Perindopril Arginine interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

  What to do: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

  8 sources

  1. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595

• Food High in Potassium

  Moderate

  Synergy

  Moderate-to-high dietary intake of potassium can cause hyperkalemia in some patients who are using angiotensin converting enzyme (ACE) inhibitors. In some cases, affected patients were using a potassium-rich salt substitute. ACE inhibitors can promote hyperkalemia through inhibition of the renin-aldosterone-angiotensin (RAA) system.

  What to do: It is recommended that patients who are taking ACE inhibitors be advised to avoid moderately high or high potassium dietary intake. Particular attention should be paid to the potassium content of salt substitutes.

  3 sources

  1. "Product Information. Vasotec (enalapril)." Merck & Co., Inc (2002):
  2. Good CB, McDermott L "Diet and serum potassium in patients on ACE inhibitors." JAMA 274 (1995): 538
  3. Ray K, Dorman S, Watson R "Severe hyperkalaemia due to the concomitant use of salt substitutes and ACE inhibitors in hypertension: a potentially life threatening interaction." J Hum Hypertens 13 (1999): 717-20

Conditions

Conditions in which Perindopril Arginine needs care, as documented in this source.

• Angioedema

  Major

  The use of these agents is contraindicated in patients with hereditary angioedema or a history of idiopathic angioedema. Patients with a history of angioedema unrelated to ACE inhibitors may be at increased risk of angioedema while receiving an ACE inhibitor. Patients should be advised to immediately report any signs or symptoms suggestive of angioedema (swelling of face, extremities, eyes, lips, or tongue, or difficulty swallowing or breathing) and to stop taking the medication until otherwise directed by their physician. Emergency therapy and/or measures to prevent airway obstruction are required for angioedema involving the tongue, glottis, or larynx. Treatment with ACE inhibitors should be discontinued permanently if angioedema develops in association with therapy.

  34 sources

  1. Suarez M, Ho PW, Johnson ES, Perez G "Angioneurotic edema, agranulocytosis, and fatal septicemia following captopril therapy." Am J Med 81 (1986): 336-8
  2. Roberts JR, Wuerz RC "Clinical characteristics of angiotensin-converting enzyme inhibitor-induced angioedema." Ann Emerg Med 20 (1991): 555-8
  3. Jett GK "Captopril-induced angioedema ." Ann Emerg Med 13 (1984): 489-90
  4. McElligott S, Perlroth M, Raish L "Angioedema after substituting lisinopril for captopril ." Ann Intern Med 116 (1992): 426-7
  5. Hedner T, Samuelsson O, Lunde H, et al. "Angio-oedema in relation to treatment with angiotensin converting enzyme inhibitors." Br Med J 304 (1992): 941-6
  6. Wood SM, Mann RD, Rawlins MD "Angio-oedema and urticaria associated with angiotensin converting enzyme inhibitors." Br Med J 294 (1987): 91-2
  7. Seidman MD, Lewandowski CA, Sarpa JR, et al. "Angioedema related to angiotensin-converting enzyme inhibitors." Otolaryngol Head Neck Surg 102 (1990): 727-31
  8. Werber JL, Pincus RL "Oropharyngeal angioedema associated with the use of angiotensin-converting enzyme inhibitors." Otolaryngol Head Neck Surg 101 (1989): 96-8

  Show all 34 sourcesShow fewer sources

  9. Jason DR "Fatal angioedema associated with captopril." J Forensic Sci 37 (1992): 1418-21
  10. Gianos ME, Klaustermeyer WB, Kurohara M, et al. "Enalapril induced angioedema." Am J Emerg Med 8 (1990): 124-6
  11. Gonnering RS, Hirsch SR "Delayed drug-induced periorbital angioedema ." Am J Ophthalmol 110 (1990): 566-8
  12. Chin HL, Buchan DA "Severe angioedema after long-term use of an angiotensin-converting enzyme inhibitor ." Ann Intern Med 112 (1990): 312-3
  13. Abidin MR, Eisele DW "Angioedema after long-term use of angiotensin-converting enzyme inhibitor ." Arch Otolaryngol Head Neck Surg 117 (1991): 1059
  14. Orfan N, Patterson R, Dykewicz MS "Severe angioedema related to ACE inhibitors in patients with a history of idiopathic angioedema." JAMA 264 (1990): 1287-9
  15. Gannon TH, Eby TL "Angioedema from angiotensin converting enzyme inhibitors: a cause of upper airway obstruction." Laryngoscope 100 (1990): 1156-60
  16. "Product Information. Lotensin (benazepril)." Ciba-Geigy Pharmaceuticals (2002):
  17. "Product Information. Capoten (captopril)." Bristol-Myers Squibb (2002):
  18. "Product Information. Vasotec (enalapril)." Merck & Co., Inc (2002):
  19. "Product Information. Prinivil (lisinopril)." Merck & Co., Inc (2002):
  20. Soo Hoo GW, Dao HT, Klaustermeyer WB "Severe angioedema and respiratory distress associated with lisinopril use." West J Med 158 (1993): 412-7
  21. "Product Information. Accupril (quinapril)." Parke-Davis (2001):
  22. "Product Information. Monopril (fosinopril)." Bristol-Myers Squibb (2001):
  23. "Product Information. Altace (ramipril)." Hoechst Marion Roussel (2001):
  24. "Product Information. Aceon (perindopril)." Solvay Pharmaceuticals Inc (2001):
  25. Frontera Y, Piecuch JF "Multiple episodes of angioedema associated with lisinopril, an ACE inhibitor." J Am Dent Assoc 126 (1995): 217-20
  26. Gimenez JC "Angioneurotic edema produced by enalapril." Ann Pharmacother 29 (1995): 317
  27. Gonzalo FE, Montagut LB, Vecina ST "Angioedema caused by ramipril." Ann Pharmacother 29 (1995): 431-2
  28. "Product Information. Univasc (moexipril)." Schwarz Pharma (2001):
  29. Forslund T, Tohmo H, Weckstrom G, Stenborg M, Jarvinen S "Angio-oedema induced by enalapril." J Intern Med 238 (1995): 179-81
  30. Alderman CP "Adverse effects of the angiotensin-converting enzyme inhibitors." Ann Pharmacother 30 (1996): 55-61
  31. "Product Information. Mavik (trandolapril)." Knoll Pharmaceutical Company (2001):
  32. Gunkel AR, Thurner KH, Kanonier G, Sprinzl GM, Thumfart WF "Angioneurotic edema as a reaction to angiotensin-converting enzyme inhibitors." Am J Otolaryngol 17 (1996): 87-91
  33. O'Mara NB, O'Mara EM Jr "Delayed onset of andioedema with angiotensin-converting enzyme inhibitors: case report and review of the literature." Pharmacotherapy 16 (1996): 675-9
  34. Kaplan NM "The CARE study: a postmarketing evaluation of ramipril in 11,100 patients." Clin Ther 18 (1996): 658-70

• Bone Marrow Failure Disorders

  Major

  ACE inhibitors may cause bone marrow suppression, rarely in uncomplicated individuals but more frequently in patients with renal impairment, especially if they also have a collagen-vascular disease such as systemic lupus erythematosus or scleroderma. Neutropenia, agranulocytosis, aplastic anemia, hemolytic anemia, eosinophilia and thrombocytopenia have been reported, mostly with captopril. Therapy with ACE inhibitors should be administered cautiously in patients with preexisting blood dyscrasias or complications that may increase the risk of bone marrow depression during ACE inhibitor therapy. Monitoring of blood counts, particularly white blood cells, should be considered.

  38 sources

  1. Elijovisch F, Krakoff LR "Captopril associated granulocytopenia in hypertension after renal transplantation." Lancet 1 (1980): 927-8
  2. Vidt DG, Bravo EL, Fouad FM "Captopril." N Engl J Med 306 (1982): 214-9
  3. Kim CR, Maley MB, Mohler ER "Captopril and aplastic anemia." Ann Intern Med 111 (1989): 187-8
  4. Davies RO, Irvin JD, Kramsch PK, Walker JF, Moncloa F "Enalapril worldwide experience." Am J Med 77 (1984): 23-35
  5. Chalmers D, Whitehead A, Lawson DH "Postmarketing surveillance of captopril for hypertension." Br J Clin Pharmacol 34 (1992): 215-23
  6. Suarez M, Ho PW, Johnson ES, Perez G "Angioneurotic edema, agranulocytosis, and fatal septicemia following captopril therapy." Am J Med 81 (1986): 336-8
  7. Gavras I, Graff LG, Rose BD, et al. "Fatal pancytopenia associated with the use of captopril." Ann Intern Med 94 (1981): 58-9
  8. Grosbois B, Milton D, Beneton C, Jacomy D "Thrombocytopenia induced by angiotensin converting enzyme inhibitors." Br Med J 298 (1989): 189-90

  Show all 38 sourcesShow fewer sources

  9. el-Makri A, Larabi MS, Kechrid C, et al. "Fatal bone-marrow suppression associated with captopril." Br Med J 283 (1981): 277-8
  10. Strair RK, Mitch WE, Faller DV, Skorecki KL "Reversible captopril-associated bone marrow aplasia ." Can Med Assoc J 132 (1985): 320-2
  11. Shindo K, Matsuya F, Ura T, et al. "Captopril-associated granulocytopenia in hypertension after renal transplantation." Clin Nephrol 22 (1984): 314-6
  12. Forslund T, Borgmastars H, Fyrquist F "Captopril-associated leucopenia confirmed by rechallenge in patient with renal failure ." Lancet 1 (1981): 166
  13. Elijovisch F, Krakoff LR "Captopril associated granulocytopenia in hypertension after renal transplantation ." Lancet 1 (1980): 927-8
  14. Pillans PI, Koopowitz A "Captopril-associated agranulocytosis: a report of 3 cases." S Afr Med J 79 (1991): 399-400
  15. Israeli A, Or R, Leitersdorf E "Captopril-associated transient aplastic anemia." Acta Haematol 73 (1985): 106-7
  16. Hirakata H, Onoyama K, Iseki K, et al. "Worsening of anemia induced by long-term use of captopril in hemodialysis patients." Am J Nephrol 4 (1984): 355-60
  17. Edwards IR, Coulter DM, Beasley DM, MacIntosh D "Captopril: 4 years of post marketing surveillance of all patients in New Zealand." Br J Clin Pharmacol 23 (1987): 529-36
  18. Torello J, Duran JA, Abadin JA "Captopril-associated aplastic anemia ." Drug Intell Clin Pharm 24 (1990): 543-4
  19. Onoyama K, Sanai T, Motomura K, Fujishima M "Worsening of anemia by angiotensin converting enzyme inhibitors and its prevention by antiestrogenic steroid in chronic hemodialysis patients." J Cardiovasc Pharmacol 13 (1989): s27-30
  20. Waeber B, Gavras I, Brunner HR, Gavras H "Safety and efficacy of chronic therapy with captopril in hypertensive patients: an update." J Clin Pharmacol 21 (1981): 508-16
  21. Beroniade V "Severe side-effects of captopril in advanced chronic kidney insufficiency." Proc Eur Dial Transplant Assoc 20 (1983): 530-7
  22. Vlahakos DV, Canzanello VJ, Madaio MP, Madias NE "Enalapril-associated anemia in renal transplant recipients treated for hypertension." Am J Kidney Dis 17 (1991): 199-205
  23. Loftus WK, Ierino F, Mathew TH "Enalapril and anaemia ." Med J Aust 148 (1988): 209-10
  24. Elis A, Lishner M, Lang R, Ravid M "Agranulocytosis associated with enalapril." Drug Intell Clin Pharm 25 (1991): 461-2
  25. Knapp LE, Frank GJ, McLain R, Rieger MM, Posvar E, Singer R "The safety and tolerability of quinapril." J Cardiovasc Pharmacol 15 (1990): s47-55
  26. Materson BJ "Adverse effects of angiotensin-converting enzyme inhibitors in antihypertensive therapy with focus on quinapril." Am J Cardiol 69 (1992): c46-53
  27. "Product Information. Lotensin (benazepril)." Ciba-Geigy Pharmaceuticals (2002):
  28. "Product Information. Capoten (captopril)." Bristol-Myers Squibb (2002):
  29. "Product Information. Vasotec (enalapril)." Merck & Co., Inc (2002):
  30. "Product Information. Prinivil (lisinopril)." Merck & Co., Inc (2002):
  31. "Product Information. Accupril (quinapril)." Parke-Davis (2001):
  32. "Product Information. Monopril (fosinopril)." Bristol-Myers Squibb (2001):
  33. "Product Information. Altace (ramipril)." Hoechst Marion Roussel (2001):
  34. "Product Information. Aceon (perindopril)." Solvay Pharmaceuticals Inc (2001):
  35. "Product Information. Univasc (moexipril)." Schwarz Pharma (2001):
  36. Harrison BD, Laidlaw ST, Reilly JT "Fatal aplastic anaemia associated with lisinopril." Lancet 346 (1995): 247-8
  37. Alderman CP "Adverse effects of the angiotensin-converting enzyme inhibitors." Ann Pharmacother 30 (1996): 55-61
  38. "Product Information. Mavik (trandolapril)." Knoll Pharmaceutical Company (2001):

• Diseases requiring hemodialysis

  Major

  Anaphylactoid reactions have been reported in patients undergoing hemodialysis with high-flux polyacrylonitrile membranes and treated concomitantly with an ACE inhibitor. The frequency and mechanism of this interaction have not been established, and it is not known whether the interaction occurs with other membrane types. Therapy with ACE inhibitors should be administered cautiously in patients requiring hemodialysis.

  10 sources

  1. "Product Information. Lotensin (benazepril)." Ciba-Geigy Pharmaceuticals (2002):
  2. "Product Information. Capoten (captopril)." Bristol-Myers Squibb (2002):
  3. "Product Information. Vasotec (enalapril)." Merck & Co., Inc (2002):
  4. "Product Information. Prinivil (lisinopril)." Merck & Co., Inc (2002):
  5. "Product Information. Accupril (quinapril)." Parke-Davis (2001):
  6. "Product Information. Monopril (fosinopril)." Bristol-Myers Squibb (2001):
  7. "Product Information. Altace (ramipril)." Hoechst Marion Roussel (2001):
  8. "Product Information. Aceon (perindopril)." Solvay Pharmaceuticals Inc (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Univasc (moexipril)." Schwarz Pharma (2001):
  10. "Product Information. Mavik (trandolapril)." Knoll Pharmaceutical Company (2001):

• Heart Failure

  Major

  ACE inhibitors can cause marked renal impairment in patients whose renal function depends on the activity of the renin-angiotensin-aldosterone system. In addition, symptomatic and sometimes excessive hypotension can occur in susceptible individuals, particularly during the initiation of treatment, which may compromise renal and myocardial perfusion. In patients with severe congestive heart failure (CHF), treatment with ACE inhibitors may be associated with oliguria and/or progressive azotemia and, rarely, renal failure, myocardial ischemia and death. Therapy with ACE inhibitors should be initiated under very close medical supervision in patients with severe CHF, especially when accompanied by volume and/or sodium depletion. Patients should be monitored closely for several hours after an initial dose until blood pressure has stabilized, and followed closely for the first 2 weeks of treatment and whenever the dosage of ACE inhibitor or diuretic is increased. If feasible, the risk of severe hypotension may be minimized by reducing or temporarily withholding the dosing of diuretics and/or liberalizing dietary sodium intake for 2 to 3 days prior to starting ACE inhibitor therapy. In patients who experience a worsening of renal function, discontinuation of ACE inhibitor therapy is usually not required provided there is symptomatic improvement of the heart failure and renal deterioration is well-tolerated. Transient hypotension is also not a contraindication to further treatment with ACE inhibitors. After blood pressure stabilizes, therapy can usually be reinstated with caution, although a lower dosage of the ACE inhibitor and/or dosage reduction or discontinuation of concomitantly administered diuretics may be necessary.

  21 sources

  1. Schwartz D, Averbuch M, Pines A, et al. "Renal toxicity of enalapril in very elderly patients with progressive, severe congestive heart failure." Chest 100 (1991): 1558-61
  2. Ljungman S, Kjekshus J, Swedberg K "Renal function in severe congestive heart failure during treatment with enalapril." Am J Cardiol 70 (1992): 479-87
  3. Heintz B, Verho M, Brockmeier D, Kirsten R, Nelson K, Maigatter S, Lefevre G, Kierdorf H, Sieberth HG "Influence of ramipril on renal function in patients with chronic congestive heart failure." J Cardiovasc Pharmacol 18 (1991): s174-9
  4. Moyses C, Higgins TJ "Safety of long-term use of lisinopril for congestive heart failure." Am J Cardiol 70 (1992): c91-7
  5. Moyses C, Higgins TJ "Safety of long-term use of lisinopril for congestive heart failure." Am J Cardiol 70 (1992): c91-7
  6. Dietz R, Nagel F, Osterziel KJ "Angiotensin-converting enzyme inhibitors and renal function in heart failure." Am J Cardiol 70 (1992): c119-25
  7. "Product Information. Lotensin (benazepril)." Ciba-Geigy Pharmaceuticals (2002):
  8. "Product Information. Capoten (captopril)." Bristol-Myers Squibb (2002):

  Show all 21 sourcesShow fewer sources

  9. "Product Information. Vasotec (enalapril)." Merck & Co., Inc (2002):
  10. "Product Information. Prinivil (lisinopril)." Merck & Co., Inc (2002):
  11. "Product Information. Accupril (quinapril)." Parke-Davis (2001):
  12. "Product Information. Monopril (fosinopril)." Bristol-Myers Squibb (2001):
  13. "Product Information. Altace (ramipril)." Hoechst Marion Roussel (2001):
  14. "Product Information. Aceon (perindopril)." Solvay Pharmaceuticals Inc (2001):
  15. Kostis JB, Shelton BJ, Yusuf S, Weiss MB, Capone RJ, Pepine CJ, Gosselin G, Delahaye F, Probstfield JL, Cahill L, Dutton D "Tolerability of enalapril initiation by patients with left ventricular dysfunction: results of the medication challenge phase of the studies of left ventricular dysfunction." Am Heart J 128 (1994): 358-64
  16. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  17. "Product Information. Univasc (moexipril)." Schwarz Pharma (2001):
  18. Antonios TFT, Macgregor GA "Angiotensin converting enzyme inhibitors in hypertension: potential problems." J Hypertens 13 Suppl (1995): s11-6
  19. Kostis JB, Shelton B, Gosselin G, Goulet C, Hood WB, Kohn RM, Kubo SH, Schron E, Weiss MB, Willis PW, Young JB, Probstfie "Adverse effects of enalapril in the studies of left ventricular dysfunction (SOLVD)." Am Heart J 131 (1996): 350-5
  20. Kober L, Torp-Pedersen C, Carlsen JE, Bagger H, Eliasen P, Lyngborg K, Videbaek J, Cole DS, Auclert L, Pauly NC, et al. "A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandolapril Cardiac Evaluation (TRACE) Study Group." N Engl J Med 333 (1995): 1670-6
  21. "Product Information. Mavik (trandolapril)." Knoll Pharmaceutical Company (2001):

• Hyperkalemia

  Major

  In patients with hyperkalemia, especially those associated with impaired renal function or congestive heart failure, ACE inhibitors may further raise serum potassium levels. Therapy with ACE inhibitors should be administered cautiously in patients with or predisposed to hyperkalemia, and serum potassium levels should be carefully monitored. Risk factors for the development of hyperkalemia during ACE inhibitor therapy include renal insufficiency, diabetes mellitus, and the concomitant use of potassium-sparing diuretics, potassium supplements, and/or potassium-containing salt substitutes.

  18 sources

  1. Kindler J, Schunkert H, Gassmann M, Lahn W, Irmisch R, Debusmann ER, Ocon-Pujadas J, Ritz E, Sieberth HG "Therapeutic efficacy and tolerance of ramipril in hypertensive patients with renal failure." J Cardiovasc Pharmacol 13 (1989): s55-8
  2. Moyses C, Higgins TJ "Safety of long-term use of lisinopril for congestive heart failure." Am J Cardiol 70 (1992): c91-7
  3. "Product Information. Lotensin (benazepril)." Ciba-Geigy Pharmaceuticals (2002):
  4. "Product Information. Capoten (captopril)." Bristol-Myers Squibb (2002):
  5. "Product Information. Vasotec (enalapril)." Merck & Co., Inc (2002):
  6. "Product Information. Prinivil (lisinopril)." Merck & Co., Inc (2002):
  7. "Product Information. Accupril (quinapril)." Parke-Davis (2001):
  8. "Product Information. Monopril (fosinopril)." Bristol-Myers Squibb (2001):

  Show all 18 sourcesShow fewer sources

  9. "Product Information. Altace (ramipril)." Hoechst Marion Roussel (2001):
  10. "Product Information. Aceon (perindopril)." Solvay Pharmaceuticals Inc (2001):
  11. Kostis JB, Shelton BJ, Yusuf S, Weiss MB, Capone RJ, Pepine CJ, Gosselin G, Delahaye F, Probstfield JL, Cahill L, Dutton D "Tolerability of enalapril initiation by patients with left ventricular dysfunction: results of the medication challenge phase of the studies of left ventricular dysfunction." Am Heart J 128 (1994): 358-64
  12. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  13. "Product Information. Univasc (moexipril)." Schwarz Pharma (2001):
  14. Antonios TFT, Macgregor GA "Angiotensin converting enzyme inhibitors in hypertension: potential problems." J Hypertens 13 Suppl (1995): s11-6
  15. Alderman CP "Adverse effects of the angiotensin-converting enzyme inhibitors." Ann Pharmacother 30 (1996): 55-61
  16. Kostis JB, Shelton B, Gosselin G, Goulet C, Hood WB, Kohn RM, Kubo SH, Schron E, Weiss MB, Willis PW, Young JB, Probstfie "Adverse effects of enalapril in the studies of left ventricular dysfunction (SOLVD)." Am Heart J 131 (1996): 350-5
  17. "Product Information. Mavik (trandolapril)." Knoll Pharmaceutical Company (2001):
  18. Tramonti G, Donadio C, Confessore N, Bianchi C "Antihypertensive activity and renal effects of benazepril in humans." Kidney Int (suppl 5) (1996): s107-8

• Hypotension

  Major

  ACE inhibitors can cause symptomatic hypotension, most often during the initiation of therapy and in patients who are volume- and/or sodium-depleted or treated for congestive heart failure (CHF). Therapy with ACE inhibitors should be administered cautiously in such patients and in those predisposed to hypovolemic or hyponatremic states (e.g., patients on diuretic therapy, especially if it was recently instituted; those on dietary salt restriction; those with severe or prolonged diarrhea or vomiting; and renal dialysis patients). Volume and/or sodium depletion should be corrected prior to initiating therapy with ACE inhibitors, and the patient should be hemodynamically stable. If concomitant diuretics and/or dietary sodium restriction are employed, reducing or temporarily withholding the dosing of diuretics and/or liberalizing dietary sodium intake for 2 to 3 days in advance can help minimize the risk of severe hypotension in patients who are able to tolerate such adjustments. ACE inhibitors should also be used cautiously in patients in whom excessive hypotension may have serious consequences, such as patients with coronary or cerebrovascular insufficiency. Patients at risk for excessive hypotension should initiate ACE inhibitor therapy under very close medical supervision, and followed closely for the first 2 weeks of treatment and whenever the dosage of ACE inhibitor or diuretic is increased.

  32 sources

  1. Forette B, Koen R, Vivaut E "Efficacy and safety of quinapril in the elderly hypertensive patient." Am Heart J 123 (1992): 1426-32
  2. Chalmers D, Whitehead A, Lawson DH "Postmarketing surveillance of captopril for hypertension." Br J Clin Pharmacol 34 (1992): 215-23
  3. Schnaper HW "Comparison of the efficacy and safety of quinapril vs. captopril in treatment of moderate to severe hypertension." Angiology 40 (1989): 389-95
  4. Schoenberger JA, Testa M, Ross AD, et al. "Efficacy, safety, and quality-of-life assessment of captopril antihypertensive therapy in clinical practice." Arch Intern Med 150 (1990): 301-6
  5. Edwards IR, Coulter DM, Beasley DM, MacIntosh D "Captopril: 4 years of post marketing surveillance of all patients in New Zealand." Br J Clin Pharmacol 23 (1987): 529-36
  6. Black J, Hunt TL, Godley PJ "Initiation of captopril therapy: the first-dose effect." J Clin Pharmacol 26 (1986): 539-40
  7. Russell RM, Jones RM "Postoperative hypotension associated with enalapril." Anaesthesia 44 (1989): 837-8
  8. Inman WH, Rawson NS, Wilton LV, et al. "Postmarketing surveillance of enalapril. I: results of prescription-event monitoring." Br Med J 297 (1988): 826-9

  Show all 32 sourcesShow fewer sources

  9. Cooper WD, Sheldon D, Brown D, et al. "Post-marketing surveillance of enalapril: experience in 11,710 hypertensive patients in general practice." J R Coll Gen Pract 37 (1987): 346-9
  10. Osterziel KJ, Karr M, Busch C, Dietz R "Comparison of the first-dose effect of captopril and lisinopril in heart failure." Am J Cardiol 70 (1992): c137-9
  11. MacNab M, Mallows S "Safety profile of benazepril in essential hypertension." Clin Cardiol 14 Suppl I (1991): iv33-7
  12. Balfour J, Goa K "Benazepril: A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in hypertension and congestive heart failure." Drugs 42 (1991): 511-39
  13. "Product Information. Lotensin (benazepril)." Ciba-Geigy Pharmaceuticals (2002):
  14. "Product Information. Capoten (captopril)." Bristol-Myers Squibb (2002):
  15. "Product Information. Vasotec (enalapril)." Merck & Co., Inc (2002):
  16. "Product Information. Prinivil (lisinopril)." Merck & Co., Inc (2002):
  17. Young BA "ACE inhibitor first dose effect." Med J Aust 158 (1993): 577
  18. "Product Information. Accupril (quinapril)." Parke-Davis (2001):
  19. "Product Information. Monopril (fosinopril)." Bristol-Myers Squibb (2001):
  20. "Product Information. Altace (ramipril)." Hoechst Marion Roussel (2001):
  21. "Product Information. Aceon (perindopril)." Solvay Pharmaceuticals Inc (2001):
  22. Kostis JB, Shelton BJ, Yusuf S, Weiss MB, Capone RJ, Pepine CJ, Gosselin G, Delahaye F, Probstfield JL, Cahill L, Dutton D "Tolerability of enalapril initiation by patients with left ventricular dysfunction: results of the medication challenge phase of the studies of left ventricular dysfunction." Am Heart J 128 (1994): 358-64
  23. Lang RM, Dibianco R, Broderick GT, Gottlieb SS, Kostis J, Lyle PA, Makris L, Rajfer SI, Rucinska EJ "First-dose effects of enalapril 2.5 mg and captopril 6.25 mg in patients with heart failure: a double-blind, randomized, multicenter study." Am Heart J 128 (1994): 551-6
  24. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  25. Larochelle P, Haynes B, Maron N, Dugas S "A postmarketing surveillance evaluation of quinapril in 3742 canadian hypertensive patients - the ACCEPT study." Clin Ther 16 (1994): 838-53
  26. Schmitt JK, Koch KS, Midha M "Profound hypotension in a tetraplegic patient following angiotensin-converting enzyme inhibitor lisinopril. case report." Paraplegia 32 (1994): 871-4
  27. "Product Information. Univasc (moexipril)." Schwarz Pharma (2001):
  28. Antonios TFT, Macgregor GA "Angiotensin converting enzyme inhibitors in hypertension: potential problems." J Hypertens 13 Suppl (1995): s11-6
  29. Alderman CP "Adverse effects of the angiotensin-converting enzyme inhibitors." Ann Pharmacother 30 (1996): 55-61
  30. "Product Information. Mavik (trandolapril)." Knoll Pharmaceutical Company (2001):
  31. Kaplan NM "The CARE study: a postmarketing evaluation of ramipril in 11,100 patients." Clin Ther 18 (1996): 658-70
  32. Howes LG, Nguyen T, Jackson B "Safety and efficacy of quinapril in hypertensive geriatric patients." J Am Geriatr Soc 44 (1996): 1135

• Hepatic Insufficiency

  Moderate

  The bioavailability of perindoprilat, the active moiety of perindopril is increased in patients with impaired hepatic function. Plasma concentrations of perindoprilat in patients with impaired liver function were about 50% higher than those observed in healthy subjects or hypertensive patients with normal liver function. Caution should be exercised when using perindopril in these patients.

  1 source

  1. "Product Information. Aceon (perindopril)." Solvay Pharmaceuticals Inc (2001):

• Kidney Diseases

  Moderate

  With the exception of fosinopril, ACE inhibitors (and/or their active metabolites in some cases) are primarily eliminated by the kidney and may accumulate in patients with renal impairment. ACE inhibitors can also worsen renal function in some patients by blocking the effect of angiotensin II-mediated efferent arteriolar vasoconstriction, thereby decreasing glomerular filtration. Therapy with ACE inhibitors should be administered cautiously in patients with preexisting renal dysfunction, particularly those with renovascular disease. Patients with moderate to severe renal impairment usually require lower or less frequent doses and smaller increments in dose. In addition, a dosage reduction or discontinuation of any concomitantly administered diuretics may be helpful. Fosinopril probably does not require dosage adjustments unless hepatic function is also significantly impaired. In patients with bilateral renal artery stenosis or renal artery stenosis in a solitary kidney, ACE inhibitors may reduce renal perfusion to a critically low level. Renal function should be monitored closely for the first few weeks of therapy.

  32 sources

  1. Schwartz D, Averbuch M, Pines A, et al. "Renal toxicity of enalapril in very elderly patients with progressive, severe congestive heart failure." Chest 100 (1991): 1558-61
  2. Forette B, Koen R, Vivaut E "Efficacy and safety of quinapril in the elderly hypertensive patient." Am Heart J 123 (1992): 1426-32
  3. Ljungman S, Kjekshus J, Swedberg K "Renal function in severe congestive heart failure during treatment with enalapril." Am J Cardiol 70 (1992): 479-87
  4. Thind GS "Renal insufficiency during angiotensin-converting enzyme inhibitor therapy in hypertensive patients with no renal artery stenosis." J Clin Hypertens 1 (1985): 337-43
  5. Champ JD "Case report: azotemia secondary to enalapril and diuretic use and the diagnosis of renovascular hypertension." Am J Med Sci 305 (1993): 25-7
  6. Inman WH, Rawson NS, Wilton LV, et al. "Postmarketing surveillance of enalapril. I: results of prescription-event monitoring." Br Med J 297 (1988): 826-9
  7. O'Donnell D "Renal failure due to enalapril and captopril in bilateral renal artery stenosis: greater awareness needed." Med J Aust 148 (1988): 525-7
  8. Heeg JE, de Jong PE, de Zeeuw D "Lisinopril and renal failure ." Lancet 1 (1989): 846

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  9. Thomson AH, Kelly JG, Whiting B "Lisinopril population pharmacokinetics in elderly and renal disease patients with hypertension." Br J Clin Pharmacol 27 (1989): 57-65
  10. Sica DA, Cutler RE, Parmer RJ, Ford NF "Comparison of the steady-state pharmacokinetics of fosinopril, lisinopril and enalapril in patients with chronic renal insufficiency." Clin Pharmacokinet 20 (1991): 420-7
  11. Knapp LE, Frank GJ, McLain R, Rieger MM, Posvar E, Singer R "The safety and tolerability of quinapril." J Cardiovasc Pharmacol 15 (1990): s47-55
  12. Heintz B, Verho M, Brockmeier D, Kirsten R, Nelson K, Maigatter S, Lefevre G, Kierdorf H, Sieberth HG "Influence of ramipril on renal function in patients with chronic congestive heart failure." J Cardiovasc Pharmacol 18 (1991): s174-9
  13. Dietz R, Nagel F, Osterziel KJ "Angiotensin-converting enzyme inhibitors and renal function in heart failure." Am J Cardiol 70 (1992): c119-25
  14. Frank GJ, Knapp LE, McLain RW "Overall tolerance and safety of quinapril in clinical trials." Angiology 40 (1989): 405-15
  15. Cetnarowski-Cropp AB "Quinapril: a new second-generation ACE inhibitor." DICP 25 (1991): 499-504
  16. Frank GJ, Knapp LE, Olson SC, Phelps MC, Quade MM, Rieger MM, Sedman AJ "Overview of quinapril, a new ACE inhibitor." J Cardiovasc Pharmacol 15 (1990): s14-23
  17. Murray BM, Venuto RC, Kohli R, Cunningham EE "Enalapril-associated acute renal failure in renal transplants: possible role of cyclosporine." Am J Kidney Dis 16 (1990): 66-9
  18. "Product Information. Lotensin (benazepril)." Ciba-Geigy Pharmaceuticals (2002):
  19. "Product Information. Vasotec (enalapril)." Merck & Co., Inc (2002):
  20. "Product Information. Prinivil (lisinopril)." Merck & Co., Inc (2002):
  21. "Product Information. Accupril (quinapril)." Parke-Davis (2001):
  22. "Product Information. Monopril (fosinopril)." Bristol-Myers Squibb (2001):
  23. "Product Information. Altace (ramipril)." Hoechst Marion Roussel (2001):
  24. "Product Information. Aceon (perindopril)." Solvay Pharmaceuticals Inc (2001):
  25. "Product Information. Univasc (moexipril)." Schwarz Pharma (2001):
  26. "Moexipril: another ace inhibitor for hypertension." Med Lett Drugs Ther 37 (1995): 75-6
  27. Antonios TFT, Macgregor GA "Angiotensin converting enzyme inhibitors in hypertension: potential problems." J Hypertens 13 Suppl (1995): s11-6
  28. Alderman CP "Adverse effects of the angiotensin-converting enzyme inhibitors." Ann Pharmacother 30 (1996): 55-61
  29. "Product Information. Mavik (trandolapril)." Knoll Pharmaceutical Company (2001):
  30. Persson B, Stimpel M "Evaluation of the antihypertensive efficacy and tolerability of moexipril, a new ACE inhibitor, compared to hydrochlorothiazide in elderly patients." Eur J Clin Pharmacol 50 (1996): 259-64
  31. Howes LG, Nguyen T, Jackson B "Safety and efficacy of quinapril in hypertensive geriatric patients." J Am Geriatr Soc 44 (1996): 1135
  32. Olivier PB, German ML, Carette BD, Millart HG, Trenque TC "Elevation of serum creatinine following fosinopril therapy." Ann Pharmacother 33 (1999): 382-3

• Liver Diseases

  Moderate

  Rarely, elevations of liver enzymes and/or serum bilirubin have occurred with the use of ACE inhibitors. Patients receiving ACE inhibitors who develop jaundice or marked elevations of hepatic enzymes should discontinue the ACE inhibitor and receive appropriate medical follow-up.

  10 sources

  1. "Product Information. Lotensin (benazepril)." Ciba-Geigy Pharmaceuticals (2002):
  2. "Product Information. Capoten (captopril)." Bristol-Myers Squibb (2002):
  3. "Product Information. Vasotec (enalapril)." Merck & Co., Inc (2002):
  4. "Product Information. Prinivil (lisinopril)." Merck & Co., Inc (2002):
  5. "Product Information. Accupril (quinapril)." Parke-Davis (2001):
  6. "Product Information. Monopril (fosinopril)." Bristol-Myers Squibb (2001):
  7. "Product Information. Altace (ramipril)." Hoechst Marion Roussel (2001):
  8. "Product Information. Aceon (perindopril)." Solvay Pharmaceuticals Inc (2001):

  Show all 10 sourcesShow fewer sources

  9. "Product Information. Univasc (moexipril)." Schwarz Pharma (2001):
  10. "Product Information. Mavik (trandolapril)." Knoll Pharmaceutical Company (2001):

Therapeutic duplication

Drug classes that overlap with Perindopril Arginine, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

• angiotensin converting enzyme in

  The recommended maximum number of medicines in the 'angiotensin converting enzyme inhibitors' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'angiotensin converting enzyme inhibitors' category.

  Example product in the source data (US market): Captopril/hydrochlorothiazide

• angiotensin converting enzyme in

  The recommended maximum number of medicines in the 'angiotensin converting enzyme inhibitors' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'angiotensin converting enzyme inhibitors' category.

  Example product in the source data (US market): Hydrochlorothiazide/quinapril

• angiotensin converting enzyme in

  The recommended maximum number of medicines in the 'angiotensin converting enzyme inhibitors' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'angiotensin converting enzyme inhibitors' category.

  Example product in the source data (US market): Trandolapril/verapamil

• angiotensin converting enzyme in

  The recommended maximum number of medicines in the 'angiotensin converting enzyme inhibitors' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'angiotensin converting enzyme inhibitors' category.

  Example product in the source data (US market): Monopril hct

• angiotensin converting enzyme in

  The recommended maximum number of medicines in the 'angiotensin converting enzyme inhibitors' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'angiotensin converting enzyme inhibitors' category.

  Example product in the source data (US market): Vaseretic

• angiotensin converting enzyme in

  The recommended maximum number of medicines in the 'angiotensin converting enzyme inhibitors' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'angiotensin converting enzyme inhibitors' category.

  Example product in the source data (US market): Uniretic

• angiotensin converting enzyme in

  The recommended maximum number of medicines in the 'angiotensin converting enzyme inhibitors' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'angiotensin converting enzyme inhibitors' category.

  Example product in the source data (US market): Lotensin hct

• angiotensin converting enzyme in

  The recommended maximum number of medicines in the 'angiotensin converting enzyme inhibitors' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'angiotensin converting enzyme inhibitors' category.

  Example product in the source data (US market): Prinzide

• angiotensin converting enzyme in

  The recommended maximum number of medicines in the 'angiotensin converting enzyme inhibitors' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'angiotensin converting enzyme inhibitors' category.

  Example product in the source data (US market): Lotrel