Sacubitril Valsartan
Contraindicated
Textbook
Increased risk of angioedema.
Do not use in conjunction with ACEIs.
Source: G&G 14e · p602
Drug reference
Perindopril
Angiotensin-converting enzyme (ACE) inhibitor (prodrug) · Antihypertensive
Also known as Perindopril arginine
START
5 mg PO once daily (2.5 mg if elderly/renal/HF/volume-deplete), titrate to 10 mg/day
TYPICAL MAX
10 mg/day (arginine)
STOP IF
Angioedema (stop permanently), pregnancy, K+ >6.0, AKI (creatinine rise >30%)
WATCH
K+ and creatinine 1–2 weeks after start/titration, BP, cough/angioedema, pregnancy status
CDSCO approvedATC C09AA04
KDIGO 2024 + manufacturer label
- ONSET
- 1h · BP onset
- PEAK
- 5h · perindoprilat peak
- t½
- 1d · effective t½
- DURATION
- 1d · once-daily
EXCRETION
Hepatic activation; renal perindoprilat/metabolites
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Contraindicated 2nd/3rd trimester — fetal renal failure, oligohydramnios, death; discontinue if pregnancy detected
FDA category + note
Top interactionssee all 12 →
- Sacubitril ValsartanContraindicatedTextbookG&G 14e · p602
- AliskirenContraindicatedDatabaseKimi deep-research + Cla
- SacubitrilContraindicatedDatabaseKimi deep-research + Cla
- AminoglycosidesSevereTextbookG&G 14e
Available in India
17 branded formulations and 8 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Mechanism
Prodrug hydrolysed to perindoprilat which inhibits ACE, reducing angiotensin II and aldosterone and decreasing bradykinin breakdown → vasodilation, reduced afterload/BP and favourable cardiovascular/renal remodelling.
Indications
HypertensionStable coronary artery disease (cardiovascular risk reduction)Symptomatic heart failureReduction of recurrent stroke risk (with indapamide)
Dosing
- Adult
- Perindopril arginine 5 mg PO once daily (start 2.5 mg if elderly/renal/HF), titrate to 10 mg/day. (Erbumine salt: 4 mg → 8 mg.)
- Pediatric
- Not established.
- Renal adjustment
- CrCl 30–60: 2.5 mg/day; CrCl 15–30: 2.5 mg alternate days; dialysis: 2.5 mg on dialysis day.
- Hepatic adjustment
- No specific adjustment (prodrug activation hepatic — caution in severe).
- Geriatric
- Start 2.5 mg/day; titrate per BP/renal function.
- Max dose
- 10 mg/day (arginine); 8 mg/day (erbumine)
Pharmacokinetics
Onset
~1 h (BP); peak effect 4–8 h
Peak effect
Perindoprilat ~3–7 h
Duration
~24 h
Half-life
Effective perindoprilat ~25 h (tight ACE binding)
Bioavailability
Perindopril ~65–75%; perindoprilat ~20%
Protein binding
~10–20%
Metabolism
Hepatic hydrolysis to active perindoprilat
Excretion
Renal (perindoprilat and metabolites)
Contraindications
- Pregnancy (2nd/3rd trimester)
- History of ACE-inhibitor angioedema / hereditary or idiopathic angioedema
- Concomitant aliskiren in diabetes
- Concomitant sacubitril/valsartan (or within 36 h)
- Bilateral renal artery stenosis
Side effects
Common
Dry persistent coughDizziness/hypotensionHeadacheHyperkalaemiaFatigue
Serious
- Angioedema (potentially life-threatening, airway)
- Acute kidney injury (bilateral RAS, volume depletion, NSAID)
- Severe hyperkalaemia
- First-dose/severe hypotension
- Fetal toxicity; rare neutropenia/hepatic injury
Pregnancy & lactation
Pregnancy
Contraindicated 2nd/3rd trimester — fetal renal failure, oligohydramnios, death; discontinue if pregnancy detected
Lactation
Avoid (esp. neonates/preterm) — limited data; alternatives preferred
Drug interactions
Aliskiren
Contraindicated
Database
Dual RAAS blockade → hyperkalaemia/AKI
Do not combine in diabetes/eGFR <60
Source: Kimi deep-research + Cla
Sacubitril
Contraindicated
Database
Additive angioedema risk (dual neprilysin/ACE)
Do not combine; ≥36 h washout
Source: Kimi deep-research + Cla
Aminoglycosides
Severe
Textbook
Increased risk and severity of renal impairment and nephrotoxicity.
Not explicitly stated, but implies careful monitoring of renal function and cautious co-administration.
Source: G&G 14e
Angiotensin Receptor Blockers
Severe
Textbook
Greater incidence of acute kidney injury (AKI) and adverse cardiac events.
The combination of these two classes should be avoided.
Source: Harrison 22e · p2396
Azilsartan
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Candesartan
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Dipeptidyl Peptidase Iv Inhibitor
Severe
Textbook
Increased risk of angioedema.
Avoid combination.
Source: G&G 14e · p600
Losartan + Hydrochlorothiazide
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Olmesartan + Amlodipine
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Olmesartan + Hydrochlorothiazide
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Olmesartan Medoxomil
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Related guidelines
Other Angiotensin-converting enzyme (ACE) inhibitor (prodrug) drugs
Ask House about Perindopril
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19