History of airway surgery. Withdraw if there is significant increase in LFTs. Risk factors for hyperkalaemia; monitor potassium closely. Patients dependent on renin-angiotensin-aldosterone system; consider withdrawal in patients with progressive deterioration in renal function. Collagen vascular disease. Hypovolaemia; monitor BP with the 1st dose. Unilateral renal artery stenosis and pre-existing renal insufficiency; valvular aortic stenosis. Before, during, or immediately after anaesthesia. May impair ability to drive or operate machinery. Lactation.
Lactation: not known if distributed into breast milk; use caution
Indication
Hypertension, IHD, Heart failure
Contra Indication
History of angioedema related to previous ACE inhibitor treatment. Pregnancy (2nd/3rd trimesters).
Dose
N/A
Side Effect
>10%
Headache (23%),Cough (12%)
1-10%
Dizziness (8%),Back pain (6%),Lower extremity pain (5%),Abnormal ECG (2%),Palpitation (1%),Depression (2%),Somnolence (1%),Menstrual disorder (1%),Edema (4%),ALT increased (2%),Sexual dysfunction (male 1%),Sleep disorder (3%),Chest pain (2%),Nausea/vomiting (2%),Flatulence (1%),Rash (2%),Hyperkalemia (1%),Tinnitus (2%)
Frequency Not Defined
Intestinal angioedema,Liver failure (rare),Leukopenia,Pruritus,Stroke,Syncope,Urinary retention,Vertigo,Amnesia
Angioedema, More frequent in black patients (0.1%), Angioedema of lips, More frequent in black patients (0.1%), Angioedema of throat, More frequent in black patients (0.1%)
Potentially Fatal: Anaphylactoid reactions, angioedema.
Pregnancy Category
Name :
D
Description
There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Mode of Action
Perindopril is an ACE inhibitor, which acts by inhibiting the conversion of angiotensin I to angiotensin II, reducing the activity of the sympathetic nervous system and inhibiting enzyme kininase, which is involved in the conversion of bradykinin and other substances.
Interaction
May enhance hypotensive effect w/ diuretics. Additive hyperkalaemic effect w/ K supplements, K-sparing diuretics, and other drugs (e.g. ciclosporin, heparin, indometacin). May increase serum levels and toxicity of lithium. Antihypertensive effect may be reduced by aspirin or other NSAIDs. Coadministration w/ NSAIDs may also increase the risk of renal impairment. Increased risk of hypoglycaemia w/ antidiabetic agents. Rarely, nitritoid reactions occur w/ concomitant use of gold (sodium aurothiomalate).
Potentially Fatal: Increased risk of hypotension, hyperkalaemia and changes in renal function (including acute renal failure) w/ aliskiren in patients w/ diabetes or renal impairment.
Pregnancy Category Note
Pregnancy Category: D
Discontinue as soon as pregnancy detected; during the second and third trimesters of pregnancy, drugs that act directly on the renin-angiotensin have been associated with fetal injury that includes hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death
Lactation: not known if distributed into breast milk; use caution
Adult Dose
Oral
Adult
Hypertension
4-8 mg PO qDay or divided q12hr
Maximum: 16 mg/day PO divided q12hr
Stable Coronary Artery Disease (CAD)
4 mg PO qDay for 2 weeks, THEN increase as tolerated to 8 mg/day PO divided q12hr
Reduce risk of cardiovascular mortality or MI in patients with stable CAD
Heart Failure
2 mg PO qDay initially to maximum 8-16 mg PO qDay
Elderly: Initially, 2 mg once daily. Dose may be increased to max 8 mg
Should be taken on an empty stomach. Take before meals.
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