Perindopril: clinical use

Prescribing considerations

• Assess blood pressure, renal function, electrolytes and volume status before treatment and after clinically significant changes.
• Marked hypotension is more likely with volume or salt depletion, diuretic treatment, severe heart failure or renin-dependent hypertension.
• Use caution with renal impairment, suspected renovascular disease, aortic or mitral stenosis, hypertrophic cardiomyopathy and ischaemic heart or cerebrovascular disease.
• Review treatment during acute dehydrating illness and before major surgery or general anaesthesia.
• Persistent ACE-inhibitor cough may require an alternative medicine.

Contraindications and cautions

• Hypersensitivity to perindopril, an excipient or another ACE inhibitor.
• Previous ACE-inhibitor-associated angioedema, or hereditary or idiopathic angioedema.
• Concomitant sacubitril/valsartan treatment.
• Concomitant aliskiren in patients with diabetes or qualifying renal impairment.
• Second or third trimester of pregnancy.

Monitoring

• Monitor blood pressure and symptoms of hypotension.
• Check renal function, serum potassium and sodium before treatment and following treatment changes.
• Continue periodic renal function and electrolyte checks, with increased frequency for higher-risk patients.
• Investigate clinically important rises in creatinine or potassium.
• Advise patients to report facial or airway swelling immediately.

Clinical pharmacology

Perindopril is an orally absorbed prodrug converted to the active ACE inhibitor perindoprilat. Perindoprilat reduces angiotensin II and aldosterone activity while increasing bradykinin-mediated vasodilation; it is principally eliminated through the kidneys.

Formulation and product differences

• Perindopril erbumine is also called perindopril tert-butylamine.
• Perindopril arginine and erbumine work similarly, but their labelled strengths are not directly interchangeable; verify the salt and prescription when switching products.
• The tablet formulation contains hydroxypropylbetadex and should be stored in its original moisture-protective packaging.

Tablet

Route: Oral

Strengths: 2 mg, 4 mg, 8 mg