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(per-IN-doe prill ehr-BYOO-meen)
Aceon
Class: Antihypertensive/Angiotensin-converting enzyme (ACE) inhibitor

 Action Competitively inhibits angiotensin I-converting enzyme, resulting in prevention of angiotensin I conversion to angiotensin II, a potent vasoconstrictor that also stimulates aldosterone release. Clinical consequences are a decrease in BP, reduced sodium resorption and potassium retention.

 Indications Treatment of essential hypertension.

 Contraindications Hypersensitivity or history of angioedema related to ACE inhibitor treatment.

 Route/Dosage

Uncomplicated Hypertension

ADULTS: PO Initial dose 4 mg qd; then titrate upward until BP, just before the next dose, is controlled or a maximum of 16 mg/day. Usual maintenance dose is 4 to 8 mg daily. PATIENTS > 65 YRS: PO Initial dose 4 mg daily in 1 or 2 divided doses; then titrate upward until BP, just before the next dose, is controlled, or a max of 8 mg/day.

Use with Concomitant Diuretics

ADULTS: PO If BP is not adequately controlled with perindopril alone, a diuretic may be added. In patients being treated with a diuretic, to reduce the likelihood of the occurrence of symptomatic hypotension, discontinue the diuretic 2 to 3 days prior to beginning perindopril. If the diuretic cannot be discontinued, use an initial dose of 2 to 4 mg daily of perindopril and titrate the dose as above.

Impaired Renal Function

ADULTS (CREATININE CLEARANCE < 30 ML/MIN): PO Initial dose 2 mg/day (max dose 8 mg/day).

 Interactions

Diuretics: Increased risk of excessive reduction in BP. Potassium supplements, potassium-sparing diuretics (eg, spironolactone), drugs capable of increasing serum potassium (eg, cyclosporine, heparin, indomethacin): Increased risk of hyperkalemia. Lithium: Increased risk of lithium toxicity.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Palpitation; abnormal ECG. RESP: Cough; upper respiratory infection. CNS: Headache; dizziness; sleep disorder; depression; somnolence; nervousness. EENT: Sinusitis; ear infection; rhinitis; pharyngitis; seasonal allergy; tinnitus. GI: Dyspepsia; diarrhea; abdominal pain; nausea; vomiting; flatulence. GU: Proteinuria; urinary tract infection; sexual dysfunction; menstrual disorder. HEPA: Increased ALT. DERM: Rash. META: Increased triglycerides. OTHER: Asthenia; viral infection; upper and lower extremity pain; hypertonia; fever; edema; chest pain; neck pain; paresthesia; joint pain; myalgia; arthritis.

 Precautions

Pregnancy: Category C (first trimester); category D (second and third trimesters). Lactation: Undetermined. Children: Safety and efficacy not established. Elderly: Perindopril plasma concentrations may be increased. Angioedema: May occur and is potentially fatal if laryngeal edema occurs. Use drug with extreme caution in patients with history of angioedema. Cough: Chronic nonproductive cough may occur. Hepatic failure: Has occurred rarely with other ACE inhibitors. Hypotension: Symptomatic hypotension may occur. Neutropenia and agranulocytosis: Has occurred rarely with other ACE inhibitors; risk appears greater with renal dysfunction, heart failure, or immunosuppression. Renal impairment: Changes in renal function may occur in susceptible individuals.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Store at controlled room temperature in tightly closed container. Protect from moisture.
  • Administer alone or in combination with other antihypertensives or diuretics.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Monitor for signs of hypersensitivity including angioedema involving swelling of the face, lips, and tongue. If occurring, withold therapy and notify the primary care provider. Where there is involvement of the tongue, glottis, or larynx likely to cause airway obstruction, promptly administer emergency therapy, which could include epinephrine.
  • Monitor BP and pulse. Should hypotension, tachycardia, or bradycardia result, hold the medication and notify the primary care provider.
  • Monitor for adverse reactions and drug interactions.
  • Monitor laboratory tests for increases in serum creatinine and BUN, hemoglobin, hematocrit, and liver function tests.
  • Institute fall precautions in unstable patients including the elderly and patients with CHF.
  • Assist patient with position changes and ambulation during initial phases of therapy.
OVERDOSAGE: SIGNS & SYMPTOMS
  Hypotension, hypothermia, circulatory arrest, death

 Patient/Family Education

  • Instruct patient to take the medication as prescribed at the same time each day, and not to discontinue medication suddenly even if feeling better.
  • Inform patient that perindopril can control but does not cure hypertension.
  • Instruct patient in BP and pulse measurement skills. Caution patient to call primary care provider should abnormal readings occur or if experiencing lightheadedness.
  • Instruct patient to stop medication and consult physician if fainting occurs.
  • Instruct patient in methods of fall prevention including arising slowly and sitting on the side of the bed before standing, especially early in therapy.
  • Inform patient of the importance of adjunct therapies such as dietary planning, a regular exercise program, weight reduction, a low sodium diet, smoking cessation program, alcohol reduction, and stress management.
  • Instruct patient to report the following symptoms to primary caregiver: Dyspnea, loss of taste, swelling of eyes, face, lips, tongue, or throat, difficulty breathing, speaking, or swallowing.
  • Instruct patient to monitor renal, hepatic, and hematologic symptoms including urinary output and any discomfort during urination, weakness, fatigue, dizziness, lightheadedness, jaundice, and inform their primary care provider should symptoms arise.
  • Explain to patient that chronic cough may occur. Instruct patient to avoid cough, cold, or allergy medication, and to notify the physician.
  • Warn patient that inadequate fluid intake, excessive perspiration, diarrhea, or vomiting, resulting in reduced fluid volume, may lead to an excessive fall in BP resulting in lightheadedness and possible fainting.
  • Tell patient not to use potassium supplements or salt substitutes containing potassium without consulting physician.
  • Instruct patient to report any indications of an infection such as a sore throat that could indicate neutropenia.
  • Caution patient to notify physician or dentist prior to surgery or treatment.
  • Caution female patients to notify primary care provider at once if pregnant, planning to become pregnant, or planning to breastfeed.

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