Adult Dosing
Hypertension
- Uncomplicated hypertensive patients
- Initial dose: 4 mg PO qd; may titrate the dose, if indicated, up to 16 mg/day
- Maintenance dose: 4-8 mg PO qd or in two divided doses
- Max dose: 16 mg/day
- Elderly patients
- Start with 4 mg PO in one or two divided doses; may titrate, as needed, up to 8 mg/day
- Doses >8 mg/day should be administered with careful blood pressure monitoring under close medical supervision
- Use with diuretic
- In patients already on a diuretic, the initial dose of perindopril may cause symptomatic hypotension. To minimize this, stop the diuretic 2-3 days prior to initiating perindopril therapy. If the BP is not controlled with perindopril alone, resume diuretic therapy cautiously
- If the diuretic cannot be stopped, initiate perindopril at a dose of 2-4 mg/day in one or two divided doses with close supervision for several hours until the BP has stabilized
Heart failure (Non-FDA Approved)
- Note that similar dosing to that used for hypertension is typically used for this indication
Stable coronary artery disease
- Initial Dose: 4 mg PO qd x 2 wks; increase as tolerated to a maintenance dose of 8 mg PO qd
- Elderly patients (>70 yrs)
- Initial: 2 mg PO qd x 1st week; may titrate the dose to 4 mg PO qd in 2nd week
- Maintenance dose: 8 mg PO qd
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Renal Dose Adjustment: (Based on CrCl)
- >30 mL/min: Start 2 mg PO qd. Max: 8 mg/day
- <30 mL/min: Not recommended
Hepatic Dose Adjustment
- Hepatic impairment: Caution advised, dose adjustments not defined
See Supplemental Patient Information
- Angioedema involving the extremities, face, lips, tongue, glottis or larynx and intestinal angioedema have been reported in patients treated with ACE inhibitors. If airway obstruction occurs, promptly administer emergency therapy including subcutaneous epinephrine. The incidence of angioedema is higher in black patients receiving ACE inhibitors
- Symptomatic hypotension has been reported with ACE inhibitors, most likely in patients who have been volume or salt-depleted
- Perindopril may cause excessive hypotension in patients with severe CHF, which may be associated with oliguria, progressive azotemia, and rarely acute renal failure and death. An excessive fall in BP could result in myocardial infarction or a cerebrovascular accident in patients with ischemic heart disease or cerebrovascular disease
- Start perindopril therapy under very close medical supervision in patients at risk of excessive hypotension. If excessive hypotension occurs, place the patient in supine position and treat with an IV infusion of physiological saline, as indicated
- Hypotension may occur in patients undergoing major surgery or during anesthesia, as the therapy may block angiotensin II formation that would otherwise occur secondary to compensatory renin release
- Agranulocytosis and bone marrow depression have been associated with ACE inhibitors. This risk increases in renal impairment, especially in patients with a collagen vascular disease
- Use of ACE inhibitors during second and third trimesters of pregnancy can cause fetal and neonatal morbidity/mortality, including hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure. When pregnancy is detected, discontinue therapy at the earliest [US Black Box Warning]
- If there is no alternative to ACE inhibitors, mothers should be apprised of the potential hazards to their fetuses; serial ultrasound examinations should be performed to assess the intra-amniotic environment
- Oligohydramnios has been reported during therapy, caused due to decreased fetal renal function. If this occurs, discontinue therapy unless it is considered life-saving for the mother
- Closely observe the infants with a history of in utero exposure to ACE inhibitors for hypotension, oliguria and hyperkalemia
- As a consequence of inhibiting the renin-angiotensin-aldosterone system, changes in renal function may occur in susceptible individuals
- In hypertensive patients with unilateral or bilateral renal artery stenosis, reversible increases in BUN and serum creatinine have been reported with ACE inhibitor therapy. Monitor renal functions during the first few weeks of therapy
- Persistent nonproductive cough, due to inhibition of the degradation of endogenous bradykinin, has been reported with ACE inhibitors
- Serum potassium levels may be elevated in certain patients treated with ACE inhibitors; monitor serum potassium periodically during therapy
- ACE inhibitors have been rarely associated with a syndrome that begins with cholestatic jaundice and progresses to fulminant hepatic necrosis and sometimes death; discontinue therapy if marked elevations of hepatic enzymes occur
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Aortic stenosis
- Concomitant diuretic
- Coronary artery disease
- Hypertrophic cardiomyopathy
- Hyponatremia
- Elderly patients
- Dialysis with high-flux membranes
- LDL apheresis with dextran
- Antigen desensitization therapy
Supplemental Patient Information
- Alert female patients of childbearing age about the potential for serious adverse effects to the fetus with this drug if taken during pregnancy
- Advise patients to report their physicians if they develop any signs or symptoms suggestive of angioedema; instruct them to discontinue therapy until they have consulted a physician
- Instruct patients to promptly report any indication of infection such as sore throat or fever, which could indicate neutropenia
Pregnancy Category:D
Breastfeeding: Very low levels have been reported in milk with similar drugs; ACE inhibitors that are studied should be preferred. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 12 January 2011). Manufacturer advises caution.
US Trade Name(s)
US Availability
perindopril (generic)
Aceon (perindropil erbumine)
Canadian Trade Name(s)
Canadian Availability
perindopril (generic)
Coversyl (perindropil erbumine)
UK Trade Name(s)
UK Availability
perindopril (generic)
Coversyl Arginine (perindropil arginine)
Australian Trade Name(s)
- Indopril
- Perindo
- Ozapace
- Coversyl
Australian Availability
perindopril (generic)
Indopril, Perindo, Ozapace (perindropil erbumine)
Coversyl (perindropil arginine)
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Perindopril Erbumine 2 MG TABS [Bottle] (AUROBINDO PHARMA)
100 mg = $75.99
300 mg = $199.98 - Perindopril Erbumine 8 MG TABS [Bottle] (ROXANE)
100 mg = $88.99
300 mg = $227.97 - Aceon 8 MG TABS [Bottle] (SOLVAY)
100 mg = $278.49
200 mg = $556.97 - Perindopril Erbumine 4 MG TABS [Bottle] (ROXANE)
100 mg = $80.99
300 mg = $211.98 - Aceon 2 MG TABS [Bottle] (SOLVAY)
100 mg = $199
200 mg = $383.98 - Aceon 4 MG TABS [Bottle] (SOLVAY)
30 mg = $77.99
90 mg = $207.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
