amlodipine + perindopril: clinical use

Prescribing considerations

• Use only as substitution therapy in patients controlled on corresponding separate components; unsuitable for initiation or titration.
• Consider volume depletion, hypotension, renal or hepatic impairment, heart failure, valve obstruction, diabetes and medicines that raise potassium.
• Review during significant vomiting, diarrhoea or other dehydration-producing illness.
• Efficacy and tolerability have not been established in children or adolescents.

Contraindications and cautions

• Previous ACE-inhibitor-associated, hereditary or idiopathic angioedema
• Severe hypotension, shock or haemodynamically unstable heart failure after acute myocardial infarction
• Significant bilateral renal artery stenosis or stenosis affecting a single functioning kidney
• Severe left-ventricular outflow obstruction
• Second or third trimester of pregnancy
• Concomitant sacubitril/valsartan, and specified aliskiren use in diabetes or renal impairment
• Hypersensitivity to an ACE inhibitor, dihydropyridine or product excipient

Monitoring

• Blood pressure and symptoms of hypotension
• Renal function, potassium and sodium before and after clinically significant treatment changes and during intercurrent illness
• Peripheral oedema, persistent cough and angioedema
• Blood glucose where relevant, particularly with antidiabetic treatment

Clinical pharmacology

Perindopril is a prodrug converted to the active ACE inhibitor perindoprilat; food reduces this conversion. Amlodipine is a long-acting dihydropyridine calcium-channel blocker that relaxes arterial smooth muscle.

Formulation and product differences

• The selected product contains perindopril tert-butylamine and amlodipine as besilate in a fixed-dose tablet.
• Perindopril tert-butylamine and perindopril arginine are not milligram-for-milligram interchangeable; verify the salt and intended component strengths when switching.
• The tablet should remain in its original packaging to protect it from light and moisture.

Tablet

Route: Oral

Strengths: 4 mg + 10 mg, 4 mg + 5 mg, 8 mg + 10 mg, 8 mg + 5 mg