Perindopril erbumine with amlodipine

How it works

Perindopril inhibits angiotensin-converting enzyme to reduce angiotensin-II-mediated vasoconstriction and aldosterone release, while amlodipine blocks vascular L-type calcium channels to relax arterial smooth muscle, giving complementary blood-pressure lowering.

Prescribing in practice

• Avoid in pregnancy because the ACE-inhibitor component is foetotoxic; advise effective contraception in women of childbearing potential.
• ACE inhibitors can cause angioedema, which may be life-threatening and requires permanent withdrawal, as well as a persistent dry cough; risk of hyperkalaemia and renal impairment rises with volume depletion or NSAIDs.
• Amlodipine commonly causes dose-related ankle oedema and flushing, and the combination may cause symptomatic hypotension.

Monitoring

Monitor blood pressure, renal function and serum potassium after initiation and following any dose change.

Counselling the patient

• Seek urgent medical help for swelling of the face, lips, tongue or throat.
• Ankle swelling and flushing are common and relate to the amlodipine component.
• Report a persistent dry cough and inform your doctor at once if you become pregnant.

Evidence & guidelines

The perindopril-amlodipine combination is supported by the ASCOT-BPLA trial, which favoured this regimen over a beta-blocker plus thiazide for cardiovascular outcomes, and aligns with NICE step-up hypertension management.