perindopril erbumine

Action

Inhibits conversion of angiotensin I to angiotensin II (a potent vasoconstrictor). This effect leads to decreased plasma angiotensin II, reduced vasoconstriction, enhanced plasma renin activity, and decreased aldosterone activity.

Availability

Tablets: 2 mg, 4 mg, 8 mg

Indications and dosages

➣ Essential hypertension

Adults: 4 mg P.O. daily; may titrate upward to 16 mg/day, given as a single dose or in two divided doses. (Start with 2 to 4 mg/day in patients receiving diuretics.)

➣ Coronary artery disease

Adults: Initially, 4 mg P.O. daily for 2 weeks; then increase as tolerated to a maintenance dosage of 8 mg P.O. daily.

Dosage adjustment

• Renal impairment

• Elderly patients

Off-label uses

• Heart failure

• Diabetic nephropathy

Contraindications

• Hypersensitivity to drug or other ACE inhibitors

• Hereditary or idiopathic angioedema

Precautions

Use cautiously in:

• hepatic failure, renal impairment, renal artery stenosis, hyperkalemia, cough

• black patients

• pregnant or breastfeeding patients

• children (safety not established).

Administration

• Give without regard to food.

See Know that drug (especially first dose) may cause angioedema. Keep epinephrine and antihistamines at hand in case of airway obstruction.

• For elderly patient, titrate dosage upward very slowly.

• Know that drug may be given alone or with other drugs.

Adverse reactions

CNS: dizziness, fatigue, headache, insomnia, sleep disorder, weakness, asthenia, drowsiness, vertigo, depression, paresthesia

CV: hypotension, angina pectoris, palpitations, chest pain, abnormal ECG, tachycardia

EENT: ear infection, sinusitis, rhinitis, pharyngitis

GI: nausea, vomiting, diarrhea, abdominal pain, flatulence

GU: proteinuria, urinary tract infection, erectile or other male sexual dysfunction, decreased libido, menstrual disorder

Metabolic: hyperkalemia

Musculoskeletal: back, arm, leg, neck, or joint pain; hypertonia; myalgia; arthritis

Respiratory: cough, upper respiratory infection

Skin: rash, angioedema

Other: fever, viral infection, edema

Interactions

Drug-drug.

Antihypertensives, general anesthetics, nitrates, phenothiazines: additive hypotension

Diuretics: excessive hypotension Gold (sodium aurothiomalate): increased risk of rare nitritoid reactions (including facial flushing, nausea, vomiting, and hypotension)

Lithium: increased lithium toxicity Nonsteroidal anti-inflammatory drugs: may result in deterioration of renal function, including acute renal failure and attenuated ACE inhibitor antihypertensive effect

Potassium-sparing diuretics, potassium supplements: increased risk of hyperkalemia

Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, potassium, triglycerides: increased levels Hematocrit, hemoglobin: decreased values

Drug-food. Salt substitutes containing potassium: hyperkalemia

Drug-herbs. Capsaicin: cough

Drug-behaviors. Acute alcohol ingestion: additive hypotension

Patient monitoring

• Assess blood pressure. Be aware that dosage increases or concomitant diuretic use may cause severe hypotension.

See Watch for angioedema, especially after first dose.

• Stay alert for signs and symptoms of infection, particularly EENT and respiratory infections.

• Monitor potassium level. Watch for signs and symptoms of hyperkalemia.

• Monitor liver and kidney function tests before and during therapy.

See In black patients, watch closely for angioedema and monitor drug efficacy. Monotherapy may be less effective in these patients.

Patient teaching

• Tell patient to take at same time each day, with or without food.

See Instruct patient to stop using drug and contact prescriber immediately if hoarseness or difficulty swallowing or breathing occurs.

• Tell patient to avoid excessive perspiration or decreased fluid intake, which may cause symptomatic blood pressure drop. Inform him that vomiting or diarrhea also may lower blood pressure.

• Tell patient to report signs and symptoms of infection.

• Advise patient not to use potassium-containing salt substitutes.

See Caution female patient of child-bearing age to contact prescriber immediately if she suspects pregnancy.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.