Covinace Warnings

INCREASED RISK OF BIRTH DEFECTS, FOETAL AND NEONATAL MORBIDITY AND DEATH WHEN USED THROUGHOUT PREGNANCY.
Risk of arterial hypotension and/or renal failure: considerable water and sodium depletion (strict sodium-free diet and/or diuretic treatment) or stenosis of the renal arteries causing a stimulation of the renin-angiotensin system. The blocking of this system by a converting enzyme inhibitor may then induce, in particular after the first dose and during the first two weeks of treatment, a precipitous fall in blood pressure and/or although more rarely and after a variable time, sometimes acute functional renal failure.
On institution of treatment in these specific situations, the following recommendations must be respected: In hypertension previously treated with a diuretic: The diuretic should be withdrawn at least 3 days before institution of perindopril and reinstituted later if necessary; If this is impossible, therapy should be instituted at an initial dose of 2 mg.
In renovascular hypertension, a low initial dose of 2 mg should be used (see Precautions).
Plasma creatinine should be assayed before treatment and during the month following institution of treatment.