A fixed-dose combination (FDC) antihypertensive medication containing an ACE inhibitor (Perindopril) and a thiazide-like diuretic (Indapamide). It provides synergistic blood pressure lowering through complementary mechanisms, offering improved efficacy and adherence compared to monotherapy. It is a first-line treatment for essential hypertension in India, especially when monotherapy is insufficient.
Adult: One tablet (Perindopril 4mg + Indapamide 1.25mg) orally once daily, preferably in the morning. Dose may be titrated after 3-4 weeks of therapy if needed. Initiation with a lower dose (e.g., Perindopril 2mg) may be considered in some patients.
Note: Swallow whole with a glass of water. Can be taken with or without food, but taking it consistently with respect to meals is advised. Morning administration minimizes nocturnal diuresis.
Perindopril inhibits Angiotensin Converting Enzyme (ACE), reducing the conversion of angiotensin I to the potent vasoconstrictor angiotensin II and decreasing aldosterone secretion, leading to vasodilation and reduced sodium/water retention. Indapamide inhibits sodium reabsorption in the early distal convoluted tubule of the nephron, promoting natriuresis and diuresis, reducing plasma and extracellular fluid volume. The combination reduces peripheral vascular resistance and blood volume synergistically.
Pregnancy: CONTRANDICATED in 2nd and 3rd trimesters (ACE inhibitors cause fetal toxicity: oligohydramnios, renal dysplasia, skull hypoplasia, death). Discontinue immediately if pregnancy is detected. Use in 1st trimester only if clearly needed.
Driving: May cause dizziness, lightheadedness, or fatigue, especially during initiation. Patients should not drive or operate machinery until their individual response is known.
| Potassium-sparing diuretics (Spironolactone, Amiloride) | Increased risk of severe hyperkalemia | Major |
| Lithium | Reduced renal clearance of lithium, leading to toxicity | Major |
| NSAIDs (e.g., Ibuprofen, Diclofenac) | Reduced antihypertensive effect, risk of acute renal impairment | Major |
| Other Antihypertensives (Beta-blockers, CCBs) | Additive hypotensive effect | Moderate |
| Antidiabetics (Insulin, Sulfonylureas) | Indapamide may alter glucose tolerance, requiring dose adjustment | Moderate |
| Digoxin | Hypokalemia (from indapamide) potentiates digoxin toxicity | Moderate |
| Corticosteroids (systemic) | Increased risk of hypokalemia | Moderate |
| Allopurinol | Increased risk of hypersensitivity reactions | Moderate |
Same composition (Perindopril erbumine (4mg) + Indapamide (1.25mg)), different brands: