Perindopril

DEA Class; Rx

Common Brand Names; Aceon

• ACE Inhibitors

Angiotensin converting enzyme (ACE) inhibitors dilate arteries and veins by competitively inhibiting the conversion of angiotensin I to angiotensin II (a potent endogenous vasoconstrictor) and by inhibiting bradykinin metabolism; these actions result in preload and afterload reductions on the heart

ACE inhibitors also promote sodium and water excretion by inhibiting angiotensin-II induced aldosterone secretion; elevation in potassium may also be observed

ACE inhibitors also elicit renoprotective effects through vasodilation of renal arterioles

ACE inhibitors reduce cardiac and vascular remodeling associated with chronic hypertension, heart failure, and myocardial infarction

Indicated for the treatment of hypertension

Hypersensitivity to perindopril/other ACE inhibitors

History of hereditary or angioedema associated with previous ACE inhibitor treatment

Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan

Bilateral renal artery stenosis

Do not coadminister with aliskiren in patients with diabetes mellitus or with renal impairment (ie, GFR <60 mL/min/1.73 m²)

• Headache (23%)
• Cough (12%)
• Dizziness (8%)
• Back pain (6%)
• Lower extremity pain (5%)
• Abnormal ECG (2%)
• Palpitation (1%)
• Depression (2%)
• Somnolence (1%)
• Menstrual disorder (1%)
• Edema (4%)
• ALT increased (2%)
• Sexual dysfunction (male 1%)
• Sleep disorder (3%)
• Chest pain (2%)
• Nausea/vomiting (2%)
• Flatulence (1%)
• Rash (2%)
• Hyperkalemia (1%)
• Tinnitus (2%)
• Intestinal angioedema
• Liver failure (rare)
• Leukopenia
• Pruritus
• Stroke
• Syncope
• Urinary retention
• Vertigo
• Amnesia

Apheresis (LDL) with dextran sulfate, hypertrophic cardiomyopathy, collagen vascular disease, excessive hypotension – volume depletion, hemodialysis with high flux membrane, aortic stenosis

ACE inhibition also causes increased bradykinin levels which putatively mediates angioedema

Coadministration with mTOR inhibitors (eg, temsirolimus) may increased risk for angioedema

Dual blockade of the renin angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for hypotension, hyperkalemia, and renal function changes (including acute renal failure) compared to monotherapy

Symptomatic hypotension is most likely to occur in patients who have been volume or salt-depleted as a result of prolonged diuretic therapy, dietary salt restriction, dialysis, diarrhea or vomiting; in patients with ischemic heart disease or cerebrovascular disease, an excessive fall in blood pressure could result in a myocardial infarction or a cerebrovascular accident; If excessive hypotension occurs, place patient in a supine position and, if necessary, treat with intravenous infusion of physiological saline; perinopril treatment can usually be continued following restoration of volume and blood pressure

Discontinue immediately if pregnant (see Contraindications and Black Box Warnings)

Less effective in blacks

Renal impairment may occur

Neutropenia/agranulocytosis reported

Cough may occur within the first few months

Cholestatic jaundice may occur

Renal impairment

Pregnancy Category: D

Discontinue as soon as pregnancy detected; during the second and third trimesters of pregnancy, drugs that act directly on the renin-angiotensin have been associated with fetal injury that includes hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death

Lactation: not known if distributed into breast milk; use caution