page140
Side-effects
see under Perindopril Erbumine and
notes above
Dose
. Hypertension, initially 5 mg once daily in the morning
for 1 month,
subsequently adjusted according to
response;
if used in addition to diuretic (see notes
above), in elderly,
in renal impairment,
in cardiac
decompensation, or in volume depletion,
initially
2.5 mg once daily; max.
10 mg daily
. Heart failure (adjunct), initially 2.5 mg once daily in
the morning under close medical supervision (see
notes above),
increased after 2 weeks to max.
5 mg
once daily if tolerated
. Following myocardial infarction or revascularisation,
initially 5 mg once daily in the morning increased after
2 weeks to 10 mg once daily if tolerated;
ELDERLY
2.5 mg once daily for 1 week, then 5 mg once daily for
1 week, thereafter increased to 10 mg once daily if
tolerated
Coversyl
c
Arginine
(Servier) A
Tablets
,
f/c,
perindopril arginine 2.5 mg (white),
net
price 30-tab pack = £8.27;
5 mg (light green,
scored),
30-tab pack = £9.36;
10 mg (green),
30-tab pack =
£11.02.
Label:
22
Perindopril arginine with diuretic
Note
For hypertension not adequately controlled by perindo-
pril alone.
For prescribing information on indapamide, see
section 2.2.1
Coversyl
c
Arginine Plus
(Servier) A
Tablets
,
f/c,
perindopril arginine 5 mg,
indapamide
1.25 mg,
net price 30-tab pack = £12.65.
Label:
22
QUINAPRIL
Indications
essential hypertension;
congestive heart
failure (adjunct—see section 2.5.5)
Cautions
see notes above
Contra-indications
see notes above
Hepatic impairment
see notes above
Renal impairment
see notes above;
max.
initial dose
2.5 mg once daily if eGFR less than 40 mL/minute/
1.73 m
2
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see notes above;
asthenia, chest pain,
oedema,
flatulence,
nervousness,
depression,
insom-
nia,
blurred vision,
impotence,
and back pain
Dose
. Hypertension,
initially 10 mg once daily;
with a
diuretic (see notes above), in elderly,
or in renal
impairment initially 2.5 mg daily;
usual maintenance
dose 20–40 mg daily in single or 2 divided doses; up to
80 mg daily has been given
. Heart failure (adjunct), initial dose 2.5 mg daily under
close medical supervision (see notes above),
increased gradually to 10–20 mg daily in 1–2 divided
doses if tolerated;
max.
40 mg daily
Quinapril
(Non-proprietary) A
Tablets
,
quinapril (as hydrochloride) 5 mg,
net price
28-tab pack = £2.05;
10 mg,
28-tab pack = £1.91;
20 mg,
28-tab pack = £2.39;
40 mg,
28-tab pack =
£2.81
Brands include
Quinil
c
Accupro
c
(Pfizer) A
Tablets
,
f/c,
quinapril (as hydrochloride) 5 mg
(brown), net price 28-tab pack = £8.60; 10 mg (brown),
28-tab pack = £8.60;
20 mg (brown),
28-tab pack =
£10.79;
40 mg (red-brown),
28-tab pack = £9.75
With diuretic
Note
For hypertension in patients stabilised on the individual
components in the same proportions.
For prescribing infor-
mation on thiazides, see section 2.2.1
Accuretic
c
(Pfizer) A
Tablets
, pink, f/c, scored, quinapril (as hydrochloride)
10 mg,
hydrochlorothiazide 12.5 mg,
net price 28-tab
pack = £11.75
RAMIPRIL
Indications
hypertension;
symptomatic heart failure
(adjunct—see section 2.5.5);
following myocardial
infarction in patients with clinical evidence of heart
failure; prevention of cardiovascular events in patients
with atherosclerotic cardiovascular disease or with
diabetes mellitus and at least one additional risk factor
for cardiovascular disease; nephropathy (consult pro-
duct literature)
Cautions
see notes above
Contra-indications
see notes above
Hepatic impairment
max. daily dose 2.5 mg; see also
notes above
Renal impairment
see notes above;
max.
daily dose
5 mg if eGFR 30–60 mL/minute/1.73 m
2
;
max.
initial
dose 1.25 mg once daily (do not exceed 5 mg once
daily) if eGFR 10–30 mL/minute/1.73 m
2
; max. initial
dose 1.25 mg once daily (do not exceed 2.5 mg once
daily) if eGFR less than 10 mL/minute/1.73 m
2
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see notes above;
arrhythmias,
angina,
chest pain,
syncope,
cerebrovascular accident,
myo-
cardial infarction,
loss of appetite,
stomatitis, dry
mouth, skin reactions including erythema multiforme
and pemphigoid exanthema;
precipitation or exacer-
bation of Raynaud’s syndrome; conjunctivitis,
ony-
cholysis, confusion, nervousness, depression, anxiety,
impotence,
decreased libido,
alopecia, bronchitis and
muscle cramps
Dose
. Hypertension,
initially 1.25–2.5 mg once daily,
increased at intervals of 2–4 weeks to max.
10 mg
once daily;
if used in addition to diuretic see notes
above
. Heart failure (adjunct), initially 1.25 mg once daily
under close medical supervision (see notes above),
increased gradually at intervals of 1–2 weeks to max.
10 mg daily if tolerated (preferably taken in 2 divided
doses)
. Prophylaxis after myocardial infarction (started at
least 48 hours after infarction),
initially 2.5 mg twice
daily,
increased after 3 days to 5 mg twice daily
Note
If initial 2.5-mg dose not tolerated, give 1.25 mg twice
daily for 2 days before increasing to 2.5 mg twice daily, then
5 mg twice daily; withdraw if dose cannot be increased to
2.5 mg twice daily
. Prophylaxis of cardiovascular events,
initially 2.5 mg
once daily,
increased after 1–2 weeks to 5 mg once
daily,
then increased after a further 2–3 weeks to
10 mg once daily
120
2.5.5 Drugs affecting the renin-angiotensin system
BNF 61
2
Cardiovascular system