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Perindopril is a long-acting ACE inhibitor used to treat high blood pressure, heart failure, or stable coronary artery disease However, the dose prescribed to achieve the same effect differs due to different molecular weights for the two forms. A prodrug, perindopril is hydrolyzed to its active metabolite, perindoprilat, in the liver.
Contents
1 Medical uses
2 Composition
3 Trade names
4 Contraindications
5 Precautions
6 Side effects
7 Marketing
8 References
9 Further reading
10 External links
Medical uses
Perindopril shares the indications of ACE inhibitors as a class, including essential hypertension, stable coronary artery disease (reduction of risk of cardiac events in patients with a history of myocardial infarction and/or revascularization) and treatment of symptomatic heart disease or heart failure. In addition, the Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS) found that perindopril reduces the risk of stroke in both hypertensive and normotensive individuals with a history of stroke or transient ischemic attack.
The Anglo-Scandinavian Cardiac Outcomes Trial showed the benefits of taking the two drugs perindopril and amlodipine together. About 9000 British patients aged 40 to 79 were involved in the five-year trial. Half were given the new drug combination; the rest were given traditional drugs. Perindopril and amlodipine were found to be so effective, the trial was stopped early so all patients could receive the combination.
Composition
Each tablet contains 2, 4, or 8 mg of the tert-butylamine salt of perindopril. Perindopril is also available under the trade name Coversyl Plus, containing 4 mg of perindopril combined with 1.25 mg indapamide.
In Australia, each tablet contains 2.5, 5, or 10 mg of perindopril arginine. Perindopril is also available under the trade name Coversyl Plus, containing 5 mg of perindopril arginine combined with 1.25 mg indapamide and Coversyl Plus LD, containing 2.5 mg of perindopril arginine combined with 0.625 mg indapamide.
The efficacy and tolerability of a fixed-dose combination of 4 mg perindopril and 5 mg amlodipine, a calcium channel antagonist, has been confirmed in a prospective, observational multicenter trial of 1,250 hypertensive patients. A preparation of the two drugs is available commercially as Coveram.
Trade names
Also, it is available under the brand names:
Acertil
Actiprex
Armix
Coverene
Coverex
Coversum
Coversyl
Covinace
Indapril
Perineva
Prenessa
Prestarium
Preterax
Prexanil
Prexum
Procaptan
Provinace
Pericard
Percarnil
Perindal
Repres
Contraindications
Children
Pregnancy
Lactation
Situations where a patient has a history of hypersensitivity
Renal failure
Precautions
Assess kidney function before and during treatment where appropriate.
Renovascular hypertension
Surgery/anesthesia
Kidney failure: the dose should be cautiously adjusted in accordance with the creatinine clearance (refer to complete data sheet).
Symptomatic low blood pressure is rarely seen, but is more likely in volume-depleted patients, those receiving diuretics, or with the first two doses. In diuretic-treated patients, stop the diuretic three days before starting perindopril. A diuretic may later be given in combination if necessary; potassium-sparing diuretics are not recommended. Combination with neuroleptics or imipramine-type drugs may increase the blood pressure lowering effect. Serum lithium concentrations may rise during lithium therapy.
Side effects
Side effects are mild, usually at the start of treatment; they include:
Cough
Fatigue
Weakness/ Asthenia
Headache
Disturbances of mood and/or sleep
Less often
Taste impairment
Epigastric discomfort
Nausea
Abdominal pain
Rash
Reversible increases in blood urea and creatinine may be observed. Proteinuria has occurred in some patients. Rarely, angioneurotic edema and decreases in hemoglobin, red cells, and platelets have been reported.
Marketing
On 9 July 2014, the European Commission imposed fines of €427,700,000 on Laboratoires Servier and 5 companies which produce generics due to Servier’s abuse of their dominant market position, in breach of European Union Competition law. Servier’s strategy had included acquiring the principal source of generic production of Perindopril and entering into several pay-for-delay agreements with potential generic competitors.

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