Perindopril

FDA label

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Titration Stable CAD: increase to 8 mg once daily after 2 weeks as tolerated.

Renal CrCl <30 mL/min: not recommended. Lesser impairment: start 2 mg/day, do not exceed 8 mg/day.

Hepatic Perindoprilat exposure is increased in hepatic impairment; no specific dose adjustment provided.

Elderly: experience above 8 mg/day is limited.

Instructions

• Consider reducing diuretic dose before starting to limit first-dose hypotension
• Discontinue as soon as pregnancy is detected
• Start under close supervision in volume/salt-depleted patients

Contraindications

• Angioedema (hereditary, idiopathic, or related to prior ACE inhibitor therapy)
• Co-administration of aliskiren in patients with diabetes
• Use with a neprilysin inhibitor (e.g., sacubitril); do not give within 36 h of sacubitril/valsartan

Cautions

• Angioedema of face/extremities/larynx (may be fatal) and intestinal angioedema
• Symptomatic hypotension, especially if volume/salt-depleted
• Hyperkalemia
• Impaired renal function - monitor periodically
• Neutropenia/agranulocytosis
• Persistent nonproductive cough
• Rare hepatic failure (cholestatic jaundice to hepatic necrosis)

Adverse reactions

• Cough
• Dizziness
• Back pain
• Headache
• Hypotension
• Hyperkalemia

Pregnancy Pregnancy Category D - fetal toxicity; discontinue as soon as pregnancy is detected.

Lactation Unknown whether secreted in human milk; exercise caution in nursing mothers.