Perindopril erbumine is a long-acting, non-sulfhydryl angiotensin-converting enzyme (ACE) inhibitor prodrug. It is hydrolyzed in vivo to its active metabolite, perindoprilat. It is widely used in India for the management of hypertension and heart failure, and for the secondary prevention of cardiovascular events in patients with stable coronary artery disease. Its long duration of action allows for once-daily dosing, improving patient compliance.
Adult: Hypertension: Initial dose 2-4 mg once daily, preferably before food. Maintenance: 4-8 mg once daily. Max: 8 mg/day. Heart Failure/Coronary Artery Disease: Start at 2 mg once daily, titrate to 4-8 mg once daily as tolerated.
Note: Swallow the tablet whole with a glass of water. Can be taken with or without food, but taking it before a meal is recommended for consistent bioavailability. Administer at the same time each day. Do not crush or chew.
Perindopril is a prodrug hydrolyzed to perindoprilat, which competitively inhibits angiotensin-converting enzyme (ACE or kininase II). This inhibition prevents the conversion of angiotensin I to the potent vasoconstrictor angiotensin II and decreases the degradation of bradykinin, a potent vasodilator. The reduction in angiotensin II leads to decreased vasoconstriction, aldosterone secretion, and sympathetic outflow, resulting in vasodilation, reduced blood volume, and lowered blood pressure.
Pregnancy: CONTRANDICATED in second and third trimesters (Pregnancy Category D in 2nd/3rd trimester, Category C in 1st trimester). Can cause fetal injury and death: oligohydramnios, fetal hypocalvaria, renal failure, lung hypoplasia, contractures. Discontinue immediately if pregnancy is detected.
Driving: May cause dizziness, lightheadedness, or fatigue, especially during initiation. Patients should not drive or operate machinery until their individual response is known.
| Diuretics (especially Potassium-sparing: Spironolactone, Amiloride) | Profound first-dose hypotension; Severe hyperkalemia | Major |
| NSAIDs (e.g., Ibuprofen, Diclofenac) | Reduced antihypertensive effect; Increased risk of renal impairment | Major |
| Lithium | Increased serum lithium levels and toxicity | Major |
| Aliskiren | Increased risk of hyperkalemia, hypotension, and renal impairment | Major (contraindicated in diabetes/renal impairment) |
| Antidiabetics (Insulin, Sulfonylureas) | Potentiation of hypoglycemic effect | Moderate |
| Gold injections (Sodium aurothiomalate) | Nitritoid reactions (flushing, nausea, hypotension) | Moderate |
| Allopurinol, Procainamide, Immunosuppressants | Increased risk of hypersensitivity reactions, neutropenia | Moderate |
Same composition (Perindopril erbumine (2mg)), different brands: