|Trade names||Coversyl, Coversum, Aceon, others|
|Drug class||ACE inhibitor|
|Main uses||High blood pressure, heart failure, diabetic kidney disease, coronary artery disease|
|Side effects||Cough, palpitations, muscle cramps, protein in the urine|
|Elimination half-life||1–17 hours for perindoprilat (active metabolite)|
|Chemical and physical data|
|Molar mass||368.474 g·mol−1|
|3D model (JSmol)|
|(what is this?)|
Perindopril is a medication used to treat high blood pressure, heart failure, diabetic kidney disease, and coronary artery disease. It is taken by mouth. Maximum effect occurs over several weeks.
Common side effects include cough, palpitations, muscle cramps, and protein in the urine. Other side effects may include angioedema, low blood pressure, and kidney failure. Use during pregnancy may harm the baby. A lower dose should be used in those with kidney problems. It is an ACE inhibitor and works by inhibiting the renin-angiotensin-aldosterone system.
Perindopril was patented in 1980 and approved for medical use in 1988. It is available as a generic medication. In the United Kingdom a month of medication costs the NHS about 7 pounds. In the United States this amount costs about 15 USD as of 2021. It is available as perindopril erbumine and perindopril arginine.
Perindopril shares the indications of ACE inhibitors as a class, including essential hypertension, stable coronary artery disease (reduction of risk of cardiac events in patients with a history of myocardial infarction and/or revascularization), treatment of symptomatic coronary artery disease or heart failure, and diabetic nephropathy.
In combination with indapamide, perindopril has been shown to reduce the progression of chronic kidney disease and kidney complications with type 2 diabetes. In addition, perindopril by itself demonstrated no benefit in reducing recurrent strokes when compared to placebo, the addition of low dose indapamide to perindopril therapy was associated with larger reductions in both blood pressure lowering and recurrent stroke risk in people with pre-existing cerebrovascular disease, irrespective of their blood pressure.  There is evidence that perindopril and indapamide prevents strokes and improves mortality in people with a history of stroke, transient ischaemic attack or other cardiovascular disease.
A comparison of the combination of atenolol and bendroflumethiazide to the combination of amlodipine and perindopril found improved outcomes with the laterThe combination of amlodipine and perindopril remains in the treatment guidelines for hypertension.
- Situations where a patient has a history of hypersensitivity
- Kidney failure
Side effects are mild, usually at the start of treatment; they include:
- Disturbances of mood and/or sleep
- Taste impairment
- Epigastric discomfort
- Abdominal pain
Reversible increases in blood urea and creatinine may be observed. Proteinuria has occurred in some patients. Rarely, angioneurotic edema and decreases in hemoglobin, red cells, and platelets have been reported.
- Assess kidney function before and during treatment where appropriate.
- Renovascular hypertension
- An analysis on the PROGRESS trial showed that perindopril has key benefits in reducing cardiovascular events by 30% in patients with chronic kidney disease defined as a CrCl <60ml/min. A 2016 and 2017 meta-analysis review looking at ACE inhibitors demonstrated a reduction in cardiovascular events but also slowed the decline of renal failure by 39% when compared to placebo. These studies included patients with moderate to severe kidney disease and those on dialysis.
- Its renoprotective benefits of decreasing blood pressure and removing filtration pressure is highlighted in a 2016 review. ACE inhibitor can result in an initial increase of serum creatinine, but mostly returns to baseline in a few weeks in majority of patients. It has been suggested that increased monitoring, especially in advanced kidney failure, will minimise any related risk and improve long-term benefits.
- Use cautiously in patients with sodium or volume depletion due to potential excessive hypotensive effects of renin-angiotensin blockade causing symptomatic hypotension. Careful monitoring or short-term dose reduction of diuretics prior to commencing perindopril is recommended to prevent this potential effect. A diuretic may later be given in combination if necessary; potassium-sparing diuretics are not recommended in combination with perindopril due to the risk of hyperkalaemia.
- Combination with neuroleptics or imipramine-type drugs may increase the blood pressure lowering effect. Serum lithium concentrations may rise during lithium therapy.
Society and culture
Perindopril is available under the following brand names among others:
Perindopril is taken in the form of perindopril arginine (trade names include Coversyl, Coversum) or perindopril erbumine (Aceon). Both forms are therapeutically equivalent and interchangeable, but the dose prescribed to achieve the same effect differs between the two forms. It is also often combined with another medication, sometimes in the same tablet (see #Combinations below).
Each tablet contains 2, 4, or 8 mg of the tert-butylamine salt of perindopril. Perindopril is also available under the trade name Coversyl Plus, containing 4 mg of perindopril combined with 1.25 mg indapamide, a thiazide-like diuretic.
In Australia, each tablet contains 2.5, 5, or 10 mg of perindopril arginine. Perindopril is also available under the trade name Coversyl Plus, containing 5 mg of perindopril arginine combined with 1.25 mg indapamide and Coversyl Plus LD, containing 2.5 mg of perindopril arginine combined with 0.625 mg indapamide.
The efficacy and tolerability of a fixed-dose combination of 4 mg perindopril and 5 mg amlodipine, a calcium channel antagonist, has been confirmed in a prospective, observational multicenter trial of 1,250 hypertensive patients. A preparation of the two drugs is available commercially as Coveram.
On 9 July 2014, the European Commission imposed fines of €427,700,000 on Laboratoires Servier and 5 companies which produce generics due to Servier's abuse of their dominant market position, in breach of European Union Competition law. Servier's strategy had included acquiring the principal source of generic production of Perindopril and entering into several pay-for-delay agreements with potential generic competitors.
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