Perindopril is a type of drug called an ACE inhibitor that works by stopping the angiotensin II hormone from being produced, which usually causes the blood pressure to increase. When it stops the hormone from being formed, the blood pressure gets lower and can help to manage hypertension.
If you or someone you know needs to take perindopril to help lower your blood pressure or improve your heart health, this page has most of the information that you’ll need.
Brand Names and Doses
There are two different types of perindopril: perindopril arginine and perindopril erbumine. Both of these are are the names of the active drug in the medication but have a slightly different chemical form and have different recommended doses. They are both metabolized by your liver to form perindoprilat, which is the compound that actually exerts a pharmaceutical effect on your body.
Perindopril arginine
This type is available under the brand name Coversyl with three different doses available: 2.5mg, 5mg, and 10mg.
It is also available in combination with other medications to treat hypertension, such as amlodipine and indapamide.
Coveram and Reaptan are brand names that contain a combination or perindopril arginine with amlodipine, available in several doses: 5mg perindopril arginine/5mg amlodipine, 5mg perindopril arginine/10mg amlodipine and 10mg perindopril arginine/5mg amlodipine.
Coversyl Plus is perindopril arginine in combination with indapamide. There are two doses available: 2.5mg perindopril arginine/0.625mg indapamide and 5mg perindopril arginine/1.25mg indapamide.
Perindopril erbumine
This typeis available under several brand names including:
- Idaprex
- Indopril
- Perindo
There are three different doses, which are 2mg, 4mg and 8mg. These are slightly different to perindopril arginine, because the size of the chemical molecule is different.
Perindopril erbumine 4mg is also available in combination with indapamide 1.25 mg under these brand names:
- Idaprex Combi
- Perindo Combi
What type of drug is it?
Perindopril is a type of drug called an angiotensin-converting enzyme (ACE) inhibitor, a group of medications that work in a similar way to lower blood pressure. Other medicines in the same class are:
How does it work?
ACE inhibitor drugs work to lower blood pressure by stopping an enzyme in the body from converting angiotensin I to angiotensin II. Angiotensin II is the active form, which usually helps to keep the blood pressure higher when it’s too low, by tightening the blood vessels and increasing the amount of blood travelling through them.
When you take perindopril, you don’t have as much angiotensin II in your body and it can’t work its effect as usual to increase the blood pressure. This is what happens:
- The muscles around your blood vessels relax, creating more room for the blood to pass through.
- Your kidneys reabsorb less water and you excrete more in your urine, which means you will have less blood in your blood system.
This means that you will have less blood pumping around blood vessels that are roomier than usual. If you think of it like a plumbing system, that means there is going to be less pressure on your cardiovascular system and helping your heart.
Side Effects
ACE inhibitors have a broad action on the body and there are several side effects that can occur when you take perindopril. The most important ones are explained below, but you should check the medicine information leaflet for the complete list.
Low blood pressure (hypotension)
The most common side effects happen because it’s working too well and you end up with low blood pressure. You might notice symptoms of:
- Headache
- Tiredness
- Dizziness
- Flushing
This is most common when you first start taking perindopril or if your dose has recently increased, and they usually get better in a few days as your body gets used to the drug. If you still notice these effects after more than a week, your blood pressure might be low because you’re taking a higher dose than you need. You can test your blood pressure to make sure (most pharmacies do this for free) and you can talk to your doctor if you need to lower the dose.
Excess Potassium (Hyperkalaemia)
It causes more water to be excreted in the urine that usual, which can upset the balance of potassium and other salts in your body. Less potassium is excreted and it can build-up in your body, causing symptoms of tiredness and muscle weakness.
The best way to check if you have high potassium levels is to take a simple blood test, so simply have a chat with your doctor if you think you might have hyperkalemia.
Cough
Perindopril can cause some people to get a dry cough, which can be quite frustrating as it does not seem to go away. If you experience a cough and it annoys you, you can talk to your doctor about alternative medications like an angiotensin II channel blocker.
Cautions
There are a couple of things you should be aware of before you start taking perindopril, as they can have serious consequences for some people. It’s best to know these things in advance!
Angioedema
Rarely, it can cause swelling of the mouth and throat called angioedema. This is serious because it can stop you from breathing as normal. If you have suffered from angioedema before, you should not take perindopril because you are more likely than others to experience it again. If you are taking the medication and you notice swelling around your mouth and face, see a doctor immediately.
Renal Impairment
Perindopril puts extra pressure on the kidneys and increases the risk of renal impairment, particularly when used with other medications, such as NSAIDS and diuretics. If you have poor kidney function, it is not likely to be the best choice of drug for you.
Stopping Suddenly
Perindopril should be taken every day to manage high blood pressure over the long-term. If you suddenly stop taking it, the amount of angiotensin II in your body will increase once again and cause more blood to push through smaller blood vessels. Your hypertension might be even worse because of the sudden change, called rebound hypertension. Instead, you should gradually reduce the dose over a few weeks when you want to stop taking perindopril.
Drug Interactions
Lithium + Perindopril Interaction
It can decrease the amount of lithium that is excreted from the body, leading to high concentrations and increased risk of side effects. The dose of lithium can be reduced to manage this, or a different antihypertensive medication can be used.
Loop Diuretic + Perindopril Interaction
Taking a these drugs together increases the risk of blood pressure that is too low, particularly for the first few doses. You may need a lower dose or to stop taking the loop diuretic for a few days when beginning perindopril. Using both may also increase risk of renal impairment.
NSAID + Perindopril Interaction
These drugs can sometimes be used together in young otherwise healthy patients, but it might not work as well to reduce your blood pressure.
Thiazide Diuretic + Perindopril Interaction
Taking these drugs together increases the risk of blood pressure that is too low, particularly for the first few doses, and may increase the risk of renal impairment. Using a lower dose is okay for some people but the combination is not recommended for others – it depends on your individual situation.
Pregnancy and Breastfeeding
You should not take perindopril if you are pregnant, breastfeeding or planning to become pregnant in the future. Doses in the first trimester can cause birth defects and later in the pregnancy may lead to renal dysfunction of the baby.
You can take this drug when you are breastfeeding. Very small amounts may be excreted in the breast milk, but no side effects have been reported. It is best to monitor for possible signs of low blood pressure in your baby, however, such as tiredness and irritability.
