Pendoril

Coversyl is a long-acting ACE (Angiotensin Converting Enzyme) inhibitor and is indicated in-
Essential hypertension,
Stable coronary artery disease,
Congestive heart failure.

Hypertension
: One Perindopril 4 tablet once daily preferably in the morning. If necessary, the dose may be increased to 8 mg after 1 month of treatment. Perindopril should be taken before food.
Stable coronary artery disease
: Perindopril 4 once daily for two weeks, then increased to 8 mg once daily, depending on renal function and provided that the 4 mg dose is well tolerated. Elderly patients should receive Perindopril 2 mg once daily for one week, then Perindopril 4 once daily the next week, before increasing the dose up to 8 mg once daily, depending on renal, function. The dose should be increased only if the previous lower dose is well tolerated.
Congestive heart failure
: Perindopril should be started under close medical supervision at a starting dose of 2 mg in the morning. If necessary dose may be increased to 4 mg.
Elderly patients
: Start at low daily dose (4 mg or less) and titrate slowly as needed. Experience with doses exceeding 8 mg is limited.

Rare and mild
: usually at the start of treatment cough, fatigue, asthenia, headache, disturbances of mood and/or sleep have been reported.
Less often
: Taste impairment, epigastric discomfort, nausea, abdominal pain and rash. Reversible increase in blood urea and creatinine may be observed. Proteinuria has occurred in some patients.
Rarely
: Angioneurotic edema and decrease in hemoglobin, red cells and platelets have been reported.

In the following cases, Coversyl should be used with caution:
Renovascular hypertension
Surgery/Anesthesia
Renal failure: The dose should be cautiously adjusted in accordance with the creatinine clearance
Symptomatic hypotension is rarely seen, but is more likely in volume-depleted patients, those receiving diuretics, or with the first two doses
In diuretic-treated patients: stop the diuretic 3 days before starting Coversyl. A diuretic may later be given in combination if necessary; potassium-sparing diuretics are not recommended
Combination with neuroleptics or imipramine-type drugs may increase the hypotensive effect. Serum lithium concentrations may rise during lithium therapy

Perindopril is a nonsulphydryl ACE inhibitor used in the treatment of hypertension. Following oral administration, perindopril is rapidly hydrolysed to perindoprilat, its principal active metabolite. ACE catalyses the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II. Angiotensin II also stimulates aldosterone secretion by the adrenal cortex. Inhibition of ACE activity leads to decreased levels of angiotensin II, thereby resulting in decreased vasoconstriction and decreased aldosterone secretion. The latter change may result in a small increase in serum potassium. Decreased levels of angiotensin II and the accompanying lack of negative feedback on renal renin secretion results in increases in plasma renin activity. Perindopril administration may interfere with the degradation of the vasodepressor peptide bradykinin. It is not known whether this effect contributes to the therapeutic activity of perindopril. The mechanism through which perindopril lowers BP appears to result primarily from suppression of the RAAS.