Perindopril erbumine

How it works

Its active metabolite perindoprilat inhibits angiotensin-converting enzyme, reducing formation of angiotensin II and decreasing aldosterone, which lowers vasoconstriction and sodium retention and reduces blood pressure and cardiac afterload.

Prescribing in practice

• It is contraindicated in pregnancy and in a history of ACE-inhibitor-associated angioedema, and can cause hyperkalaemia and renal impairment, especially with concomitant potassium-sparing agents, NSAIDs or in bilateral renal artery stenosis.
• A dry persistent cough is a common reason for discontinuation, and first-dose hypotension may occur, particularly in volume-depleted or diuretic-treated patients.
• Check renal function and electrolytes before starting and after initiation or dose increase; consult the SPC for cautions and interactions.

Monitoring

Monitor blood pressure, serum creatinine and potassium before starting and after initiation and dose changes.

Counselling the patient

• Advise reporting any swelling of the face, lips or throat urgently, as this can indicate angioedema.
• Explain that a dry cough may occur and to seek advice, and to avoid pregnancy and salt substitutes containing potassium.
• Suggest taking the first dose at a time when any dizziness can be managed safely.

Evidence & guidelines

Perindopril-based regimens reduced cardiovascular events in trials such as EUROPA and PROGRESS, and ACE inhibitors are recommended in NICE guidance for hypertension and heart failure.