Perindopril

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 work 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. 

What is Perindopril?

Perindopril is a type of medication known a 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 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.

Inactive Ingredients

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

Active Ingredients

The active ingredient in Perindopril is perindopril tert-butylamine.

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. 

Perindopril Dosage

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

How to stop taking Perindopril

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

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 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 dont worry - just take your next dose at the normal time. Never take a double dose to make up for a missed one.

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 alcohol during the first few days of treatment, and to stop drinking altogether if dizziness persists.   

Will Perindopril affect my fertility?

There is not 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 Side Effects

Like all medications, Perindopril can cause side effects in some patients. If you experience any of the following serious side effects, stop taking your tablets and contact your doctor immediately:

• Swelling of the face, lips, mouth, tongue or throat
• Difficulty breathing
• Feeling dizzy or faint
• Severe abdominal pain
• Other side effects are usually mild, but you can speak to a doctor if they are troubling you.

Common side effects, which can affect up to 1 in 10 people, include:

• Headache
• Dizziness or vertigo
• Pins and needles
• Vision disturbances
• Tinnitus
• Lightheadedness
• Cough or shortness of breath
• Gastrointestinal disorder (nausea, vomiting, abdominal pain, taste disturbances, dyspepsia or difficulty of digestion, diarrhoea, constipation)
• Allergic reaction such as skin rashes or itching
• Muscle cramps
• Fatigue

Less common side effects (affecting u to 1 in 100 people) include:

• Mood swings
• Sleep disturbances
• Bronchospasm (tightening of the chest, wheezing, shortness of breath)
• Dry mouth
• Intense itching or skin rashes, blister clusters
• Kidney problems
• Impotence
• Sweating
• Excess of a type of white blood cell called eosinophils
• Drowsiness
• Fasting
• Palpitations
• Tachycardia
• Vasculitis (inflammation of the blood vessels)
• Increased sensitivity to sunlight
• Joint or muscle pain
• Restlessness or uneasiness
• Oedema peripheral
• Fever
• Change in laboratory parameters, including high blood level of potassium, low level of sodium, hypoglycemia (low blood sugar level) in diabetic patients, increased blood urea or creatinine.

The following rare side effects may affect up to 1 in 1000 people:

• Increased level of liver enzymes
• High level of serum bilirubin
• Psoriasis worsening

Very rarely (1 in 10,000) the following side effects may be experienced:

• Confusion
• Cardiovascular disorder (irregular heartbeat, heart attack, stroke)
• Eosinophilic pneumonia
• Rhinitis (blocked or runny nose)
• Erythema multiforme
• Acute renal failure
• Change in blood value such as lower number of white or red blood cells, lower haemoglobin, lower number of blood platelets
• Inflammation of the pancreas, causing severe pain in the abdomen and back
• Hepatitis  

Contraindications

Do NOT take Perindopril if:

• You are allergic to any of the ingredients in this medication, or to any other ACE inhibitor
• You have had symptoms such as wheezing, swelling of the face, tongue or throat, intense itching, skin rash, fainting or feeling dizzy
• You are more than 3 months pregnant (it is best to avoid taking Perindopril at all during pregnancy)
• You have diabetes mellitus or kidney problems and you are treated with aliskiren

Before taking Perindopril, talk to your doctor if:

• You have aortic stenosis (narrowing of the aorta), hypertrophic cardiomyopathy (heart muscle disease) or renal artery stenosis (narrowing of the artery supplying blood to the kidney)
• You have any other heart problems
• You have liver problems
• You have kidney problems or are receiving dialysis
• You suffer from a collagen vascular disease such as systemic lupus erythematosus or scleroderma
• You have diabetes
• You have been told to limit the salt in your diet or to use a salt-substitute containing potassium
• You are to undergo anaesthesia
• You are to undergo LDL apheresis
• You are going to undergo desensitisation treatment to reduce the effect of an allergy to insect stings
• You have recently suffered from diarrhoea or vomiting, or are dehydrated
• You are of Afro-Caribbean descent, since you may have higher risk of angioedema and/or this medicine may be less effective
• You have an intolerance to some sugars

Drug Interactions

Before taking Perindopril, tell your doctor about any other medications you are taking, including those purchased over the counter without a prescription. In particular, tell your doctor if you are taking any of the following:

• Other medicines for high blood pressure, including aliskiren, diuretics, and angiotensin II receptor blocker (ARBS)
• Racecadotril (used to treat diarrhoea)
• Potassium-sparing drugs, potassium supplements or potassium-containing salt substitutes
• Eplerenone or spironolactone at doses between 12.5 mg and 50 mg per day
• Lithium
• Non-steroidal anti-inflammatory drugs such as ibuprofen or aspirin
• Baclofen
• Medicines used to treat mental disorders, such as tricyclic antidepressants or antipsychotics
• Immunnosuppressants 
• Trimethoprim
• Estramustine
• Allopurinol
• Procainamide
• Vasodilators
• Heparin
• Medicines used to treat low blood pressure, shock or asthma
• Gold salts, particularly with intravenous administration
• Medicines used to avoid rejection of transplanted organs

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, and must NOT be taken after the third month of 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 of 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 had 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, spek 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 wellbeing. 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 6g per day. Cut back on fatty foods and include plenty plenty of fruit and vegetable, wholegrains 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 and find time to relax. 

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.

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

Treatment with Perindopril is usually long-term, often for the rest of your life.

Is Perindopril addictive?

Perindopril is not addictive.

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 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. 

Sources

• Patient Information Leaflet
• NHS > Perindopril
• NHS > High Blood Pressure