Perindopril

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

Additional recommended knowledge

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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 disease or failure.

Dosage and administration

Coversyl (perindopril) should be taken in the morning before food.

For 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.

In Australia, Coversyl is available as perindopril arginine. In hypertension, the initiation dose is 5 mg once daily, then the dose may be increased to 10 mg after 1 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 Coversyl and amlodipine together. The 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. Coversyl and amlodipine were found to be so effective that the trial was stopped early so that all patients could receive the combination.^[1][2]

For 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.

In Australia, Coversyl is available as perindopril arginine. A starting dose of 5 mg for 2 weeks is recommended, then uptitration to 10 mg once daily, depending on acceptability.

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.

In Australia, Coversyl (perindopril arginine) should be started under close medical supervision at a starting dose of 2.5 mg. This may be increased to 5 mg once blood pressure acceptability has been demonstrated.

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

Contraindications include; children, pregnancy, lactation and situations where a patient has 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.

In Australia, each tablet contains 2.5 mg, 5 mg or 10 mg of arginine. Perindopril is also available under the trade name Coversyl Plus® and Coversyl Plus LD®, containing 5mg of perindopril combined with 1.25mg indapamide and 2.5mg of perindopril combined with 0.625mg indapamide respectively.

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 ® and
• Procaptan ®

References

• 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.
• 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.
• Morgan T and Anderson A; "Clinical efficacy of perindopril in hypertension." Clin Exp Pharmacol Physiol. 1992;19:61-65.
• 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.
• "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)." The Lancet 2003;362:782-788.