Overview
Perindopril is an ACE inhibitor used primarily for the treatment of hypertension and heart failure. It works by inhibiting the angiotensin-converting enzyme, leading to vasodilation and reduced blood pressure. It is also indicated to reduce cardiovascular risk in certain patient populations.
Mechanism of Action
Perindopril is an angiotensin-converting enzyme (ACE) inhibitor that blocks the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This inhibition reduces systemic vascular resistance and blood pressure while decreasing aldosterone secretion, which helps reduce sodium and water retention.
Indications
- Treatment of hypertension
- Management of heart failure to reduce mortality and hospitalization
- Reduction of cardiovascular events in patients with stable coronary artery disease
Common Doses
- 2 mg
- 4 mg
- 8 mg
Dosage
For hypertension: Initial dose typically 4 mg once daily, may be increased to 8 mg once daily based on response. For heart failure: Start with 2 mg once daily, titrate upward as tolerated. Dosage adjustments required in renal impairment and elderly patients.
Contraindications
- Hypersensitivity to perindopril or other ACE inhibitors
- History of angioedema related to ACE inhibitor therapy
- Hereditary or idiopathic angioedema
- Concomitant use with aliskiren in patients with diabetes
- Concomitant use with neprilysin inhibitors (e.g., sacubitril)
Side Effects
- Cough (most common)
- Dizziness
- Headache
- Fatigue
- Hyperkalemia
- Angioedema (serious)
- Renal impairment
- Hypotension
Interactions
- Potassium supplements/potassium-sparing diuretics: Increased risk of hyperkalemia
- Diuretics: Enhanced hypotensive effect
- NSAIDs: May reduce antihypertensive effect and increase renal impairment risk
- Lithium: Increased lithium levels and toxicity risk
- Neprilysin inhibitors: Contraindicated within 36 hours of switching
Counseling Points
- Take medication at same time each day, with or without food
- Report any signs of angioedema (swelling of face, lips, tongue, throat) immediately
- Monitor blood pressure regularly
- Avoid potassium supplements unless prescribed by healthcare provider
- Report persistent dry cough to healthcare provider
- Stay hydrated, especially in hot weather or during illness
- Inform all healthcare providers about ACE inhibitor use before procedures