Perindopril Dosage

Usual Adult Dose for Coronary Artery Disease

Initial dose: 4 mg orally once a day for two weeks, then increased as tolerated to a maintenance dose of 8 mg orally once a day.
Maintenance dose: 4 mg to 8 mg orally once a day.

Usual Adult Dose for Congestive Heart Failure

Initial dose: 4 mg orally once a day
Maintenance dose: 4 mg to 8 mg orally daily in one or two divided doses

Usual Adult Dose for Diabetic Nephropathy

Initial dose: 4 mg orally once a day
Maintenance dose: 4 mg to 8 mg orally daily in one or two divided doses

Usual Adult Dose for Hypertension

Initial dose: 4 mg orally once a day
Maintenance dose: 4 mg to 8 mg orally daily in one or two divided doses

Usual Adult Dose for Left Ventricular Dysfunction

Initial dose: 4 mg orally once a day
Maintenance dose: 4 mg to 8 mg orally daily in one or two divided doses

Usual Adult Dose for Myocardial Infarction

Initial dose: 4 mg orally once a day
Maintenance dose: 4 mg to 8 mg orally daily in one or two divided doses

Usual Geriatric Dose for Coronary Artery Disease

Greater than 70 years:
Initial dose: 2 mg orally once a day in the first week, followed by 4 mg orally once a day in the second week, then 8 mg orally once a day for maintenance if tolerated.
Maintenance dose: 4 mg to 8 mg orally once a day.

Renal Dose Adjustments

CrCl less than 80 mL/min and greater than or equal to 30 mL/min:
Initial dose: 2 mg orally once a day
Maintenance dose: 2 mg to 4 mg daily in one or two divided doses

CrCl less than 30 mL/min:
Not recommended for use in patients with significant renal impairment

Liver Dose Adjustments

No adjustment recommended

Dose Adjustments

In patients currently being treated with a diuretic, symptomatic hypotension occasionally can occur following the initial dose of perindopril. To reduce likelihood of such reaction, the diuretic should, if possible, be discontinued 2 to 3 days prior to the beginning of perindopril therapy. Then, if blood pressure is not controlled with perindopril alone, the diuretic should be resumed.

If the diuretic cannot be discontinued, an initial dose of 2 to 4 mg daily in one or in two divided doses should be used with careful medical supervision for several hours and until blood pressure has stabilized.

After the first dose of perindopril, the patient should be followed closely for the first two weeks of treatment and whenever the dose of perindopril and/or diuretics is increased. To reduce the likelihood of hypotension in patients currently being treated with a diuretic, the dose of diuretic (if possible) can be adjusted which may diminish the likelihood of hypotension.

Precautions

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

Perindopril and perindoprilat (the active metabolite) are removed by hemodialysis. An increased risk of hypotension exists if the dose is given immediately following dialysis. Ideally, the drug should be given sometime after dialysis when the patient is hemodynamically stable.

Other Comments

If blood pressure is not controlled by perindopril alone, a diuretic may be added.

Compared with Caucasian patients, Black patients have a reduced blood pressure response to monotherapy with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers; however, the reduced response is largely eliminated if combination therapy that includes an adequate dose of a diuretic is instituted.

Following first time MI, all ACE inhibitors, at comparable appropriate dosages, appear to be equally effective for reducing mortality and recurrent MI rates.

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