What is the dosing of Coversyl (Perindopril) for hypertension?

Perindopril (Coversyl) Dosing for Hypertension

The recommended initial dose of perindopril for hypertension is 4 mg once daily, which can be titrated up to a maximum of 8 mg once daily for most patients, with dosage adjustments based on blood pressure response. 1

Initial Dosing and Titration

• Standard initial dose: 4 mg once daily
• Titration: Increase gradually until blood pressure is controlled or maximum dose reached
• Maintenance dose range: 4-8 mg once daily
• Maximum dose: 8 mg daily for most patients (up to 16 mg in some cases) 1

Special Population Considerations

Elderly Patients (>65 years)

• Initial dose: 4 mg once daily
• Maximum dose: 8 mg once daily
• Note: Doses above 8 mg should be administered with caution and close medical supervision 1

Patients with Renal Impairment

• Creatinine clearance >30 mL/min: Initial dose 2 mg/day, maximum 8 mg/day
• Creatinine clearance <30 mL/min: Not recommended (safety and efficacy not established) 1

Patients Taking Diuretics

• Preferred approach: If possible, discontinue diuretic 2-3 days before starting perindopril
• If diuretic cannot be discontinued: Start with lower dose (2-4 mg daily) with careful medical supervision
• Monitor: Follow patient closely for the first two weeks of treatment and whenever dose is increased 1

Administration Options

• Can be administered as a single daily dose or in two divided doses
• When comparing once-daily to twice-daily dosing, the twice-daily regimen was slightly superior, but only by about 0.5-1.0 mm Hg 1

Combination Therapy

• If blood pressure is not adequately controlled with perindopril alone, a diuretic may be added 1
• The combination of perindopril (ACE inhibitor) and indapamide (thiazide-like diuretic) has shown particular efficacy in clinical trials 2

Clinical Efficacy

• In clinical trials, perindopril 4-8 mg once daily significantly reduced systolic and diastolic blood pressure 3
• Blood pressure reductions are maintained for at least 24 hours with once-daily dosing 3
• Response rates of 67-80% have been reported with perindopril 4-8 mg once daily 3

Monitoring

• Monitor blood pressure response regularly
• Check renal function and serum potassium within 1-2 weeks of initiation and periodically thereafter, especially in patients with:
  • Pre-existing hypotension
  • Hyponatremia
  • Diabetes mellitus
  • Azotemia
  • Those taking potassium supplements 4

Common Side Effects

• Cough (most common side effect and most common reason for discontinuation)
• Headache
• Dizziness
• Asthenia 1, 5

Important Precautions

• Contraindicated in patients with history of angioedema related to previous ACE inhibitor therapy
• Use with caution in patients with renal artery stenosis
• Avoid in pregnancy (risk of fetal toxicity)
• Monitor for hyperkalemia and acute kidney injury 4, 1

Perindopril has demonstrated benefits beyond blood pressure control, including improvement of endothelial function and normalization of vascular and cardiac structure 6, making it a valuable option for hypertension management, particularly in patients with additional cardiovascular risk factors.