Perindopril

Perindopril is not suitable for some people. For example, check with your doctor that it's OK to take if you have heart, kidney or liver problems.

Perindopril comes as tablets you take once a day. Follow the instructions that come with your medicine.

Side effects of perindopril include a cough, feeling dizzy and headaches. More serious side effects can happen in rare cases.

Perindopril is not recommended in pregnancy. Always check with a pharmacist or doctor.

You may be able to take perindopril if you're breastfeeding, but talk to your doctor or pharmacist first.

Taking perindopril with other medicines, such as aspirin or medicines for low blood pressure, may cause problems.

Most adults aged 18 and over can 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 (hypotension)
• have diabetes – perindopril can lower your blood sugar (glucose) levels
• 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)
• have angioedema

Your dose of perindopril depends on why you're taking it. Always take it how your doctor tells you to.

Before deciding the correct dose for you, your doctor will check your blood pressure. You may also have blood tests to check how well your kidneys are working and the amount of potassium in your blood.

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.

There are 2 different types of perindopril. Perindopril erbumine (also called perindopril tert-butylamine) and perindopril arginine 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. The usual dose:

• for high blood pressure usually starts at 4mg once a day (the maximum dose is 8mg once a day)
• after a heart attack is up to 8mg once a day
• heart failure is up to 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. The the usual dose:

• for high blood pressure usually starts at 5mg once a day (the maximum dose is 10mg once a day)
• after a heart attack is up to 10mg, once a day
• for heart failure is up to 5mg, taken once a day

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

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 before breakfast. Try to take it at the same time every day.

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 not go straight 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. GOV.UK has more information on the law on drugs and driving.

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 do not go away 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, watery diarrhoea or any diarrhoea that lasts 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.

If it it does not go away, 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.

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.

You may be able 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.

There's not much information about using perindopril while breastfeeding, but it shows that only very 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 lower your baby's blood pressure. Your doctor might recommend a different medicine for you to take.

It's important to keep monitoring your baby if you're taking any medicine while breastfeeding.

Contact your healthcare professional or call 111 as soon as possible if you notice that your baby:

• is not feeding as well as usual or putting on weight as you would expect
• seems unusually sleepy
• looks much paler than usual
• is irritable
• has diarrhoea or constipation, or is being sick (vomiting)
• is peeing less (fewer wet nappies)

If your baby has any symptoms that are not listed, or if you're worried about them, you can also call 111 or contact any healthcare professional.

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

Tell your doctor if you're taking other medicines, including:

• 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
• medicines that increase the risk of angioedema, such as valsartan and vidagliptin
• 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

These are not all the medicines that may cause problems if you take them with perindopril. For a full list, see the leaflet inside your medicine packet.