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, especially in patients requiring more than one drug to achieve target BP.
Adult: One tablet (Perindopril 8mg + Indapamide 2.5mg) once daily, preferably in the morning. Initiation with lower strength (e.g., 4mg+1.25mg) may be considered.
Note: Swallow whole with a glass of water, with or without food. Preferably taken in the morning to avoid nocturia. Ensure adequate hydration but avoid excessive fluid intake.
Perindopril inhibits Angiotensin Converting Enzyme (ACE), reducing conversion of Angiotensin I to potent vasoconstrictor Angiotensin II, leading to vasodilation, decreased aldosterone secretion (reducing sodium/water retention), and increased bradykinin levels. Indapamide inhibits sodium reabsorption in the early distal convoluted tubule, 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 (Category D). Can cause fetal injury, oligohydramnios, neonatal skull hypoplasia, renal failure, and death. Discontinue as soon as pregnancy detected. 1st trimester use should be avoided (Category C).
Driving: Caution advised, especially during initiation and dose adjustment, due to potential for dizziness, lightheadedness, or fatigue.
| Potassium-sparing diuretics (Spironolactone, Amiloride) | Increased risk of severe hyperkalemia | Major |
| Lithium | Increased lithium toxicity (reduced renal clearance) | Major |
| NSAIDs (e.g., Ibuprofen, Diclofenac) | Reduced antihypertensive effect, risk of acute renal failure, hyperkalemia | Major |
| Other Antihypertensives (Beta-blockers, CCBs) | Additive hypotensive effect | Moderate |
| Antidiabetics (Insulin, Sulfonylureas) | Indapamide may alter glucose control; Perindopril may enhance hypoglycemic effect | Moderate |
| Digoxin | Hypokalemia from Indapamide increases risk of digoxin toxicity | Moderate |
| Corticosteroids (Systemic) | Increased risk of hypokalemia | Moderate |
| Allopurinol | Increased risk of hypersensitivity reactions | Moderate |
Same composition (Perindopril erbumine (8mg) + Indapamide (2.5mg)), different brands: