diuretics, however, and this was associated with a decrease in plasma ACE inhibition.

Potassium Supplements and Potassium-Sparing Diuretics: Prexanil may increase serum potassium because of its potential to decrease aldosterone production. Use of potassium-sparing diuretics (spironolactone, amiloride, triamterene and others), potassium supplements or other drugs capable of increasing serum potassium (indomethacin, heparin, cyclosporine and others) can increase the risk of hyperkalemia. Therefore, if concomitant use of such agents is indicated, they should be given with caution and the patient's serum potassium should be monitored frequently.

Lithium: Increased serum lithium and symptoms of lithium toxicity have been reported in patients receiving concomitant lithium and ACE inhibitor therapy. These drugs should be co-administered with caution and frequent monitoring of serum lithium concentration is recommended. Use of a diuretic may further increase the risk of lithium toxicity.

Gold: 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 including Prexanil.

Digoxin: A controlled pharmacokinetic study has shown no effect on plasma digoxin concentrations when co-administered with Prexanil, but an effect of digoxin on the plasma concentration of Prexanil/perindoprilat has not been excluded.

Gentamicin: Animal data have suggested the possibility of interaction between Prexanil and gentamicin. However, this has not been investigated in human studies. Co-administration of both drugs should proceed with caution.

Food Interaction:

Oral administration of Prexanil with food does not significantly lower the rate or extent of Prexanil absorption relative to the fasted state. However, the extent of biotransformation of Prexanil to the active metabolite, perindoprilat, is reduced approximately 43%, resulting in a reduction in the plasma ACE inhibition curve of approximately 20%, probably clinically insignificant. In clinical trials, Prexanil was generally administered in a nonfastingstate.

References

1. FDA/SPL Indexing Data. "Y5GMK36KGY: The UNique Ingredient Identifier (UNII) is an alphanumeric substance identifier from the joint FDA/USP Substance Registration System (SRS).". https://www.fda.gov/ForIndustry/Data... (accessed September 17, 2018).
2. MeSH. "Antihypertensive Agents". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
3. European Chemicals Agency - ECHA. "1H-Indole-2-carboxylic acid, 1-[(2S)-2-[[(1S)-1-(ethoxycarbonyl)butyl]amino]-1-oxopropyl]octahydro-, (2S,3aS,7aS): The European Chemicals Agency (ECHA) is an agency of the European Union which is the driving force among regulatory authorities in implementing the EU's groundbreaking chemicals legislation for the benefit of human health and the environment as well as for innovation and competitiveness.". https://echa.europa.eu/ (accessed September 17, 2018).

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Information checked by Dr. Sachin Kumar, MD Pharmacology