Perindopril

  1. About perindopril

    Perindopril is a medicine used to treat high blood pressure and heart failure. It's also prescribed after a heart attack.

    Perindopril helps to reduce the risk of future strokes and heart attacks. It also improves your survival if you're taking it following a heart attack or heart surgery.

    This medicine is only available on prescription. It comes as tablets.

    Perindopril is also available combined with 2 other blood pressure medicines called indapamide and amlodipine.

  2. Key facts

    • Perindopril lowers your blood pressure and makes it easier for your heart to pump blood around your body.
    • Your very first dose of perindopril may make you feel dizzy, so take it at bedtime. After that, if you don't feel dizzy, it's best to take perindopril in the morning before breakfast. 
    • Some people get a dry, irritating cough with perindopril.
    • Perindopril can be called perindopril arginine, perindopril erbumine or perindopril tert-butylamine. This is because the medicine contains another chemical to make it easier for your body to take up and use it. It doesn't matter what your perindopril is called. They all work as well as each other.
    • Perindopril is also called by the brand name Coversyl Arginine. When it's mixed with indapamide and amlodipine it's called Coversyl Arginine Plus.
  3. Who can and can't take perindopril

    Perindopril can be taken by adults aged 18 and over.

    If you have diabetes, check your blood sugar (glucose) more often, particularly in the first few weeks. This is because perindopril can lower the sugar level in your blood.

    Perindopril isn't suitable for everyone.

    To make sure perindopril is safe for you, tell your doctor if you:

    • have had an allergic reaction to perindopril or any other medicine in the past
    • are trying to get pregnant, are already pregnant or you are breastfeeding
    • are having dialysis or any other type of blood filtration
    • have heart, liver or kidney problems
    • have unstable or low blood pressure
    • have diabetes or faulty kidneys
    • have recently had diarrhoea or vomiting
    • are on a low-salt diet
    • are going to have desensitisation treatment to reduce your allergy to insect stings
    • are going to have a major operation or a general anaesthetic to put you to sleep
    • have a blood problem such as too few white blood cells (neutropenia or agranulocytosis)
  4. How and when to take it

    It's usual to take perindopril once a day, in the morning before breakfast.

    You may be advised to take your first dose before bedtime, because it can make you feel dizzy. After the very first dose, if you don't feel dizzy, take perindopril in the morning ideally 30 to 60 minutes before breakfast. Swallow perindopril tablets whole with a drink.

    How much will I take?

    The dose of perindopril you take depends on why you need the medicine. Take it as instructed by your doctor.

    To decide the correct dose for you, your doctor will check your blood pressure and ask you if you are getting any side effects. You may also have blood tests to check how well your kidneys are working and the amount of potassium in your blood. 

    Perindopril comes as perindopril erbumine (also called perindopril tert-butylamine) or perindopril arginine.

    They both work in the same way, but the doses vary.

    Perindopril erbumine (also called perindopril tert-butylamine)

    Depending on why you're taking perindopril erbumine, the usual starting dose is between 2mg and 4mg once a day.

    This dose may be increased gradually over a few weeks to a usual dose of:

    • 4mg once a day for high blood pressure. The maximum dose is 8mg once a day.
    • 8mg once a day after a heart attack
    • 4mg once a day for heart failure

    Perindopril arginine

    Depending on why you're taking perindopril arginine, the usual starting dose is between 2.5mg and 5mg once a day.

    This dose may be increased gradually over a few weeks to a usual dose of:

    • 5mg once a day for high blood pressure. The maximum dose is 10mg once a day.
    • 10mg once a day after a heart attack
    • 5mg once a day for heart failure

    Will my dose go up or down?

    You will probably be prescribed a low dose of perindopril at first so it doesn't make you feel dizzy. This will usually be increased gradually until you reach the right dose for you. If you have side effects with perindopril, you may stay on a lower dose.

    Take perindopril even if you feel well, as you will still be getting the benefits of the medicine.

    What if I forget to take it?

    If you miss a dose of perindopril, take it as soon as you remember that day. If you don't remember until the following day, skip the missed dose. Do not take a double dose to make up for a forgotten one.

    If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

    What if I take too much?

    If you take too many perindopril tablets, contact your doctor or nearest hospital straight away. An overdose of perindopril can cause dizziness, sleepiness and a pounding heartbeat

    The amount of perindopril that can lead to an overdose varies from person to person.

    If you take too much perindopril by accident, call your doctor or go to your nearest hospital straight away.

    If you need to go to hospital, don't drive yourself - get someone else to drive you or call for an ambulance. Take the perindopril packet or leaflet inside it plus any remaining medicine with you.

  5. Side effects

    Like all medicines, perindopril can cause side effects in some people but many people have no side effects or only minor ones. Side effects often improve as your body gets used to the medicine.

    Common side effects

    These common side effects happen in more than 1 in 100 people.

    Talk to your doctor or pharmacist if they bother you or don’t go away:

    • dry, tickly cough that does not go away
    • feeling dizzy or light headed, especially when you stand up or sit up quickly. This is more likely to happen when you start taking perindopril or if you move onto a higher dose.
    • headache
    • diarrhoea and vomiting 
    • a mild skin rash
    • blurred vision

    Serious side effects

    It happens rarely, but some people may have serious side effects when taking perindopril.

    Tell a doctor straight away if you think you might have:

    • weak arms and legs or problems speaking - these can be signs of a stroke
    • yellow skin or eyes - this can be a sign of liver problems.
    • paleness, feeling tired, faint or dizzy, purple spots, any sign of bleeding (like bleeding from the gums and bruising more easily), sore throat and fever and getting infections more easily - these can be signs of a blood or bone marrow disorder
    • a faster heart rate, chest pain and tightness in your chest - these can be signs of heart problems
    • shortness of breath, wheezing and tightening of the chest - these can be signs of lung problems
    • severe tummy pain - this can be a sign of an inflamed pancreas
    • swollen ankles, blood in your pee or not peeing at all - these can be signs of kidney problems

    Serious allergic reaction

    In rare cases, it’s possible to have a serious allergic reaction to perindopril.

    A serious allergic reaction is an emergency. Contact a doctor straight away if you think you or someone around you is having a serious allergic reaction.

    The warning signs of a serious allergic reaction are:

    • getting a skin rash that may include itchy, red, swollen, blistered or peeling skin
    • wheezing
    • tightness in the chest or throat
    • having trouble breathing or talking
    • swelling of the mouth, face, lips, tongue, or throat

    These are not all the side effects of perindopril. For a full list see the leaflet inside your medicines packet.

    You can report any suspected side effect to the UK safety scheme.

  6. How to cope with side effects

    What to do about:

    • dry irritating cough - cough medicines don’t usually help for coughs caused by perindopril. Sometimes, the cough gets better on its own. Talk to your doctor if it carries on, bothers you or stops you from sleeping as another medicine may be better. Even if you stop taking perindopril, the cough may take up to a month to go away.
    • feeling dizzy - if perindopril makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you don't faint, then sit until you feel better. 
    • headaches - make sure you rest and drink plenty of fluids. Don’t drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if they last longer than a week or are severe.
    • diarrhoea and vomiting - drink plenty of water in small, frequent sips. It may also help to take oral rehydration solutions. You can buy these from a pharmacy or supermarket to prevent dehydration. Don’t take any other medicines to treat diarrhoea or vomiting without speaking to a pharmacist or doctor. If you get diarrhoea or vomiting from a stomach bug or illness, tell your doctor. You may need to temporarily stop taking perindopril until you feel better.
    • itching or a mild rash - try rubbing a gentle, fragrance-free skin moisturiser over the affected skin. It may also help to take an antihistamine which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you.
    • blurred vision - don’t drive for a week. 
  7. Pregnancy and breastfeeding

    Perindopril is not normally recommended in pregnancy or when breastfeeding. However, it may be prescribed if your doctor thinks the benefits of the medicine outweigh the risks.

    If you're planning a pregnancy or you're already pregnant, talk to your doctor about the benefits and possible harms of taking perindopril. These will depend on how many weeks pregnant you are and the reason you need to take it. There may be other treatments that are safer for you.

    Perindopril and breastfeeding

    Small amounts of perindopril may get into breast milk. This can cause low blood pressure in the baby. Talk to your doctor, as other medicines might be better while you're breastfeeding.

    Tell your doctor if you're trying to get pregnant, are already pregnant or if you're breastfeeding.

  8. Cautions with other medicines

    There are some medicines that may interfere with the way perindopril works.

    Tell your doctor if you’re taking:

    • anti-inflammatory medicines such as ibuprofen or indomethacin and aspirin for pain relief. (Low dose aspirin - 75mg a day - is safe to take with perindopril.)
    • medicines to treat low blood pressure, heart failure, asthma or allergies, such as ephedrine, noradrenaline or adrenaline.
    • medicines to treat high blood pressure, such as aliskeren
    • other medicines which can lower your blood pressure such as some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), anaesthetics or medicines for an enlarged prostate gland
    • medicines to damp down your immune system such as ciclosporin and tacrolimus
    • water tablets such as furosemide
    • medicines which can increase the amount of potassium in your blood such as spironolactone, triamterene, amiloride, potassium supplements, trimethoprim (for infections) and heparin (for thinning blood)
    • steroid medicines such as prednisolone
    • allopurinol (for gout)
    • procainamide (for heartbeat problems)
    • medicines for diabetes
    • racecadotril (for diarrhoea)
    • lithium (for mental health problems)

    Mixing perindopril with herbal remedies or supplements

    There's very little information about taking herbal remedies and supplements with perindopril.

    For safety, speak to your pharmacist or doctor before taking any herbal or alternative remedies with perindopril.

    Tell your doctor or pharmacist if you are taking any other medicines, including herbal medicines, vitamins or supplements.

  9. Common questions

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