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Perindopril : Side effects, dosage, uses, and more

Highlights for perindopril

Important warnings

FDA warning: Use during pregnancy

  • This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.
  • You shouldn’t take this drug if you’re pregnant or planning to become pregnant. It can harm or end your pregnancy. Talk to your doctor about other ways to lower your blood pressure if you become pregnant. If you get pregnant while taking perindopril, tell your doctor right away.

Other warnings

  • Angioedema (swelling) warning: This drug can cause sudden swelling of your face, arms, legs, lips, tongue, throat, and intestines. This can be fatal. Tell your doctor right away if you have swelling in these areas or abdominal pain. You’ll be taken off of perindopril and possibly given medication to reduce the swelling. Angioedema can happen at any time while you’re taking perindopril.
  • Low blood pressure warning: Perindopril can cause hypotension (low blood pressure), especially during the first few days of treatment. Tell your doctor if you feel lightheaded or have any fainting spells. Your risk of low blood pressure may be higher if you:
    • don’t drink enough fluids
    • sweat heavily
    • have diarrhea or are vomiting
    • have heart failure
    • are on dialysis
    • take diuretics (water pills)

    What is perindopril?

    Perindopril is a prescription drug. It comes as an oral tablet.

    Perindopril isn’t available as a brand-name drug. It’s only available as a generic drug. Generic drugs usually cost less than brand-name versions.

    Perindopril may be used as part of a combination therapy. That means you need to take it with other drugs.

    Why it’s used

    Perindopril oral tablet is used to treat hypertension (high blood pressure). Reducing your blood pressure lowers your risk of complications, such as stroke or heart attack.

    Perindopril is also used to lower your risk of death or heart attack if you have stable coronary artery disease.

    How it works

    Perindopril belongs to a class of drugs called angiotensin-converting enzyme (ACE) inhibitors. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

    Perindopril works by helping your blood vessels relax and widen. This lowers your blood pressure.

    Perindopril side effects

    Perindopril oral tablet doesn’t cause drowsiness, but it can cause other side effects.

    More common side effects

    Some of the more common side effects that can occur with use of perindopril include:

    • dizziness
    • weakness
    • headaches
    • upset stomach
    • stomach pain
    • diarrhea
    • cough
    • back pain
    • low blood pressure, which may make you feel dizzy or faint

    If these effects are mild, they may disappear within a few days or a couple of weeks. If they’re more severe or don’t disappear, talk to your doctor or pharmacist.

    Serious side effects

    Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

    • Breathing problems. Symptoms can include:
      • trouble breathing or swallowing
      • hoarseness
      • swelling of your face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
      • lightheadedness
      • fainting
      • fever
      • sore throat
      • chills
      • irregular or rapid heart rate
      • yellowing of your skin and the whites of your eyes
      • nausea
      • vomiting
      • pain in the upper right part of your abdomen
      • fatigue
      • elevated liver enzymes

      Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

      Perindopril may interact with other medications

      Perindopril oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

      To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

      Examples of drugs that can cause interactions with perindopril are listed below.

      Sacubitril

      Taking perindopril with sacubitril, which is used with valsartan to treat high blood pressure and heart failure, raises your risk of angioedema (serious swelling). You should not use perindopril within 36 hours of using sacubitril.

      Nonsteroidal anti-inflammatory drugs (NSAIDs)

      Taking NSAIDs with perindopril can increase your risk of kidney problems. Your risk may be higher if you’re a senior, have kidney problems, or are dehydrated. Examples of these drugs include:

      • ibuprofen
      • indomethacin

      Diuretics (water pills)

      Taking diuretics with perindopril can sometimes increase your risk of low blood pressure. Examples of these drugs include:

      • hydrochlorothiazide
      • furosemide
      • bumetanide
      • chlorthalidone
      • torsemide
      • indapamide

      Potassium-sparing diuretics, potassium supplements, and salt substitutes

      Taking these drugs with perindopril can increase your risk of high potassium levels in your blood. Examples of these drugs include:

      • spironolactone
      • triamterene
      • amiloride
      • potassium-containing salt substitutes

      Blood thinner

      Taking heparin with perindopril can increase your risk of high potassium levels in your blood.

      Blood pressure medications

      Taking these drugs with perindopril can increase your risk of high potassium levels. It can also lower your blood pressure too much and cause decreased kidney function. Examples of these drugs include:

      • aliskiren
      • losartan
      • valsartan
      • olmesartan
      • candesartan
      • benazepril
      • captopril
      • enalapril
      • lisinopril

      Mood stabilizer

      Taking lithium with perindopril may increase the amount of lithium in your body.

      Drugs to prevent organ transplant rejection

      Taking these drugs with perindopril raises your risk of angioedema (swelling), a severe allergic reaction. Examples of these drugs include:

      • temsirolimus
      • sirolimus
      • everolimus

      In addition, taking cyclosporine with perindopril can increase your risk of high potassium levels in your blood.

      Gold

      Using injectable gold (sodium aurothiomalate) with perindopril may increase your risk of a nitritoid reaction. Symptoms of this condition can include flushing (warming and reddening of your face and cheeks), nausea, vomiting, and low blood pressure.

      Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

      Perindopril warnings

      This drug comes with several warnings.

      Allergy warning

      Perindopril can cause a severe allergic reaction. Symptoms can include:

      • trouble breathing
      • swelling of your throat or tongue
      • hives

      If you develop these symptoms, call 911 or go to the nearest emergency room.

      Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

      Warnings for people with certain health conditions

      For people with angioedema: If you have a history of hereditary or idiopathic angioedema that’s not related to previous use of drugs similar to perindopril (ACE inhibitors), you may have a higher risk of angioedema while taking perindopril.

      For people with liver failure: Your body may not clear this drug out of your system as well as it should. This could cause higher levels of perindopril in your body, leading to more side effects.

      For people with kidney problems: Perindopril may decrease how well your kidneys work. Your doctor may have you stop taking this drug if your kidney function gets worse while you’re taking it.

      For people with lupus: Perindopril can lower your white blood cell counts. This raises your risk of infections. This is more likely to occur if you have lupus. If you have lupus and take this drug, tell your doctor any time you have a fever or sore throat.

      For people with scleroderma: Perindopril can lower your white blood cell counts. This raises your risk of infections. This is more likely to occur if you have scleroderma. If you have this condition and take this drug, tell your doctor any time you have a fever or sore throat.

      Warnings for other groups

      For pregnant women: Perindopril is a category D pregnancy drug. That means two things:

      Talk to your doctor if you’re pregnant or planning to become pregnant. Ask your doctor to tell you about the specific harm that may be done to your pregnancy. This drug should be only used if the potential risk to the fetus is acceptable given the drug’s potential benefit.

      If you become pregnant while taking this drug, call your doctor right away.

      For women who are breastfeeding: It isn’t known if perindopril passes into breast milk. If it does, it may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

      For seniors: Your body may process drugs more slowly than it used to. A normal adult dosage may cause levels of this drug to be higher than normal in your body. You may need a lower dosage or a different dosage schedule.

      For children: This drug hasn’t been studied in children. It shouldn’t be used in children younger than 18 years.

      How to take perindopril

      All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

      • your age
      • the condition being treated
      • how severe your condition is
      • other medical conditions you have
      • how you react to the first dose

      Drug form and strengths

      Generic: Perindopril

      • Form: oral tablet
      • Strengths: 2 mg, 4 mg, 8 mg

      Dosage for hypertension (high blood pressure)

      Adult dosage (ages 18–64 years)

      • Typical starting dosage: 4 mg taken once per day.
      • Typical dosage: 4–8 mg taken once per day or split into two divided doses.
      • Dosage increases: Your doctor may change your dosage based on your blood pressure.
      • Maximum dosage: 16 mg per day.

      Child dosage (ages 0–17 years)

      This drug hasn’t been studied in children. It shouldn’t be used in people younger than 18 years.

      Senior dosage (ages 65 years and older)

      • Typical starting dosage: 4 mg taken once per day or split into two divided doses.
      • Dosage increases: Your doctor will increase your dosage slowly to reduce your risk of side effects. If your doctor increases your dosage above 8 mg per day, they should carefully monitor your blood pressure.

      Dosage for stable coronary artery (heart) disease

      Adult dosage (ages 18–64 years)

      • Typical starting dosage: 4 mg taken once per day for two weeks.
      • Dosage increases: Your doctor may increase your dosage up to 8 mg taken once per day if tolerated.

      Child dosage (ages 0–17 years)

      This drug hasn’t been studied in children. It shouldn’t be used in children younger than 18 years.

      Senior dosage (ages 65–70 years)

      • Typical starting dosage: 4 mg taken once per day for two weeks.
      • Dosage increases: Your doctor may increase your dosage up to 8 mg taken once per day if tolerated.

      Senior dosage (ages 71 years and older)

      • Typical starting dosage: 2 mg taken once per day in the first week, and 4 mg taken once per day in the second week.
      • Dosage increases: Your doctor may increase your dosage up to 8 mg taken once per day if tolerated.

      Special dosage considerations

      For people with kidney disease: For people with mild to moderate kidney disease, the starting dosage is 2 mg taken once per day. The maximum dosage is 8 mg taken once per day. If you have severe kidney disease, you shouldn’t use this drug.

      Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

      Take as directed

      Perindopril oral tablet is used for long-term treatment. It comes with serious risks if you don’t take it as prescribed.

      If you stop taking the drug suddenly or don’t take it at all: Your high blood pressure will stay high. This may lead to serious complications, such as a heart attack or stroke.

      If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, it needs to be taken on a regular basis.

      If you take too much: You could have dangerous levels of the drug in your body. This may cause you to have more side effects. These can include:

      • very low blood pressure, which may cause dizziness or fainting
      • kidney problems
      • high potassium levels

      If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

      What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

      How to tell if the drug is working: Your blood pressure should be lower.

      Important considerations for taking perindopril

      Keep these considerations in mind if your doctor prescribes perindopril for you.

      General

      • You can take perindopril with or without food.
      • You can crush or cut the tablet.

      Storage

      • Store perindopril at room temperature between 68°F and 77°F (20°C and 25°C).
      • Store this away from light.
      • Don’t freeze this drug.
      • Don’t store this medication in moist or damp areas, such as bathrooms.

      Refills

      A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

      Travel

      When traveling with your medication:

      • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
      • Don’t worry about airport X-ray machines. They can’t harm your medication.
      • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
      • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

      Self-management

      Your doctor may tell you to check your blood pressure at home in between appointments. You may need to buy a blood pressure monitor to do this.

      Clinical monitoring

      You and your doctor should monitor certain health issues. This can help make sure you stay safe while you take this drug. They will check you for signs of swelling. They may also check issues that may include your:

      • kidney function
      • electrolyte levels
      • lithium levels (if you’re also taking lithium)
      • blood pressure

      Availability

      Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

      Hidden costs

      You may need to buy a blood pressure monitor to check your blood pressure at home.

      Prior authorization

      Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

      Are there any alternatives?

      There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

      Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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