Perindopril

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Perindopril
Systematic (IUPAC) name
1-[2-(1-ethoxycarbonylbutylamino) propanoyl] -2,3,3a,4,5,6,7,7a- octahydroindole-2-carboxylic acid
Identifiers
CAS number	107133-36-8
ATC code	C09AA04
PubChem	107807
DrugBank	APRD01178
Chemical data
Formula	C₁₉H₃₂N₂O₅
Mol. mass	368.468 g/mol
Pharmacokinetic data
Bioavailability	?
Metabolism	?
Half life	?
Excretion	?
Therapeutic considerations
Pregnancy cat.	?
Legal status
Routes	?

Coversyl (perindopril) is a long-acting ACE inhibitor. International nonproprietary name: Perindopril.

Indications: Essential hypertension. Stable coronary artery disease: reduction of risk of cardiac events in patients with a history of myocardial infarction and/or revascularization. Treatment of symptomatic heart failure.

Dosage and administration: Coversyl (perindopril) should be taken in the morning before food. Hypertension: 4 mg once daily, then the dose may be increased to 8 mg after 1 month of treatment to improve blood pressure control or in case of concomitant stable coronary artery disease. Stable coronary artery disease: A starting dose of 4 mg for 2 weeks is recommended, then uptitration to 8 mg once daily, depending on acceptability. Congestive heart failure: 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: start treatment at 2 mg daily. Contraindications: Children. Pregnancy. Lactation. Patients with a history of hypersensitivity to Coversyl (perindopril).

Precautions: Assess renal function before and during treatment where appropriate. Renovascular hypertension. Surgery/anesthesia. Renal failure: the dose should be cautiously adjusted in accordance with the creatinine clearance (refer to complete data sheet). Symptomatic hypotension is rarely seen, but is more likely in volume-depleted patients, those receiving diuretics, or with the first two doses. In diuretic-treated patients, stop the diuretic 3 days before starting Coversyl (perindopril). A diuretic may later be given in combination if necessary; potassium-sparing diuretics are not recommended. Combination with neuroleptics or imipramine-type drugs may increase the hypotensive effect. Serum lithium concentrations may rise during lithium therapy.

Side effects: Rare and mild, usually at the start of treatment. Cough, fatigue, asthenia, headache, disturbances of mood and/or sleep have been reported. Less often, taste impairment, epigastric discomfort, nausea, abdominal pain, and rash. Reversible increases in blood urea and creatinine may be observed. Proteinuria has occurred in some patients. Rarely, angioneurotic edema and decreases in hemoglobin, red cells, and platelets have been reported.

Composition: Each tablet contains 2 mg, 4 mg or 8 mg of the tert-butylamine salt of perindopril. Perindopril is also available under the trade name Coversyl Plus®, containing 4mg of perindopril combined with 1.25mg indapamide.

Presentation: Packs of 30 tablets of Coversyl (perindopril) 2 mg. Packs of 30 tablets of Coversyl (perindopril) 4 mg (scored). Packs of 30 tablets of Coversyl (perindopril) 8 mg.

Also available under the brand names: Aceon ®, Acertil ®, Armix ®, Coverene ®, Coverex ®, Coversum ®, Prestarium ®, Prexanil ®, Prexum ®, Procaptan ®

1. Myers MG, on behalf of the perindopril multicentre dose-response study group. A dose-response study of perindopril in hypertension: effects on blood pressure 6 and 24h after dosing. Can J Cardiol. 1996;12:1191-1196.

2. Morgan T, Anderson A. Clinical efficacy of perindopril in hypertension. Clin Exp Pharmacol Physiol. 1992;19:61-65.

3. Lechat P, Granham SP, Desche P, et al. Efficacy and acceptability of perindopril in mild-to-moderate chronic congestive heart failure. Am Heart J. 1993;126:798-806.

4. Bounhoure JP, Bottineau G, Lechat P, et al. Value of perindopril in the treatment of chronic congestive heart failure: multicentre double-blind placebo-controlled study. Clin Exp Hypertens. 1989;A11(suppl 2):575-586.

5. The EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomized, double-blind, placebo controlled, multicentre trial (the EUROPA study). Lancet. 2003;362:782-788.