Perindopril

Significant hypotension with first dose. Start low dose and in bed perhaps at night for initiation. Seen more when used to manage heart failure rather than hypertension. If occurs - lie patient down and raise legs and start IV if BP still low.

About: Always check the BNF

• For Perindopril Arginine or Perindopril Erbumine prescribing advice
• Competitively inhibit angiotensin-converting enzyme
• Prevent formation of Angiotensin II a potent vasoconstrictor
• Can lead to increased Bradykinin
• Blood pressure reduction without reflex tachycardia

Indications/Dose

• Hypertension, Herat failure, Diabetic nephropathy
• Reduce cardiac remodelling post MI
• Start the lowest dose with heart failure but aim for highest tolerated dose

Dose range: Check U+E, document starting BP, identify target BP

Cautions

• May not be effective in African-Caribbean patients

Contraindications

• Pregnancy and breastfeeding - cause birth defects
• Caution in severe aortic stenosis and hypertrophic cardiomyopathy
• Renal artery stenosis, Hyperkalaemia

Interactions

• Alteplase leads to Angioneurotic oedema in stroke thrombolysis, Avoid NSAIDs
• Hyperkalaemia (caution with potassium sparing diuretics)

Side effects

• Significant Postural hypotension with the first dose. See above
• Raised bradykinin causes Cough, Angioneurotic oedema
• Reduced renal perfusion with bilateral renal artery stenosis
• Hyperkalaemia (caution with potassium sparing diuretics)
• Urticaria, taste disturbance

Monitoring

• Check renal function 4 days and 2 weeks following initiation
• Check renal function 1 week after an increase in dose