Perindopril

What is Perindopril?

• Perindopril (Aceon) is a angiotensin-converting enzyme (ACE) inhibitor used in the therapy of hypertension and stable coronary artery disease.

Perindoprilat

Perindopril

What are the uses of this medicine?

Perindopril (Aceon) is indicated for the:

• Treatment of patients with essential hypertension.
• Treatment of patients with stable coronary artery disease to reduce the risk of cardiovascular mortality or nonfatal myocardial infarction.

How does this medicine work?

• Perindopril (per in' doe pril) is an ACE inhibitor which is approved for use alone and in combination with other agents in the therapy of hypertension.
• Like other ACE inhibitors, perindopril inhibits the conversion of angiotensin I, a relatively inactive molecule, to angiotensin II which is the major mediator of vasoconstriction and volume expansion induced by the renin-angiotensin system.
• Other host enzymes besides that which converts angiotensin I to II may be inhibited as well, which may account for some of the side effects of the ACE inhibitors.

Who Should Not Use this medicine ?

This medicine cannot be used in patients:

• with Angioedema related to previous treatment with an ACE inhibitor, or a history of hereditary or idiopathic angioedema.
• with diabetes who use aliskiren.
• who use a neprilysin inhibitor (e.g., sacubitril).

• Do not administer perindopril erbumine within 36 hours of switching to or from sacubitril/valsartan, a neprilysin inhibitor.

What drug interactions can this medicine cause?

Tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following:

• cyclosporine (Gengraf, Neoral, Sandimmune), diuretics ('water pills'), heparin, indomethacin (Indocin, Tivorbex), lithium (Lithobid), and potassium supplements (K-Dur, Klor-Con, others).

• Tell your doctor or pharmacist if you are taking valsartan and sacubitril (Entresto) or if you have stopped taking it within the last 36 hours.
• Also, tell your doctor if you have diabetes and you are taking aliskiren (Tekturna, in Amturnide, Tekamlo, Tekturna HCT).

Is this medicine FDA approved?

• Perindopril was approved for use in the United States in 1993, and current indications are for therapy of hypertension and to reduce the risk of cardiovascular mortality in patients with stable coronary artery disease.

How should this medicine be used?

Recommended dosage: Hypertension:

• The recommended initial dose is 4 mg once a day.
• The dosage may be titrated upward until blood pressure, when measured just before the next dose, is controlled or to a maximum of 16 mg per day.

Stable Coronary Artery Disease:

• Perindopril should be given at an initial dose of 4 mg once daily for 2 weeks, and then increased, as tolerated, to a maintenance dose of 8 mg once daily.

Administration:

• Perindopril comes as a tablet to take by mouth.
• It is usually taken once or twice a day.
• Your doctor may start you on a low dose of perindopril and gradually increase your dose.
• Perindopril controls high blood pressure but does not cure it.
• Continue to take perindopril even if you feel well.
• Do not stop taking perindopril without talking to your doctor.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As Tablets: 2 mg, 4 mg and 8 mg

This medicine is available in fallowing brand namesː

• Aceon ; As perindopril arginine (trade names include Coversyl, Coversum)

What side effects can this medication cause?

The most common side effects of this medicine include: In Hypertension:

• cough, dizziness and back pain

In Stable Coronary Artery Disease:

• cough, drug intolerance, and hypotension

Perindopril may cause serious side effects which may include:

• swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• fainting
• fever, sore throat, chills, and other signs of infection
• irregular or rapid heartbeats
• hoarseness
• difficulty swallowing or breathing
• lightheadedness

What special precautions should I follow?

• Angioedema of the face, extremities, lips, tongue, glottis, or larynx has been reported in patients treated with ACE inhibitors, including perindopril. Patients taking concomitant mTOR inhibitor (e.g., temsirolimus) therapy or a neprilysin inhibitor may be at increased risk for angioedema.
• Intestinal angioedema has been reported in patients treated with ACE inhibitors. Intestinal angioedema should be included in the differential diagnosis of patients on ACE inhibitors presenting with abdominal pain.
• Perindopril can cause symptomatic hypotension. If excessive hypotension occurs, the patient should be placed immediately in a supine position and, if necessary, treated with an intravenous infusion of physiological saline. Perindopril treatment can usually be continued following restoration of volume and blood pressure.
• ACE inhibitors have been associated with agranulocytosis and bone marrow depression, most frequently in patients with renal impairment, especially patients with a collagen vascular disease such as systemic lupus erythematosus or scleroderma.
• Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death. When pregnancy is detected discontinue perindopril as soon as possible.
• As a consequence of inhibiting the renin-angiotensin-aldosterone system, changes in renal function may be anticipated in susceptible individuals. Renal function should be monitored periodically in patients receiving perindopril.
• Elevations of serum potassium have been observed in some patients treated with ACE inhibitors, including perindopril. Serum potassium should be monitored periodically in patients receiving perindopril.
• Persistent nonproductive cough has been reported with all ACE inhibitors, generally resolving after discontinuation of therapy. Consider ACE inhibitor-induced cough in the differential diagnosis of cough.
• Patients receiving ACE inhibitors who develop jaundice or marked elevations of hepatic enzymes should discontinue the ACE inhibitor and receive appropriate medical follow-up.

What to do in case of emergency/overdose?

Symptoms of overdosage may include:

• hypotension
• hypothermia

Management of overdosage:

• Treatment should be symptomatic and supportive.
• Therapy with the ACE inhibitor should be discontinued, and the patient should be observed.
• Dehydration, electrolyte imbalance and hypotension should be treated by established procedures.
• Perindopril can be removed by hemodialysis, with clearance of 52 mL/min for perindopril and 67 mL/min for perindoprilat.
• Angiotensin II could presumably serve as a specific antagonist-antidote in the settling of perindopril overdose.
• Because the hypotensive effect of perindopril is achieved through vasodilation and effective hypovolemia, it is reasonable to treat perindopril overdose by infusion of normal saline solution.

Can this medicine be used in pregnancy?

• Pregnancy Category D.
• Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death.

Can this medicine be used in children?

• Safety and effectiveness of perindopril in pediatric patients have not been established.

What are the active and inactive ingredients in this medicine?

Active Ingredient:

• PERINDOPRIL ERBUMINE

Inactive Ingredients:

• ANHYDROUS LACTOSE
• MAGNESIUM STEARATE
• MICROCRYSTALLINE CELLULOSE
• SILICON DIOXIDE

Who manufactures and distributes this medicine?

Distr. by:

• West-Ward Pharmaceuticals Corp.
• Eatontown, NJ

What should I know about storage and disposal of this medication?

• Store at 20° to 25°C (68° to 77°F).
• Protect from moisture.
• Dispense in a tight, child-resistant container as defined in the USP/NF.

• Dailymed label info on Perindopril
• FDA Perindopril

Perindopril Resources
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Common ACE inhibitors include the following:

• Benazepril
• Captopril
• Enalapril
• Fosinopril
• Lisinopril
• Moexipril
• Perindopril
• Quinapril
• Ramipril
• Trandolapril