Introduction About PERINDIL 4 TABLET

PERINDIL 4 TABLET contains Perindopril which belongs to the group of medicines called Angiotensin Converting Enzyme Inhibitors. It is used to manage hypertension in adults. Hypertension is a condition in which the force of the blood against blood vessel walls is too high. Symptoms of hypertension includes early morning headaches, irregular heartbeat, vision changes, feeling overtiredness, vomiting, confusion, anxiety, and chest pain. It is also used to manage heart failure (a condition where the pumping of heart is inadequate to meet body’s need which is characterized by shortness of breath, fatigue, fast heartbeat.). It also reduces the risk of cardiac events such as heart attack in patients with stable coronary artery disease (a condition where the blood supply to the heart is reduced or blocked resulting in pain or discomfort in chest, arms or shoulders; weakness, light-headedness and feeling sick), in patients who have the history of heart attack and/or an operation to improve blood supply to heart.

Perindopril works by inhibiting the activity of an enzyme called angiotensin converting enzyme (an enzyme which is responsible for causing constriction of blood vessels), resulting in easy flow of blood around the body. Your doctor may check your kidney function, blood pressure, and the amount of electrolytes (Ex. potassium) in your body prior to the management or at regular intervals along with the management.

PERINDIL 4 TABLET is not recommended for use in patients having kidney artery stenosis.  PERINDIL 4 TABLET should be used in caution with patient having aortic stenosis, hypertrophic cardiomyopathy, diabetes, liver, and kidney problems or under dialysis. If you are pregnant or breast-feeding, consult your doctor for advice before taking this medicine. PERINDIL 4 TABLET is not recommended for use in children and adolescents up to the age of 18 years. The most common side effects of taking PERINDIL 4 TABLET are low blood pressure, headache, dizziness, muscle cramps, shortness of breath, cough and headache. Consult your doctor if the symptoms worsen.

Uses Of PERINDIL 4 TABLET

• To manage hypertension (high blood pressure)
• To manage heart failure (a condition where the pumping of heart is inadequate to meet body’s need)
• To reduce the risk of heart attack in patients with stable coronary artery disease (a condition where the blood supply to the heart is reduced or blocked) and in patients who have the history of heart attack and/or in surgeries to improve blood supply to the heart

How PERINDIL 4 TABLET Works

PERINDIL 4 TABLET works by inhibiting the activity of an enzyme called angiotensin converting enzyme (an enzyme which is responsible for causing constriction of blood vessels), resulting in easy flow of blood around the body.

How to use PERINDIL 4 TABLET

Take PERINDIL 4 TABLET as advised by your physician. Take it before meals. Swallow this medicine, do not crush, or chew the medicine. Your doctor will decide the correct dose and duration for you depending upon your age, body weight and disease condition.

Side Effects Of PERINDIL 4 TABLET

How To Manage Side Effects

Diarrhea

Drink lots of fluids, such as water or fruit juice to keep yourself hydrated. Do not consume any medicine on your own without consulting your doctor.

Dizziness Or Drowsiness

When you feel dizzy, lie or sit down immediately. If you're experiencing a severe episode of vertigo, lie in a dark and quite place with eyes closed. Vehicle driving should be avoided if you experience frequent dizziness without warning. Talk to your doctor if the symptom worsens.

Nausea And Vomiting

Take this medicine with, or just after meals. Stick to simple meals. Avoid eating oil rich or spicy foods, sugary snacks, and drinks. Avoid drinking too much liquid along with your meals. Consult your doctor if your symptom worsens.

Stomach Pain

Try to rest and relax. Try to have smaller and frequent meals. Keep a warm pad on your stomach. If the symptom does not improve, contact your doctor.

Warning & Precautions

Pregnancy

Contraindicated

 PERINDIL 4 TABLET is not recommended in early pregnancy and must not be taken when more than three months pregnant, as it may cause serious harm to the baby if used after 3rd month of pregnancy. Consult your doctor before taking PERINDIL 4 TABLET.

Breastfeeding

Contraindicated

PERINDIL 4 TABLET is not recommended for use in breastfeeding women. Your doctor may prescribe an alternative medicine especially if you want to breast-feed when your baby is new-born or born prematurely. Consult your doctor for advice before taking PERINDIL 4 TABLET.

Driving and Using Machines

Use with Caution

Do not drive or operate any machines if you feel dizziness or weakness due to low blood pressure after taking PERINDIL 4 TABLET. Consult your doctor before taking PERINDIL 4 TABLET.

Alcohol

Consult your doctor

Avoid consumption of alcohol as it may increase the risk of low blood pressure, dizziness and lightheaded

Kidney

Consult your doctor

PERINDIL 4 TABLET is not recommended for use in patients with kidney artery stenosis (narrowing of blood vessels to one or both the kidneys). PERINDIL 4 TABLET should be used in caution with patients having other kidney problems or under dialysis. Consult your doctor before taking PERINDIL 4 TABLET.

Liver

Use with Caution

 PERINDIL 4 TABLET should be used with caution in patients having liver problems. Consult your doctor before taking PERINDIL 4 TABLET.

Allergy

Contraindicated

PERINDIL 4 TABLET is not recommended for use if you are allergic to Perindopril or any other ACE inhibitors like captopril, enalapril.

Heart Disease

Use with Caution

PERINDIL 4 TABLET should be used in caution with patients having aortic stenosis (narrowing of the main blood vessel in heart), hypertrophic cardiomyopathy (condition in which heart muscle become thick abnormally) or any other heart problems. Before taking PERINDIL 4 TABLET consult with your doctor.

Use In Pediatrics

Contraindicated

PERINDIL 4 TABLET is not recommended for use in children and adolescents (under 18 years of age). Talk to your doctor before taking PERINDIL 4 TABLET.

Use In Geriatrics

Contraindicated

PERINDIL 4 TABLET is used with caution in patients above 60 years of age. Before taking PERINDIL 4 TABLET, consult your doctor.

Interactions

A. Drug - Drug interactions:

Before taking PERINDIL 4 TABLET, inform your doctor if you are taking any of the following medicine:

• angiotensin II receptor blockers used to manage high blood pressure (Ex. Telmisartan, losartan, valsartan)     
•  aliskiren (medicine used to manage high blood pressure)
• diuretics such as furosemide, hydrochlorothiazide (used to manage oedema or high blood pressure)
• medicines that may increase blood potassium levels such as salt substitutes containing potassium, potassium-sparing diuretics (Ex. amiloride, spironolactone)
• antibiotic trimethoprim (medicine used to manage urinary tract infections)
• immunosuppressive agents such as ciclosporin or tacrolimus (used to manage organ rejection after transplant)
• heparin (medicine used to manage blood clot)
• non-steroidal anti-inflammatory drugs - medicines used to manage pain and inflammation (Ex. aspirin, ibuprofen)
• baclofen (medicine used for muscle spasm)
• medicines containing lithium (used to manage some types of depression)
• antidepressants such as citalopram, fluoxetine, paroxetine (medicine used to manage depression)
• estramustine (medicine used in cancer therapy)
•  procainamide (used for management of irregular heartbeat)
• medicines such as ephedrine, noradrenaline or adrenaline used to manage low blood pressure, shock, or asthma
• vasodilators including nitrates like nitro-glycerine, isosorbide (medicine that make the blood vessels become wider)
• medicines which are most often used to manage diarrhoea (Ex. racecadotril)
• medicines used to manage to manage diabetes (insulin or metformin)
• allopurinol (medicine used to manage gout)
• gold salts (used to manage symptoms of rheumatoid arthritis)
• valsartan (medicine used to manage long-term heart failure)
• Mammalian target of rapamycin (mTOR inhibitors) like sirolimus, everolimus (medicines used to avoid rejection of transplanted organs)

Overdosage:

If you or anyone else accidentally take too much of PERINDIL 4 TABLET, consult your doctor immediately or visit the nearby hospital. The most common symptom of overdose is low blood pressure (which can make you feel dizzy, or fainting).

Synopsis

More Information

• keep PERINDIL 4 TABLET out of reach of children
• Store at room temperature

FAQs About PERINDIL 4 TABLET

Q: Can PERINDIL 4 TABLET be used to manage high blood pressure?

A: PERINDIL 4 TABLET can be considered to manage high blood pressure. It contains perindopril which helps to relax the blood vessels and then normalize the blood pressure. Although, PERINDIL 4 TABLET can manage high blood pressure, you doctor might manage you with other drugs depending upon your condition.

Q: Can PERINDIL 4 TABLET cause low blood pressure (hypotension)?

A: Yes. PERINDIL 4 TABLET can causes fall in blood pressure especially during the first few days of management. Tell your doctor if you experience lightheaded or have any feeling of fainting. Your risk of low blood pressure may be higher if you don’t drink enough fluids and sweat heavily.

Q: What should I avoid while taking PERINDIL 4 TABLET?

A: Potassium supplements, potassium-containing salt substitutes and even high-potassium foods (Ex. Banana, avocado, potato) should be avoided by those taking perindopril, unless directed otherwise by their doctor.

Q: What precautions do I need to follow while taking PERINDIL 4 TABLET?

A: Patients taking PERINDIL 4 TABLET must inform their doctor about their pre-existing disease conditions like kidney, heart, or liver problems. Consult your doctor immediately if you experience any unusual symptoms after taking PERINDIL 4 TABLET.

Q: What happens if I stop taking PERINDIL 4 TABLET?

A: Do not stop taking PERINDIL 4 TABLET without talking to your doctor first. Stopping this medicine suddenly can cause your blood pressure to spike and may increase the risk for heart attack or stroke.

References

1. KD. Tripathi. Drugs Affecting Renin Angiotensin System. Essentials of medical pharmacology. Eighth edition. 2019. Page – 532-533.

2. Andrew Thomson and Mary Greenacre. Perindopril: the evidence of its therapeutic impact in hypertension. NIH National Library of Medicine, National center for biotechnology information. PubMed Central. March 2007. [Accessed 13th May 2022] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012553/

3. Enisa Hodzic, Ehlimana Pecar, Alen Dzubur, Elnur Smajic, Zorica Hondo, Daniela Delic, and Edhem Rustempasic. Efficacy and Safety of Perindopril in Patients with Essential Hypertension. NIH National Library of Medicine, National center for biotechnology information. PubMed Central. March 2020. [Accessed 13th May 2022] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7219713/

4. Tillomed LaboratoriesLtd. Electronic Medicines Compendium (EMC). [Revised in September 2021] [Accessed 13th May 2022] https://www.medicines.org.uk/emc/files/pil.9913.pdf

5. Patheon Pharmaceuticals, Inc. U.S. Food & Drug Administration [Revised in March 2012] [Accessed 13th May 2022] https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020184s019lbl.pdf

Useful Diagnostic Tests

• kidney function test
• electrolyte test