Perindopril and Amlodipine

ACE Inhibitor · ACE inhibitor/Calcium antagonist

Indications

Hypertension in patients in adequately controlled on the individual component in the same proportion.

Dosage

Adults: 1 tab once daily. Children: Not recommended.

Adverse Effects

Perindopril: Localised skin rashes, or flushing, angioneurotic oedema, nausea, abdominal pain, fatigue, asthaenia, headache, mild cough. Decreases in haemoglobin, red cells and platelets. Reversible increase in blood urea and creatinine. Proteinuria, pruritus, hypotension, dysgeusia, GI upset, muscle cramps, paraesthesia, dizziness, visual disturbance, tinnitus, dyspnoea. Hyperkalaemia, rarely, blood dyscrasias. Amlodipine: Headache, oedema, fatigue, nausea, flushing and dizziness, rash, gingival hyperplasia. Rarely, alopecia, pruritus, angioedema, palpitations, dyspnoea, abdominal pain, back pain, dyspepsia, muscle cramps, asthaenia, somnolence, altered bowel habit, myalgia, arthralgia, peripheral neuropathy, pancreatitis, mood changes, dry mouth, increased micturition, hyperglycaemia, impotence, sweating, syncope, thrombocytopenia, vasculitis, visual disturbances, palpitation, GI…

Risk Factor (Pregnancy/Lactation)

Pregnancy: Contraindicated in pregnancy. Lactation: Contraindicated or not recommended. Contraindications: Perindopril: History of angioedema associated with previous ACE inhibitor therapy, hereditary/idiopathic angioedema. Amlodipine: Cardiogenic shock, aortic stenosis, unstable angina, left ventricular outflow obstruction, severe hypotension, unstable heart failure following MI. Hypersensitivity to dihydropyridines. Precautions: Perindopril: Renal impairment, surgery/anaesthesia, Risk factors for hypotension. Aortic and mitral valve stenosis, hypertrophic cardiomyopathy, unstable angina during first month of treatment, haemodialysis. LDL-apheresis with dextran sulfate, desensitisation, black care, hyperkalaemia. Monitor serum electrolytes. Amlodipine: Within one month of MI. Impaired hepatic function. Hypertensive crisis, heart failure. Elderly.

Interactions

Perindopril: K+ sparing diuretics or K+ supplements, lithium, antidepressants, other antihypertensives, NSAIDs, high dose aspirin, antidiabetic agents, antipsychotics, TCADs, vasodilators, anaesthetics, sympathomimetics, hyposensitising agents, immunosuppressants, heparin, sodium aurothiomalate (gold), estramustine, baclofen, trimethoprim, everolimus, racecadotril, high-flux dialysis memebranes, alcohol. Amlodipine: Azole antifungals, erythromycin, cyclosporin, sildenafil, rifampicin, CYP3A4 inhibitors and inducers, dantrolene, simvastatin, tacrolimus, other antihypertensives, grape fruit juice.

Advice to Patient

Take before meals.

Pharmacokinetics

PERINDOPRIL: Onset of action: Peak effect: 1-2 hrs. Metabolism: Hepatic. Bioavailability: Approx. 75%. Half-life elimination: 1.5-3 hrs. Time to peak: Chronic therapy: Approx. 1 hr. Excretion: Urine. AMLODIPINE: Onset of action: Antihypertensive effect: Significant reductions in blood pressure at 24-48 hrs after first dose. Duration: Antihypertensive effect: At least 24 hrs. Discontinuation after 6-7 wks of treatment: Duration extends to at least 72 hrs. Absorption: Well absorbed. Metabolism: Hepatic. Bioavailability: 64%-90%. Half-life elimination: Terminal (biphasic): 30-50 hrs. Time to peak, plasma: 6-12 hrs. Excretion: Urine.

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.