Concise Prescribing Info
Perindopril arginine
HTN. Stable CAD: Reduction of cardiac events risk in patients w/ history of MI &/or revascularisation. 5 mg tab: Symptomatic heart failure.
Dosage/Direction for Use
Individualized dosage. HTN Initially 5 mg once daily, may be increased to 10 mg once daily after 1 mth. Patient w/ strongly activated renin-angiotensin-aldosterone system (RAAS) Initially 2.5 mg, may be increased to 10 mg once daily after 1 mth. Patient in concomitant use w/ diuretic that cannot be discontinued Initially 2.5 mg, monitor renal function & serum K levels. Elderly Initially 2.5 mg, may be increased to 5 mg after 1 mth, then to 10 mg if necessary depending on renal function. Stable CAD Initially 5 mg once daily for 2 wk, then increased to 10 mg once daily if well tolerated, depending on renal function. Elderly 2.5 mg once daily for 1 wk, then 5 mg once daily on the following wk, then increased up to 10 mg once daily, depending on renal function. Symptomatic heart failure Initially 2.5 mg, may be increased to 5 mg once daily after 2 wk if tolerated. Renal impairment: CrCl ≥60 mL/min 5 mg daily, 30-60 mL/min 2.5 mg daily, 15-30 mL/min 2.5 mg every other day, <15 mL/min 2.5 mg on the day of dialysis (take dose after dialysis in haemodialysis patients).
Should be taken on an empty stomach: Take in the morning before a meal.
Hypersensitivity to perindopril or any other ACE inhibitor. History of angioedema associated w/ previous ACE inhibitor therapy; hereditary or idiopathic angioedema. Extracorporeal treatments leading to contact of blood w/ negatively charged surfaces. Significant bilateral renal artery stenosis or stenosis of the artery to a single functioning kidney. Concomitant use w/ aliskiren-containing products in patients w/ DM or renal impairment (GFR <60 mL/min/1.73 m2); sacubitril/valsartan. Pregnancy (2nd & 3rd trimesters).
Special Precautions
Anaphylactoid reactions during haemodialysis using high flux membranes. Temporarily withhold treatment prior to exams in the presence of anaphylactoid reactions during LDL apheresis w/ dextran sulphate or desensitisation treatment. Discontinue in case of hypersensitivity/angioedema/intestinal angioedema (monitor until complete resolution of symptoms); if jaundice or marked elevations of hepatic enzymes develop. Dual blockade of the RAAS is not recommended. Not to be used concomitantly w/ angiotensin II receptor blockers in patients w/ diabetic nephropathy. Not recommended in patients w/ primary hyperaldosteronism. Perform careful appraisal of the benefit/risk before continuing treatment if unstable angina pectoris occurs during the 1st month. Hypotension; renovascular HTN; non-productive, persistent cough. Patients w/ mitral valve stenosis & obstruction in the outflow of the left ventricle eg, aortic stenosis or hypertrophic cardiomyopathy; collagen vascular disease, on immunosuppressant therapy, treated w/ allopurinol or procainamide (periodically monitor WBC counts); risk factors for hyperkalemia; diabetic patients. Black patients. Discontinue 1 day prior to surgery if undergoing major surgery or anesth. Not to initiate until 36 hr after last dose of sacubitril/valsartan. Concomitant use w/ other NEP inhibitors (eg, racecadotril) & ACE inhibitors; mTOR inhibitors eg, sirolimus, everolimus, temsirolimus may increase risk of angioedema. Not recommended in concomitant use w/ lithium; K-sparing drugs, K supplements or K-containing salt substitutes. Not to be taken by patients w/ rare hereditary problems of galactose intolerance, glucose-galactose malabsorption, or the Lapp lactase deficiency. May impair ability to drive or operate machinery. Preexisting renal impairment. Not recommended during 1st trimester of pregnancy & lactation, in childn & adolescents <18 yr.
Adverse Reactions
Dizziness, headache, paraesthesia, vertigo; visual disturbances; tinnitus; hypotension; cough, dyspnoea; abdominal pain, constipation, diarrhoea, dysgeusia, dyspepsia, nausea, vomiting; pruritus, rash; muscle cramps; asthenia.
Drug Interactions
Higher frequency of adverse events w/ angiotensin II receptor-blockers or aliskiren. Increased risk of hyperkalaemia w/ aliskiren, K salts, K-sparing diuretics, ACE inhibitors, AIIA, NSAIDs, heparins, immunosuppressant agents (eg, ciclosporin or tacrolimus), trimethoprim. May increase blood glucose-lowering effect of antidiabetic agents eg, insulins, oral hypoglycaemic agents. Increased antihypertensive effect w/ baclofen. Excessive BP reduction w/ non-K-sparing diuretics. Risk of hyperkalaemia w/ K-sparing diuretics eg, eplerenone, spironolactone. Antihypertensive effect may be attenuated w/ NSAIDs (eg, aspirin ≥3 g daily, COX-2 inhibitors & non-selective NSAIDs) & may be reduced w/ sympathomimetics. May increase risk of angioedema w/ racecadotril; mTOR inhibitors eg, sirolimus, everolimus, temsirolimus. May increase hypotensive effects w/ antihypertensive agents & vasodilators. May further reduce BP w/ nitroglycerin & other nitrates, or other vasodilators; TCAs/antipsychotics/anesth. Increased risk of angiooedema w/ gliptines eg, linagliptine, saxagliptine, sitagliptine, vildagliptine. Nitritoid reactions w/ injectable gold (Na aurothiomalate). Contraindicated: Increased risk of hyperkalaemia, worsening of renal function & increased CV morbidity & mortality w/ aliskiren in diabetic or impaired renal patients. Increased risk of severe anaphylactoid reactions w/ extracorporeal treatments. May increase risk of angioedema w/ sacubitril/valsartan. Not recommended: Aliskiren. Higher frequency of hypotension, syncope, hyperkalaemia, & worsening renal function w/ angiotensin-receptor blocker. Risk of increased angioneurotic oedema w/ estramustine. May increase risk of hyperkalaemia w/ co-trimoxazole. Hyperkalaemia w/ K-sparing diuretics (eg, triamterene, amiloride) & K salts. Reversible increased serum conc & toxicity of lithium.
MIMS Class
ACE Inhibitors/Direct Renin Inhibitors
ATC Classification
C09AA04 - perindopril ; Belongs to the class of ACE inhibitors. Used in the treatment of cardiovascular disease.
Coversyl FC tab 10 mg
Coversyl FC tab 5 mg
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