Acertil AR

Perindopril arginine

HTN, stable CAD. Symptomatic heart failure.

HTN Initially 5 mg once daily, may be increased to 10 mg once daily after 1 mth of treatment. Patient w/ strongly activated renin-angiotensin-aldosterone system; patient in whom diuretic cannot be discontinued Initially 2.5 mg. Patient w/ renal impairment CrCl 30-60 mL/min 2.5 mg per day; CrCl 15-30 mL/min 2.5 mg every other day; CrCl <15 mL/min (haemodialysed patient) 2.5 mg on the day of dialysis. Elderly Initially 2.5 mg once daily, may be progressively increased to 5 mg after 1 mth then to 10 mg if necessary depending on renal function. Stable CAD Initially 5 mg once daily for 2 wk, then increased to 10 mg once daily depending on renal function. Elderly 2.5 mg once daily for 1 wk, then 5 mg once daily the next wk, before increasing the dose up to 10 mg once daily depending on renal function. Symptomatic heart failure Initially 2.5 mg daily, may be increased after 2 wk to 5 mg once daily if tolerated.

Should be taken on an empty stomach: Preferably taken in the morning.

Hypersensitivity to perindopril arginine, or to any ACE inhibitor. History of angioedema associated w/ previous ACE inhibitor therapy; hereditary or idiopathic angioedema. Significant bilateral renal artery stenosis or stenosis of the artery to a single functioning kidney. Concomitant use w/ aliskiren-containing products in patients w/ DM or renal impairment (GFR <60 mL/min/1.73 m²). Concomitant use w/ sacubitril/valsartan. Extracorporeal treatments leading to contact of blood w/ negatively charged surfaces. 2nd & 3rd trimesters of pregnancy.

Risk of symptomatic hypotension. Use w/ caution in patients w/ mitral valve stenosis & obstruction in the outflow of the left ventricle eg, aortic stenosis or hypertrophic cardiomyopathy. Reports of hypersensitivity/angioedema; neutropenia/agranulocytosis, thrombocytopenia & anaemia; non-productive, persistent cough. Anaphylactoid reactions during dialysis w/ high-flux membranes, LDL apheresis w/ dextran sulphate or desensitisation. Increased risk of hypotension & renal insufficiency in patient w/ bilateral renal artery stenosis or stenosis of the artery to a single functioning kidney. Discontinue treatment if jaundice or marked elevations of hepatic enzymes develops. May be less effective in lowering BP in Black patients. Higher rate of angioedema in Black patients. Stop treatment 1 day prior to surgery. Risk of hyperkalemia. Monitor glycaemic control during the 1st mth of treatment in diabetic patients treated w/ oral antidiabetics or insulin. Combination w/ lithium, K-sparing drugs, K supplements or K-containing salt substitutes. Dual blockade of the renin-angiotensin-aldosterone system w/ ACE inhibitors, angiotensin II receptor blockers or aliskiren. Not recommended in primary aldosteronism. Rare hereditary problems of galactose intolerance, glucose-galactose malabsorption, Lapp lactase deficiency. May impair ability to drive or operate machinery. Patients w/ renal impairment. Recent kidney transplantation. Not recommended during the 1st trimester of pregnancy & during lactation. Childn <18 yr.

Dizziness, headache, paraesthesia, vertigo; visual disturbances; tinnitus; hypotension; cough, dyspnoea; abdominal pain, constipation, diarrhoea, dysgeusia; dyspepsia, nausea, vomiting; pruritus, rash; muscle cramps; asthenia.

Higher frequency of adverse events w/ other ACE inhibitors, angiotensin II receptor blockers or aliskiren. Increased occurrence of hyperkalaemia w/ K salts, K-sparing diuretics, other ACE inhibitors, angiotensin II receptor antagonists, NSAIDs, heparin, immunosuppressants; co-trimoxazole. Risk of hyperkalaemia, worsening of renal function & CV morbidity & mortality increase w/ aliskiren in diabetic or impaired renal patients. Increased risk of angioedema w/ sacubitril/valsartan; estramustine; racecadotril; mTOR inhibitors (eg, sirolimus, everolimus, temsirolimus); gliptins (eg, linagliptin, saxagliptin, sitagliptin, vildagliptin). Increased serum lithium conc & toxicity. Increased blood-glucose lowering effect of antidiabetic medicines. Increased antihypertensive effect w/ baclofen; non-K-sparing diuretics; nitroglycerin & other nitrates or other vasodilators; certain anaesth, TCAs & antipsychotics. Reduced antihypertensive effect w/ NSAIDs including aspirin ≥3 g/day; sympathomimetics. Nitritoid reactions w/ inj gold.

ACE Inhibitors/Direct Renin Inhibitors

C09AA04 - perindopril ; Belongs to the class of ACE inhibitors. Used in the treatment of cardiovascular disease.

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