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CARDIOVASCULAR SYSTEM › AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM › ACE INHIBITORS, PLAIN › ACE inhibitors, plain
perindopril
C09AA04
Forms & Strengths
- Oral tablets: 2 mg, 4 mg, 8 mg (as perindopril erbumine)
Adult Dosing
- Hypertension: Initial 4 mg once daily, titrate up to 8 mg daily
- Heart Failure: Initial 2 mg once daily, titrate to target 4 mg daily
- Stable Coronary Artery Disease: Initial 4 mg once daily for 2 weeks, then increase to 8 mg daily if tolerated
Pediatric Dosing
- Safety and efficacy not established in pediatric patients
Indications
- Treatment of essential hypertension
- Reduction of risk of cardiovascular death or nonfatal myocardial infarction in stable coronary artery disease
- Management of symptomatic heart failure
Mechanism of Action
- Inhibits angiotensin-converting enzyme (ACE), preventing the conversion of angiotensin I to angiotensin II
- Decreases systemic vascular resistance, blood pressure, and aldosterone secretion while increasing plasma renin activity
Contraindications
- History of angioedema related to previous ACE inhibitor therapy
- Hereditary or idiopathic angioedema
- Concomitant use with aliskiren in patients with diabetes mellitus
- Co-administration with neprilysin inhibitors (e.g., sacubitril/valsartan)
Adverse Reactions
- Cough (dry, persistent)
- Dizziness and headache
- Hyperkalemia
- Hypotension (especially orthostatic)
- Increased serum creatinine and renal impairment
- Angioedema (rare but severe)
Drug Interactions
- Diuretics and other antihypertensives: Increased risk of severe hypotension
- Potassium-sparing diuretics, potassium supplements, or salt substitutes: Increased risk of hyperkalemia
- Lithium: Decreased renal clearance, leading to potential lithium toxicity
- NSAIDs: May diminish antihypertensive effect and increase risk of renal impairment
- ARBs or direct renin inhibitors: Increased risk of hypotension, hyperkalemia, and renal dysfunction
Curated Content: Needs Vetting Before Put to Clinical Use