From the Research
Perindopril (Aceon) should not be used in patients with an estimated Glomerular Filtration Rate (eGFR) below 30 mL/min/1.73m². For patients with an eGFR between 30-60 mL/min/1.73m², dose adjustment is recommended, typically starting with a lower dose of 2 mg daily. Perindopril is primarily eliminated by the kidneys, and reduced kidney function leads to drug accumulation, increasing the risk of adverse effects such as hyperkalemia, worsening renal function, and hypotension. In patients with severe renal impairment (eGFR <30 mL/min/1.73m²), alternative antihypertensive medications with less renal elimination should be considered. Regular monitoring of kidney function and electrolytes is essential for patients with reduced renal function who are taking perindopril. If a patient's eGFR drops below 30 mL/min/1.73m² while on perindopril, the medication should be discontinued and alternative treatments explored in consultation with a healthcare provider 1. Key considerations for perindopril use in patients with renal impairment include:
- Monitoring eGFR and electrolytes regularly
- Adjusting the dose based on renal function
- Considering alternative antihypertensive medications in severe renal impairment
- Being aware of the potential for drug accumulation and adverse effects in patients with reduced kidney function 2. It is also important to note that the treatment benefits of perindopril are consistent and not modified by mild to moderate renal insufficiency, as shown in the EUROPA trial 3. However, the most recent and highest quality study 4 supports the continuation of sacubitril/valsartan, a related medication, even when eGFR declines below 30 mL/min/1.73m², but this does not directly apply to perindopril. Therefore, the recommendation for perindopril use in patients with renal impairment prioritizes caution and careful monitoring to minimize the risk of adverse effects.