perindopril erbumine

perindopril erbumine

Aceon, Coversyl (UK)

Pharmacologic class: Angiotensin-converting enzyme (ACE) inhibitor

Therapeutic class: Antihypertensive

Pregnancy risk category C (first trimester), D (second and third trimesters)

FDA Boxed Warning

• When used during second or third trimester of pregnancy, drug may cause fetal harm or death. Discontinue as soon as pregnancy is detected.

Action

Inhibits conversion of angiotensin I to angiotensin II (a potent vasoconstrictor). This effect leads to decreased plasma angiotensin II, reduced vasoconstriction, enhanced plasma renin activity, and decreased aldosterone activity.

Availability

Tablets: 2 mg, 4 mg, 8 mg

⊘Indications and dosages

➣ Essential hypertension

Adults: 4 mg P.O. daily; may titrate upward to 16 mg/day, given as a single dose or in two divided doses. (Start with 2 to 4 mg/day in patients receiving diuretics.)

➣ Coronary artery disease

Adults: Initially, 4 mg P.O. daily for 2 weeks; then increase as tolerated to a maintenance dosage of 8 mg P.O. daily.

Dosage adjustment

• Renal impairment
• Elderly patients

Off-label uses

• Heart failure
• Diabetic nephropathy

Contraindications

• Hypersensitivity to drug or other ACE inhibitors
• Angioedema during previous ACE inhibitor use
• Pregnancy

Precautions

Use cautiously in:
• hepatic failure, renal impairment, renal artery stenosis, hyperkalemia, cough
• black patients with hypertension
• breastfeeding patients
• children (safety not established).

Administration

• Give without regard to food.
☞ Know that drug (especially first dose) may cause angioedema. Keep epinephrine and antihistamines at hand in case of airway obstruction.
• For elderly patient, titrate dosage upward very slowly.
• Know that drug may be given alone or with other drugs.

Route	Onset	Peak	Duration
P.O.	1 hr	3-7 hr	12-24 hr

Adverse reactions

CNS: dizziness, fatigue, headache, insomnia, sleep disorder, weakness, asthenia, drowsiness, vertigo, depression, paresthesia

CV: hypotension, angina pectoris, palpitations, chest pain, abnormal ECG, tachycardia

EENT: ear infection, sinusitis, rhinitis, pharyngitis

GI: nausea, vomiting, diarrhea, abdominal pain, flatulence

GU: proteinuria, urinary tract infection, erectile or other male sexual dysfunction, decreased libido, menstrual disorder

Metabolic: hyperkalemia

Musculoskeletal: back, arm, leg, neck, or joint pain; hypertonia; myalgia; arthritis

Respiratory: cough, upper respiratory infection

Skin: rash, angioedema

Other: fever, viral infection, edema

Interactions

Drug-drug. Antacids: decreased perindopril absorption

Antihypertensives, general anesthestics, nitrates, phenothiazines: additive hypotension

Cyclosporine, heparin, indomethacin, potassium-sparing diuretics, potassium supplements: hyperkalemia

Diuretics: excessive hypotension

Lithium: increased lithium toxicity

Nonsteroidal anti-inflammatory drugs: blunted antihypertensive response

Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, potassium, triglycerides: increased levels

Hematocrit, hemoglobin: decreased values

Drug-food. Salt substitutes containing potassium: hyperkalemia

Drug-herbs. Capsaicin: cough

Drug-behaviors. Acute alcohol ingestion: additive hypotension

Patient monitoring

• Assess blood pressure. Be aware that dosage increases or concomitant diuretic use may cause severe hypotension.
☞ Watch for angioedema, especially after first dose.
• Stay alert for signs and symptoms of infection, particularly EENT and respiratory infections.
• Monitor potassium level. Watch for signs and symptoms of hyperkalemia.
• Monitor liver and kidney function tests before and during therapy.
☞ In black patients, watch closely for angioedema and monitor drug efficacy. Monotherapy may be less effective in these patients.

Patient teaching

• Tell patient to take at same time each day, with or without food.
☞ Instruct patient to stop using drug and contact prescriber immediately if hoarseness or difficulty swallowing or breathing occurs.
• Tell patient to avoid excessive perspiration or decreased fluid intake, which may cause symptomatic blood pressure drop. Inform him that vomiting or diarrhea also may lower blood pressure.
• Tell patient to report signs and symptoms of infection.
• Advise patient not to use potassium-containing salt substitutes.
☞ Caution female patient of childbearing age to contact prescriber immediately if she suspects pregnancy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.