Perindopril: uses, doses, side effects and cautions

Perindopril is used to treat high blood pressure and heart failure and is also prescribed after a heart attack. It is an ACE inhibitor and comes as tablets. It is available only on prescription.

Two forms exist. Perindopril erbumine (also called perindopril tert-butylamine) and perindopril arginine are not interchangeable milligram for milligram, which is why the doses below differ. A combination tablet with the diuretic indapamide is sold as Coversyl Arginine Plus.

According to the NHS, perindopril starts to work within a few hours, but it can take a few weeks to reach its full effect on blood pressure. Blood pressure checks, rather than how you feel, show whether it is working.

The NHS page states these typical figures. Your own dose may differ and your prescriber sets it.

Swallow the tablets whole with a drink of water. The first dose may be taken at bedtime because of dizziness; after that the NHS suggests taking it in the morning before breakfast, at the same time every day.

Treatment is usually long term and may continue for life. If you miss a dose, take it as soon as you remember that day; never take two doses together. If you exceed your dose, call NHS 111, since it can make you dizzy and your heartbeat more noticeable. Stopping can cause blood pressure to rise, so talk to your doctor before stopping.

Most adults aged 18 and over can take perindopril. Tell the prescriber about previous allergic reactions, pregnancy or breastfeeding, dialysis, heart, liver or kidney problems, unstable or low blood pressure, diabetes, planned major surgery, recent diarrhoea or vomiting, a low-salt diet, insect-sting desensitisation, certain blood disorders and angioedema. Before starting, doctors check blood pressure and may arrange blood tests for kidney function and potassium.

A dry persistent cough, dizziness, headaches, vomiting, diarrhoea, mild rash, blurred vision and muscle cramps are listed. Cough medicines do not usually help a perindopril cough. Rise slowly if dizzy; do not drive with dizziness or blurred vision.

Call NHS 111 for yellow eyes or skin, unusual paleness with tiredness, severe stomach pain, swollen ankles or blood in urine. Call 999 for weakness down one side, chest pain, breathing difficulty or swelling of the face or throat; angioedema risk is higher in Black patients.

The NHS names ibuprofen, indomethacin and aspirin (75 mg a day is safe), ephedrine, noradrenaline, adrenaline, aliskiren, valsartan, nitrates, baclofen, procainamide, vildagliptin, furosemide, spironolactone, triamterene, amiloride, potassium supplements, trimethoprim, heparin, ciclosporin, tacrolimus, lithium, prednisolone, allopurinol, diabetes medicines, antidepressants and prostate medicines. There is not enough information to say herbal remedies are safe with it.

Perindopril is not used in pregnancy because it can damage the baby's kidneys; stop by 12 weeks at the latest and speak to a doctor. Small amounts pass into breast milk; use is generally discouraged if the baby was born prematurely. Report side effects via the Yellow Card scheme.