perindopril
Perindopril is a prescription medication that's used to treat high blood pressure. It's also used to lower the risk of death or heart attack in certain people with coronary artery disease (CAD). The dosage for perindopril can differ if you're older, have kidney problems, or are taking diuretics ("water pills"). Common side effects include dry cough, dizziness, and back pain. Although the brand name for this medication, Aceon, is discontinued, perindopril is available as a lower-cost, generic tablet.
What is Perindopril?
What is Perindopril used for?
- Treatment of high blood pressure
- Treatment of stable coronary artery disease (CAD) in certain people to lower the risk of death or heart attack
How Perindopril works
Perindopril is an angiotensin-converting enzyme (ACE) inhibitor. It works by blocking a hormone called angiotensin II. The main role of angiotensin II is to narrow your blood vessels, which can raise your blood pressure and cause your heart to work harder to pump out blood to the rest of your body. By blocking this hormone, perindopril relaxes your blood vessels. This helps lower your blood pressure and stress on your heart.
Drug facts
Side effects of Perindopril
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Cough (12%)
- Dizziness (8%)
- Back pain (6%)
Perindopril serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Angioedema (severe swelling): swelling of the face, arms, legs, lips, tongue, or throat
- Dangerously low blood pressure: dizziness, lightheadedness, pale skin, feeling faint
- Serious kidney problems: urinating less often than usual; swelling in your feet, ankles, or hands; unexplained weight gain
- High blood potassium levels: nausea, muscle weakness, abnormal heartbeat
- Serious liver problems: swelling of your stomach, yellowing of your skin or the whites of your eyes, confusion, dark or brown urine
The following Perindopril side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Body aches or pain
chills
difficulty breathing
ear congestion
headache
loss of voice
unusual tiredness or weakness
Less common
Bladder pain
bloody or cloudy urine
change in hearing
congestion
difficult, burning, or painful urination
dryness of the throat
ear drainage
frequent urge to urinate
general feeling of discomfort or illness
hoarseness
joint pain
loss of appetite
lower back or side pain
shivering
stomach pain
swelling
tender, swollen glands in the neck
trouble sleeping
trouble with swallowing
voice changes
vomiting
Rare
Blurred vision
confusion
decreased urination
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
irregular heartbeat
muscle cramps or pain
numbness, tingling, pain, or weakness in the hands or feet
rapid breathing
seizures
sunken eyes
sweating
thirst
trembling
weakness and heaviness of the legs
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Back pain
lack or loss of strength
pain or tenderness around the eyes and cheekbones
tightness of the chest
Less common
Belching
bloated feeling
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
difficulty moving
discouragement
excess air or gas in the stomach or intestines
feeling of fullness
feeling sad or empty
hearing loss
injury
irritability
leg pain
loss of interest or pleasure
muscle ache, stiffness, tension, or tightness
neck pain
nervousness
pain, swelling, or redness in the joints
passing of gas
rash
sleepiness or unusual drowsiness
stomach discomfort or upset
swollen joints
trouble concentrating
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Perindopril
Pros
- Available as a lower-cost generic medication
- Typically taken once a day
- Lowers the risk of heart attack or death due to heart problems in people with CAD
Cons
- Can’t take while pregnant
- More likely to cause dry cough compared to angiotensin II receptor blockers (ARBs)
- Might cause severe swelling of the face, tongue, throat (angioedema)
Pharmacist tips for Perindopril
- You can track how well perindopril is working to control your blood pressure by checking your blood pressure regularly at home. Write down your blood pressure readings, and bring them to your appointments with your provider so you can discuss how well perindopril is working for you.
- Let your provider know if you develop a dry cough after starting perindopril since it's a common side effect of this medication. If your dry cough doesn't go away, your provider might suggest a different treatment option.
- Perindopril works to lower your blood pressure, but this can cause dizziness and lightheadedness. You're more likely to feel dizzy or lightheaded if you're suddenly standing up from a sitting or lying down position. Make sure to get up slowly from these positions after taking perindopril. Tell your provider if you experience fainting or dizziness while taking this medication.
- Mark your calendar with your appointments to see your provider and to get any blood work done when you take perindopril. Your provider might order tests to check your potassium levels and kidney health during treatment. Based on your lab results and your blood pressure readings, they might change your dose to make sure the medication is safe and working well for you.
- Remember to drink enough water to stay hydrated while you're taking perindopril, especially on hot days or after exercising. Dehydration can put you at risk for very low blood pressure, dizziness, and falls. In addition, not having enough fluids in your body might raise your risk of kidney damage during treatment with this medication.
- Don't take perindopril if you're pregnant since it can cause harm to the unborn baby. If you're pregnant or thinking of getting pregnant during treatment, contact your provider right away. Your provider might prescribe you a different medication that's safer during pregnancy or suggest lifestyle changes.
- Perindopril can interact with many medications. Let your provider or pharmacist know what medications you're taking, including over-the-counter products and supplements, before you start perindopril. Talk with your provider or pharmacist if you have any questions about interactions with this medication.
Common questions about Perindopril
Maybe. Depending on when your blood pressure is the highest during the day, your provider might ask you to take perindopril either in the morning or evening. But regardless of what time of the day you're taking this medication, it's important to take it at the same time every day. Taking perindopril regularly can help better control your blood pressure, which lowers your risk of heart diseases, such as heart attack and stroke. If you have trouble remembering to take your medications, consider using a pill box to organize your medications.
No, perindopril isn't a diuretic (or a "water pill"). It's an ACE inhibitor. It relaxes your blood vessels by blocking a hormone (angiotensin II) from squeezing your blood vessels. If you're using perindopril to lower blood pressure and it's not enough on its own, your provider might prescribe additional blood pressure-lowering medications, such as a diuretic, to help. These other medications work differently than ACE inhibitors to lower your blood pressure. For example, diuretics work on your kidneys to help you urinate out extra fluids in the body and lower blood pressure.
Talk to your provider first before taking any over-the-counter pain medications, such as ibuprofen (Advil) or acetaminophen (Tylenol). Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), can raise your risk of kidney problems when they're taken with perindopril. The risk is higher for people who are older, who have a history of kidney problems, or are taking diuretics. If you have one of these risk factors, acetaminophen (Tylenol) might be a safer option for you. But be aware that acetaminophen (Tylenol) might not be a good choice for you either if you have liver problems too. Make sure to tell your provider about your medical history and all the medications you're taking before starting perindopril.
Weight gain isn't a known side effect of perindopril. If you find yourself gaining weight while taking perindopril, talk with your provider. They can examine you and discuss with you about possible other causes of your weight gain, such as other medications or medical conditions.
ACE inhibitors like perindopril don't commonly make it difficult to get or maintain an erection. In studies done with a different ACE inhibitor called lisinopril (Zestril), rare cases of erectile dysfunction happened, but the effect was temporary and went away after the first month of treatment. In some cases, if erectile dysfunction is caused by high blood pressure and stiff blood vessels, taking perindopril might help to raise blood flow to the genital area. Talk to your provider if you're concerned about this side effect.
It isn't clear how long perindopril takes to work. But once it starts working, it's the most effective 2 to 4 hours after a dose. For people with high blood pressure, perindopril can lower your blood pressure for at least 24 hours.
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Risks and warnings for Perindopril
Perindopril can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Harm to unborn baby
Taking perindopril during the second and third trimesters of pregnancy might raise the risk for birth defects, such as small skull, low blood pressure, and kidney failure. Sometimes, this can be fatal to the unborn baby. Because of this potential risk, if you find out that you're pregnant while you're taking perindopril, stop and let your provider know right away. If you're pregnant or are planning to become pregnant, discuss safer treatment options with your provider.
Angioedema (swelling)
- Risk factors: People of African descent | History of angioedema | Taking Entresto (sacubitril / valsartan)
People who take medications that contain an ACE inhibitor, like perindopril, can experience a rare, but serious side effect called angioedema. Angioedema is a medical condition that involves swelling in different parts of the body, including the face, throat, tongue, and guts. In particular, swelling of the tongue or throat can be life-threatening, since it can lead to difficulty breathing. Get medical attention right away if you experience swelling in the facial area, belly pain, nausea, vomiting, or shortness of breath. Your provider will ask you to stop taking perindopril and monitor you until these symptoms go away.
Low blood pressure
- Risk factors: Dehydration (e.g., diarrhea, vomiting) | Low salt levels in your body | People on dialysis | Taking diuretics for a long time
Sometimes, taking perindopril can cause your blood pressure to drop too much. This can cause you to feel dizzy, tired, or lightheaded. Low blood pressure is more common in the first 2 weeks of starting perindopril and when your dose goes up. Make sure to stay well hydrated during treatment. Don't get up suddenly from a sitting or lying down position, since this can cause your blood pressure to drop quickly. If you frequently feel dizzy, lightheaded, faint, tired, or confused while taking perindopril, let your provider know.
Worsening kidney problems
- Risk factors: Severe heart failure | Kidney problems | Taking diuretics
Perindopril can usually improve blood flow to the kidneys, which is good for people with high blood pressure and chronic kidney disease (CKD). But in some cases, perindopril can make kidney problems worse. The risk is higher for people who have certain medical conditions, such as blockage of the kidney artery or severe heart failure. As a result, your provider might order lab tests during treatment to make sure your kidneys are healthy and working properly. Let your provider know if you're urinating less often than usual, feeling tired, nauseous, or have chills. These can be symptoms of kidney damage.
Low blood cell count
In some rare cases, taking perindopril might lower your white blood cell counts or cause bone marrow suppression, which can lead to blood problems. The risk might be higher if you have kidney problems and lupus. Tell your provider about your full medical history before starting perindopril.
High levels of potassium
- Risk factors: Diabetes | Kidney problems | Taking other medications that also raise potassium
Very rarely, perindopril can raise the amount of potassium in your body, which can be dangerous. Your risk of developing high potassium is greater if you have diabetes, kidney problems, or are taking other medications that also raise potassium levels. For this reason, make sure your provider knows your full medical history and what medications you're taking before starting perindopril. If you experience signs of high potassium, such as nausea, muscle weakness, or abnormal heartbeat, tell your provider right away.
Dry cough
Perindopril can cause you to develop a dry cough. This is because it blocks a protein called bradykinin, which causes your airways to narrow and leads to a cough. Typically, dry cough goes away after you stop taking perindopril. If you notice a dry cough after starting this medication, let your provider know.
Liver problems
- Risk factor: History of liver problems
In some rare cases, people who took ACE inhibitors, like perindopril, have developed a blocked bile duct. This can lead to severe liver problems or liver failure. Although it's not clear how perindopril can cause these problems, make sure to let your provider know if you have belly pain, tiredness, or yellowing of your skin and the whites of your eyes. These can be symptoms of a liver problem.
Perindopril dosage
Interactions between Perindopril and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Aliskiren
- Sacubitril
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Alteplase, Recombinant
- Amiloride
- Azathioprine
- Azilsartan
- Azilsartan Medoxomil
- Candesartan Cilexetil
- Canrenoate
- Cyclosporine
- Eplerenone
- Eprosartan
- Everolimus
- Irbesartan
- Lithium
- Losartan
- Mercaptopurine
- Olmesartan Medoxomil
- Potassium
- Potassium Phosphate
- Sirolimus
- Spironolactone
- Telmisartan
- Triamterene
- Trimethoprim
- Valsartan
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Azosemide
- Bromfenac
- Bufexamac
- Bumetanide
- Bupivacaine
- Bupivacaine Liposome
- Capsaicin
- Celecoxib
- Choline Salicylate
- Clonixin
- Dexibuprofen
- Dexketoprofen
- Diclofenac
- Diflunisal
- Dipyrone
- Droxicam
- Ethacrynic Acid
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenoprofen
- Fepradinol
- Feprazone
- Floctafenine
- Flufenamic Acid
- Flurbiprofen
- Furosemide
- Gold Sodium Thiomalate
- Ibuprofen
- Indomethacin
- Ketoprofen
- Ketorolac
- Lornoxicam
- Loxoprofen
- Lumiracoxib
- Meclofenamate
- Mefenamic Acid
- Meloxicam
- Morniflumate
- Nabumetone
- Naproxen
- Nepafenac
- Nesiritide
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Oxaprozin
- Oxyphenbutazone
- Parecoxib
- Phenylbutazone
- Piketoprofen
- Piretanide
- Piroxicam
- Proglumetacin
- Propionic Acid
- Propyphenazone
- Proquazone
- Rofecoxib
- Salicylic Acid
- Salsalate
- Sodium Salicylate
- Sulindac
- Tenoxicam
- Tiaprofenic Acid
- Tolfenamic Acid
- Tolmetin
- Torsemide
- Valdecoxib
How much does Perindopril cost?
$49.57
Perindopril contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Perindopril will not be safe for you to take.
- History of angioedema (e.g., puffy or swollen face, swollen hands or feet)
- Take with aliskiren (Tekturna) and you also have diabetes
- Take within 36 hours of Entresto (sacubitril / valsartan)
What are alternatives to Perindopril?
