📋 Indications & Clinical Dosage
*Hypertension not adequately controlled by perindopril alone:*
Adults: 1 tab daily in the morning before food.
Children: Not recommended.
⛔ Contraindications
History of angioneurotic oedema associated with ACE therapy, hereditary or idiopathic angioneu-rotic oedema, severe renal or hepatic failure, renal artery stenosis, hyperkalaemia/hypokalaemia, hepatic encephalopathy, sulphonamide sensitivity, haemodialysis uncompensated heart failure.
⚠️ Precautions & Warnings
Renal impairment, monitor renal function before and during treatment. Monitor serum electrolytes volume & electrolyte depletion, immuno-suppression, surgery/anaesthesia.
🔄 Drug Interactions
K+ sparing diuretics or K+ supplements, NSAIDs, antidiabetic agents, baclofen, neuroleptics, tricy-clic antidepressants, antihypertensives, corticosteroids, immuno-suppressants, anaesthetics, drugs prolonging QT interval or causing torsade de pointes, allopurinol, antiarrhythmics, cardiac glycosides, amphotericin, laxatives, metformin, Ca+ + salts, cyclosporin.
⚠️ Adverse Reactions / Side Effects
Headache, oedema, fatigue, nausea, GI upset, flushing and dizziness, rash, gingival hyperplasia, mood changes, dry mouth, palpitations, dyspnoea, muscle cramps, asthenia, Rarely, alopecia, pruritus, angioedema, somnolence, myalgia, arthralgia, peripheral neuropathy, pancreatitis, increased micturition, hyperglycaemia, impotence, sweating, syncope, thrombocytopenia, vasculitis, visual disturbances, asthenia, mild cough, decreases in haemoglobin, red cells and platelets counts, reversible increase in blood urea and creatinine, proteinuria.
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Contraindicated in pregnancy.
Lactation / Breastfeeding:
Not recommended.
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.