| PERINDOPRIL ERBUMINE
Classifications: angiotensin-converting enzyme (ace) inhibitor; antihypertensive; Therapeutic: antihypertensive; ace inhibitor
Pregnancy Category: C first trimester; D second and third trimester
2 mg, 4 mg, 8 mg tablets
Angiotensin-converting enzyme (ACE) inhibitor. ACE catalyzes the conversion of angiotensin I to angiotensin II, a potent
vasoconstrictor substance. Lowers BP by inhibition of ACE. Reduced aldosterone is associated with potassium-sparing effect.
In addition, it decreases systemic vascular resistance (afterload) and pulmonary capillary wedge pressure (PCWP), a measure
of preload, and improves cardiac output as well as activity tolerance.
Effective in lowering blood pressure by vasodilatation resulting from inhibition of ACE. Improves cardiac output as well
as activity tolerance in coronary artery disease.
Hypertension, stable coronary artery disease.
Hypersensitivity to perindopril or any other ACE inhibitor; history of angioedema induced by an ACE inhibitor, pregnancy
(category C first trimester, category D second and third trimester); lactation; patients with hypertrophic cardiomyopathy,
renal artery stenosis.
Renal insufficiency, volume-depleted patients, severe liver dysfunction; autoimmune diseases, immunosuppressant drug therapy;
hyperkalemia or potassium-sparing diuretics; older adult; surgery; neutropenia; febrile illness.
Route & Dosage
|Hypertension, Stable Coronary Artery Disease
Adult: PO 4 mg once daily, may be increased to 8 mg daily in 1 or 2 divided doses (max:16 mg/d)
Clcr >30 mL/min: start with 2 mg dose; can increase up to 8 mg
- Manufacturer recommends an initial dose of 24 mg in 1 or 2 divided doses if concurrently ordered diuretic cannot be
discontinued 23 d before beginning perinodopril. Consult physician.
- Give on an empty stomach 1 h before meals.
- Dosage adjustments are generally made at intervals of at least 1 wk.
- Store at 20°25° C (68°77° F) and protect from moisture.
Adverse Effects (≥1%)CNS:
Dizziness, light-headedness (in the absence of postural hypotension), headache, mood and sleep disorders, fatigue
Nausea, vomiting, epigastric pain, diarrhea
, taste disturbances, dyspepsia. Urogenital:
Proteinuria, impotence, sexual dysfunction. Special Senses:
Dry eyes, blurred vision. Body as a Whole: Cough, angioedema,
pruritus, muscle cramps, sinusitis
, hypertonia, fever. Skin:
InteractionsDrug: potassium-sparing diuretics (amiloride, spironolactone, triamterene)
may increase the risk of hyperkalemia. potassium supplements
increase the risk of hyperkalemia; lithium
levels can be increased. Food:
Food can decrease drug absorption 35%.
Readily from GI tract, absorption significantly decreased when taken with food. Peak: Perindopril:
1 h; perindoprilat:
37 h. Duration:
24 h. Metabolism:
Hydrolyzed in the liver to its active form, perindoprilat. Elimination:
Primarily in urine. Half-Life: Perindopril:
0.81 h, perindoprilat:
Assessment & Drug Effects
- Monitor BR and HR carefully following initial dose for several hours until stable, especially in patients using concurrent
diuretics, on salt restriction, or volume depleted.
- Place patient immediately in a supine position if excess hypotension develops.
- Lab tests: Monitor serum potassium, serum sodium, BUN and creatinine, ALT, blood glucose, lipid profile, and WBC with differential
- Monitor kidney function in patients with CHF closely.
- Monitor serum lithium levels and assess for S&S of lithium toxicity frequently when used concurrently; increased caution
is needed when diuretic therapy is also used.
Patient & Family Education
- Discontinue drug and immediately report S&S of angioedema (i.e., swelling) of face or extremities to physician. Seek emergency
help for swelling of the tongue or any other signs of potential airway obstruction.
- Be aware that light-headedness can occur, especially during early therapy; excess fluid loss of any kind (e.g., vomiting,
diarrhea) will increase risk of hypotension and syncope.
- Avoid using potassium supplements unless specifically directed to do so by physician.
- Report S&S of infection (e.g., sore throat, fever) promptly to physician.