Adult: As perindopril erbumine: Initially, 4 mg once daily, may be titrated according to clinical response. Max: 8 mg daily. As perindopril arginine: Initially, 5 mg once daily, may be titrated according to clinical response. Max: 10 mg daily. Patient with renovascular hypertension, volume depletion, severe hypertension or patient on diuretics: As perindopril erbumine: Initially, 2 mg once daily; As perindopril arginine: 2.5 mg once daily. Elderly: As perindopril erbumine: Initially, 2 mg once daily, may increase dose to 4 mg if necessary. Max: 8 mg daily. As perindopril arginine: 2.5 mg once daily, may increase dose to 5 mg if necessary. Max: 10 mg daily.
Oral Heart failure
Adult: As perindopril erbumine: Initially, 2 mg once daily, preferably in the morning, may adjust according to clinical response. Usual maintenance dose: 4 mg once daily. As perindopril arginine: Initially, 2.5 mg once daily, preferably in the morning, may adjust dose according to clinical response. Usual maintenance dose: 5 mg once daily.
Oral Stable coronary artery disease
Adult: As perindopril erbumine: Initially, 4 mg once daily for 2 weeks, may be titrated according to clinical response. Max dose: 8 mg daily. As perindopril arginine: Initially, 5 mg once daily for 2 weeks, may be titrated according to clinical response. Max dose: 10 mg daily. Elderly: As perindopril erbumine: Initially, 2 mg once daily for 1 week, then may increase dose to 4 mg once daily, may further titrate to 8 mg once daily according to clinical response. As perindopril arginine: Initially, 2.5 mg once daily for 1 week, then may increase dose to 5 mg once daily, may further titrate to 10 mg once daily according to clinical response.
2 mg (as perindopril erbumine) or 2.5 mg (as perindopril arginine) on dialysis days.
2 mg (as perindopril erbumine) or 2.5 mg (as perindopril arginine) every other day.
2 mg (as perindopril erbumine) or 2.5 mg (as perindopril arginine) once daily.
Should be taken on an empty stomach.
History of angioedema related to previous ACE inhibitor treatment, hereditary or idiopathic angioedema, bilateral or unilateral renal stenosis, patients with extracorporeal treatments leading to contract of blooding with negatively charged surfaces. Concomitant use with aliskiren especially in patient with diabetes mellitus or renal impairment (GFR <60 mL/min/1.73 m2). Concomitant use with sacubitril/valsartan. Pregnancy and lactation.
Patient with hypertrophic cardiomyopathy with outflow tract obstruction, salt or volume depletion, collagen vascular disease (e.g. SLE, scleroderma), severe mitral valve and aortic stenosis, ascites due to cirrhosis, refractory ascites, diabetes, primary aldosteronism, CV disease (e.g. ischaemic heart disease). Patients undergoing major surgery or during anaesthesia. Black race. Desensitisation treatment (e.g. hymenoptera venom). Renal and hepatic impairment. Elderly.
Significant: Cholestatic jaundice, hypotension, syncope, hyperkalaemia, cough, neutropenia, agranulocytosis, anaemia, thrombocytopenia. Cardiac disorders: Palpitations, tachycardia. Ear and labyrinth disorders: Tinnitus. Eye disorders: Visual disturbance. Gastrointestinal disorders: Nausea, constipation, diarrhoea, dyspepsia, vomiting, abdominal pain. General disorders and admin site conditions: Asthenia, peripheral oedema. Immune system disorders: Urticaria. Investigations: Elevated BUN, increased serum creatinine, increased serum bilirubin. Musculoskeletal and connective tissue disorders: Muscle cramps. Nervous system disorders: Headache, paresthesia, vertigo, dysgeusia, dizziness. Psychiatric disorders: Mood disturbances, sleep disorders. Renal and urinary disorders: Renal insufficiency, proteinuria. Reproductive system and breast disorders: Erectile dysfunction. Respiratory, thoracic and mediastinal disorders: Dyspnoea, bronchospasm. Skin and subcutaneous tissue disorders: Pruritus, rash. Vascular disorders: Vasculitis, flushing, impaired peripheral circulation, epistaxis, Raynaud’s phenomenon. Potentially Fatal: Angioedema, arrhythmia. Rarely, fulminant hepatic necrosis.
Monitor BP, BUN, serum K and creatinine levels, renal function, CBC with differential. Monitor for signs of angioedema and assess pregnancy status.
Symptoms: Hypotension, bradycardia, circulatory shock, renal failure, hyperventilation, electrolyte disturbances, tachycardia, palpitations, dizziness, anxiety, and cough. Management: Administer IV infusion of NaCl 0.9%. If hypotension occurs, place the patient in shock position. May also consider administration of angiotensin II infusion and/or IV catecholamines. Haemodialysis may be beneficial.
Increased hypotensive effect with antihypertensive agents, diuretics, nitrates and baclofen. Increased risk of hyperkalaemia with K-sparing diuretics (e.g. spironolactone, eplerenone), K supplements, or other agents affecting serum K concentrations (e.g. trimethoprim, ciclosporin, heparin). May increase hypoglycaemic effect with insulin and oral hypoglycaemics agents. Increased risk of angioedema with mammalian target of rapamycin (mTOR) inhibitors (e.g. temsirolimus, sirolimus, everolimus), neutral endopeptidase (NEP) inhibitors (e.g. racecadotril), and dipeptidyl peptidase-IV (DPP-IV) inhibitors (e.g. sitagliptin, linagliptin). Concomitant use with NSAIDs including selective COX-2 inhibitors may result to renal function deterioration and reduced antihypertensive effect. May increase serum levels and toxicity of lithium. Coadministration with parenteral gold (e.g. Na aurothiomalate) may cause nitritoid reaction characterized by facial flushing, nausea, vomiting, and hypotension. Potentially Fatal: Increased risk of hypotension, hyperkalaemia, and changes in renal function with aliskiren. Increased risk of angioedema with sacubitril/valsartan. May cause anaphylactoid reactions with dextran sulfate in LDL apheresis.
May reduce hepatic biotransformation with food.
May result to false-negative aldosterone/renin ratio (ARR).
Description: Mechanism of Action: Perindopril, a prodrug of perindoprilat, is an ACE inhibitor which prevents conversion of angiotensin I to angiotensin II, thereby increasing plasma renin activity and decreasing vasoconstriction and aldosterone secretion. Onset: 1-2 hours. Pharmacokinetics: Absorption: Rapidly absorbed from the gastrointestinal tract. Slightly reduced absorption with food. Bioavailability: Approx 65-75% (perindopril); approx 25% (perindoprilat). Time to peak plasma concentration: Approx 1 hour (perindopril); 3-4 hours (perindoprilat). Distribution: Volume of distribution: Approx 0.2 L/kg (perindoprilat). Plasma protein binding: Approx 60% (perindopril); 10-20% (perindoprilat). Metabolism: Extensively metabolised in the liver via hydrolysis to by hepatic esterases to perindoprilat (as active form) and inactive metabolites including glucuronides. Excretion: Via urine (75%, 4-12% as unchanged drug). Terminal elimination half-life: 25-30 hours or longer (perindoprilat).
Store between 20-25°C. Protect from light and moisture.