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.
HEALTH CANADA ADVISORY
February 4, 2014
Health Canada has issued new restrictions concerning the use of perindopril. To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.
Abnormal heart rhythms: This medication can cause abnormal heart rhythms. Certain medications (e.g., sotalol, quinidine, thioridazine, chlorpromazine, droperidol, pimozide, moxifloxacin, mefloquine, pentamidine, arsenic trioxide, dolasetron mesylate, tacrolimus) can increase the risk of a type of abnormal heart rhythm called torsades de pointes and should be used with caution with indapamide.
If you are taking medication for abnormal heart rhythms, 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.
Allergic reaction: This medication may cause a serious allergic reaction called angioedema, which may be fatal if not treated promptly. If you have difficulty breathing, notice hives or swelling of the face, lips, tongue, or throat, stop taking this medication and get emergency medical help at once.
Other ACE inhibitors should not be taken in the future. People who have had angioedema caused by other substances may be at increased risk of angioedema while receiving this medication.
Blood disorders: In rare cases, a low white blood cell count has been reported by people taking this medication. Your doctor may occasionally monitor your level of white blood cells by performing blood tests. Low white blood cell levels may increase your risk for infection. If you notice any signs of infection (e.g., fever, sore throat), contact your doctor as soon as possible.
Cough: People taking perindopril may develop a dry, persistent cough that usually disappears only after stopping this medication.
Decreased blood pressure: Occasionally, blood pressure drops too low after taking this medication, especially when getting up from a sitting or lying position. This may lead to fainting. It is more common after the first or second dose, when the dose is increased, or when a person is dehydrated. To reduce the risk of dizziness, get up slowly from a lying down or sitting position. If low blood pressure causes you to faint or feel lightheaded, contact your doctor.
Diabetes: Indapamide may make it more difficult for people with diabetes to control their blood sugar. Your doctor will monitor you while you are taking this medication and may need to adjust your doses of antidiabetes medications.
Fluid and electrolyte balance: Your levels of electrolytes, such as potassium, sodium, calcium, magnesium, and chloride, may change due to this medication. Your doctor may periodically ask for tests to check that these are in balance. If you experience symptoms of fluid and electrolyte imbalance such as muscle pains or cramps; dry mouth; numb hands, feet, or lips; or racing heartbeat, contact your doctor as soon as possible. Salt substitutes containing potassium should be avoided.
Gout: High levels of uric acid may occur in the blood or gout (a type of arthritis that causes sudden, severe attacks of joint pain with redness, warmth, and swelling in the affected area) may be brought on in certain people receiving indapamide.
Kidney function: This medication may change the kidney function in certain people. Your doctor will monitor you closely while you are taking this medication. Let your doctor know if you notice any decrease in urine production, or increased swelling of the lower limbs, suggesting accumulation of fluid due to decreased urination.
Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. This medication can also worsen liver function. 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. If you notice any signs of liver problems (e.g., abdominal pain, itching of skin, or yellow eyes or skin, loss of appetite, vomiting), contact your doctor immediately.
Surgery: Tell your doctor and anesthesiologist that you are taking this medication before you undergo any surgical procedures requiring general anesthesia.
Pregnancy: ACE inhibitors such as perindopril have the potential to cause serious problems during pregnancy. This medication should not be used by pregnant women. If you become pregnant while taking this medication, stop taking it immediately and contact your doctor.
Breast-feeding: Perindopril passes into breast milk. It is not known if indapamide passes into breast milk. Do not breast-feed if you are taking this medication.
Children: The safety and effectiveness of using this medication have not been established for children. It is not recommended for children.