Perindopril

Perindopril Brand Name– Aceon

What is Perindopril

Perindopril is an oral angiotensin-converting enzyme (ACE) inhibitor which is used alone or in combination therapy for hypertension. It is a prodrug that is hydrolyzed to perindoprilat.

Perindopril is an intermediate-acting ACE inhibitor, allowing for once or twice daily dosing. In general, ACE inhibitors appear to have a lesser effect on blood pressure in black patients (low renin population) than in non-black patients. In contrast to captopril, perindopril does not contain a sulfhydryl group, which has implications regarding the drug’s adverse reaction profile.

Perindopril has also been used in heart failure, although it is not FDA approved for this use.

A large randomized placebo-controlled trial (EUROPA, n=12,218) has reported that perindopril reduces cardiac events in patients with stable coronary artery disease (see Dosage).

Although some experts believe attaining goal blood pressure is most important in patients with diabetes mellitus, a recent large, randomized, placebo-controlled trial (ADVANCE, n=11,140) has reported that the administration of a fixed combination of perindopril and indapamide to a broad range of patients with type 2 diabetes mellitus is associated with reduced risks of major vascular events, including death.

After a mean follow-up of 4.3 years, 15.5% of patients in the active treatment group vs. 16.8% in the placebo group had a major macrovascular or microvascular event (relative risk reduction, 9%; 95% CI, 0.83—1; p=0.041).

Cardiovascular death was significantly lower in the active treatment group vs. placebo group (3.8% vs. 4.6%; 95% CI, 0.68—0.98; p=0.03). Death from any cause also was significantly lower in the active treatment group vs. placebo group (7.3% vs. 8.5%; 95% CI 0.75—0.98; p=0.03).

Perindopril was approved by the FDA December 1993, but did not become available in the US until mid-1999.

Indications

1. heart failure
2. hypertension
3. myocardial infarction prophylaxis
4. reduction of cardiovascular mortality

For the treatment of hypertension

for the treatment of hypertension in patients who are not receiving diuretic therapy

Side Effects

1. agranulocytosis
2. anaphylactoid reactions
3. anemia
4. angioedema
5. arthralgia
6. asthenia
7. azotemia
8. back pain
9. cholestasis
10. cough
11. dizziness
12. elevated hepatic enzymes
13. eosinophilia
14. exfoliative dermatitis
15. fever
16. headache
17. hepatic failure
18. hepatic necrosis
19. hepatitis
20. hyperkalemia
21. hypotension
22. jaundice
23. leukocytosis
24. leukopenia
25. myalgia
26. neutropenia
27. oliguria
28. orthostatic hypotension
29. pancytopenia
30. pemphigus
31. psoriasis
32. rash
33. renal failure (unspecified)
34. syncope
35. teratogenesis
36. thrombocytopenia
37. vasculitis

Monitoring Parameters

• blood pressure
• serum creatinine/BUN
• serum potassium
• serum sodium

Contraindications

• ACE-inhibitor induced angioedema
• agranulocytosis
• angioedema
• Angiotensin-converting enzyme inhibitors (ACE inhibitors) hypersensitivity
• aortic stenosis
• Black patients
• bone marrow suppression
• breast-feeding
• cardiomyopathy
• cerebrovascular disease
• children
• collagen-vascular disease
• coronary artery disease
• diabetes mellitus
• dialysis
• geriatric
• heart failure
• hepatic disease
• hereditary angioedema
• history of angioedema
• hymenoptera venom (insect sting) allergy desensitization
• hyperkalemia
• hyponatremia
• hypotension
• hypovolemia
• immunosuppression
• infants
• jaundice
• low-density lipoprotein apheresis
• neonates
• neutropenia
• pregnancy
• renal artery stenosis
• renal disease
• renal failure
• renal impairment
• scleroderma
• surgery
• systemic lupus erythematosus (SLE)

Interactions

• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Dichloralphenazone; Isometheptene
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetaminophen; Pseudoephedrine
• Acrivastine; Pseudoephedrine
• Aldesleukin, IL-2
• Alemtuzumab
• Aliskiren
• Aliskiren; Amlodipine
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Aliskiren; Valsartan
• Alogliptin; Metformin
• Alpha-glucosidase Inhibitors
• Alprostadil
• Amifostine
• Amiloride
• Amiloride; Hydrochlorothiazide, HCTZ
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amlodipine; Olmesartan
• Amlodipine; Telmisartan
• Amlodipine; Valsartan
• Amobarbital
• Amphetamine; Dextroamphetamine Salts
• Amyl Nitrite
• Angiotensin II
• Angiotensin II receptor antagonists
• Apomorphine
• Apraclonidine
• Aprotinin
• Aripiprazole
• Asenapine
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• Azilsartan
• Azilsartan; Chlorthalidone
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• Brompheniramine; Pseudoephedrine
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• Calcium Phosphate, Supersaturated
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• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbetapentane; Guaifenesin; Phenylephrine
• Carbetapentane; Phenylephrine
• Carbetapentane; Phenylephrine; Pyrilamine
• Carbetapentane; Pseudoephedrine
• Carbidopa; Levodopa
• Carbidopa; Levodopa; Entacapone
• Carbinoxamine; Dextromethorphan; Pseudoephedrine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Carbinoxamine; Phenylephrine
• Carbinoxamine; Pseudoephedrine
• Cariprazine
• Carvedilol
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• Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
• Chlophedianol; Guaifenesin; Phenylephrine
• Chloroprocaine
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpheniramine; Pseudoephedrine
• Clozapine
• Co-Enzyme Q10, Ubiquinone
• Cocaine
• Codeine; Phenylephrine; Promethazine
• Conivaptan
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• Cyclosporine
• Dapagliflozin; Metformin
• Desloratadine; Pseudoephedrine
• Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
• Dexmethylphenidate
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Guaifenesin; Phenylephrine
• Dextromethorphan; Guaifenesin; Pseudoephedrine
• Dextromethorphan; Quinidine
• Diazoxide
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• Digoxin
• Dihydrocodeine; Guaifenesin; Pseudoephedrine
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Phenylephrine
• Drospirenone
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• Drospirenone; Ethinyl Estradiol; Levomefolate
• Duloxetine
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• Empagliflozin; Metformin
• Enflurane
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• Eprosartan; Hydrochlorothiazide, HCTZ
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• General anesthetics
• Glipizide; Metformin
• Glyburide; Metformin
• Gold
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• Halothane
• Heparin
• Hydralazine; Isosorbide Dinitrate, ISDN
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• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrochlorothiazide, HCTZ; Valsartan
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Ibritumomab Tiuxetan
• Ibuprofen; Pseudoephedrine
• Icatibant
• Iloperidone
• Iloprost
• Incretin Mimetics
• Indapamide
• Insulins
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• Metformin; Repaglinide
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• Metformin; Sitagliptin
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• Phenylephrine; Promethazine
• Polyethylene Glycol; Electrolytes
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• Potassium
• Potassium Phosphate
• Potassium Phosphate; Sodium Phosphate
• Pramlintide
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• Procaine
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• Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous
• Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
• Spironolactone
• Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
• Sulfonylureas
• Tacrolimus
• Telavancin
• Telbivudine
• Telmisartan
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• Tetrabenazine
• Tetracaine
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• Valsartan
• Yohimbine
• Ziprasidone