Makindo Medical Notes.com

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