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 the Indian market for the management of hypertension, heart failure, and stable coronary artery disease. It is known for its 24-hour blood pressure control with a single daily dose and its beneficial effects on vascular structure and function.
Adult: Hypertension: Initial dose 4mg once daily, preferably in the morning. May be increased to 8mg once daily after 1 month. Heart Failure/Post-MI/CAD: Start with 2mg once daily for 2 weeks, then increase to 4mg once daily.
Note: Take orally, with or without food, but consistency is advised (preferably before a meal). Swallow the tablet whole with a glass of water. Dose should be taken at the same time each day, usually in the morning.
Perindopril is a prodrug that is metabolized 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 nervous system activity, resulting in vasodilation, reduced blood volume, and lowered blood pressure.
Pregnancy: Category D (second and third trimester). ACE inhibitors can cause injury and death to the developing fetus, including oligohydramnios, fetal hypocalvaria, renal failure, and lung hypoplasia. Discontinue immediately if pregnancy is detected.
Driving: Caution advised, especially during initiation, due to potential for dizziness or syncope.
| Diuretics (especially potent loop diuretics or recent initiation) | Potentiates hypotensive effect; risk of first-dose hypotension. | Major |
| Potassium-sparing diuretics (Spironolactone, Amiloride), Potassium supplements | Increased risk of severe hyperkalemia. | Major |
| Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) e.g., Ibuprofen, Diclofenac | May diminish antihypertensive effect and increase risk of renal impairment. | Moderate |
| Lithium | Decreased lithium excretion; increased risk of lithium toxicity. | Major |
| Aliskiren | Increased risk of hyperkalemia, hypotension, and renal impairment (contraindicated in diabetes/renal impairment). | Major |
| Antidiabetic agents (Insulin, Sulfonylureas) | May enhance hypoglycemic effect. | Moderate |
| Gold injections (Sodium aurothiomalate) | Increased risk of nitritoid reactions (flushing, nausea, hypotension). | Moderate |
Same composition (Perindopril erbumine (4mg)), different brands: