Co-Prenessa 2 mg/0.625 mg, 4 mg/1.25 mg and 8 mg/2.5 mg tablets – perindopril and indapamide for high blood pressure

Co-Prenessa is a combination medicine for lowering blood pressure that contains two active substances: perindopril, from the group of angiotensin-converting enzyme inhibitors (ACE inhibitors), and indapamide, a diuretic that only slightly increases the amount of urine produced. Perindopril widens the blood vessels and makes it easier for the heart to pump, while indapamide lowers blood pressure further – together they control blood pressure.

It is used to treat high blood pressure (essential hypertension) in adults. In Serbia it is authorised in three strengths – 2 mg/0.625 mg, 4 mg/1.25 mg and 8 mg/2.5 mg (perindopril tert-butylamine/indapamide), 30 tablets each – made by Krka, and is available on prescription.

What is Co-Prenessa used for and how should it be taken?

Key facts about the medicine

What is Co-Prenessa used for?

According to the Summary of Product Characteristics, Co-Prenessa is used to treat essential hypertension (high blood pressure) in adults. Each strength has its own place in treatment:

Your doctor decides which strength is right for you.

How is it taken and dosed?

One tablet is taken daily, preferably in the morning before breakfast, with a glass of water.

• Take the medicine every day at about the same time – treatment of high blood pressure is usually lifelong.
• Do not change the strength yourself, split tablets to get a “lower dose” or stop treatment.

This is the general dosing from the leaflet – your doctor determines your dose.

Special patient groups

• Children and adolescents: the medicine should not be used (safety and efficacy have not been established).
• Elderly patients: with the 2 mg/0.625 mg strength, treatment is started with one tablet daily; for higher strengths the doctor assesses the blood pressure response and kidney function.
• Kidney impairment: in severe impairment (creatinine clearance below 30 mL/min) the medicine is contraindicated; in moderate impairment (30–60 mL/min) the maximum is one 2 mg/0.625 mg tablet daily, and the 8 mg/2.5 mg strength is contraindicated at clearance below 60 mL/min. Frequent potassium and creatinine checks are needed.
• Liver impairment: contraindicated in severe impairment; no dose adjustment in moderate impairment.

Contraindications – when the medicine must not be used

• allergy to perindopril or another ACE inhibitor, to indapamide or other sulphonamides, or to any of the excipients
• angioedema (swelling of the face, tongue or throat) with previous ACE inhibitor treatment, or hereditary/idiopathic angioedema in you or your family
• diabetes or impaired kidney function together with medicines containing aliskiren
• severe liver disease or hepatic encephalopathy
• renal artery stenosis (narrowing), dialysis or another type of blood filtration (depending on the device)
• low blood potassium
• decompensated heart failure (marked fluid retention, difficulty breathing)
• second and third trimester of pregnancy; breast-feeding
• treatment with sacubitril/valsartan (increased risk of angioedema)

Warnings and precautions

• Tell your doctor if you have aortic stenosis, hypertrophic cardiomyopathy, heart failure, kidney or liver disease, primary aldosteronism, lupus or scleroderma, atherosclerosis, hyperparathyroidism, gout or diabetes.
• Vision problems or eye pain may be signs of fluid build-up in the eye or increased eye pressure (within hours to weeks of starting treatment) – contact your doctor immediately; the risk is higher if you have previously had a penicillin or sulphonamide allergy.
• Tell your doctor if you are on a low-salt diet or use potassium-containing salt substitutes, if you have had photosensitivity reactions, or if you have muscle disorders (pain, weakness, cramps).
• Before surgery and anaesthesia, after recent diarrhoea/vomiting or dehydration, before dialysis, LDL apheresis, desensitisation to bee/wasp stings or imaging with iodine contrast – tell the doctor you are taking Co-Prenessa.
• Black patients have a higher risk of angioedema, and the medicine may be less effective.
• The medicine contains lactose; it contains less than 1 mmol sodium per tablet.

Interactions with other medicines, food and drink

• Avoid: lithium; aliskiren (in patients without diabetes or kidney impairment); potassium-sparing diuretics (triamterene, amiloride), potassium salts and other medicines that raise potassium (e.g. heparin, co-trimoxazole); estramustine; other ACE inhibitors and angiotensin receptor blockers.
• Increased risk of angioedema: racecadotril, mTOR inhibitors (sirolimus, everolimus, temsirolimus), sacubitril/valsartan, gliptins (e.g. sitagliptin, vildagliptin).
• Caution and possible dose change with: other blood pressure medicines and diuretics, eplerenone and spironolactone, anaesthetics, iodinated contrast agents, some antibiotics (moxifloxacin, erythromycin injection), methadone, heart rhythm medicines (e.g. amiodarone, sotalol, digoxin), allopurinol, corticosteroids, immunosuppressants, baclofen, diabetes medicines (metformin, insulin, gliptins), calcium and calcium supplements, stimulant laxatives (e.g. senna), NSAIDs (e.g. ibuprofen) and high doses of acetylsalicylic acid, antidepressants and antipsychotics, nitrates and other vasodilators.
• Food: take the tablet before breakfast, with a glass of water.

Pregnancy and breast-feeding

If you are pregnant or planning a pregnancy, tell your doctor – they will advise you to stop taking the medicine before pregnancy or as soon as you know you are pregnant and prescribe another treatment. Use is not recommended in early pregnancy, and after the third month of pregnancy the medicine must not be taken because it may seriously harm the baby. Co-Prenessa must not be taken while breast-feeding.

Driving and using machines

The medicine usually does not affect alertness, but some patients may feel dizzy or weak because of lowered blood pressure; in that case the ability to drive or use machines may be reduced.

Possible side effects

• Common: low blood potassium, headache, dizziness, pins and needles, vision disturbances, ringing in the ears, cough, shortness of breath, nausea, vomiting, abdominal pain, taste disturbance, heartburn, diarrhoea, constipation, rash, itching, muscle cramps, general weakness.
• Uncommon: mood and sleep disturbances, depression, hives, purpura, skin blisters, kidney problems, impotence, sweating, increased or decreased blood potassium and sodium, drowsiness, fainting, palpitations and fast heartbeat, hypoglycaemia in diabetics, vasculitis, dry mouth, photosensitivity, joint and muscle pain, chest pain, swelling, fever, falls.
• Rare: worsening of psoriasis, reduced urine output, acute kidney failure, SIADH (dark urine, nausea, cramps, confusion, seizures).
• Very rare: irregular heart rhythm, angina, heart attack and stroke, pancreatitis, hepatitis, eosinophilic pneumonia, blood count changes, severe skin reactions (erythema multiforme, Stevens-Johnson syndrome).

Report suspected side effects to your doctor, pharmacist or ALIMS.

Overdose, missed dose and stopping treatment

• Overdose: the most common effect is low blood pressure (nausea, vomiting, cramps, dizziness, sleepiness, confusion, changes in urine output) – contact a doctor or the nearest hospital immediately; until help arrives, lying down with the legs raised may help.
• Missed dose: take the next dose at the usual time; do not take a double dose.
• Stopping treatment: treatment of high blood pressure is usually lifelong – talk to your doctor before stopping.

Related information

For additional care and support with blood pressure monitoring, see also the category Blood pressure devices – products in this category do not replace the medicine prescribed for you.

Composition, pack and manufacturer

• Active substances: perindopril tert-butylamine and indapamide – 2 mg + 0.625 mg, 4 mg + 1.25 mg or 8 mg + 2.5 mg per tablet.
• Excipients: microcrystalline cellulose, lactose monohydrate, sodium hydrogen carbonate, colloidal silicon dioxide, magnesium stearate, calcium chloride hexahydrate and crospovidone.
• Pack: carton with 3 blisters of 10 tablets (30 tablets).
• Marketing authorisation holder: KRKA-FARMA D.O.O. BEOGRAD, Jurija Gagarina 26/V/II, Belgrade. Manufacturer: Krka d.d., Novo Mesto, Šmarješka cesta 6, Novo Mesto, Slovenia.

Storage

• Store below 30 °C, in the original package to protect from moisture.
• Keep out of the sight and reach of children.
• Do not use after the expiry date stated on the pack (shelf life for the 8 mg/2.5 mg strength: 3 years).

Frequently asked questions

What is the difference between the 2 mg/0.625 mg, 4 mg/1.25 mg and 8 mg/2.5 mg strengths?

All contain the same two active substances, but in different amounts. The 2 mg/0.625 mg strength is used in essential hypertension, 4 mg/1.25 mg when blood pressure is not controlled with perindopril alone, and 8 mg/2.5 mg as a replacement for separate tablets of perindopril 8 mg and indapamide 2.5 mg. The doctor determines the strength.

When is the best time to take Co-Prenessa?

According to the leaflet, one tablet daily, preferably in the morning before breakfast, with a glass of water.

Can Co-Prenessa cause a cough?

Yes, cough is a common side effect. If it bothers you, talk to your doctor – do not stop the medicine yourself.

May I use potassium salt or potassium tablets?

Not without agreeing this with your doctor. The leaflet states that potassium supplements, potassium-containing salt substitutes and potassium-sparing diuretics should be avoided.

Sources

• ALIMS – Summary of Product Characteristics, Co-Prenessa® 8 mg/2.5 mg tablets (Serbian)
• ALIMS – Patient leaflet, Co-Prenessa® 8 mg/2.5 mg tablets (December 2023, Serbian)
• ALIMS – Summary of Product Characteristics, Co-Prenessa® 4 mg/1.25 mg tablets (Serbian)
• ALIMS – Patient leaflet, Co-Prenessa® 4 mg/1.25 mg tablets (June 2019, Serbian)
• ALIMS – Summary of Product Characteristics, Co-Prenessa® 2 mg/0.625 mg tablets (Serbian)
• ALIMS – Patient leaflet, Co-Prenessa® 2 mg/0.625 mg tablets (June 2019, Serbian)

Sources checked on: 24 October 2026.