perindopril

Contraindicated in:

Hypersensitivity;
History of angioedema with previous use of ACE inhibitors;
History of hereditary or idiopathic angioedema;
Concurrent use with sacubitril/valsartan; must be a 36-hr washout period after switching to/from sacubitril/valsartan;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Renal impairment, hypovolemia, hyponatremia, concurrent diuretic therapy (initial dose ↓ recommended);
Black patients (monotherapy for hypertension less effective, may require additional therapy; higher risk of angioedema);
Surgery/anesthesia (hypotension may be exaggerated);
Rep: Women of reproductive potential;
Pedi: Safety and effectiveness not established in children;
Geri: Initial dosage ↓ recommended in older adults.

Exercise Extreme Caution in:

Family history of angioedema.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension

Derm: rash

F and E: hyperkalemia

GI: diarrhea, dyspepsia

GU: renal impairment

MS: back pain

Neuro: dizziness, headache, weakness

Resp: cough

Misc: ANGIOEDEMA

Interactions ⬆ ⬇

Drug-drug:

Concurrent use with sacubitril↑ risk of angioedema; concurrent use contraindicated; do not administer within 36 hr of switching to/from sacubitril/valsartan.
Excessive hypotension may occur with concurrent use of diuretics.
Additive hypotension with other antihypertensives.
↑risk of hyperkalemia with concurrent use of potassium supplements,potassium-containing salt substitutes, and potassium-sparing diuretics.
↑risk of hyperkalemia, renal dysfunction, hypotension, and syncope with concurrent use of angiotensin II receptor blockers or aliskiren; avoid concurrent use with aliskiren in patients with diabetes or CCr <60 mL/min; avoid concurrent use with angiotensin II receptor blockers
NSAIDs and selective COX-2 inhibitors may blunt the antihypertensive effect and ↑ the risk of renal impairment.
May ↑ levels and risk of toxicity of lithium.
↑risk of angioedema with temsirolimus, sirolimus, or everolimus.

Availability ⬆ ⬇

(Generic available)

Tablets: 2 mg; 4 mg; 8 mg

Route/Dosage ⬆ ⬇

Hypertension

PO (Adults ): 4 mg once daily, may be slowly ↑ up to 16 mg/day in 1–2 divided doses (should not exceed 8 mg/day in elderly patients) (initiate therapy at 2–4 mg/day (in 1–2 divided doses) in patients receiving diuretics).

Stable Coronary Artery Disease

PO (Adults ): 4 mg once daily for 2 wk; may be ↑, if tolerated, to 8 mg once daily. Older adults: 2 mg once daily for 1 wk; may be ↑, if tolerated, to 4 mg once daily for 1 wk; then, ↑ as tolerated to 8 mg once daily.

Renal Impairment

PO (Adults ): CCr 30–60 ml/min: Initiate therapy at 2 mg once daily; may be slowly titrated up to 8 mg/day in 1–2 divided doses; CCr <30 ml/min: Not recommended.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins. ACE inhibitors also increase plasma renin levels and reduce aldosterone levels. Net result is systemic vasodilation.

Therapeutic effects:

Lowering of BP in patients with hypertension.
Decreased risk of death from cardiovascular causes or MI in patients with stable coronary artery disease.

Classifications ⬆ ⬇

Therapeutic Classification: antihypertensives

Pharmacologic Classification: ace inhibitors

Pharmacokinetics ⬆ ⬇

Absorption: 25% bioavailability as perindoprilat following oral administration.

Distribution: Unknown.

Metabolism/Excretion: Converted by the liver to perindoprilat, the active metabolite; primarily excreted in urine.

Half-Life: Perindoprilat: 3–10 hr (↑ in renal impairment).

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	within 1–2 hr	3–7 hr	up to 24 hr

Patient/Family Teaching ⬆ ⬇

Emphasize the importance of continuing to take medication as directed at the same time each day, even if feeling well. Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses. Warn patient not to discontinue perindopril unless directed by health care professional.
- Caution patient to avoid salt substitutes containing potassium or foods containing high levels of potassium or sodium unless directed by health care professional (see Food Sources for Specific Nutrients).
- Caution patient to change positions slowly to minimize orthostatic hypotension. Use of alcohol, standing for long periods, exercising, and hot weather may increase orthostatic hypotension.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any Rx, OTC, or herbal products, especially NSAIDs and cough, cold, or allergy remedies.
- May cause dizziness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
- Advise patient to inform health care professional of medication regimen prior to treatment or surgery.
- Instruct patient to notify health care professional immediately if rash; mouth sores; sore throat; fever; swelling of hands or feet; irregular heartbeat; chest pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; or difficulty swallowing or breathing occurs. Persistent dry cough may occur and may not subside until medication is discontinued. Consult health care professional if cough becomes bothersome. Also notify health care professional if nausea, vomiting, or diarrhea occurs and continues.
- Advise diabetic patients to monitor blood glucose closely, especially during first mo of therapy; may cause hypoglycemia.
- Advise females of reproductive potential to use contraception and notify health care professional if pregnancy is planned or suspected or if breastfeeding. If pregnancy is detected, discontinue medication as soon as possible.
- Emphasize the importance of follow-up examinations to evaluate effectiveness of medication.
Hypertension: Encourage patient to comply with additional interventions for hypertension (weight reduction, low-sodium diet, discontinuation of smoking, moderation of alcohol consumption, regular exercise, and stress management). Medication controls but does not cure hypertension.
- Instruct patient and family on correct technique for monitoring BP. Advise them to check BP at least weekly and to report significant changes to health care professional.

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Indications ⬇

Contraind./Precautions ⬆ ⬇