1. Introduction
Perindopril is an angiotensin-converting enzyme (ACE) inhibitor used primarily to treat hypertension (high blood pressure), heart failure, and to reduce the risk of cardiovascular events in certain high-risk patients. It works by relaxing blood vessels, reducing blood pressure, and improving blood flow to the heart.
2. Indications
- Hypertension (high blood pressure)
- Symptomatic heart failure
- Stable coronary artery disease (to reduce the risk of myocardial infarction and stroke)
- Prevention of cardiovascular events in patients with a history of myocardial infarction, stroke, or peripheral arterial disease
3. Dosage
Adults:
- Hypertension:
- Initial dose: 4 mg once daily.
- Maintenance dose: 4–8 mg once daily.
- Heart failure:
- Starting dose: 2 mg once daily, increased to 4 mg daily if tolerated.
- Stable coronary artery disease:
- Initial dose: 4 mg once daily, increased to 8 mg daily after 2 weeks, if tolerated.
Elderly:
- Start with 2 mg once daily and titrate cautiously based on response and tolerability.
Children:
- Not recommended, as safety and efficacy have not been established in paediatric patients.
4. Administration
- Take orally, preferably in the morning, before meals for better absorption.
- Swallow tablets whole with water; do not crush or chew.
5. Forms Available
- Tablets: 2 mg, 4 mg, 8 mg
6. Side Effects
6.1 Common Side Effects:
- Dizziness
- Headache
- Fatigue
- Cough (dry, persistent)
6.2 Less Common Side Effects:
- Nausea
- Diarrhoea or constipation
- Muscle cramps
6.3 Rare but Serious Side Effects:
- Angioedema (swelling of face, lips, or tongue)
- Hyperkalaemia (elevated potassium levels)
- Severe hypotension
- Liver dysfunction or jaundice
7. Warnings
- Angioedema: ACE inhibitors can cause life-threatening angioedema. Discontinue immediately if symptoms occur.
- Hyperkalaemia: Monitor potassium levels, especially in patients taking potassium supplements or potassium-sparing diuretics.
- Hypotension: Risk of excessive blood pressure reduction in volume-depleted patients; correct dehydration before starting therapy.
8. Precautions
- Use cautiously in patients with renal artery stenosis, aortic stenosis, or hypertrophic cardiomyopathy.
- Monitor renal function closely in patients with pre-existing renal impairment.
- Avoid use during dialysis with high-flux membranes, as this can increase the risk of hypersensitivity reactions.
9. Interactions
- Potassium-sparing diuretics (e.g., spironolactone): Increased risk of hyperkalaemia.
- NSAIDs (e.g., ibuprofen): Reduced antihypertensive effect and potential worsening of renal function.
- Lithium: Increased lithium levels and risk of toxicity.
- Other antihypertensives: Additive blood pressure-lowering effects.
10. Monitoring Parameters
- Blood pressure (to ensure effective control)
- Renal function (e.g., serum creatinine, urea) before and during therapy
- Serum potassium levels to detect hyperkalaemia
- Monitor for signs of angioedema or persistent cough
11. Use in Children
- Not recommended for children as the safety and efficacy of Perindopril in paediatric patients have not been established.
12. Use in Pregnancy
- Contraindicated during pregnancy due to the risk of foetal harm, including renal dysfunction, oligohydramnios, and death. Discontinue immediately if pregnancy is detected.
13. Use in Elderly
- Use cautiously, starting at lower doses (e.g., 2 mg daily), with close monitoring of renal function and potassium levels.
14. Use in Kidney Disease
- Reduce the dose in patients with renal impairment based on creatinine clearance (CrCl):
- CrCl 30–60 mL/min: Maximum dose 4 mg/day.
- CrCl <30 mL/min: Maximum dose 2 mg/day.
15. Use in Liver Disease
- Use cautiously in patients with severe hepatic impairment. Regular monitoring of liver function is recommended.
16. Patient Counselling Points
- Take Perindopril at the same time every day, preferably in the morning before meals.
- Inform your doctor immediately if you experience swelling of the face, lips, or tongue, as this could indicate angioedema.
- Avoid potassium-rich foods (e.g., bananas, oranges) or supplements unless directed by your doctor.
- Stay hydrated but inform your doctor if you experience excessive vomiting or diarrhoea, as this may increase the risk of hypotension.
- Do not stop taking the medication suddenly without consulting your doctor.
17. Table of Brand Names, Manufacturer, and Prices in USD
Brand Name | Manufacturer | Strength/Dosage Form | Price (USD) |
---|---|---|---|
Coversyl | Servier | 4 mg Tablet | $30 (30 tablets) |
Perindopril Erbumine | Various | 4 mg Tablet | $20 (30 tablets) |
Generic Perindopril | Various | 8 mg Tablet | $15 (30 tablets) |
18. 15 FAQs (Frequently Asked Questions)
1. What is Perindopril used for?
Perindopril is used to treat high blood pressure, heart failure, and to reduce the risk of cardiovascular events.
2. How does Perindopril work?
It blocks the conversion of angiotensin I to angiotensin II, relaxing blood vessels and lowering blood pressure.
3. Can Perindopril cause a cough?
Yes, a persistent dry cough is a common side effect of ACE inhibitors, including Perindopril.
4. How long does Perindopril take to work?
It may take 1–2 weeks to see the full blood pressure-lowering effect.
5. Can Perindopril be taken during pregnancy?
No, it is contraindicated in pregnancy due to risks to the foetus.
6. Does Perindopril interact with other medications?
Yes, it interacts with potassium-sparing diuretics, NSAIDs, lithium, and other antihypertensives.
7. Can Perindopril cause swelling?
Yes, angioedema (swelling of the face, lips, or tongue) is a rare but serious side effect.
8. What should I do if I miss a dose?
Take it as soon as you remember, but skip the missed dose if it is close to the next dose. Do not double the dose.
9. Is Perindopril safe for elderly patients?
Yes, but lower starting doses and close monitoring are recommended.
10. Can Perindopril cause dizziness?
Yes, dizziness is a common side effect, especially during the initial days of treatment.
11. Should I avoid certain foods while taking Perindopril?
Avoid potassium-rich foods or supplements unless advised by your doctor.
12. Can I stop taking Perindopril abruptly?
No, stopping suddenly may worsen your condition. Consult your doctor before discontinuing.
13. Can I drink alcohol while taking Perindopril?
Limit alcohol intake, as it may increase the blood pressure-lowering effects and cause dizziness.
14. How should I store Perindopril?
Store at room temperature, away from moisture and heat.
15. Do I need regular tests while on Perindopril?
Yes, regular monitoring of blood pressure, renal function, and potassium levels is essential.