Perindastad 2

Rx

Indications

• Treatment of hypertension.
• Treatment of symptomatic heart failure.
• Stable coronary artery disease: Reduction of risk of cardiac events in patients with a history of myocardial infarction and/or revascularisation.

Dosage

Hypertension

• Perindopril may be used in monotherapy or in combination with other classes of antihypertensive therapy.
• The starting dose is 4 mg given once daily in the morning. The dose may be increased to 8 mg once daily after one month of treatment.
• In elderly patients treatment should be initiated at a dose of 2 mg which may be progressively increased to 4 mg after one month then to 8 mg if necessary depending on renal function.

Symptomatic heart failure

• A recommended starting dose of 2 mg is taken in the morning. This dose may be increased by increments of 2 mg at intervals of no less than 2 weeks to 4 mg once daily if tolerated.

Stable coronary artery disease

• Perindopril should be introduced at a dose of 4 mg once daily for two weeks, then increased to 8 mg once daily, depending on renal function and provided that 4 mg dose is well tolerated.
• Elderly patients should receive 2 mg once daily for one week, then 4 mg once daily the next week, before increasing the dose up to 8 mg once daily depending on renal function.

Dosage adjustment in renal impairment

• Creatinine clearance (CC) between 30 and 60 ml/minute: 2 mg per day.
• CC between 15 and 30 ml/minute: 2 mg every other day.
• Haemodialysed patients (Dialysis clearance of perindoprilat is 70 ml/min. For patients on haemodialysis, the dose should be taken after dialysis) and CC less than 15 ml/minute: 2 mg on the day of dialysis.

Usage

• Orally taken once daily in the morning before a meal.

• Hypersensitivity to perindopril, other ACE inhibitors or any ingredient in the formulation.
• History of angioedema related to previous ACE inhibitors treatment.
• Hereditary or idiopathic angioedema.
• Pregnancy and lactation.
• The concomitant use of perindopril with aliskiren-containing products is contraindicated in patients with diabetes mellitus or renal impairment (GFR < 60 ml/min/ 1.73m²).

Common

• Headache, disorders of mood and/or sleep disorders, asthenia, non specific GI disorders, taste alteration, dry cough,…

• Cardiovascular effects: Symptomatic hypotension may occur. Patients at particular risk include those with volume or salt depletion secondary to salt restriction, prolonged diuretic therapy, dialysis, diarrhea, or vomiting. Marked hypotension may occur in patients with congestive heart failure – potential for myocardial infarction or stroke in those with ischemic cardiovascular or cerebrovascular disease.
• Renal effects: Deterioration of renal function, manifested as minor and transient increases in BUN and serum creatinine concentrations, may occur following administration of ACE inhibitor therapy, particularly in hypertensive patients with unilateral or bilateral renal artery stenosis, pre-existing renal impairment, or concomitant diuretic therapy. Dosage reduction and, in some cases, discontinuance of perindopril and/or the diuretic may be required.
• Effects on potassium: Hyperkalemia can develop, especially in those with renal impairment or diabetes mellitus and those receiving drugs that can increase serum potassium concentration (e.g., potassiumsparing diuretics, potassium supplements, potassium-containing salt substitutes). The combination is generally not recommended.
• Cough: Persistent and nonproductive; resolves after drug discontinuance.
• Dual blockade of the renin-angiotensin-aldosterone system (RAAS): The concomitant use ofACE-inhibitors, angiotensin II receptor blockers or aliskiren increases the risk of hypotension, hyperkalaemia and decreased renal function (including acute renal failure).
• Aortic and mitral valve stenosis/ hypertrophic cardiomyopathy: As with other ACE inhibitors, perindopril should be given with caution to patients with mitral valve stenosis and obstruction in the outflow of the left ventricle such as aortic stenosis or hypertrophic cardiomyopathy.
• Renal impairment: In cases of renal impairment (creatinine clearance < 60 ml/min) the initial perindopril dosage should be adjusted according to the patient’s creatinine clearance and then as a function of the patient’s response to treatment. Routine monitoring of potassium and creatinine are part of normal medical practice for these patients.