indapamide + perindopril: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
indapamide + perindopril: clinical details
Prescribing considerations
- Confirm inadequate control with perindopril alone.
- Assess volume and sodium depletion, particularly after vomiting, diarrhoea or diuretic exposure.
- Review renal and hepatic function, diabetes, gout, aortic stenosis, heart failure, connective-tissue disease and medicines affecting potassium or renal perfusion.
- The selected product is not established for children or adolescents.
- Discuss pregnancy intentions and breastfeeding before prescribing.
Contraindications and cautions
- Previous ACE-inhibitor-associated, hereditary or idiopathic angioedema
- Severe renal impairment, dialysis, significant bilateral renal artery stenosis or stenosis affecting a single functioning kidney
- Severe hepatic impairment or hepatic encephalopathy
- Existing hypokalaemia
- Later pregnancy
- Concurrent sacubitril/valsartan
- Aliskiren in patients with diabetes or relevant renal impairment
- Hypersensitivity to perindopril, another ACE inhibitor, indapamide, sulfonamides or product excipients
Monitoring
- Blood pressure and postural hypotension symptoms
- Renal function and creatinine
- Potassium, sodium and magnesium where clinically relevant
- Glucose in diabetes and uric acid in hyperuricaemia or gout
- Dehydration, angioedema, persistent cough, muscle toxicity or visual symptoms
- White-cell count when neutropenia risk factors are present
Clinical pharmacology
Perindopril is a prodrug converted to the active ACE inhibitor perindoprilat and eliminated mainly through the kidneys. Indapamide is a sulfonamide-derived, thiazide-like diuretic that inhibits sodium reabsorption in the cortical diluting segment. Co-administration does not materially alter either component’s pharmacokinetics.
Formulation and product differences
- The selected product is a film-coated tablet containing perindopril as the arginine salt with indapamide.
- Perindopril arginine and perindopril erbumine products are labelled differently and should not be assumed directly interchangeable.
- The selected tablet contains lactose and is essentially sodium-free.
- The tablet is intended to be swallowed; suitability for crushing or alternative administration is not established.
indapamide + perindopril preparations and strengths
Tablet
Route: Oral
Strengths: 5 mg + 1.25 mg
indapamide + perindopril interactions
Important interactions include medicines affecting kidney function, potassium, blood pressure or angioedema risk.
Lithium
May raise lithium concentrations and cause toxicity; concurrent use is generally not recommended.
NSAIDs, including ibuprofen
May weaken blood-pressure control and increase kidney injury and high-potassium risks, especially with dehydration or kidney impairment.
Sacubitril/valsartan
Concurrent use is contraindicated because it substantially increases angioedema risk.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.