Experiences with
Perindopril

Perindopril is a medicine used to treat high blood pressure (hypertension) and heart failure. It's also prescribed after a heart attack.

Perindopril helps to reduce the risk of future strokes and heart attacks. It also improves your survival if you're taking it following a heart attack or heart surgery.

This medicine is only available on prescription. It comes as tablets. It also comes as a liquid for people who find it difficult to swallow tablets, but your pharmacist will have to order this for you.

Perindopril is also available as a tablet combined with another blood pressure medicine called indapamide.

Who can take perindopril

Most adults aged 18 and over can take perindopril.

If you have diabetes, check your blood sugar (glucose) more often, particularly in the first few weeks. This is because perindopril can lower the sugar level in your blood.

Who may not be able to take perindopril

Perindopril is not suitable for some people. To make sure it's safe for you, tell your doctor if you:

have ever had an allergic reaction to perindopril or any other medicine
are trying to get pregnant, are already pregnant or you are breastfeeding
are having dialysis or any other type of blood filtration
have heart, liver or kidney problems
have unstable or low blood pressure
have diabetes
are going to have a major operation (surgery) or general anaesthetic to put you to sleep
have recently had diarrhoea or vomiting
are on a low-salt diet
are going to have desensitisation treatment to reduce your allergy to insect stings
have a blood problem such as low white blood cell count (neutropenia or agranulocytosis)

Dosage

Your dose of perindopril depends on why you need the medicine. Take it how your doctor tells you to.

To decide the correct dose for you, your doctor will check your blood pressure and ask you if you're getting any side effects from your medicine.

You may also have blood tests to check how well your kidneys are working and the amount of potassium in your blood.

Perindopril comes as perindopril erbumine (also called perindopril tert-butylamine) or perindopril arginine. They both work in the same way, but the doses vary.

Dose for perindopril erbumine (also called perindopril tert-butylamine)

Depending on why you're taking perindopril erbumine, the usual starting dose is between 2mg and 4mg once a day.

This dose may be increased gradually over a few weeks to the usual dose for your condition:

high blood pressure – 4mg once a day (the maximum dose is 8mg once a day)
after a heart attack – 8mg once a day
heart failure – 4mg once a day

Dose for perindopril arginine

Depending on why you're taking perindopril arginine, the usual starting dose is between 2.5mg and 5mg, taken once a day.

This dose may be increased gradually over a few weeks to the usual dose for your condition:

high blood pressure – 5mg, taken once a day (the maximum dose is 10mg once a day)
after a heart attack – 10mg, taken once a day
heart failure – 5mg, taken once a day

How to take it

You'll usually take perindopril once a day.

Swallow perindopril tablets whole with a drink of water.

Your doctor may suggest that you take your first dose before bedtime because it can make you feel dizzy.

After the very first dose, if you do not feel dizzy, take perindopril in the morning, ideally 30 to 60 minutes before breakfast.

How long to take it for

Usually, treatment with perindopril is long term, and you may have to take it for the rest of your life.

Changes to your dose

You'll probably be prescribed a low dose of perindopril at first so it does not make you feel dizzy.

This will usually be increased gradually until you reach the right dose for you.

Speak to your pharmacist or doctor if you're worried about side effects with perindopril.

Take perindopril even if you feel well, as you'll still be getting the benefits of the medicine.

Contact your doctor if you get ill, such as a high temperature, sweats and shaking or severe diarrhoea or vomiting.

Your doctor may advise you to stop taking perindopril until you recover and are eating and drinking normally.

If you forget to take it

If you miss a dose of perindopril, take it as soon as you remember that day. If you do not remember until the following day, skip the missed dose and take your next dose at the usual time.

Do not take a double dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much

Taking more than your prescribed dose of perindopril can make you feel dizzy, sleepy and give you a pounding heartbeat (heart palpitations).

The amount of perindopril that can lead to an overdose varies from person to person.

you take more than your prescribed dose of perindopril

Go to 111.nhs.uk or call 111

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the perindopril packet or leaflet inside it, any remaining medicine, and any other medicines you take.

Common side effects

These common side effects of perindopril happen in more than 1 in 100 people. There are things you can do to help cope with them:

Cough medicines do not usually help for coughs caused by perindopril. Sometimes the cough gets better on its own. Talk to your doctor if it carries on, bothers you or stops you from sleeping, as another medicine may be better. Even if you stop taking perindopril, the cough may take up to a month to go away.

This is more likely to happen when you start taking perindopril or if you move on to a higher dose. If perindopril makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you do not faint, then sit until you feel better.

Do not drive, ride a bike or use tools or machinery until the dizziness passes.

Make sure you rest and drink plenty of fluids. Try not to drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if the headaches last longer than a week or are severe.

Take small, frequent sips of fluids, such as water or squash, to prevent dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat vomiting without speaking to a pharmacist or doctor first.

If you take the combined contraceptive pill or progestogen-only pill and you're being sick, your contraception may not protect you from pregnancy. Check the pill packet for advice.

If you're being sick from a stomach bug or illness, tell your doctor. You may need to stop taking perindopril for a while until you feel better.

Drink plenty of fluids, such as water or squash, to prevent dehydration. Speak to a pharmacist if you have signs of dehydration, such as peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor first.

If you take the combined contraceptive pill or progestogen-only pill and you have severe diarrhoea for more than 24 hours , your contraception may not protect you from pregnancy. Check the pill packet for advice.

If you get diarrhoea from a stomach bug or illness, tell your doctor. You may need to stop taking perindopril for a while until you feel better.

It may help to take an antihistamine, which you can buy from a pharmacy. Check with the pharmacist to see what type is suitable for you.

Do not drive, ride a bike or use tools or machinery while this is happening. GOV.UK has more information on the law on drugs and driving.

If it lasts for more than a day or two, speak to your doctor as they may need to change your treatment.

Stretching and massaging the muscle may ease the pain during a cramp.

Talk to your doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

It happens rarely, but some people may have serious side effects when taking perindopril.

Call a doctor or call 111 now if:

the whites of your eyes turn yellow, or your skin turns yellow although this may be less obvious on brown or black skin – this can be a sign of liver problems
you're paler than usual, you feel tired, faint or dizzy, have any sign of bleeding (like bleeding from the gums and bruising more easily than usual), a sore throat, a high temperature, or you get infections more easily – these can be signs of a blood or bone marrow disorder
you have severe stomach pain – this can be a sign of an inflamed pancreas (acute pancreatitis)
you have swollen ankles or blood in your pee or you're not peeing at all – these can be signs of kidney problems

you have weakness on one side of your body, trouble speaking or thinking, loss of balance or blurred eyesight – these can be signs of a stroke
you have a faster heart rate, chest pain and tightness in your chest – these can be signs of heart problems
you have shortness of breath, wheezing and tightening of the chest – these can be signs of lung problems

Find your nearest A&E

Meds - serious side effects A&E safety messaging

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to perindopril.

Meds New IA (H4) - serious allergic reaction

Taking perindopril for a long time can sometimes cause your kidneys to not work as well as they should. Your doctor will check how well your kidneys are working with regular blood tests.

Other side effects

These are not all the side effects of perindopril. For a full list see the leaflet inside your medicines packet.

Perindopril and pregnancy

Perindopril is not recommended in pregnancy. It can affect your baby's kidneys, particularly if it's taken in the second and third trimesters of pregnancy. This can result in long term damage to your baby's kidneys.

If you're already pregnant, stop taking perindopril and talk to your doctor straight away. Usually your doctor will be able to prescribe a different medicine that is safe to take in pregnancy. Perindopril should be stopped by the time you're 12 weeks pregnant at the latest.

Use contraception if you're taking perindopril and carefully plan any pregnancy with your doctor, pregnancy specialist (obstetrician) or hospital doctor. They will want to review your medical condition and medicine before you get pregnant.

Most women come off perindopril before getting pregnant, but some may continue up until they have a positive pregnancy test and then stop. Your doctor will discuss what's best for you, based on your medical condition and the risks and benefits of perindopril.

Perindopril and breastfeeding

It might be OK to take perindopril while breastfeeding, but talk to your doctor or pharmacist first. It is best not to take perindopril if your baby was born prematurely, but your doctor will help you decide.

Only small amounts of perindopril pass into breast milk, which is unlikely to cause side effects in your baby. However, there is a very small risk that it could also lower your baby's blood pressure. Your doctor might recommend a different medicine for you to take while breastfeeding.

If you notice that your baby is not feeding as well as usual, seems unusually sleepy, seems much paler than usual, or if you have any other concerns about your baby, talk to your health visitor, midwife or doctor as soon as possible.

Perindopril and fertility

There's no clear evidence to suggest that taking perindopril reduces fertility in either men or women.

But if you're trying to get pregnant, talk to your doctor as this medicine is not recommended in pregnancy.

Meds New IA (H2) - Pregnancy non-urgent care card

Cautions with other medicines

There are some medicines that may affect the way perindopril works.

Tell your doctor if you're taking any of these medicines:

anti-inflammatory medicines such as ibuprofen, indomethacin or aspirin for pain relief (low-dose aspirin – 75mg a day, is safe to take with perindopril)
medicines to treat low blood pressure, heart failure, asthma or allergies, such as ephedrine, noradrenaline or adrenaline
medicines to treat high blood pressure, such as aliskeren
other medicines that can lower your blood pressure, such as some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), anaesthetics or medicines for an enlarged prostate gland
medicines that reduce the activity of your immune system, such as ciclosporin and tacrolimus
medicines that make you pee more (diuretics), such as furosemide
medicines that can increase the amount of potassium in your blood, such as spironolactone, triamterene, amiloride, potassium supplements, trimethoprim (for infections) or heparin (for preventing blood clots)
steroid medicines such as prednisolone
allopurinol, for gout
procainamide, for heart rhythm problems
medicines for diabetes
lithium, for mental health problems