PERINDOPRIL ERBUMINE

PERINDOPRIL ERBUMINE
(per-in'do-pril)
Aceon
Classifications: angiotensin-converting enzyme (ace) inhibitor; antihypertensive;
Therapeutic: antihypertensive; ace inhibitor
Prototype: Captopril
Pregnancy Category: C first trimester; D second and third trimester

Availability

2 mg, 4 mg, 8 mg tablets

Action

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.

Therapeutic Effect

Effective in lowering blood pressure by vasodilatation resulting from inhibition of ACE. Improves cardiac output as well as activity tolerance in coronary artery disease.

Uses

Hypertension, stable coronary artery disease.

Contraindications

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.

Cautious Use

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)

Renal Impairment
Cl_cr >30 mL/min: start with 2 mg dose; can increase up to 8 mg

Administration

Oral

Manufacturer recommends an initial dose of 2–4 mg in 1 or 2 divided doses if concurrently ordered diuretic cannot be discontinued 2–3 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. CV: Palpitations. Endocrine: Hyperkalemia. GI: 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: Rash.

Interactions

Drug: 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%.

Pharmacokinetics

Absorption: Readily from GI tract, absorption significantly decreased when taken with food. Peak: Perindopril: 1 h; perindoprilat: 3–7 h. Duration: 24 h. Metabolism: Hydrolyzed in the liver to its active form, perindoprilat. Elimination: Primarily in urine. Half-Life: Perindopril: 0.8–1 h, perindoprilat: 30–120 h.

Nursing Implications

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 periodically.
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.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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