Perindopril (Oral)

Perindopril is an angiotensin converting enzyme (ACE) inhibitor that is used to treat hypertension (high blood pressure) or prevent heart attacks in patients who have coronary artery disease.

Overview

Perindopril erbumine (Aceon) belongs to a group of medications called ACE inhibitors. It is used to treat hypertension (high blood pressure). Managing high blood pressure helps prevent heart attacks, strokes and kidney complications. It can also be used to prevent heart attacks in patients with coronary artery disease. Manufactured under the brand name Aceon, perindopril can be administered alone or in combination with other medications.

Perindopril contains perindoprilat, which lowers high blood pressure by inhibiting angiotensin converting enzyme (ACE) activity.

Perindopril is available in a white, crystalline powder. This oral medication is available in 2 mg, 4 mg and 8 mg strengths. Inactive ingredients in this medication include lactose, colloidal silica, microcrystalline cellulose and magnesium stearate, with the 4 mg and 8 mg tablets containing iron oxide.

Conditions Treated

Type Of Medicine

  • Angiotensin converting enzyme (ACE) inhibitor

Side Effects

Alongside the intended effects, perindopril does come with some unwanted effects. Some of these side effects are mild and tend to go away as the body adjusts to medication. However, some perindopril side effects can be severe with need for medical attention.

Some of perindopril's less serious side effects include:

To manage lightheadedness and dizziness, get up slowly when rising from a sleeping or sitting position.

Although perindopril may be prescribed to prevent kidney problems or treat patients with kidney conditions, it may, on rare occasions, trigger kidney conditions or worsen an existing one. It is important that your healthcare provider monitors your kidney condition while you're on this medication. Inform your doctor right away if you notice any signs of kidney problems, including a reduction in the amount urine you expel.

Perindopril rarely causes severe (and possibly fatal) liver disease. Be sure to inform your healthcare provider right away if your notice symptoms of liver problems, such as persistent nausea and vomiting, stomach and abdominal pain, loss of appetite, dark urine and yellowing of the skin and eyes.

Some patients may experience allergic reactions to this medication. Therefore, get in touch with your healthcare provider as soon as you notice any symptoms of severe allergic reactions, such as hives, itching and swelling especially on the tongue, throat and face, rashes, breathing difficulty and severe dizziness.

Call your healthcare provider if you experience any of the following severe perindopril side effects (you may also report the side effects to the FDA at 1800-FDA-1088):

  • Feeling like you are about to pass out
  • Chills, frequent fevers, body aches, flu-like symptoms including sores in the mouth and throat
  • Reduced frequency of urination
  • Swelling or rapid weight gain
  • Increased blood potassium levels as characterized by weak pulse, slow heart rate, tingly feeling and general muscle weakness
  • Pale skin that easily bleeds when bruised
  • Jaundice (yellowing of the eyes and skin)

Dosage

Take your medication exactly as prescribed by your healthcare provider. Never take perindopril in larger or smaller amounts than recommended by your doctor, though your healthcare provider may occasionally recommend a change in your daily dosage to ensure that you get the best results.

Each dose should be taken with a full glass of water. Take plenty of water while on this medication. In addition, you may take your medication with or without food.

Treating high blood pressure

Administration to patients with uncomplicated hypertension

The recommended starting dose for patients with essential hypertension is 4 mg once per day. The dosage may be adjusted as need be to a maximum of 16 mg per day. However, the regular maintenance dose is 4 mg to 8 mg, administered as a single daily dose or divided into two doses.

Administration to elderly patients

The recommended daily perindopril dose for an elderly patient is 4 mg per day administered in one or two doses. Dosage above 8 mg per day should be administered under careful monitoring of the patient's blood pressure.

Use with diuretics

Patients who are on diuretic treatment may experience symptomatic hypotension following the onset of perindopril therapy. Thus, your doctor may recommend a reduction in the diuretic dose prior to starting perindopril therapy.

Treating stable coronary artery disease

When treating stable coronary artery disease, perindopril should be administered at a starting dose of 4 mg once per day for two weeks. This can be increased to a maximum dose of 8 mg per day. In elderly patients (older than 70 years of age), perindopril should be administered as a 2 mg dose once per day during the first week, before adjusting to 4 mg per day in the second week. This can be increased further to a maintenance dose of 8 mg per day.

Dosage adjustment in dialysis and renal impairment

Perindoprilat elimination is reduced in patients with renal impairment. Thus, perindopril is not recommended in patients with creatinine clearance that is greater than 30 ml/min. If the patient's degree of renal impairment is low, the initial dosage can be set at 2 mg/day, which can be adjusted systematically up to 8 mg/day. During dialysis sessions, perindopril tends to be removed with the same clearance as in patients with regular renal function.

Handling a missed dose

Take your medication as soon as possible. However, you may skip the missed dosage if it is almost time for your next dose. Never double dose to make up for the missed dosage.

Handling overdose

It is important that you seek immediate medical help if you experience the following symptoms of perindopril overdose: extreme lightheadedness, fainting and dizziness. You may also report perindopril overdose to the Poison Helpline at 1-800-222-1222.

Interactions

Generally, a drug interaction can change how the medicine works or increase your risk of developing serious side effects. A very serious reaction may occur if you are getting treatment for wasp or bee sting allergy while on perindopril therapy. Be sure to inform your doctor before treating bee or wasp bite.

Diuretics

Patients on diuretic medications, especially those who started recently, may experience a severe reduction on blood pressure (hypotension) during the first few days of perindopril treatment. This can be managed by reducing the dosage or discontinuing the diuretic, or increasing the patient's salt intake before initiating perindopril therapy. If diuretic treatment cannot be stopped momentarily, then the patient should be closely monitored, especially during the first few days of perindopril therapy.

Potassium supplements and potassium-sparing diuretics

Perindopril may increase the patient's serum potassium levels because it has the potential to decrease the production of aldosterone. Thus, use of potassium-sparing diuretics, such as amiloride, spironolactone and triamterene, potassium supplements and medications capable of increasing serum potassium, such as heparin, indomethacin and cyclosporine, may increase the risk of hyperkalemia. Thus, the patient's serum potassium should be closely monitored if concomitant use of such agents is required.

Lithium

Symptoms of lithium poisoning, as well as increased serum lithium, have been reported in patients on perindopril and concomitant lithium therapy combination. Thus, patients should be closely monitored for serum lithium concentration. Use of a diuretic during this treatment may further increase the risk of lithium poisoning.

Gold

Nitritoid reactions have been reported in patients on perindopril and injectable gold (sodium aurothiomalate) therapy. Symptoms of nitritoid reactions include nausea, facial flashing, hypotension and vomiting.

Medications that may affect the efficiency of perindopril:

  • Non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen, ibuprofen, celecoxib, indomethacin, diclofenac and meloxicam.
  • Potassium supplements, like Klor-con and K-Dur
  • Diuretics (water pills)
  • Potassium containing salt substitutes
  • Aliskiren
  • Sacubitril

Warnings

While on this medication, watch out for conditions that may lower your blood pressure, such as diarrhea, vomiting, profuse sweating, dialysis, heart disease, low salt in your diet and use of diuretics. Inform your doctor if you have a prolonged illness that is characterized by vomiting or diarrhea while on this medication.

It is important that you schedule regular appointments with your healthcare provider for kidney, liver and blood pressure monitoring.

If you are scheduled for a surgical procedure, inform your surgeon ahead of time that you are on perindopril therapy, as you will be required to stop this medication for a while before and after the surgery. Before checking in for surgery, inform your doctor or dentist about all the medications you are currently taking, including prescription and non-prescription medications, as well as vitamins and herbal supplements.

If you are taking perindopril for purposes of treating hypertension, keep taking your medication even if you feel fine. Often, hypertension has no symptoms, and you may be required to use blood pressure medication for quite some time.

Before taking perindopril, be sure to tell your healthcare provider if you are allergic to it, any of its ingredients, other ACE inhibitors, or if you have any other allergies including food, medications and animals. Perindopril may contain ingredients that may trigger allergic reactions and other problems to some patients. Be sure to talk to your healthcare provider for more details.

Before using perindopril, tell your healthcare provider or pharmacist if you have any underlying medical history, especially of:

  • Allergic reactions that include swelling of the tongue, throat (angioedema), and face
  • Blood filtering procedures like dialysis and LDL apheresis
  • High blood potassium levels
  • Liver and kidney diseases

Perindopril may make you dizzy, especially during the first few days of therapy. Therefore, do not perform activities that require alertness, such as driving or operating industrial machinery. Additionally, be sure to limit alcoholic beverages while taking this medication.

Profuse sweating, vomiting, and diarrhea may cause dehydration as a result of excessive loss of body fluid. Report prolonged vomiting, diarrhea and sweating to your healthcare provider. Be sure to take a lot of water to manage dehydration, unless advised otherwise by your healthcare provider.

This medication may trigger a rise in your blood's potassium levels. Thus, consult your doctor before using potassium supplements or taking salt substitutes that contain potassium while on perindopril.

Aging patients may be more sensitive to the side effects of this medications, such as severe rashes, dizziness, and high potassium levels.

Administration of medications that act on the renin-angiotensin system, like this medication does, during the second and third trimesters of pregnancy may reduce the fetus' renal function while increasing its morbidity and possibility of death. Other potential neonatal adverse effects of perindopril to the unborn baby include anuria, skull hypoplasia, renal failure and hypotension. Therefore, perindopril is not recommended for use during pregnancy, as it may harm the unborn baby. Use effective birth control while on this medication.

It is not known of this medication can be passed on to the nursing baby via breast milk. Consult your doctor before using perindopril if you are breastfeeding.

As already mentioned, do not use this medication if you are allergic to any ACE inhibitor, such as benazepril, fosinopril, captopril, enalapril, moexipril, lisinopril, quinapril, trandolapril or Ramipril.

Do not use perindopril if you have hereditary angioedema.

To be sure that you can safely take this medication, tell your healthcare provider if you have any of the following conditions:

Anaphylactoid and related reactions

Since ACE inhibitors affect the metabolism of polypeptides and eicosanoids, such as endogenous bradykinin, patients on perindopril may experience adverse events in the forms of neck and head angioedema, as well as intestinal angioedema.

Perindopril may cause symptomatic hypotension, especially in patients who are volume or salt depleted due to prolonged diuretic therapy, dialysis, dietary salt restriction, severe diarrhea and vomiting.

Perindopril therapy may cause excessive hypotension and may be associated with azotemia or oliguria, with rare fatality or acute renal failure. In patients suffering from ischemic heart disease or cerebrovascular disease, a sudden fall in blood pressure as a result of perindopril therapy could trigger cerebrovascular accident or myocardial infarction.

Patients who experience excessive hypotension while on perindopril should be placed in the supine position and, if need be, treated using an intravenous infusion of physiological saline. Perindopril therapy can be resumed after restoring the patient's blood pressure and volume.

Continued perindopril therapy has been associated with agranulocytosis, as well as bone marrow depression. This is particularly common in patients with renal impairment, especially those with collagen vascular disease, such as scleroderma or systematic lupus erythematosus.

Due to the drug's inhibition of the renin-angiotensin-aldosterone system, some patients may experience changes in renal function while on perindopril therapy. Thus, patients on perindopril should undergo periodic monitoring of their renal function.

Perindopril therapy in patients with severe congestive heart failure, where renal function may be affected by the activity of the renin-angiotensin-aldosterone system, may be associated with progressive azotemia, oliguria and, in severe cases, death, as a result of acute renal failure.

Perindopril therapy may trigger an increase in blood urea and serum creatinine levels in patients with unilateral or bilateral artery stenosis. This condition is usually reversible upon termination of perindopril therapy. Renal function should be monitored during the first week of perindopril therapy in such patients.

A rise in serum potassium has been observed in some patients on perindopril therapy. Risk factors for developing hyperkalemia include diabetes mellitus, renal insufficiency and concomitant use of agents like potassium supplements, potassium-sparing diuretics and potassium containing salt substitutes. Levels of serum potassium should be closely monitored in patients on perindopril therapy.

Due to the inhibition of the degradation of endogenous bradykinin, patients on perindopril treatment may experience a persistent cough. This is usually resolved with discontinuation of the treatment.

On rare circumstances, perindopril therapy has been linked to a syndrome that begins with cholestatic jaundice before progressing to fulminant hepatic necrosis or death. This medication should be discontinued immediately if the patient develops jaundice or experiences a considerable rise in levels of hepatic enzymes.

Perindopril may be block angiotensin II formation in patients undergoing surgery or during anesthesia with agents that cause hypotension. Inform your doctor if you are using this medication before checking in for any form of surgery that involves use of anesthesia, including dental surgery.

Storage

This medication should be stored at room temperature (20 to 25 degrees C). Keep the medication away from pets and children in the original container to avoid accidental administration.

Keep the medication away from direct sunlight, heat and moisture. Additionally, keep the medicine from freezing.

Do not flush the medication down the sink or toilet unless advised to do so. Consult your pharmacist on how to properly dispose of expired medications or medications that you no longer use.

Summary

Perindopril is an ACE inhibiting medication that is administered to patients with essential hypertension. It can be administered alone or in combination with other antihypertensive medications, such as thiazide diuretics. The medication is also used for treating patients with stable coronary artery disease.

This medication should not be used by pregnant women. In addition, taking alcoholic beverages while on this medication may lower the patient's blood pressure, while aggravating the side effects of perindopril.

Like with any other medication, perindopril does come with its share of side effects. Some of these side effects are mild and often go away as the body adjusts to medication. However, some perindopril side effects are severe and may require medical attention.

It is important that you read and understand the Patient Information Leaflet before you start taking this medication, as well as each time you go for a refill. Ask your doctor or pharmacist questions you might have with respect to the medication.

Perindopril should be taken by mouth as directed by your healthcare provider, usually once or twice per day. The dosage is based on the patient's medical condition and response to the therapy.

To minimize the risks of side effects, your healthcare provider may recommend that you start this medication with a low dosage and gradually increase the dose as your body adjusts to the medicine. However, this should be done under the close supervision of your healthcare provider.

To get the most benefit from it, be sure to follow your doctor's prescription without fail. You should take the medicine at the same time of day to help you remember. Keep taking perindopril, even if you feel well.