Perindopril arginine

How it works

It is a prodrug converted to perindoprilat, which inhibits angiotensin-converting enzyme to reduce angiotensin II and aldosterone, lowering vascular resistance and fluid retention.

Prescribing in practice

• Check renal function and potassium before starting and after dose changes, and be alert to first-dose hypotension in diuretic-treated or volume-depleted patients.
• Dry cough and, rarely, angioedema can occur; hyperkalaemia is a recognised risk.
• Avoid in pregnancy and in bilateral renal artery stenosis; use caution in renal impairment and with other potassium-raising agents.

Monitoring

Monitor renal function, serum potassium and blood pressure before treatment, after dose adjustments and periodically during therapy.

Counselling the patient

• Take it at the same time each day, ideally before food in the morning.
• Report a persistent dry cough or any swelling of the face, lips or throat (seek urgent help), and avoid potassium-based salt substitutes.

Evidence & guidelines

Guideline-recommended for hypertension and cardiovascular indications (NICE NG136, NG106).