- In patients not adequately controlled with monotherapy.
- As initial therapy in patients likely to need multiple drugs to achieve their blood pressure goals.
Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions
Amlodipine: Amlodipine is a dihydropyridine calcium antagonist (calcium ion antagonist or slow channel blocker) that inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle. Experimental data suggest that amlodipine binds to both dihydropyridine and nondihydropyridine binding sites. The contractile processes of cardiac muscle and vascular smooth muscle are dependent upon the movement of extracellular calcium ions into these cells through specific ion channels. Amlodipine inhibits calcium ion influx across cell membranes selectively, with a greater effect on vascular smooth muscle cells than on cardiac muscle cells. Negative inotropic effects can be detected in vitro but such effects have not been seen in intact animals at therapeutic doses.
Dosage & Administration
This combination may be used as initial therapy if a patient is likely to need multiple drugs to achieve blood pressure goals. Consider use in patients unable to achieve adequate antihypertensive effect with amlodipine monotherapy because of dose-limiting peripheral edema caused by amlodipine
Administered as monotherapy, perindopril erbumine is an effective treatment for hypertension in once-daily doses ranging from 4 mg to 16 mg daily. Amlodipine is effective in once-daily doses of 5 mg and 10 mg. Adverse reactions related to perindopril are generally uncommon and independent of dose, while those related to amlodipine are a mixture of dose-dependent phenomena (primarily peripheral edema) and dose-independent phenomena, the former much more common than the latter
perindopril and amlodipine.
- swelling of the feet, ankles, and hands
Pregnancy & Lactation
Nursing Mothers: It is not known whether perindopril or amlodipine is excreted in human milk, but radioactivity was detected in the milk of lactating rats following administration of perindopril. Because of the potential for adverse effects on the nursing infant, decide whether to discontinue nursing or discontinue this combination
Myocardial infarction: Worsening angina and acute myocardial infarction can develop after starting or increasing the dose of Perindopril & Amlodipine, particularly in patients with severe obstructive coronary artery disease
Assess for hypotension and hyperkalemia
Monitor renal function during therapy
Use in Special Population
Monitoring in Elderly Patients (Over 65 Years of Age): Monitor blood pressure for up to two weeks following titrations at dosages above 7/5 mg in patients over 65 years of age
Pediatric Use: The safety and effectiveness of in pediatric patients have not been established.
Geriatric Use: The mean blood pressure effect of perindopril was somewhat smaller in patients over 60 years of age than in younger patients, although the difference was not significant. Plasma concentrations of both perindopril and perindoprilat in elderly patients (>65 years) are approximately twice those observed in younger patients. No adverse effects were clearly increased in older patients with the exception of dizziness and rash. Amlodipine is extensively metabolized in the liver. In the elderly, clearance of amlodipine is decreased with resulting increases in peak plasma levels, elimination half-life, and AUC.
Renal Impairment: Not recommended in patients with creatinine clearances <30 mL/min.