Perindopril

Generic Name: Perindopril

Brand name: Aceon

What is Perindopril ?

Perindopril is one of the inhibitors of ACE. ACE stands for angiotensin converting enzyme.

Perindopril is used to treat high blood pressure(hypertension) and to prevent heart attack in people with coronary artery disease and heart failure.

Perindopril can also be used for reasons not mentioned in this guideline.

Warnings and precautions

Don’t Perindopril take if you are expecting? If you find yourself pregnant take this medication off and notify your doctor immediately.

Perindopril should not be used in the event that you’ve ever experienced angioedema. Don’t use Perindopril for more than 36 hours prior to or following a medication that contains sacubitril (such as Entresto).

Anaphylactoid and Possibly Related Reactions

Presumably, because angiotensin-converting enzyme inhibitors affect the metabolism of eicosanoids and polypeptides, including endogenous bradykinin, patients receiving ACE inhibitors (including Perindopril ) may be subject to a variety of adverse events, some of them serious. Black patients who are taking ACE inhibitors have a greater risk of developing angioedema as compared to non-blacks.
Angioedema of the head and neck: The appearance of angioedema on the lips, the face, extremities and tongue, glottis, or larynx have been reported in patients who are treated with ACE inhibitors, such as Perindopril (0.1 percent of patients who were treated with Perindopril within U.S. clinical trials).
Angioedema that is caused by an infection of the tongue larynx or glottis could be fatal. In such instances, stop Perindopril treatment right away and watch until the swelling goes away. If either the tongue or glottis or larynx is likely to cause obstruction to the airway and obstruction, you should administer the appropriate treatment like Subcutaneous Epinephrine Solution 1:1000 (0.3 to 0.5 milliliters) and then promptly.
Intestinal Angioedema: Angioedema in the intestine has been observed in patients by ACE inhibitors. Patients complained of abdominal discomfort (with or with or without vomiting or nausea) and in some cases, there was no experience of facial angioedema, and C-1 Esterase levels were in the normal range. The angioedema was detected with an abdominal CT scan or ultrasound or during surgery, and the symptoms disappeared when the patient stopped taking medication with an ACE inhibitor.
Intestinal angioedema must be considered as a differential diagnosis for patients taking ACE inhibitors that present with abdominal discomfort.¶

Hypotension

Perindopril can lead to symptoms of hypotension. Perindopril is associated with hypotension in 0.3 percent of hypertensive subjects within U.S. placebo-controlled studies. The symptoms of orthostatic hypotension were observed in 0.8 percent of patients.
Hypotension with symptoms is more likely to be seen in patients who are depleted in salt or volume due to prolonged diuretic treatment, diet-related dialysis, restriction of salt intake, and vomiting or diarrhea.
ACE inhibitors can trigger excessive hypotension. It can also be associated with oliguria, azotemia, or even acute renal failure or death. For patients suffering from an ischemic heart condition or cerebrovascular diseases, a sudden drop in blood pressure may cause a myocardial heart attack or a cerebral accident.
If you are a patient with a high risk of hypertension, Perindopril therapy should be begun under closely monitored medical supervision. Patients must be closely monitored throughout the first two weeks following treatment as well as anytime the dose of Perindopril and/or diuretic is raised.
If hypotension is excessive and the patient is unable to breathe, they should be immediately placed in a supine posture and when necessary, treated by intravenous infusion with physiological salicylate. The treatment with Perindopril is typically carried out following a recovery of blood pressure and volume.¶

Neutropenia/Agranulocytosis

ACE inhibitors have been linked with agranulocytosis as well as bone marrow depression, with the most frequent cases occurring in patients suffering from renal impairment, particularly those suffering from an underlying collagen-vascular disorder like systemic lupus, erythematosus, or scleroderma.¶

Fetal Toxicity

Pregnancy Category D

Utilization of drugs that alter the renin-angiotensin system in the third and second trimesters of pregnancies reduces the function of the fetal kidney and can increase neonatal and fetal morbidity as well as deaths. This oligohydramnios that result can be linked with fetal lung hypoplasia as well as the deformities of the skeletal system.
Possible neonatal adverse reactions include skull hypoplasia, anuria hypotension, renal failure, and even death. If pregnancy is suspected, stop Perindopril immediately if you can.¶

Impaired renal function

As a consequence of inhibiting the renin-angiotensin-aldosterone system, changes in renal function may be anticipated in susceptible individuals. Renal function must be evaluated regularly in patients taking Perindopril.
In patients with severe congestive heart failure, where renal function may depend on the activity of the renin-angiotensin-aldosterone system, treatment with ACE inhibitors, including Perindopril, may be associated with oliguria, progressive azotemia, and, rarely, acute renal failure and death.
In patients who suffer from hypertension with bilateral or unilateral renal artery stenosis of blood nitrogen as well as serum creatinine can occur. These are generally, these are reversed upon stopping medication ACE inhibitor. In such cases, the renal function must be observed during the first couple of weeks of treatment.
Certain patients treated with Perindopril have experienced small and temporary increases of blood nitrogen as well as serum creatinine. This is especially true for those who are treated concurrently with diuretics.

Hyperkalemia

The elevation of potassium levels in serum has been reported in a few patients taking ACE inhibitors, such as Perindopril. A majority of these cases were isolated values that were not to be clinically relevant and rarely an indication of withdrawal.
The risk factors that can lead to the development of hyperkalemia are diabetes mellitus, renal insufficiency, and the use of concomitant diuretics with potassium as a source and potassium supplements as well as salt substitutes containing potassium.
Serum potassium levels should be evaluated frequently in patients who are receiving Perindopril.

Cough

Most likely due to the suppression of the degradation of endogenous bradykinin. unproductive cough is documented in every ACE inhibitor, usually resolving following the discontinuation of therapy. Be aware of ACE inhibitor-induced cough as a possible diagnosis of cough.

Hepatic Failure

Infrequently ACE inhibitors can be associated with a disorder that begins with cholestatic jaundice and then progresses to fulminant liver necrosis, and even death. The mechanism behind this syndrome is not fully understood. Patients who are taking ACE inhibitors who exhibit an increase in jaundice or marked elevations in liver enzymes should stop taking treatment with the ACE inhibitor and undergo proper medical attention.

Surgery/Anesthesia

When patients undergo surgery or anesthesia using agents which cause hypotension, Perindopril could inhibit angiotensin II formation, which would normally be the result of the release of renin in response to compensatory. Hypotension due to this mechanism is controlled by volume expansion.

Before you start taking this medicine, make sure to consult your doctor.

Perindopril should not be used Perindopril in the event that you are allergic to perindopril, or if you:

You have angioedema that is hereditary;
you have recently taken the heart medication sacubitril.
You are allergic to another ACE inhibitor, including benazepril or captopril fosinopril, lisinopril moexipril, or trandolapril.

Don’t consume Perindopril in the first 36 hours prior to or after taking a medicine that includes sacubitril (such as Entresto).

If you suffer from diabetes don’t take Perindopril in conjunction with any other medication that has the ingredient aliskiren (a blood pressure medication).

It is also possible to stay clear of the use of Perindopril with aliskiren if suffering from kidney disease.

Speak to your doctor if have ever suffered from:

renal disease (or if you’re taking dialysis);
Liver disease;
Heart disease, also known as congestive heart failure;
diabetes or
connective tissue diseases like Marfan syndrome Sjogren’s syndrome, Lupus and Rheumatoid Arthritis.

Avoid using if you are pregnant. Tell your physician immediately in case you fall pregnant. Perindopril may cause injury or even death to an unborn child if you take the medication in the second or third trimester.

It is not recommended to breastfeed while using this medication. Talk to your doctor regarding any risks.

How do I take Perindopril?

Use Perindopril exactly as prescribed. Follow the directions on the prescription label and go through all the medication guides or instructions sheets. Your doctor might occasionally alter the dose you take.

Each dose should be taken with a glass full of water. Drink plenty of fluids while you take Perindopril.

You can take Perindopril in combination with food or not.

The blood pressure of your patients will need to be monitored regularly. The function of your liver or kidneys might also require to be assessed.

Contact your physician if you are experiencing persistent nausea or vomiting or sweat more than normal. It is possible to get dehydrated while taking perindopril. This could lead to lower blood pressure as well as electrolyte issues or kidney failure.

If you are undergoing surgery, inform the surgeon in advance that you’re using perindopril.

If you’re receiving treatment to treat high blood pressure you should continue taking this medication, even if you’re feeling good. The condition is often accompanied by no signs. It is possible that you will need medication to lower your blood pressure throughout your life.

Keep at room temperature, free of heat and moisture.

Dosing information

The usual adult dose for Coronary Artery Disease

Initial dose: 4 mg every day for two weeks. After that, increase the dose to maintain it as tolerated.
Dosage for maintenance 8 mg, orally at least once per day

Treatment for patients with stable coronary artery disease to decrease the risk of death from cardiovascular causes and nonfatal heart attack.

Usual Adult Dose for Hypertension:

Initial dose: 4 mg taken orally at least once per day
Maintenance dosage: 4-8 mg per day orally, in one or two divided doses
Maximum dose: 16 mg/day

Comments: If you are a patient with diuretics, think about cutting down on the dose of diuretics prior to beginning this medication.

Usual dose for a Geriatric Coronary Artery Disease

Over 70 Years:
Initial dose:
Week 1 2 mg of oral medication every day, once
Week 2. 4 mg taken orally daily, gradually increasing to the maintenance dose according to tolerance.
Dosage for maintenance 8 mg, orally at least once per day

Treatment of patients suffering from stable coronary artery disease to decrease the risk of death from cardiovascular causes and non-fatal heart attack.

Usual Dose of Hypertension for Geriatrics:

Initial dosage: 4 mg orally per day, in 1 or 2 doses.

Comments about doses that exceed 8 mg are not extensive; be sure to administer the dose with careful monitors of blood pressure and dosage adjustments.

What if I miss a dose?

Do not take the medicine for as long as you can, however, do not take any missed doses if it’s close to the time of the next dose. Don’t have two doses in one time.

How do I react if take too much?

For medical emergencies, seek emergency medical attention or contact for help at the Poison Help line at 1-800-222-1222.

What to avoid?

Do not get up too quickly from lying or sitting in a position where you could be dizzy. Start slowly and steady yourself to avoid falling.

Avoid using salt substitutes or potassium supplements unless your physician has advised you to.

Perindopril side effects

See a doctor immediately If you notice symptoms that indicate an allergy reaction Perindopril: hives and stomach pains that are severe or breathing difficulty and swelling of your lips, face, and tongue. It is possible that you are more likely to suffer from the reaction to Perindopril if are an African-American.

Consult your physician immediately in the event that you are suffering from:

a euphoric feeling, similar to you’ve passed out;
Chills, fever, body pain, flu symptoms, sores in your throat and mouth;
minimal or no urination
swelling and rapid weight gain
high potassium levels – nausea and a slow or abnormal pulse rate, weakening, or loss of mobility;
pale skin, no bruising, or bleeding
jaundice (yellowing of the eyes or skin).

Common Perindopril adverse effects could include:

dizziness;
lower back pain Or
cough.

This isn’t a complete list of possible side effects, and others could happen. Consult your physician for advice on medical adverse effects. You can report any side effects to the FDA by calling 1-800-FDA-1088.

What other drugs can be affecting Perindopril?

Inform your doctor about your other medications particularly:

lithium;
diuretic, also known as “water pills”;
gold injections for arthritis or
Nonsteroidal anti-inflammatory medications such as Aspirin ibuprofen (Advil, Motrin) naproxen (Aleve) Celecoxib, diclofenac, indomethacin, meloxicam, and more.

This list isn’t comprehensive. Other medications can interact with perindopril. These include prescription and over-the-counter medicines, vitamins, and herbal products. T

Additional details

Keep this and all other medications away from the reach of youngsters, never let your medications be shared with anyone else and make sure you use Perindopril only as given.

Always consult your doctor to confirm that the information provided on this site is appropriate to your specific situation.

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