Perindopril

Perindopril is a medicine used to treat high blood pressure and heart failure. It's also prescribed after a heart attack.

Perindopril helps to reduce the risk of future strokes and heart attacks. It also improves your survival if you're taking it following a heart attack or heart surgery.

This medicine is only available on prescription. It comes as tablets.

Perindopril is also available combined with 2 other blood pressure medicines called indapamide and amlodipine.


Key facts

  • Perindopril lowers your blood pressure and makes it easier for your heart to pump blood around your body.
  • Your very first dose of perindopril may make you feel dizzy, so take it at bedtime. After that, if you don't feel dizzy, it's best to take perindopril in the morning before breakfast.
  • Some people get a dry, irritating cough with perindopril.
  • If you get severe diarrhoea or vomiting from a stomach bug or illness, tell your doctor. You may need to stop taking perindopril for a while until you feel better.
  • Perindopril can be called perindopril arginine, perindopril erbumine or perindopril tert-butylamine. This is because the medicine contains another chemical to make it easier for your body to take up and use it. It doesn't matter what your perindopril is called. They all work as well as each other.
  • Perindopril is also called by the brand name Coversyl Arginine. When it's mixed with indapamide and amlodipine it's called Coversyl Arginine Plus.

Who can and can't take perindopril

Perindopril can be taken by adults aged 18 and over.

If you have diabetes, check your blood sugar (glucose) more often, particularly in the first few weeks. This is because perindopril can lower the sugar level in your blood.

Perindopril isn't suitable for everyone.

To make sure perindopril is safe for you, tell your doctor if you:

  • have had an allergic reaction to perindopril or any other medicine in the past
  • are trying to get pregnant, are already pregnant or you are breastfeeding
  • are having dialysis or any other type of blood filtration
  • have heart, liver or kidney problems
  • have unstable or low blood pressure
  • have diabetes
  • are going to have a major operation (surgery) or general anaesthetic to put you to sleep
  • have recently had diarrhoea or vomiting
  • are on a low-salt diet
  • are going to have desensitisation treatment to reduce your allergy to insect stings
  • have a blood problem such as low white blood cell count (neutropenia or agranulocytosis)

How and when to take it

It's usual to take perindopril once a day, in the morning before breakfast.

You may be advised to take your first dose before bedtime, because it can make you feel dizzy. After the very first dose, if you don't feel dizzy, take perindopril in the morning ideally 30 to 60 minutes before breakfast. Swallow perindopril tablets whole with a drink.

How much will I take?

The dose of perindopril you take depends on why you need the medicine. Take it as instructed by your doctor.

To decide the correct dose for you, your doctor will check your blood pressure and ask you if you are getting any side effects. You may also have blood tests to check how well your kidneys are working and the amount of potassium in your blood.

Perindopril comes as perindopril erbumine (also called perindopril tert-butylamine) or perindopril arginine.

They both work in the same way, but the doses vary.

Perindopril erbumine (also called perindopril tert-butylamine)

Depending on why you're taking perindopril erbumine, the usual starting dose is between 2mg and 4mg once a day.

This dose may be increased gradually over a few weeks to a usual dose of:

  • 4mg once a day for high blood pressure - the maximum dose is 8mg once a day
  • 8mg once a day after a heart attack
  • 4mg once a day for heart failure

Perindopril arginine

Depending on why you're taking perindopril arginine, the usual starting dose is between 2.5mg and 5mg once a day.

This dose may be increased gradually over a few weeks to a usual dose of:

  • 5mg once a day for high blood pressure - the maximum dose is 10mg once a day
  • 10mg once a day after a heart attack
  • 5mg once a day for heart failure

Will my dose go up or down?

You will probably be prescribed a low dose of perindopril at first so it doesn't make you feel dizzy. This will usually be increased gradually until you reach the right dose for you. If you have side effects with perindopril, you may stay on a lower dose.

Important

Take perindopril even if you feel well, as you will still be getting the benefits of the medicine.

What if I get ill while I'm taking it?

If you get severe diarrhoea or vomiting for any reason, stop taking perindopril. When you're able to eat and drink normally, wait for 24 to 48 hours, then start to take it again.

If you have questions about this, contact your doctor or pharmacist.

What if I forget to take it?

If you miss a dose of perindopril, take it as soon as you remember that day. If you don't remember until the following day, skip the missed dose. Do not take a double dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

If you take too many perindopril tablets by accident, contact your doctor or go to your nearest hospital A&E department straight away. An overdose of perindopril can cause dizziness, sleepiness and a pounding heartbeat.

The amount of perindopril that can lead to an overdose varies from person to person.

Call your doctor or go to A&E straight away if you take too much perindopril

If you need to go to hospital, do not drive yourself - get someone else to drive you or call for an ambulance.

Take the perindopril packet or leaflet inside it plus any remaining medicine with you.

Side effects

Like all medicines, perindopril can cause side effects in some people but many people have no side effects or only minor ones. Side effects often improve as your body gets used to the medicine.

Common side effects

These common side effects happen in more than 1 in 100 people.

Talk to your doctor or pharmacist if they bother you or don't go away:

  • dry, tickly cough that does not go away
  • feeling dizzy or lightheaded, especially when you stand up or sit up quickly - this is more likely to happen when you start taking perindopril or if you move on to a higher dose
  • headaches
  • being sick (vomiting) and diarrhoea
  • a mild skin rash
  • blurred vision

Serious side effects

It happens rarely, but some people may have serious side effects when taking perindopril.

Call a doctor straight away if you get:

  • yellow skin or the whites of your eyes turn yellow - this can be a sign of liver problems
  • paleness, feeling tired, faint or dizzy, any sign of bleeding (like bleeding from the gums and bruising more easily), sore throat and fever and getting infections more easily - these can be signs of a blood or bone marrow disorder
  • a faster heart rate, chest pain and tightness in your chest - these can be signs of heart problems
  • shortness of breath, wheezing and tightening of the chest - these can be signs of lung problems
  • severe stomach pain - this can be a sign of an inflamed pancreas
  • swollen ankles, blood in your pee or not peeing at all - these can be signs of kidney problems
  • weak arms and legs or problems speaking - these can be signs of a stroke

If you suspect that you or someone else is having a stroke, phone 999 immediately and ask for an ambulance.

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to perindopril.

Contact a doctor straight away if:

  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

These are warning signs of a serious allergic reaction. A serious allergic reaction is an emergency.

These are not all the side effects of perindopril. For a full list see the leaflet inside your medicines packet.

You can report any suspected side effect to the UK safety scheme.

How to cope with side effects

What to do about:

  • dry irritating cough - cough medicines don't usually help for coughs caused by perindopril. Sometimes, the cough gets better on its own. Talk to your doctor if it carries on, bothers you or stops you from sleeping as another medicine may be better. Even if you stop taking perindopril, the cough may take up to a month to go away.
  • feeling dizzy - if perindopril makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you don't faint, then sit until you feel better.
  • headaches - make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if they last longer than a week or are severe.
  • being sick (vomiting) and diarrhoea - drink plenty of fluids, such as water or squash, to prevent dehydration. If you're being sick, take small, frequent sips. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea or vomiting without speaking to a pharmacist or doctor. If you get diarrhoea or vomiting from a stomach bug or illness, tell your doctor. You may need to temporarily stop taking perindopril until you feel better.
  • itching or a mild rash - it may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you.
  • blurred vision - avoid driving or using tools or machines while this is happening. If it lasts for more than a day or two speak to your doctor as they may need to change your treatment.

Pregnancy and breastfeeding

Perindopril is not normally recommended in pregnancy or when breastfeeding. However, it may be prescribed if your doctor thinks the benefits of the medicine outweigh the risks.

If you're planning a pregnancy or you're already pregnant, talk to your doctor about the benefits and possible harms of taking perindopril. These will depend on how many weeks pregnant you are and the reason you need to take it. There may be other treatments that are safer for you.

For more information about how perindopril can affect you and your baby during pregnancy, visit the Best Use of Medicines in Pregnancy (BUMPS) website.

Perindopril and breastfeeding

Small amounts of perindopril may get into breast milk. This can cause low blood pressure in the baby. Talk to your doctor, as other medicines might be better while you're breastfeeding.

Tell your doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

Cautions with other medicines

There are some medicines that may interfere with the way perindopril works.

Tell your doctor if you're taking:

  • anti-inflammatory medicines such as ibuprofen or indomethacin and aspirin for pain relief. Low-dose aspirin - 75mg a day - is safe to take with perindopril.
  • medicines to treat low blood pressure, heart failure, asthma or allergies, such as ephedrine, noradrenaline or adrenaline
  • medicines to treat high blood pressure, such as aliskeren
  • other medicines that can lower your blood pressure such as some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), anaesthetics or medicines for an enlarged prostate gland
  • medicines to damp down your immune system such as ciclosporin and tacrolimus
  • medicines that make you pee more such as furosemide
  • medicines that can increase the amount of potassium in your blood such as spironolactone, triamterene, amiloride, potassium supplements, trimethoprim (for infections) and heparin (for thinning blood)
  • steroid medicines such as prednisolone
  • allopurinol (for gout)
  • procainamide (for heartbeat problems)
  • medicines for diabetes
  • racecadotril (for diarrhoea)
  • lithium (for mental health problems)

Mixing perindopril with herbal remedies or supplements

There's very little information about taking herbal remedies and supplements with perindopril.

Important

Tell your doctor or pharmacist if you are taking any other medicines, including herbal medicines, vitamins or supplements.

Common questions

How does perindopril work?

Perindopril is a type of medicine called an angiotensin-converting enzyme (ACE) inhibitor.

Like other ACE inhibitors, perindopril relaxes and widens the blood vessels. This lowers your blood pressure and makes it easier for your heart to pump blood around your body. This can improve the symptoms of heart failure.

How long does perindopril take to work?

Perindopril starts to work within a few hours to reduce high blood pressure but it may take up to a month to achieve its full effect.

If you're taking perindopril for heart failure, it may take weeks, even months, before you feel better.

If you're taking perindopril for high blood pressure or after a heart attack, you may not have any symptoms. In these cases, you may not feel any different when you take perindopril. This doesn't mean the medicine isn't working - and it's important to keep taking it.

How long will I take it for?

Usually, treatment with perindopril is long term, even for the rest of your life.

Is perindopril safe to take for a long time?

Perindopril is generally safe to take for a long time. In fact, it works best when you take it for a long time.

However, taking perindopril for a long time can sometimes cause your kidneys to not work as well as they should. Your doctor will check how well your kidneys are working with regular blood tests.

What will happen if I stop taking it?

Talk to your doctor if you want to stop taking perindopril.

Stopping perindopril may cause your blood pressure to rise - and this may increase your risk of heart attack and stroke.

If you're bothered by side effects, your doctor may be able to prescribe you a different medicine.

Can I come off perindopril now my blood pressure is lowered?

Even if your blood pressure is successfully lowered by perindopril, it's best to carry on taking it. If you stop taking perindopril, your blood pressure could rise back up again.

If you need blood pressure-lowering medicines, you'll probably need to take them for the rest of your life.

Remember, by keeping your blood pressure low, you're protecting yourself against having a heart attack or stroke in the future.

Can I drink alcohol with it?

Drinking alcohol can increase the blood pressure-lowering effect of perindopril, which can make you feel dizzy or lightheaded.

During the first few days of taking perindopril or after a dose increase, it is best to stop drinking alcohol until you see how the medicine affects you.

If you find perindopril makes you feel dizzy it's best to stop drinking alcohol.

Are there similar medicines to perindopril?

There are lots of other ACE inhibitor medicines that work in the same way as perindopril. They include enalapril, captopril, ramipril and lisinopril.

There are also lots of other types of blood pressure-lowering medicines:

If you can't take perindopril or other ACE inhibitor medicines because of side effects such as a dry cough, you may be able to switch to another blood pressure-lowering medicine. This will usually be a medicine called an angiotensin receptor blocker such as candesartan, irbesartan, losartan and valsartan.

What are the differences between perindopril and other ACE inhibitors?

Perindopril works as well as other ACE inhibitors when you take it to lower blood pressure and for heart failure. The side effects are also similar to those of other ACE inhibitors.

There are a few differences, though, between perindopril and other ACE inhibitors:

  • perindopril can be used after a heart attack to prevent further ones, but some ACE inhibitors are not officially approved for this
  • some ACE inhibitors are officially approved to be used in diabetic kidney disease, but perindopril is not
  • you only need to be take perindopril once a day - some other ACE inhibitors need to be taken 3 times a day

Can I take perindopril before surgery?

Tell your doctor that you're taking perindopril if you're going to be put to sleep for an operation or are going to have a major operation, such as a caesarean section, without a general anaesthetic.

Perindopril can reduce your blood pressure when it's used with a general anaesthetic.

Your doctor may advise you to stop taking it 24 hours before surgery.

Is perindopril addictive?

No, there's no evidence that perindopril is addictive.

Will it affect my contraception?

Perindopril won't affect any type of contraception.

However, some types of hormonal methods of contraception, including the combined pill and contraceptive patch, aren't usually recommended for women with high blood pressure.

Talk to your doctor if you're taking a combined hormonal contraceptive.

Will it affect my fertility?

There's no firm evidence to suggest that taking perindopril will reduce fertility in either men or women.

However, if you're a woman and you're trying to get pregnant, talk to your doctor first as this medicine is usually not recommended in pregnancy.

Is there any food or drink I need to avoid?

Do not use salt substitutes such as Lo-Salt. This is because they are high in potassium. When mixed with perindopril they may make the level of potassium in your blood too high.

There aren't any drinks you need to be careful with while taking perindopril.

Eating well can help if you have high blood pressure or heart failure.

Can I drive or ride a bike?

Perindopril can cause blurred vision and make some people feel dizzy - especially when you first start taking it or after taking a bigger dose.

If this happens to you, do not drive a car, ride a bike, or use tools or machinery.

Can lifestyle changes help?

You can boost the health of your heart by making some key lifestyle changes. These will also help if you have high blood pressure or heart failure.

  • Quit smoking - smoking increases your heart rate and blood pressure. Quitting smoking brings down your blood pressure and relieves heart failure symptoms. Try to avoid secondhand smoke.
  • Cut down on alcohol - drinking too much alcohol raises blood pressure over time. It makes heart failure worse too. Try to keep to the recommended guidelines of no more than 14 units of alcohol a week. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.
  • Exercise - regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. It doesn't need to be too energetic - walking every day will help.
  • Eat well - aim to eat a diet that includes plenty of fruit and veg, wholegrains, fat-free or low-fat dairy products and lean proteins. It's a good idea to cut down on salt too. Eating too much salt is the biggest cause of high blood pressure - the more salt you eat, the higher your blood pressure will be. Aim for no more than 6g of salt a day.
  • Deal with stress - when you're anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse too. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help avoid stress.
  • Vaccinations - if you have heart failure, it's recommended that you have a flu jab every year and a pneumonia vaccination (also known as the pneumococcal vaccine) every 5 years. Ask your doctor about these vaccinations. You can have them free on the NHS.
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