Perindopril

Quick links to important sections

Perindopril

Selected form

Medically reviewed

Marina Burgos

Last updated on 10/01/2026

This page provides general, reference-level information compiled from official medical sources. It is not a substitute for professional medical advice, diagnosis, or treatment. For decisions about your health, please consult a qualified healthcare professional.

Overview of Perindopril

Quick Facts

Property Description
Active ingredient Perindopril (as Erbumine or Arginine salt)
Form Tablet
Pharmacological class Angiotensin-Converting Enzyme (ACE) Inhibitor
Common purpose Lowering of high blood pressure
Origin Synthetic (Dipeptide-derived)

What Type of Medicine is Perindopril?

Perindopril is a synthetic, prescription-only drug that belongs to the Angiotensin-Converting Enzyme (ACE) Inhibitor pharmacological class. This classification, which is clinically recognized for cardiovascular efficacy, indicates its primary function is centered on modulating the Renin-Angiotensin-Aldosterone System (RAAS), a hormonal cascade critical to regulating blood pressure and fluid balance in the body. The substance itself is classified as a dipeptide-derived prodrug, meaning it requires metabolic conversion in the liver into its active form, perindoprilat, to become therapeutically effective. ACE inhibitors are widely utilized for managing cardiovascular risk factors.


Composition and Form: Perindopril Erbumine or Arginine Tablet

The active ingredient in this medicine is the Perindopril chemical moiety, which is primarily formulated for stability and absorption as either the Perindopril Erbumine or Perindopril Arginine salt. The medicine is a single-ingredient product delivered in a solid tablet form, intended for oral administration. The long-acting nature of the drug distinguishes it from shorter-acting ACE inhibitors. While Perindopril is the active ingredient, popular commercial names for products containing this INN include Coversyl and Aceon, which are structurally identical at the core therapeutic level. The different salt variations are pharmaceutical distinctions that address formulation stability and handling, not the core physiological action of the drug.


What is the General Purpose of an ACE Inhibitor?

The general purpose of administering an ACE inhibitor like Perindopril is to achieve a controlled and sustained lowering of blood pressure, thereby reducing overall mechanical strain on the heart and the circulatory system. By performing ACE inhibition, Perindopril causes vasodilation (blood vessel widening) because it reduces the synthesis of the powerful natural vasoconstrictor, Angiotensin II. This primary physiological effect, combined with a slight reduction in the body's retention of salt and water, ensures smoother, less strenuous blood circulation, which is the core benefit provided by this class of medication. The medication acts on the vascular system.

Regulatory References

  1. MedlinePlus ACE Inhibitor Information

What side effects are possible with Perindopril?

Possible Side Effects and Safety Information

The safety profile of Perindopril is structured by regulatory documents based on the frequency and the organ system affected by possible adverse reactions. Common adverse reactions are those observed in at least 1 out of 100 patients, as classified by government health authorities.

Documented Adverse Reactions

Side effects are officially classified into frequency tiers, including Common (e.g., headache, dizziness, dry cough, gastrointestinal disturbances, and asthenia) and Uncommon (e.g., mood changes, sleep disorders, and angioedema).

Reactions are grouped by System-Organ Classes (SOC), covering effects on the Nervous System, Respiratory System, Vascular System (including hypotension), and Skin and Subcutaneous Tissue. The common dry cough is an officially recognized effect of this class of medicine.

Serious Adverse Reactions and Safety Constraints

The official labeling documents rare but clinically critical reactions. Angioedema (swelling of the face, limbs, lips, tongue, or throat) is a serious adverse reaction that requires immediate attention. Other serious reactions reported rarely include acute renal failure, severe drops in blood pressure (hypotension), and very rare blood disorders like agranulocytosis.

Certain patient populations and conditions are noted for safety constraints. Perindopril is contraindicated in the second and third trimesters of pregnancy due to the risk of fetal injury. It is also contraindicated in individuals with a history of angioedema related to prior ACE inhibitor therapy. Hypotension may be more pronounced following the initial dose or during dose escalation, particularly in certain high-risk patients.

Overdose and Emergency Response

Overdose and When to Seek Help

The information regarding Perindopril overdose is strictly based on documented data from authoritative government regulatory sources. This content describes the reported clinical effects of an overdose and the emergency response protocols defined in the official prescribing information.

Documented Overdose Effects

System Manifestations of Overdose
Cardiovascular The most likely and serious effect is severe hypotension (low blood pressure) potentially leading to circulatory shock (a life-threatening condition), tachycardia, and palpitation.
Metabolic/Renal Documented signs include acute renal failure and severe electrolyte disturbances, particularly hyperkalemia (high potassium levels).
Other May include hyperventilation, dizziness, anxiety, and cough.

Immediate Emergency Action

Urgent medical attention must be sought immediately upon recognition of signs of severe hypotension or circulatory shock. Professional regulatory guidance outlines specific management steps:

  • If severe hypotension is present, the patient should be placed in the supine position (lying flat on the back).
  • Rapid administration of intravenous volume expanders, such as sodium chloride 0.9% solution, is recommended to manage blood pressure.
  • Treatment is generally supportive, focusing on managing symptoms and correcting metabolic disturbances.

Drug Elimination

The active metabolite of Perindopril, known as perindoprilat, can be effectively removed from the blood circulation using hemodialysis. The clearance rate is documented in regulatory materials as approximately 70 mL/min.

Therapeutic Uses of Perindopril

What Perindopril Treats: Main Uses and Benefits

Perindopril is used for managing high blood pressure (hypertension), which is a condition involving symptoms related to systemic imbalance and increased physiological stress. The medication is indicated for the treatment of essential hypertension. While hypertension is often asymptomatic, treatment is applied in situations where symptomatic assistance is needed because Perindopril is commonly used to help with symptoms related to organ-specific functional stress caused by the condition. The goal of using this medicine is considered relevant for reducing the risk of severe complications such as stroke and myocardial infarction (heart attack).


Sustained Control and Cardiovascular Support

This medication is commonly used to help manage three core therapeutic situations: essential hypertension, stable coronary artery disease (CAD), and mild to moderate chronic heart failure. For those with established heart conditions, Perindopril plays a role in managing the long-term health outlook by assisting with maintaining functional stability. In patients with chronic heart failure, it helps address symptom clusters related to heart conditions, including excessive fatigue and shortness of breath during activity, and peripheral swelling. The controlled application of this medicine contributes to improved comfort during periods of heightened symptoms.


Quick Fact: Relief for Symptoms Related to Heart Conditions

Feature Therapeutic Focus
Primary Indication Sustained management of high blood pressure.
Symptom Management Easing fatigue and breathlessness linked to heart failure.
Core Benefit Is considered relevant for easing the impact of future cardiovascular events.

Regulatory References

  1. NIH DailyMed Drug Label for Perindopril Erbumine

Eligibility and Restrictions for Use

Who Can and Cannot Use Perindopril?

The eligibility for Perindopril is strictly determined by official regulatory bodies based on medical history, co-administered medications, and physiological state.

Populations for Whom Use is Contraindicated

Perindopril must not be used in patients with a history of angioedema (hereditary, idiopathic, or prior ACE inhibitor-related) or known hypersensitivity to any ACE inhibitor. The medicine is contraindicated during the second and third trimesters of pregnancy and in patients using sacubitril/valsartan. Concomitant use with aliskiren is also contraindicated in patients with diabetes mellitus or moderate-to-severe renal impairment.

Age and Physiological Restrictions

Use is not recommended for pediatric patients (under 18 years of age) as safety and efficacy have not been established. Use is also not recommended during the first trimester of pregnancy or while breastfeeding. Older adults are an eligible population but may require closer monitoring of renal function. Patients with severe renal impairment, hepatic impairment, or primary aldosteronism require specific consideration or restricted use, as documented in regulatory guidelines.

What should I know about interactions with other medicines?

Interactions with other medicines and products

This section outlines officially documented interaction patterns for Perindopril based exclusively on governmental regulatory labeling.


Formally Contraindicated Combinations

Co-administration with specific medications is prohibited due to a high risk of severe adverse events:

  • Sacubitril/valsartan: Contraindicated due to a significantly increased risk of angioedema. A 36-hour separation period is required when switching to or from Perindopril.
  • Aliskiren: Contraindicated in patients with diabetes mellitus or moderate-to-severe renal impairment (GFR < 60 mL/min/1.73 m²) due to the heightened risks of hypotension, hyperkalemia, and renal impairment.

Documented Pharmacodynamic and Exposure Interactions

Interactions often relate to additive effects on blood pressure or electrolyte balance:

Interacting Product Category Official Interaction Description/Risk
Potassium-Sparing Diuretics/Salts Increased risk of hyperkalemia (high serum potassium).
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) May lead to renal function deterioration and may reduce the antihypertensive effect.
Lithium Perindopril officially increases serum Lithium levels, raising the risk of toxicity.
mTOR Inhibitors (e.g., Sirolimus) Increased risk for angioedema.

Population-Specific Notes

Regulatory documents state that elderly patients and those with renal impairment or chronic heart failure show increased exposure (higher AUC) to the active metabolite, Perindoprilat, due to reduced clearance, which may influence interaction severity.

Mechanism of Action

Perindopril is a prodrug that is converted in the liver to its active metabolite, perindoprilat. Perindoprilat acts as a competitive inhibitor of the zinc metalloenzyme Angiotensin-Converting Enzyme (ACE), also known as kininase II. ACE is the enzyme responsible for the proteolytic cleavage of the inactive decapeptide angiotensin I to the active octapeptide angiotensin II.

By inhibiting ACE, perindoprilat decreases the systemic concentration of angiotensin II, a potent pressor agent. This reduction diminishes the agonism of the angiotensin II type 1 ( AT1) receptors on vascular smooth muscle, resulting in vasodilation and a reduction in systemic vascular resistance. Simultaneously, the decrease in angiotensin II concentration reduces the stimulation of aldosterone secretion from the adrenal cortex. This cascade leads to decreased sodium and water reabsorption in the distal nephron, promoting natriuresis and diuresis.

ACE also metabolizes bradykinin, a vasodilator peptide. ACE inhibition prevents bradykinin degradation, leading to elevated local levels of this peptide, which contributes to the overall vasodilation via B2 receptor signaling. The system-level physiological consequence is the modulation of vascular tone and fluid volume through the Renin-Angiotensin-Aldosterone System (RAAS) and the kallikrein-kinin system.

Dosage and Administration Information

How to Use Perindopril: Official Administration Guidelines

Perindopril administration is governed by a strict protocol concerning route, frequency, and dose titration, as defined by standard regulatory guidelines. The medicine is supplied as a tablet intended for oral administration only. This drug is generally prescribed for chronic, long-term management of cardiovascular conditions.


Official Dosing and Scheduling Principles

The standard regimen dictates a once-daily schedule, which is designed to be taken at a consistent time each day. Standard administration guidelines typically instruct that the tablet should be taken before a meal (often the morning meal) and administered with water. This pre-meal timing is specified to optimize the drug’s absorption profile.

Treatment follows a pattern of dose titration, meaning therapy begins with a low dose and is gradually adjusted upward. For essential hypertension, the starting dose is typically 4 mg once daily, while for stable coronary artery disease or heart failure, the initial dose may be 2 mg once daily. The maximum daily dose generally reaches 8 mg in standard maintenance use, although higher doses are specified in some circumstances.


Population-Specific and Procedural Rules

Official instructions mandate dose adjustments for specific patient populations. Older adults (e.g., those over 70 years) and individuals with renal impairment (reduced kidney function) must initiate treatment at a lower dose, such as 2 mg once daily, with subsequent dose increases being carefully monitored. Furthermore, if the patient is taking concurrent diuretic therapy, the Perindopril starting dose should also be reduced.

If a dose is missed, it should be taken as soon as remembered. If it is nearly time for the next scheduled dose, the missed dose is skipped entirely to maintain the proper schedule and avoid taking two doses too closely together.

Recent Clinical Evidence

Research Evidence / Overview of Studies for Perindopril

This section describes the structure of the clinical research that has evaluated Perindopril, focusing on what was studied and where uncertainties exist, without offering clinical advice. Research findings describe group patterns, not personal outcomes.


Evidence from Trials for Essential Hypertension (High Blood Pressure)

Perindopril was evaluated in numerous Randomized Controlled Trials (RCTs) that measured outcomes such as Systolic and Diastolic Blood Pressure (SBP/DBP). These studies also monitored changes in vascular indicators. Studies described patterns observed in the measured outcomes, including changes in SBP and DBP readings across various adult populations. Regulatory documents describe this evidence as a high level of evidence. Comparative evidence is often limited when assessing its effect against every other medication in the same drug class.


Evidence from Trials for Stable Coronary Artery Disease (CAD)

The evidence base for this evaluation includes large-scale, international RCTs that examined patients with documented stable coronary artery disease. Researchers studied the occurrence of a composite outcome that included serious events like cardiovascular death and nonfatal heart attack over observation periods exceeding four years. The main outcomes trial described the measured event rates of this combined outcome. Results apply only to the populations studied, and data for certain subgroups, such as younger adults, remain insufficient.


Evidence for Symptom Management in Chronic Heart Failure

Clinical evaluation in the context of heart failure included controlled trials that explored changes in patient-reported outcomes describing discomfort (like fatigue) and monitored outcomes reflecting daily functioning. While trials over 2.2 years described a pattern in how patient-reported outcomes evolved over time, comparative evidence is often lacking against newer classes of heart failure medications.


Understanding Research Gaps and Uncertainties

Long-term follow-up for certain outcomes in heart failure is limited, as is the availability of data for specific patient groups, including children. Major uncertainties include where comparative evidence is lacking or where findings were mixed when assessing direct comparisons against all other medications in the same class.

Key Studies & References Label: PERINDOPRIL ERBUMINE tablet (FDA/DailyMed)

Frequently Asked Questions (FAQ)

Common questions about Perindopril (FAQ)

Q: What is perindopril used for?

Perindopril is an angiotensin-converting enzyme (ACE) inhibitor medication. It is primarily used to treat high blood pressure (hypertension), heart failure, and to reduce the risk of cardiovascular events in patients with stable coronary artery disease.

Q: How does perindopril work?

Perindopril works by blocking the action of the ACE enzyme. This enzyme is responsible for converting angiotensin I to angiotensin II, a powerful substance that narrows blood vessels. By blocking this, perindopril causes blood vessels to relax and widen, which lowers blood pressure and makes it easier for the heart to pump blood.

Q: What are the common side effects of perindopril?

Some common side effects of perindopril may include:

  • A persistent, dry cough (this is a class effect of ACE inhibitors).
  • Dizziness or lightheadedness, especially when standing up.
  • Headache.
  • Fatigue.

Tell your healthcare provider if these side effects are persistent or bothersome.

Q: When should I take perindopril?

Perindopril is usually taken once a day.

  • Your healthcare provider will tell you the best time to take your dose, but it is often recommended to take it at the same time each day.
  • It can be taken with or without food.
  • Follow the specific instructions given to you by your prescribing healthcare provider.

Q: Can I suddenly stop taking perindopril?

No, you should not suddenly stop taking perindopril without speaking to your healthcare provider first.

  • Stopping this medication abruptly can cause your blood pressure to rise quickly or worsen your heart condition.
  • If you need to stop treatment, your healthcare provider will guide you on how to safely lower your dose over time.

Q: Does perindopril interact with other medications?

Yes, perindopril can interact with several other medications. It is important to inform your healthcare provider about all medicines you are taking, including over-the-counter drugs and herbal supplements. Key interactions include:

  • Potassium-sparing diuretics or potassium supplements, which can increase the risk of high potassium levels (hyperkalemia).
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), which may decrease perindopril's effectiveness and increase the risk of kidney problems.
  • Lithium (used for mental health conditions), as perindopril can increase lithium levels and the risk of toxicity.

Q: Is perindopril safe to take during pregnancy?

No, perindopril is not safe to take during pregnancy, particularly in the second and third trimesters.

  • ACE inhibitors like perindopril can harm the developing fetus and have been linked to fetal kidney problems and death.
  • If you are pregnant, planning to become pregnant, or become pregnant while taking perindopril, you must contact your healthcare provider immediately to discuss safe alternative treatments.

Q: Should perindopril be taken if I have kidney problems?

Perindopril is used with caution in people with pre-existing kidney problems or those who develop kidney problems while on the medication.

  • Your doctor may perform blood tests to monitor your kidney function (such as creatinine and urea levels) before and during treatment.
  • The dosage may need to be adjusted based on the results of these tests.

How should Perindopril be stored and disposed of?

Storage and Disposal of Perindopril

Perindopril tablets must be stored at controlled room temperature, specifically between 20^circC and 25^circC (68^circF and 77^circF). Storage excursions are officially permitted up to 30^circC (86^circF).

Official Storage Conditions

Condition Requirement
Temperature Controlled room temperature
Packaging Store in the original container and keep it tightly closed
Environment Protect from moisture
Safety Keep out of the sight and reach of children

Official Disposal Instructions

Unused or expired Perindopril must be disposed of according to the instructions provided by the drug manufacturer or a local waste disposal company. Regulatory guidelines advise utilizing a medicine take-back program when available. The medication must not be flushed down the toilet or poured into a drain unless a regulatory authority or disposal program explicitly instructs otherwise.

Attention! Always consult to a doctor or pharmacist before using pills or medicines.

Available in countries:

Equivalent of Perindopril found in:

A-Z Index: