Perindopril

ACEON

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Pronunciation: per-IN-doe-pril

Perindopril ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Perindopril ballicule

Perindopril ACEON mascot mnemonic cartoon — Visual mnemonic: Perindopril mascot
**“Parental Aces on (duty)”**
Easter/April theme → ACE inhibitor = -pril (aPril)
Bananas in bunches → ↑ serum potassium

What it isACE inhibitor; hypertension, coronary disease and stroke prevention.

Why this oneCardiovascular event reduction in stable coronary disease, a broader indication than most of the class.

What limits itCough, hyperkalemia and the hemodynamic creatinine rise. Contraindicated in pregnancy.

Perindopril molecular structure (skeletal formula) — Molecular structure: Perindopril

FDA-approved for

hypertension (1993)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Fetal toxicity: drugs acting on the renin-angiotensin system can cause fetal injury and death; discontinue as soon as pregnancy is detected.

FDA dosing	Population	Start	Target	Max
Hypertension	adult	4 mg QD	4-8 mg/day (QD or divided BID)	16 mg/day
Stable coronary artery disease	adult	4 mg QD x2 weeks	8 mg QD	8 mg/day
Stable coronary artery disease	elderly (>70 yr)	2 mg QD wk1, then 4 mg QD wk2	8 mg QD	8 mg/day

Titration Stable CAD: increase to 8 mg once daily after 2 weeks as tolerated.

Renal CrCl <30 mL/min: not recommended. Lesser impairment: start 2 mg/day, do not exceed 8 mg/day.

Hepatic Perindoprilat exposure is increased in hepatic impairment; no specific dose adjustment provided.

Elderly: experience above 8 mg/day is limited.

Instructions

Consider reducing diuretic dose before starting to limit first-dose hypotension
Discontinue as soon as pregnancy is detected
Start under close supervision in volume/salt-depleted patients

Available strengths

tab 2, 4, 8 mg

Contraindications

Angioedema (hereditary, idiopathic, or related to prior ACE inhibitor therapy)
Co-administration of aliskiren in patients with diabetes
Use with a neprilysin inhibitor (e.g., sacubitril); do not give within 36 h of sacubitril/valsartan

Cautions

Angioedema of face/extremities/larynx (may be fatal) and intestinal angioedema
Symptomatic hypotension, especially if volume/salt-depleted
Hyperkalemia
Impaired renal function - monitor periodically
Neutropenia/agranulocytosis
Persistent nonproductive cough
Rare hepatic failure (cholestatic jaundice to hepatic necrosis)

Adverse reactions

Cough
Dizziness
Back pain
Headache
Hypotension
Hyperkalemia

Pregnancy Pregnancy Category D - fetal toxicity; discontinue as soon as pregnancy is detected.

Lactation Unknown whether secreted in human milk; exercise caution in nursing mothers.

Cost

Perindopril (ACEON)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	CostPlus
2 mg	tab	30 qd	$14.65	offered
4 mg	tab	30 qd	$14.84	offered
8 mg	tab	30 qd	$16.26	offered

Generic entry2009

⚠ BOXED WARNING

Fetal toxicity

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk4 / 4

Legacy pregnancy categoryD

Defining liabilityHyperkalemia, kidney injury, angioedema, fetal toxicity and increased lithium exposure.

Active metabolites

Perindoprilat

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Memory aids: interaction avatars

Box: minimal PK interactions

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