Perindopril arginine

eMC SPC 4.2 (Coversyl Arginine 10 mg Film-coated Tablets). The dose should be individualised according to the patient profile and blood pressure response; the dose may be increased to 10 mg once daily after one month of treatment. A starting dose of 2.5 mg is recommended, with initiation under medical supervision, in patients with a strongly activated renin-angiotensin-aldosterone system (in particular renovascular hypertension, salt and/or volume depletion, cardiac decompensation or severe hypertension). Symptomatic hypotension may occur after initiation, more likely in patients concurrently treated with diuretics - if possible discontinue the diuretic 2 to 3 days before starting; where the diuretic cannot be discontinued, initiate at 2.5 mg and monitor renal function and serum potassium, adjusting subsequent dosage according to blood pressure response. ELDERLY (hypertension): initiate at 2.5 mg, increase progressively to 5 mg after one month, then to 10 mg if necessary depending on renal function. SYMPTOMATIC HEART FAILURE: recommended starting dose 2.5 mg taken in the morning, introduced under close medical supervision and generally associated with a non-potassium-sparing diuretic and/or digoxin and/or a beta-blocker; may be increased after 2 weeks to 5 mg once daily if tolerated, adjusted to the individual clinical response. In severe heart failure and other high-risk patients (impaired renal function with a tendency to electrolyte disturbance, concurrent diuretics and/or vasodilators) initiate under careful supervision; correct salt depletion, hyponatraemia or hypovolaemia beforehand if possible and monitor blood pressure, renal function and serum potassium closely before and during treatment. STABLE CORONARY ARTERY DISEASE: 5 mg once daily for two weeks, then increased to 10 mg once daily depending on renal function and provided the 5 mg dose is well tolerated; elderly patients should receive 2.5 mg once daily for one week, then 5 mg once daily the next week, before increasing up to 10 mg once daily depending on renal function. Increase the dose only if the previous lower dose is well tolerated. HEPATIC IMPAIRMENT: no dosage adjustment is necessary. PAEDIATRIC: safety and efficacy in children and adolescents aged below 18 years have not been established; no recommendation on a posology can be made and use in children and adolescents is not recommended - no per-kg dose is stated; refer to a children's formulary. NOTE: the fetched extract does not include SPC section 4.5, so the interaction list below is drawn only from sections 4.2/4.3/4.4 and is incomplete - clinician to check the full interaction section.