Perindopril

What is perindopril?

Perindopril is a type of medication known as an angiotensin-converting enzyme (ACE) inhibitor, used in the treatment of high blood pressure (hypertension) and heart failure. It is prescribed to patients at high risk of heart attack or stroke, and patients who have recently had a heart attack or heart surgery.

How does perindopril work?

When blood pressure is too high, the heart and arteries are forced to work much harder to pump blood around the body. Overexertion can lead to damaged vessels in the brain, heart and kidneys, heart failure, stroke or kidney failure. Perindopril works by blocking the mechanism of a substance in the body which causes blood vessels to constrict. This relaxes the blood vessels, lowering blood pressure and increasing the supply of oxygen to the heart.

How long does it take for perindopril to work?

Perindopril will begin to work within just a few hours of your first dose, but it will take a few weeks for it to take full effect.

Active ingredients

The active ingredient in perindopril is perindopril tert-butylamine.

Inactive ingredients

The inactive ingredients in perindopril are lactose anhydrous and magnesium stearate.

Please Note: Different generic brands may contain different inactive ingredients.

How to start taking perindopril?

Never start taking perindopril without the instruction of a doctor. You will begin with a low dose that can be gradually increased over time if necessary.

How to take perindopril?

Perindopril tablets should be taken once daily in the morning and before a meal. Your daily dose will be decided by a doctor. Perindopril works best when taken regularly, but if you forget to take a dose don’t worry, just take your next dose at the normal time. Never take a double dose to make up for a missed one.

Can perindopril be split or crushed?

Perindopril tablets can be crushed or split to reduce the dosage or to make them easier to swallow. 

How to stop taking perindopril?

Perindopril is usually taken for life. Never stop taking this medication without the instruction of a doctor.

Perindopril dosage

The maximum dose of perindopril is 8mg per day. The recommended starting dose for treatment of high blood pressure or stable coronary artery disease in adults is 4mg per day. For treating heart failure, or patients over the age of 65, the recommended starting dose is 2mg per day. For patients with kidney problems, a doctor will need to alter the dose according to kidney function.

Perindopril side effects

Like all medications, perindopril can cause side effects in some people. Stop taking perindopril and see a doctor if you experience any of the following serious side effects:

• A severe allergic reaction, including swelling of the face, lips or throat, difficulty breathing, itching or rashes.
• A severe skin reaction, including rash, ulcers in your mouth, worsening of pre-existing skin disease, reddening, blistering or detachment of skin.
• Yellow skin or eyes – this can be a sign of liver problems
• Unexpected bleeding or bruising, catching infections more easily, or feeling tired – this can indicate a blood disorder
• Faster, uneven or forceful heart rate, chest pain or tightness – this can be signs of a heart problem
• Shortness of breath, wheezing or a persistent cough – this can be a lung problem
• Severe stomach pain that may reach through to your back – this can indicate a problem with the pancreas
• Not passing as much urine as normal – this can be a sign of kidney problems
• Weakness in the arms or legs, or problems speaking – these may indicate a stroke

Common side effects (affecting up to 1 in 10 people) include:

• Dry, tickly cough
• Feeling dizzy
• Fainting, hypotension (abnormally low blood pressure)
• Headache
• Nausea or vomiting
• Diarrhoea, or constipation
• Mild skin rash
• Blurred vision
• Hair loss
• Sinusitis or bronchitis
• Dry mouth
• Breathlessness
• Stomach upset or gut pain
• Chest pain or angina
• Muscle pain or cramps
• Blood tests showing more potassium than usual in the blood
• Angioedema (rapid swelling of the skin)
• Palpitations or an irregular heartbeat
• Fatigue
• Drowsiness
• Sensory changes e.g. pins and needles or numbness
• Changes in kidney function
• Runny nose
• Sleep disorders
• Altered taste
• Tinnitus (ringing in the ears)
• Visual impairment

Uncommon side effects can affect up to 1 in 100 people and include:

• Joint pain
• Confusion
• Erectile dysfunction
• Fever
• Anaemia
• Hyperhidrosis (increased sweating)
• Heart attack 
• Pancreatitis
• Peripheral oedema (swelling in the hands or feet)
• Sensitivity to sunlight
• Respiratory (lung) disorders
• Stroke
• Falls
• Hypoglycaemia (low blood sugar)
• Fatigue or tiredness
• Altered mood
• Vasculitis (inflammation of the vessels, causing rash)

The following rare side effects can affect up to 1 in 1,000 people:

• Blood tests showing a decrease in red blood cells, white blood cells, platelets or haemoglobin
• Hepatitis (liver inflammation)
• Stevens-Johnson syndrome (a red rash typically causing blisters)
• Cholestasis (a problem with the bile salts)

Contraindications

Do NOT take perindopril if:

• You are allergic to any of the ingredients in this medication
• You have a history of angioedema, a severe allergic reaction that includes itching, hives, red marks on the hands, feet and throat, swelling around the eyes or lips, difficulty breathing and swallowing
• You are pregnant or breastfeeding

Before taking perindopril, tell your doctor if you:

• Have heart problems including cardiomyopathy and valvular heart disease
• Have liver problems
• Have kidney problems, including if you are having dialysis
• Have diabetes 
• Are of black African or Caribbean origin
• Have any problem with the salts in your blood (e.g. potassium, sodium)
• Have lost a lot of salts or fluids through vomiting, diarrhoea, sweating more than usual, being on a low-salt diet, taking diuretics or having dialysis
• Have primary aldosteronism
• Are going to receive an anaesthetic
• Might become pregnant
• Have blood pressure that is abnormally low or unstable
• Have severe or symptomatic aortic stenosis
• Are having desensitization treatment for wasp stings
• Have a collagen vascular disease such as scleroderma or systemic lupus erythematosus
• Have a peripheral vascular disease or generalised atherosclerosis

Drug interactions

Before taking perindopril, tell your doctor if you are taking any other medicines, including those purchased over the counter without a prescription. 

In particular, tell your doctor if you are taking any of the following:

• Angiotensin receptor blockers (ARB) e.g. Candesartan, lorsartan
• Calcium channel blockers e.g. amlodipine
• Aliskiren
• Anti-inflammatory medicines such as ibuprofen 
• Diuretics e.g. indapamide, bendroflumethiazide, furosemide
• Allopurinol 
• Bee/wasp venom extracts
• Antacids
• Amiloride
• Eplerenone
• Heparins
• Potassium salts
• Trimethoprim
• Medicines for heart rhythm such as digoxin or procainamide
• Alpha-blockers e.g. doxasocin 
• Medicines for diabetes e.g. insulin, metformin, and sulfonylureas
• Lithium
• Steroid medicines for inflammation such as prednisolone
• Sacubitril/valsartan for treatment of long-term chronic heart failure
• Medicines used for the treatment of low blood pressure, shock, cardiac failure, asthma or allergies such as ephedrine, noradrenaline or adrenaline
• Chemotherapy medicines
• Medicines to stop the rejection of organs after surgery such as ciclosporin, temsirolimus, cirolimus, everolimus
• Spironolactone
• Racecadotril

Perindopril food interactions

You should avoid using salt substitutes such as Lo-Salt, which are high in potassium. When used in combination with perindopril, they can cause the potassium levels in your blood to become too high. Drinking alcohol with perindopril can increase its blood pressure-lowering effect, causing you to feel dizzy. It is best to avoid alcohol during the first few days of treatment and to stop drinking altogether if dizziness persists.

Will perindopril affect my fertility?

There is no evidence to suggest that perindopril affects fertility in men or women. Tell your doctor if you are female and planning on becoming pregnant, as they may suggest an alternative high blood pressure treatment.

Perindopril and pregnancy

Before taking perindopril, speak to your doctor if you think you might be pregnant or are trying to become pregnant. This medication is not recommended for use during pregnancy. Perindopril is not suitable for use in women who are breastfeeding.

How to cope with perindopril side effects?

Most people do not experience side effects on perindopril, and when they do, they are generally mild. Perindopril can cause you to feel dizzy at first, and for this reason, your doctor will start by prescribing you a low dose. If you experience dizziness, stop what you are doing and find somewhere to lie down until the sensation has passed. Do not try to drive, ride a bike, or operate heavy machinery. Mild headaches can be managed by drinking plenty of fluids and taking painkillers where necessary. However, if headaches or dizziness continue for longer than a week, speak to your doctor for advice.

Lifestyle changes to make when taking perindopril

Making a few changes to your lifestyle will help to reduce blood pressure and contribute to your overall well being. The main cause of high blood pressure is having too much salt in the diet, so try and limit your intake to the recommended maximum of 6 grams per day. Cut back on fatty foods and include plenty of fruit and vegetables, whole grains and lean proteins in your diet. If you haven’t already done so, quit smoking, and reduce the amount of alcohol you drink to the recommended limit of 14 units per week. Exercising regularly will help to keep your heart and blood vessels in good condition and will also help to relieve stress. Stress can also cause blood pressure to rise, so it is best to try and avoid it where possible. Spend time with family and friends, go for daily walks and try to find time to relax.

Will I need to take perindopril for the rest of my life?

Treatment with perindopril is usually long-term, and is usually taken for the rest of your life.

Is long term use of perindopril safe?

Perindopril is safe for long term use and works best when used over a long period of time. Many people continue to take perindopril for the rest of their lives. 

Can I take perindopril before surgery?

You should tell your doctor if you are scheduled to undergo surgery whilst taking Perindopril, as it can reduce your blood pressure when used in combination with a general anaesthetic. Your doctor may tell you to stop taking Perindopril 24 hours before surgery. 

Is perindopril addictive?

Perindopril is not addictive.

Is perindopril a beta-blocker?

Perindopril is not a beta-blocker, it is an ACE inhibitor. Beta-blockers can also be prescribed to treat high blood pressure.