Perindopril belongs to the class of medications called angiotensin converting enzyme (ACE) inhibitors. It is used to treat high blood pressure. It helps to control blood pressure by relaxing blood vessels. Perindopril may be used alone or in combination with other medications that reduce blood pressure, especially thiazide diuretics (water pills).

Perindopril is also used to treat mild-to-moderate congestive heart failure in combination with other medications such as diuretics and digoxin. It may also be used to decrease the risk of further cardiac (heart) events after a recent heart attack or for people with coronary artery disease.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

To treat high blood pressure or after a heart attack, the usual starting dose of perindopril is 4 mg taken once daily. The dose may be increased after 2 weeks up to a maximum of 8 mg once daily depending on blood pressure control. Perindopril may be used alone or in combination with other medications to reduce blood pressure.

When used to treat congestive heart failure, the starting dose of perindopril is 2 mg. It may then be increased to 4 mg once daily depending on the effect of the medication and side effects.

For best results, the tablets should be taken before a meal and on an empty stomach. Once-daily doses should be taken in the morning before breakfast. Seniors and people with kidney disease may require smaller doses.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones given here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by the doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

2 mg
Each white, round, biconvex tablet, engraved with "P" on one face and "2" on other face, contains 2 mg of perindopril erbumine. Nonmedicinal ingredients: hydrophobic colloidal silica, lactose monohydrate, magnesium stearate, and microcrystalline cellulose.

4 mg
Each light green, capsule-shaped, biconvex, scored tablet, engraved with "P" on both sides of the score line on one face and engraved with "4" on one side of the score line on another face, contains 4 mg of perindopril erbumine. Nonmedicinal ingredients: Aluminum Lake (D&C Yellow No. 10, FD&C Blue No. 1, FD&C Yellow No. 6), hydrophobic colloidal silica, lactose monohydrate, magnesium stearate, and microcrystalline cellulose.

8 mg
Each green, round, biconvex tablet, engraved with "PP" on one face and "8" on other face, contains 8 mg of perindopril erbumine. Nonmedicinal ingredients: Aluminum Lake (D&C Yellow No. 10, FD&C Blue No. 1, FD&C Yellow No. 6), hydrophobic colloidal silica, lactose monohydrate, magnesium stearate, and microcrystalline cellulose.

Do not take perindopril if you:

• are allergic to perindopril or any ingredients of the medication
• are pregnant or may become pregnant
• are breast-feeding
• are taking the medication sacubitril-valsartan
• have been diagnosed with hereditary angioedema
• have had angioedema (a serious allergic reaction which causes the area around the throat and tongue to swell) after taking any other ACE inhibitors (e.g., captopril, enalapril, ramipril)
• have narrowing of the arteries in the kidneys
• have diabetes or kidney disease and are taking aliskiren
• have galactose intolerance, Lapp lactase deficiency (a rare hereditary condition), or glucose-galactose malabsorption​
• are receiving dialysis or any other type of blood filtration

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• cold symptoms (e.g., nasal congestion, runny nose, cough, sore throat)
• cough (dry, persistent)
• diarrhea
• difficulty maintaining an erection
• dizziness
• drowsiness
• feeling weak
• headache
• loss of taste
• metallic taste in mouth
• swelling of the hands, feet, or ankles
• trouble sleeping
• unusual tiredness

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• chest pain
• numbness or tingling in the fingers or toes
• pounding or irregular heartbeat
• ringing in the ears
• severe abdominal pain with or without nausea and vomiting
• signs of bleeding (e.g., unusual nosebleeds, blood in urine, coughing blood, bruising easily, cuts that won't stop bleeding)
• signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
• signs of fluid and electrolyte imbalance (e.g., drowsiness, muscle pain or cramps, weakness, irregular heartbeat)
• signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
• signs of kidney problems (e.g., increased urination at night, decreased urine production, blood in the urine, change of urine colour)
• signs of low blood pressure (e.g., dizziness, lightheadedness, fainting)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• signs of too much potassium in the body (e.g., confusion; irregular heartbeat; nervousness; numbness or tingling in hands, feet, or lips; shortness of breath or difficulty breathing; weakness or heaviness of legs)
• skin rash, with or without itching, skin blisters, fever, or joint pain
• swelling of the hands, feet, or ankles
• worsening symptoms of psoriasis

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of a serious allergic reaction (i.e., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• signs of heart attack (e.g., sudden chest pain or pain radiating to back, down arm, jaw; sensation of fullness of the chest; nausea; vomiting; sweating; anxiety)
• signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
• signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort
• signs of stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)
• signs of angioedema (e.g., swollen mouth, lips, tongue, difficulty swallowing or breathing)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Angioedema: Although not common, angioedema (a serious allergic reaction that causes the area around the throat and tongue to swell) may occur with ACE inhibitors, including perindopril. If you experience swelling of the face, tongue, or glottis, or experience unexpected abdominal pain that may be accompanied by nausea or vomiting, stop taking perindopril at once and seek immediate medical attention. People who have had angioedema caused by other substances may be at increased risk of angioedema while taking an ACE inhibitor such as perindopril.

Blood counts: This medication can decrease the number of neutrophils (a type of white blood cell that helps fight infection), red blood cells (which carry oxygen), and platelets (which help your blood to clot). Your doctor will do blood tests to monitor this. If you notice any signs of infection (e.g., fever, chills, or sore throat) or unusual bleeding or bruising, contact your doctor immediately.

Cough: People taking perindopril may develop a dry, persistent cough that usually disappears only after stopping or lowering the perindopril dose. Be sure to tell your doctor of any cough which does not seem to be related to a usual cause.

Diabetes: Perindopril may affect blood sugar control. If you have diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. You may need to test your blood sugar more often when you first start taking this medication.

Taking perindopril in combination with aliskiren increases the risk of severe low blood pressure, fainting, stroke, and decreasing kidney function. People with diabetes must not take both of these medications.

Drowsiness/reduced alertness: Perindopril can cause dizziness, drowsiness, or fatigue that may reduce alertness, especially when you first start to take this medication. Avoid driving, operating machinery, or performing other potentially hazardous tasks until you have determined how this medication affects you.

Fluid and electrolyte balance: Increases in blood levels of potassium may occur as a result of taking perindopril. This rarely causes problems, but your doctor may want to monitor your potassium levels regularly with blood tests.

Kidney function: Perindopril may affect the function of the kidneys, causing decreased kidney function, kidney failure, or possibly death. The use of diuretics (water pills), nonsteroidal anti-inflammatory drugs (NSAIDs), or aliskiren may further increase risk of kidney problems for people already at risk for this problem. Certain people may be more likely to experience changes in kidney function (e.g., people with narrowed blood vessels in their kidneys, or those with severe congestive heart failure). If you have kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Rarely, people taking this medication experience decreases in liver function, possibly leading to liver failure. Your doctor will do blood tests to monitor this. If you notice any signs of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

Low blood pressure: Occasionally, blood pressure drops too low after perindopril is taken. This usually happens after the first or second dose or when the dose is increased. It is more likely to occur for those who take aliskiren, water pills, have a salt-restricted diet, are on dialysis, are suffering from diarrhea or vomiting, or have been sweating excessively and not taking in enough fluids. To reduce the risk of dizziness, get up slowly from a lying or sitting position. If low blood pressure causes you to faint or feel lightheaded, contact your doctor.

Surgery: Perindopril may increase the blood pressure lowering effects of some medications used in surgery. Make sure to let all health-care providers in your team know that you are taking this medication.

Pregnancy: ACE inhibitors such as perindopril may cause severe harm or death to a developing baby if taken by the mother during pregnancy. This medication should not be used during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking perindopril, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of the use of perindopril by children have not been established. Its use by this age group is not recommended.

Seniors: Due to age-related decreases in kidney function, seniors may require lower doses of this medication.

There may be an interaction between perindopril and any of the following:

• acetazolamide
• acetylsalicylic acid (ASA)
• aldesleukin
• aliskiren
• allopurinol
• alpha-agonists (e.g., clonidine, methyldopa)
• alpha-blockers (e.g., alfuzosin, doxazosin, tamsulosin)
• amifostine
• amiodarone
• amphetamines (e.g., dextroamphetamine, lisdexamfetamine)
• other angiotensin converting enzyme inhibitors (ACEIs; captopril, enalapril, ramipril)
• angiotensin receptor blockers (ARBs; e.g., candesartan, irbesartan, losartan)
• antipsychotics (e.g., clozapine, olanzapine, quetiapine, risperidone)
• apomorphine
• azathioprine
• barbiturates (e.g., butalbital, pentobarbital, phenobarbital)
• beta-adrenergic blockers (e.g., atenolol, propranolol, sotalol)
• brimonidine
• bromocriptine
• calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine, verapamil)
• conivaptan
• dexmethylphenidate
• diabetes medications (e.g., canagliflozin, glyburide, insulin, metformin, saxagliptin)
• digoxin
• diuretics (water pills; e.g., furosemide, amiloride, spironolactone, triamterene)
• drospirenone
• duloxetine
• eplerenone
• everolimus
• gold salts
• grass pollen allergen extract
• guanfacine
• heparin
• iron dextran
• levodopa
• lithium
• low molecular weight heparins (e.g., dalteparin, enoxaparin, tinzaparin)
• medications that increase blood levels of potassium (e.g., potassium chloride, salt substitutes containing potassium)
• metformin
• methylphenidate
• monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
• morphine
• nabilone
• nitrates (e.g., isosorbide dinitrate, isosorbide mononitrate)
• nonsteroidal anti-inflammatory medications (NSAIDs; e.g., diclofenac, ibuprofen, indomethacin, ketorolac)
• obinutuzumab
• pentoxifylline
• phosphodiesterase 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
• pramipexole
• pregabalin
• riociguat
• ropinirole
• rotigotine
• sacubitril
• sirolimus
• sodium phosphates
• tacrolimus
• temsirolimus
• tizanidine
• tolvaptan
• trimethoprim
• yohimbine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.