What side effects are possible with this medication?

A side effect is an unwanted response to a medication when it is taken in normal doses. A side effect may be mild or severe, temporary or permanent, but does not occur in everyone. Not everyone will experience side effects, and which side effects a person experiences cannot be anticipated.

The following side effects have been reported by at least 1% of people taking this medication. If you develop any of these side effects (or any other side effects not listed here) or they change in intensity, speak to your doctor or pharmacist for advice on managing them and on the risks and benefits of the medication.

• cough
• diarrhea
• difficulty sleeping
• dizziness
• drowsiness
• headache
• heartburn
• muscle tightness or pain
• nausea
• nervousness
• pain
• pounding heartbeat
• protein in the urine
• rash
• ringing in the ears
• sexual problems
• swelling
• weakness
• vomiting

Click here to learn about serious side effects that can potentially occur with any medication. These examples are provided for information purposes only and are not meant to be exhaustive. Always consult your doctor for sound medical advice specific to your particular medication and treatment.

Are there any other precautions or warnings for this medication?

Be sure to inform your doctor of all your medical conditions before you begin taking a medication. Some conditions can affect how you should take this medication.

Angioedema: Angioedema (swelling of the mouth, lips, tongue, eyes, or throat causing difficulty swallowing or breathing) has been reported in a small number of people who take perindopril. If any of these symptoms occur, get immediate medical attention. Also, consult your doctor immediately about any unexplained rash, fever, or itching. If you experience angioedema with perindopril, do not take any other ACE inhibitors (e.g., enalapril, lisinopril, or ramipril).

Cough: A dry, persistent cough, which usually disappears only after stopping perindopril may occur.

Kidney function: Changes in kidney function have been seen for some individuals who are sensitive to this effect. For certain people, use of diuretics (water pills) may further increase risk of kidney problems.

Liver function: Changes in liver function and jaundice have occurred in people with or without pre-existing liver problems during treatment with this medication. If you develop yellow skin or eyes; abdominal pain; dark urine; clay-colored stools; loss of appetite; or nausea and vomiting, stop taking this medication and get immediate medical attention.

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 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 light-headed, contact a doctor.

Potassium: This medication may increase blood potassium levels, especially in people with kidney problems, diabetes, or who are taking certain medications. Do not use salt substitutes containing potassium without checking with your doctor. Your doctor may order blood tests to monitor your potassium levels while you are taking perindopril. Check with your doctor before using potassium supplements or salt substitutes using potassium. Warning signs or symptoms of high blood potassium include:

• confusion
• irregular heartbeat
• nervousness
• numbness or tingling in hands, feet, or lips
• shortness of breath or difficult breathing
• unusual tiredness or muscle weakness
• weakness or heaviness of legs

White blood cells: Perindopril may decrease white blood cell counts, especially if you have impaired kidney function or a collagen vascular disease (e.g., scleroderma, systemic lupus erythematosus). Your doctor may order blood tests to monitor your white blood cell counts while you are taking this medication. Contact your doctor if you experience any signs of infection, such as sore throat or fever.

Pregnancy: Perindopril should not be used during pregnancy. If you discover you are pregnant, you should stop taking perindopril immediately and talk to your doctor.

Breast-feeding: It is not known if perindopril passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of this medication have not been established for children.

What other drugs could interact with this medication?

An interaction between medications does not always mean that you must stop taking one of them. The following medications may affect the way perindopril works, be affected by perindopril, or increase the risk of side effects:

• diuretics (water pills, e.g., hydrochlorothiazide)
• Gentamicin
• lithium
• medications which increase potassium levels (such as potassium supplements, spironolactone, amiloride, heparin, cyclosporine, and salt substitutes containing potassium)
• medications which lower blood pressure (e.g., beta-blockers)
• nonsteroidal anti-inflammatory medications (NSAIDs, e.g., ibuprofen, naproxen)

If you are taking any of these or other medications (including non-prescription, herbal, and supplement products), speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want to change your therapy or may suggest ways of managing any interactions. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your doctor know if you use them. Medications other than those listed above may also interact with this medication.