Introduction
Peripril belongs to a group of medicines known as angiotensin converting enzyme (ACE) inhibitor. It is widely used to treat high blood pressure and heart failure and may be prescribed after a heart attack. It also lowers the chances of having a heart attack or stroke.
Peripril can be prescribed either alone or in combination with other medicines. It should be taken on an empty stomach. This medicine should be taken at the same time each day to get the most benefit. It is important to continue taking it regularly even if you feel well or even if your blood pressure is controlled. Most people with high blood pressure do not feel ill, but if you stop taking this medicine, your condition could get worse. This medicine is considered safe for long-term use.
Making some changes in your lifestyle will also help lower your blood pressure. These may include regular exercise, losing weight, smoking cessation, reducing alcohol intake, and reducing the amount of salt in your diet as advised by your doctor. The most common side effects of this medicine include feeling dizzy or drowsy, headache, dry cough, fatigue, nausea, vomiting, diarrhea, stomach pain, and low blood pressure. Most of these are temporary and resolve with time. Talk to your doctor if any of the side effects bother you or do not go away.
Before taking this medicine, let your doctor know if you have any kidney or liver problems. Pregnant or breastfeeding mothers should also consult their doctor before taking it. Your doctor may check your kidney function, blood pressure and potassium levels in your blood at regular intervals while you are taking this medicine.
Uses of Peripril
- Hypertension (high blood pressure)
- Prevention of heart attack and stroke
- Heart failure
Side effects of Peripril
Common
- Decreased blood pressure
- Cough
- Increased potassium level in blood
- Fatigue
- Weakness
- Dizziness
How to use Peripril
Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Peripril is to be taken empty stomach.
How Peripril works
Peripril is an angiotensin converting enzyme (ACE) inhibitor. It works by reducing stress on the heart and relaxing blood vessel so that blood flows more smoothly and the heart can pump blood more efficiently.
What if you forget to take Peripril?
If you miss a dose of Peripril, skip it and continue with your normal schedule. Do not double the dose.
Indication
Hypertension, IHD, Heart failure
Administration
Should be taken on an empty stomach. Take before meals.
Adult Dose
Oral
Adult
Hypertension
4-8 mg PO qDay or divided q12hr
Maximum: 16 mg/day PO divided q12hr
Stable Coronary Artery Disease (CAD)
4 mg PO qDay for 2 weeks, THEN increase as tolerated to 8 mg/day PO divided q12hr
Reduce risk of cardiovascular mortality or MI in patients with stable CAD
Heart Failure
2 mg PO qDay initially to maximum 8-16 mg PO qDay
Elderly: Initially, 2 mg once daily. Dose may be increased to max 8 mg
Renal Dose
Renal impairment:
CrCl (ml/min) Dosage Recommendation
<15 2 mg on dialysis days.
15-30 2 mg on alternate days.
30-60 2 mg
Contraindication
History of angioedema related to previous ACE inhibitor treatment. Pregnancy (2nd/3rd trimesters).
Mode of Action
Perindopril is an ACE inhibitor, which acts by inhibiting the conversion of angiotensin I to angiotensin II, reducing the activity of the sympathetic nervous system and inhibiting enzyme kininase, which is involved in the conversion of bradykinin and other substances.
Precaution
History of airway surgery. Withdraw if there is significant increase in LFTs. Risk factors for hyperkalaemia; monitor potassium closely. Patients dependent on renin-angiotensin-aldosterone system; consider withdrawal in patients with progressive deterioration in renal function. Collagen vascular disease. Hypovolaemia; monitor BP with the 1st dose. Unilateral renal artery stenosis and pre-existing renal insufficiency; valvular aortic stenosis. Before, during, or immediately after anaesthesia. May impair ability to drive or operate machinery. Lactation.
Lactation: not known if distributed into breast milk; use caution
Side Effect
>10%
Headache (23%),Cough (12%)
1-10%
Dizziness (8%),Back pain (6%),Lower extremity pain (5%),Abnormal ECG (2%),Palpitation (1%),Depression (2%),Somnolence (1%),Menstrual disorder (1%),Edema (4%),ALT increased (2%),Sexual dysfunction (male 1%),Sleep disorder (3%),Chest pain (2%),Nausea/vomiting (2%),Flatulence (1%),Rash (2%),Hyperkalemia (1%),Tinnitus (2%)
Frequency Not Defined
Intestinal angioedema,Liver failure (rare),Leukopenia,Pruritus,Stroke,Syncope,Urinary retention,Vertigo,Amnesia
Angioedema, More frequent in black patients (0.1%), Angioedema of lips, More frequent in black patients (0.1%), Angioedema of throat, More frequent in black patients (0.1%)
Potentially Fatal: Anaphylactoid reactions, angioedema.
Interaction
May enhance hypotensive effect w/ diuretics. Additive hyperkalaemic effect w/ K supplements, K-sparing diuretics, and other drugs (e.g. ciclosporin, heparin, indometacin). May increase serum levels and toxicity of lithium. Antihypertensive effect may be reduced by aspirin or other NSAIDs. Coadministration w/ NSAIDs may also increase the risk of renal impairment. Increased risk of hypoglycaemia w/ antidiabetic agents. Rarely, nitritoid reactions occur w/ concomitant use of gold (sodium aurothiomalate).
Potentially Fatal: Increased risk of hypotension, hyperkalaemia and changes in renal function (including acute renal failure) w/ aliskiren in patients w/ diabetes or renal impairment.