Perindopril !

A long-acting ACE inhibitor prodrug. Used for high blood pressure and, in stable coronary disease, to lower cardiovascular death and infarction.

Updated 2026-11-01

Class: ACE inhibitors
Enzyme: Angiotensin-converting enzyme (ACE)
ATC code: C09AA04

Angiotensin-converting enzyme (ACE)Perindopril

The figure shows perindoprilat, the active form of perindopril, bound to the zinc active site of the C-domain of human ACE.

Target in 3D: Angiotensin-converting enzyme (ACE). PDB structure 9QAQ (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Perindopril is hydrolysed to perindoprilat, which blocks ACE. Angiotensin II and aldosterone fall, arterioles dilate and bradykinin builds up. In stable coronary disease, long-term treatment reduces cardiovascular death and non-fatal infarction.

Perindopril is hydrolysed to perindoprilat, its active form
Perindoprilat blocks the zinc active site of ACE
Less angiotensin II and aldosterone; bradykinin builds up

Pharmacokinetics

Absorption: Well absorbed; only part is converted to perindoprilat
Metabolism: Prodrug hydrolysed to perindoprilat; liver impairment raises perindoprilat
Elimination: Extensively metabolised; the dose is adjusted in kidney impairment

Indications

Essential hypertension Arterial hypertension →
Stable coronary artery disease, to reduce cardiovascular death or non-fatal infarction Stable angina →

Adverse effects

Common

Dry cough
Dizziness and hypotension
Headache
Hyperkalaemia

Contraindications

Pregnancy
Previous angioedema with an ACE inhibitor, or hereditary or idiopathic angioedema
Use with sacubitril/valsartan or within 36 hours of it
Use with aliskiren in people with diabetes

Key interactions

Potassium-sparing diuretics, potassium supplements or salt substitutes: Hyperkalaemia
NSAIDs, including COX-2 inhibitors: Weaker effect and risk of kidney injury
Lithium: Higher lithium levels and toxicity
Injectable gold: Nitritoid reactions: flushing, nausea, vomiting and hypotension

What is monitored

Blood pressure
Potassium and creatinine
Signs of angioedema

Administration and safety

Given by mouth once a day
Several «-pril» names look alike: the name is checked on every order

Nursing care

Check blood pressure, potassium and creatinine when starting and after changes
Watch for dizziness, especially in patients on diuretics
Ask women of childbearing age about pregnancy plans
Teach the patient that face, lip or tongue swelling is an emergency

Pregnancy and breastfeeding

Contraindicated: drugs acting on the renin-angiotensin system can injure and kill the developing fetus; it is stopped as soon as pregnancy is detected.

Test yourself

Think of the answer, then tap the question to see it.

What is the active metabolite of perindopril?

Perindoprilat, formed by hydrolysis.

In which patients without heart failure is perindopril used to reduce cardiovascular death?

Patients with stable coronary artery disease.

Which reaction can follow injectable gold in a patient on perindopril?

A nitritoid reaction: facial flushing, nausea, vomiting and hypotension.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: DailyMed - PERINDOPRIL ERBUMINE tablet (DailyMed (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.