Perindopril

Perindopril is a long-acting ACE inhibitor used to treat high blood pressure, heart failure, or stable coronary artery disease^[1] in form of perindopril arginine (trade names include Coversyl, Coversum) or perindopril erbumine (Aceon). According to the Australian government's Pharmaceutical Benefits Scheme website, based on data provided to the Australian Department of Health and Aging by the manufacturer, perindopril arginine and perindopril erbumine are therapeutically equivalent and may be interchanged without differences in clinical effect.^[2] However, the dose prescribed to achieve the same effect differs due to different molecular weights for the two forms.

Indications[edit]

Perindopril shares the indications of ACE inhibitors as a class, including essential hypertension, stable coronary artery disease (reduction of risk of cardiac events in patients with a history of myocardial infarction and/or revascularization) and treatment of symptomatic heart disease or failure. In addition, the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) found that perindopril reduces the risk of stroke in both hypertensive and nonhypertensive individuals with a history of stroke or transient ischemic attack.^[3]

Dosage and administration[edit]

For perindopril as treatment for hypertension, the initial dose is 5 mg perindopril arginine (or 4 mg perindopril erbumine) once daily, then the dose may be increased to 10 mg perindopril arginine (or 8 mg perindopril erbumine) after one month of treatment to improve blood pressure control or in case of concomitant stable coronary artery disease.

The Anglo-Scandinavian Cardiac Outcomes Trial showed the benefits of taking the two drugs perindopril and amlodipine together. About 9000 British patients aged 40 to 79 were involved in the five-year trial. Half were given the new drug combination; the rest were given traditional drugs. Perindopril and amlodipine were found to be so effective, the trial was stopped early so all patients could receive the combination.

For stable coronary artery disease

A starting dose of 4 mg for two weeks is recommended, then uptitration to 8 mg once daily, depending on acceptability.

For congestive heart disease

Coversyl (perindopril) should be started under close medical supervision at a starting dose of 2 mg. This may be increased to 4 mg once blood pressure acceptability has been demonstrated.

Elderly patients should start treatment at 2 mg daily (2.5 mg daily of perindopril arginine in Australia).

For secondary prevention of stroke

The PROGRESS study recommends a dose of 4 mg daily, optionally supplemented by 2.5 mg-daily indapamide. The reduction of stroke risk seems to be stronger with a combination of the two drugs.