BMA Concise Guide to Medicine & Drugs

Perindopril

Brand name Coversyl

Used in the following combined preparation Coversyl Plus

QUICK REFERENCE

Drug group ACE inhibitor and antihypertensive drug

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes

Available as generic No

GENERAL INFORMATION

Perindopril is an ACE inhibitor, a group of drugs used to treat high blood pressure, heart failure, and to reduce the risk of cardiac events such as a heart attack in patients with certain heart conditions. The drug relaxes the muscles in the blood-vessel walls, allowing the vessels to dilate, thereby easing blood flow. Perindopril lowers blood pressure promptly, but may need to be taken for several weeks to achieve maximum effect. For heart failure, it is usually combined with a diuretic. This can give dramatic improvement, relaxing the muscle in blood vessel walls and reducing the heart’s workload.

At the start of treatment, ACE inhibitors can cause a very rapid fall in blood pressure. Therefore, the first dose is usually low and taken at bedtime so that the patient can stay lying down.

The most characteristic adverse effect of perindopril is a persistent dry cough, which may occur in up to 20 per cent of patients.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets.

Frequency and timing of doses Once daily, 30 minutes before food, usually in the morning.

Adult dosage range 2mg initially, then 4–8mg daily.

Onset of effect 30–60 minutes; full beneficial effect may take several weeks.

Duration of action 24 hours.

Diet advice Your doctor may advise you to reduce your salt intake to help control your blood pressure.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next dose is due within the next 8 hours, take a single dose now, and skip the next.

Stopping the drug Do not stop the drug without consulting your doctor; stopping the drug may lead to worsening of the underlying condition.

Exceeding the dose An occasional unintentional extra dose is unlikely to cause problems. Large overdoses may cause dizziness or fainting. Notify your doctor.

POSSIBLE ADVERSE EFFECTS

Perindopril may cause a variety of adverse effects but they are usually mild and disappear soon after treatment has started. It may also cause kidney impairment or affect the blood with long-term use (see Prolonged use). All adverse effects should be reported to your doctor. The most common effects are a persistent dry cough and a rash. More rarely, there may be mouth ulcers or a sore mouth, dizziness, sore throat, or fever. If swelling of the mouth or lips or breathing difficulties occur, stop taking the drug and contact your doctor immediately.

INTERACTIONS

Lithium Blood levels and toxicity of this drug may be raised by perindopril.

Vasodilators, diuretics, and other antihypertensives These drugs may increase the blood-pressure-lowering effect of perindopril.

Ciclosporin, potassium salts, and potassium-sparing diuretics increase the risk of high blood potassium levels with perindopril and should be avoided.

Non-steroidal anti-inflammatory drugs (NSAIDs) may reduce the effects of perindopril. There is also a risk of kidney damage when they are taken together.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have long-term kidney or liver problems.

· You have heart problems.

· You have had angioedema or a previous allergic reaction to ACE inhibitors.

· You are taking other medicines.

· You are pregnant or intend to become pregnant.

Pregnancy Not prescribed. There is evidence of harm to the developing fetus.

Breast-feeding Safety not established. Discuss with your doctor.

Infants and children Not recommended.

Over 60 Reduced dose may be necessary.

Driving and hazardous work Avoid such activities until you have learned how perindopril affects you because the drug can cause dizziness and fainting.

Alcohol Avoid. Alcohol may increase the blood-pressure-lowering and adverse effects of the drug.

Surgery and general anaesthetics Perindopril may have to be stopped before you have a general anaesthetic. Discuss with your doctor or dentist before any operation.

PROLONGED USE

No problems expected.

Monitoring Periodic checks on potassium levels, white blood cell count, kidney function, and urine are usually performed.