Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Angioedema: Although not common, angioedema (a serious allergic reaction that causes the area around the throat and tongue to swell) may occur with ACE inhibitors, including perindopril. If you experience swelling of the face, tongue, or glottis, stop taking perindopril at once and seek immediate medical attention. People who have had angioedema caused by other substances may be at increased risk of angioedema while taking an ACE inhibitor such as perindopril.
Blood counts: This medication can decrease the number of neutrophils (a type of white blood cell that helps fight infection), red blood cells (which carry oxygen), and platelets (which help your blood to clot). Your doctor will do blood tests to monitor this. If you notice any signs of infection (e.g., fever, chills, or sore throat) or unusual bleeding or bruising, contact your doctor immediately.
Cough: People taking perindopril may develop a dry, persistent cough that usually disappears only after stopping or lowering the perindopril dose. Be sure to tell your doctor of any cough which does not seem to be related to a usual cause.
Diabetes: Perindopril may affect blood sugar control. If you have diabetes, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. You may need to test your blood sugar more often when you first start taking this medication.
Taking perindopril in combination with aliskiren increases the risk of severe low blood pressure, fainting, stroke, and decreasing kidney function. People with diabetes must not take both of these medications.
Fluid and electrolyte balance: Increases in blood levels of potassium may occur as a result of taking perindopril. This rarely causes problems, but your doctor will probably want to monitor your potassium levels regularly with blood tests.
Kidney function: Changes in kidney function have been seen in certain people who take this medication. The use of diuretics (water pills) or aliskiren may further increase the risk of kidney problems for those already at risk for this problem. If you have kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Liver function: Rarely, people taking this medication experience decreases in liver function, possibly leading to liver failure. Your doctor will do blood tests to monitor this. If you notice any signs of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.
If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.
Low blood pressure: Occasionally, blood pressure drops too low after perindopril is taken. This usually happens after the first or second dose or when the dose is increased. It is more likely to occur for those who take aliskiren, water pills, have a salt-restricted diet, are on dialysis, are suffering from diarrhea or vomiting, or have been sweating excessively and not taking in enough fluids. If low blood pressure causes you to faint or feel lightheaded, contact your doctor.
Pregnancy: ACE inhibitors such as perindopril may cause severe harm or death to a developing baby if taken by the mother during pregnancy. This medication should not be used during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking perindopril, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Children: The safety and effectiveness of the use of perindopril by children have not been established. Its use by this age group is not recommended.