[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [ACE inhibitors](https://durgical.com/en/pharmacology/classes/ace-inhibitors/) › Perindopril

[Pharmacology](https://durgical.com/en/pharmacology/) · [ACE inhibitors](https://durgical.com/en/pharmacology/classes/ace-inhibitors/)

# 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](https://durgical.com/en/pharmacology/classes/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](https://www.rcsb.org/structure/9QAQ) · Drag to rotate · pinch to zoom

## 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 →](https://durgical.com/en/conditions/arterial-hypertension/)
- Stable coronary artery disease, to reduce cardiovascular death or non-fatal infarction [Stable angina →](https://durgical.com/en/conditions/stable-angina/)

## Adverse effects

### Common

- Dry cough
- Dizziness and hypotension
- Headache
- Hyperkalaemia

### Serious (rare, important)

- Angioedema
- Acute kidney injury
- Fetal toxicity

## 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.

## Memory aid

PERINDOPRIL is PERmanent protection IN coronary disease: fewer deaths and infarcts.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/perindopril/)

## Related drugs

- [Ramipril](https://durgical.com/en/pharmacology/ramipril/)
- [Enalapril](https://durgical.com/en/pharmacology/enalapril/)
- [Lisinopril](https://durgical.com/en/pharmacology/lisinopril/)

## Related conditions

- [Arterial hypertension](https://durgical.com/en/conditions/arterial-hypertension/)
- [Stable angina](https://durgical.com/en/conditions/stable-angina/)

[← Back to the class: ACE inhibitors](https://durgical.com/en/pharmacology/classes/ace-inhibitors/)

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](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=87768fbf-7c63-47da-8925-0316f343d6ef) (DailyMed (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=C09AA04) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/perindopril/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/perindopril/