Perindopril

Perindopril is a medication used to treat high blood pressure, heart failure, or stable coronary artery disease.[3][4][5]

As a long-acting ACE inhibitor, perindopril works by inhibiting production of the vasoconstriction hormone, angiotensin, thereby relaxing blood vessels, increasing urine output, and decreasing blood volume, leading to a reduction of blood pressure. It also increases blood renin activity and decreases aldosterone secretion, causing increased urine production and excretion of sodium.[3]

As a prodrug, perindopril is hydrolyzed in the liver to its active metabolite, perindoprilat. It was patented in 1980 and approved for medical use in 1988.[3][6] Perindopril is taken in the form of perindopril arginine/amlodipine or perindopril erbumine.[1] Both forms are therapeutically equivalent and interchangeable.[1][3] The combination perindopril/amlodipine/indapamide is on the World Health Organization's List of Essential Medicines.[7]

Perindopril should not be used during pregnancy, as it may harm the fetus.[1] Some people may have allergic reactions to perindopril, while common side-effects may include cough, headache, dizziness, diarrhea, or upset stomach.[1]

In Australia during 2023-24, it was the fourth-most prescribed drug.[8]

Medical uses

Perindopril shares the indications of ACE inhibitors as a class, including essential hypertension, stable coronary artery disease (reduction of risk of cardiac events in patients with a history of myocardial infarction or revascularization), treatment of symptomatic coronary artery disease or heart failure, and diabetic nephropathy.[1][3][9]

Warning and adverse effects

Perindopril may cause death or birth defects of a fetus if taken by the mother during pregnancy.[1][3] It is poisonous in children and is not prescribed for them.[4]

It may cause allergic reactions, and may have adverse effects in people with heart, liver or kidney problems.[1]

Precautions

• Assess kidney function before and during treatment where appropriate.[1]
• Renovascular hypertension
• Surgery/anesthesia
• An analysis on the PROGRESS trial showed that perindopril has key benefits in reducing cardiovascular events by 30% in patients with chronic kidney disease defined as a CrCl <60ml/min.[17] A 2016 and 2017 meta-analysis review looking at ACE inhibitors demonstrated a reduction in cardiovascular events but also slowed the decline of renal failure by 39% when compared to placebo.[18] These studies included patients with moderate to severe kidney disease and those on dialysis.
• Its renoprotective benefits of decreasing blood pressure and removing filtration pressure is highlighted in a 2016 review.[19]

Side effects

Usually mild at the start of treatment, side effects may include cough, fatigue, headache, nausea, or upset stomach, among other minor effects.[1][4]

Composition

Each tablet contains 2, 4, or 8 mg of the tert-butylamine salt of perindopril.[1] Perindopril is also available under the trade name Coversyl Plus, containing 4 mg of perindopril combined with 1.25 mg indapamide, a thiazide-like diuretic.[1]

In Australia, each tablet contains 2.5, 5, or 10 mg of perindopril arginine. Perindopril is also available under the trade name Coversyl Plus, containing 5 mg of perindopril arginine combined with 1.25 mg indapamide and Coversyl Plus LD, containing 2.5 mg of perindopril arginine combined with 0.625 mg indapamide.

The efficacy and tolerability of a fixed-dose combination of 4 mg perindopril and 5 mg amlodipine, a calcium channel antagonist, is used.[1][4]

Society and culture

Further reading

External links