Pervasyl 4 Mg Tablet

Perindopril is a prodrug metabolized to its active form, perindoprilat, which inhibits ACE. This reduces the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, leading to relaxed blood vessels, lowered blood pressure, and increased blood and oxygen supply to the heart. It also decreases aldosterone secretion, promoting sodium and water excretion

Tablet Description:

• Appearance: White to off-white, capsule-shaped, uncoated tablets, debossed with specific markings (e.g., “D” on one side and “5” & “8” on either side of a break line, depending on the manufacturer). The tablet can be divided into two equal doses.
• Dimensions: Approximately 8.00 ± 0.10 mm x 4.00 ± 0.10 mm (varies by manufacturer).
• Excipients: Includes lactose (e.g., 59.330 mg per tablet), microcrystalline cellulose, magnesium stearate, and hydrophobic colloidal silica. Contains lactose, so caution is advised for patients with lactose intolerance

Dosage and Administration:

• Hypertension: Recommended starting dose is 4 mg once daily in the morning, which may be increased to 8 mg once daily after one month, based on blood pressure response. Maximum dose is 16 mg/day.
• Heart Failure: Start with 2 mg once daily under medical supervision, increasing to 4 mg once daily if tolerated.
• Stable Coronary Artery Disease: Start with 4 mg once daily for two weeks, then increase to 8 mg once daily if tolerated.
• Elderly: Initiate at 2 mg once daily, titrating to 4 mg, and up to 8 mg if needed, based on renal function.
• Renal Impairment: Adjust dose based on creatinine clearance (e.g., 2 mg/day for mild impairment; not recommended if clearance <30 mL/min). For hemodialysis patients, take the dose after dialysis.
• Administration: Swallow whole with water, ideally 30–60 minutes before a meal, at the same time each day.

Contraindications:

• Hypersensitivity to perindopril, other ACE inhibitors, or any excipients.
• History of angioedema associated with ACE inhibitor therapy.
• Concomitant use with aliskiren in patients with diabetes or renal impairment (GFR <60 mL/min/1.73 m²).
• Pregnancy (can cause fetal harm or death).
• Concomitant use with sacubitril/valsartan (Entresto) within 36 hours.
• Extracorporeal treatments involving blood contact with negatively charged surfaces.

Warnings and Precautions:

• Angioedema: Risk of swelling in the face, lips, tongue, or throat; discontinue immediately if it occurs. Higher risk in African-American patients.
• Hypotension: May occur, especially in patients with volume depletion or those on diuretics. Start with 2 mg in such cases.
• Renal Function: Monitor renal function and serum potassium, especially in patients with renal impairment or on diuretics.
• Pregnancy and Breastfeeding: Contraindicated in pregnancy. Not recommended during breastfeeding due to potential transfer into breast milk.
• Surgery: Inform the surgeon, as perindopril may enhance hypotensive effects under anesthesia.

Drug Interactions:

• Potassium-Sparing Diuretics/Supplements: Risk of hyperkalemia; use with caution and monitor potassium levels.
• Lithium: May increase lithium levels; monitor closely.
• NSAIDs: May reduce antihypertensive effects and affect renal function.
• Aliskiren or Sacubitril/Valsartan: Contraindicated in certain patients due to increased risk of renal issues or hypotension.
• Gold Injections: Rare risk of nitritoid reactions (flushing, nausea, hypotension).

Side Effects:

• Common: Cough (dry, irritating), dizziness, headache, fatigue, nausea, upset stomach.
• Serious: Angioedema, hypotension, hyperkalemia, renal impairment, liver dysfunction.
• Rare: Skin sensitivity to UV rays, allergic reactions

Storage:

• Store at room temperature (20–25°C; excursions permitted to 15–30°C).
• Keep in a tightly closed container, away from heat, moisture, and direct light.
• Dispose of unused medication via a take-back program, not via wastewater or household waste.