Formulary
Perindopril erbumine: Indications, Dosing, Side Effects and Interactions
Perindopril erbumine clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 5 min read
Perindopril erbumine: Indications, Dosing, Side Effects and Interactions
Perindopril erbumine clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Hypertension**
- **Adult** (By Mouth): Initially 4 mg once daily for 1 month, dose to be taken in the morning, then, adjusted according to response; maximum 8 mg per day.
- **Elderly** (By Mouth): Initially 2 mg once daily for 1 month, dose to be taken in the morning, then, adjusted according to response; maximum 8 mg per day.
**Hypertension, if used in addition to diuretic, or in cardiac decompensation or volume depletion**
- **Adult** (By Mouth): Initially 2 mg once daily for 1 month, dose to be taken in the morning, then, adjusted according to response; maximum 8 mg per day.
**Heart failure (adjunct) (under close medical supervision)**
- **Adult** (By Mouth): Initially 2 mg once daily for at least 2 weeks, dose to be taken in the morning, then increased if tolerated to 4 mg once daily.
**Prophylaxis of cardiac events following myocardial infarction or revascularisation in stable coronary artery disease**
- **Adult** (By Mouth): Initially 4 mg once daily for 2 weeks, dose to be taken in the morning, then increased if tolerated to 8 mg once daily.
- **Elderly** (By Mouth): Initially 2 mg once daily for 1 week, then increased if tolerated to 4 mg once daily for 1 week, then increased if tolerated to 8 mg once daily.
Cautions
For all angiotensin-converting enzyme inhibitors Concomitant diuretics; diabetes (may lower blood glucose; increased risk of hyperkalaemia); first dose hypotension (especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with cerebrovascular disease, ischaemic heart disease, or heart failure); patients of black African or African-Caribbean origin (may respond less well to ACE inhibitors); peripheral vascular disease or generalised atherosclerosis (risk of clinically silent renovascular disease); primary aldosteronism (patients may respond less well to ACE inhibitors); the risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended); use with care in patients with aortic or mitral valve stenosis (risk of hypotension); use with care in patients with hypertrophic cardiomyopathy Cautions, further information Anaphylactoid reactions To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux membranes (e.g. polyacrylonitrile) and during low-density lipoprotein apheresis with dextran sulfate; they should also be withheld before desensitisation with wasp or bee venom. M Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: with hyperkalaemia with persistent postural hypotension i.e. recurrent drop in systolic blood pressure 20 mmHg (risk of syncope and falls)
Contraindications
For all angiotensin-converting enzyme inhibitors Hereditary or idiopathic angioedema; history of angioedema associated with prior ACE inhibitor therapy; the combination of an ACE inhibitor with aliskiren is contra-indicated in patients with an eGFR less than 60 mL/minute/1.73 m 2 ; the combination of an ACE inhibitor with aliskiren is contra-indicated in patients with diabetes mellitus
Side effects
For all angiotensin-converting enzyme inhibitors Common or very common Alopecia; angina pectoris; angioedema (can be delayed; more common in black patients); arrhythmias; asthenia; chest pain; constipation; cough; depression; diarrhoea; dizziness; drowsiness; dry mouth; dyspnoea; electrolyte imbalance; gastrointestinal discomfort; headache; hypotension; myalgia; nausea; palpitations; paraesthesia; renal impairment; rhinitis; skin reactions; sleep disorder; syncope; taste altered; tinnitus; vertigo; vomiting Uncommon Arthralgia; confusion; eosinophilia; erectile dysfunction; fever; haemolytic anaemia; hyperhidrosis; myocardial infarction; pancreatitis; peripheral oedema; photosensitivity reaction; respiratory disorders; stroke Rare or very rare Agranulocytosis; hepatitis; leucopenia; neutropenia; pancytopenia; Stevens-Johnson syndrome; thrombocytopenia Side-effects, further information In light of reports of cholestatic jaundice, hepatitis, fulminant hepatic necrosis, and hepatic failure, ACE inhibitors should be discontinued if marked elevation of hepatic enzymes or jaundice occur. Side-effects For perindopril erbumine Common or very common Muscle cramps; visual impairment Uncommon Anxiety; fall; hypoglycaemia; malaise; mood altered; vasculitis Rare or very rare Flushing; SIADH Frequency not known Cardiac arrest; Raynaud's phenomenon
Interactions
**Severe interactions:**
- Potassium sparing diuretics (e.g.
**Other interactions (13):**
- Diuretics Patients on diuretics, and especially those who are volume and/or salt depleted, may experience excessive reduction in blood pressure after initiation of therapy with an ACE inhibitor.
- Potassium sparing diuretics, potassium supplements or potassium-containing salt substitutes Although serum potassium usually remains within normal limits, hyperkalaemia may occur in some patients...
- Care should also be taken when perindopril is co-administered with other agents that increase serum potassium, such as trimethoprim and co-trimoxazole (trimethoprim/sulfamethoxazole) as trimethoprim...
- Ciclosporin Hyperkalaemia may occur during concomitant use of ACE inhibitors with ciclosporin.
- Heparin Hyperkalaemia may occur during concomitant use of ACE inhibitors with heparin.
- Lithium Reversible increases in serum lithium concentrations and toxicity have been reported during concomitant administration of lithium with ACE inhibitors.
Pregnancy
Important safety information For all angiotensin-converting enzyme inhibitors MHRA/CHM advice: ACE inhibitors and angiotensin II receptor antagonists: not for use in pregnancy (December 2014) See Conception and contraception and Pregnancy . MHRA/CHM advice: ACE inhibitors and angiotensin II receptor antagonists: recommendations on how to use for breastfeeding (December 2014) See Breast feeding .
Breast feeding
For all angiotensin-converting enzyme inhibitors Information on the use of ACE inhibitors in breast-feeding is limited. Breast feeding For perindopril erbumine Not recommended; alternative treatment options, with better established safety information during breast-feeding, are available.
Hepatic impairment
Perindopril is a prodrug.
Renal impairment
For all angiotensin-converting enzyme inhibitors Caution (hyperkalaemia and other side-effects of ACE inhibitors are more common in those with impaired renal function). M Dose adjustments Start with low dose and adjust according to response. M Renal impairment For perindopril erbumine Dose adjustments Max. initial dose 2 mg once daily if creatinine clearance 30-60 mL/minute; 2 mg once daily on alternate days if creatinine clearance 15-30 mL/minute. M See Prescribing in renal impairment .
Medicinal forms
Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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