Can Perindopril Cause Body Aches?
Yes, perindopril can cause body aches, though this is not among its most common adverse effects. Musculoskeletal complaints including myalgia (muscle pain) and arthralgia (joint pain) occur in approximately 1-2% of patients treated with perindopril, but these rates are generally similar to placebo. 1
Common Adverse Effects of Perindopril
The most frequent side effects you should anticipate are:
- Cough occurs in 12-26.9% of patients and represents the leading cause of drug discontinuation 2, 1
- Dizziness/syncope affects 29-33% of patients, significantly higher than placebo, and appears dose-related 2, 1
- Hypotension occurs in approximately 16% of patients, particularly during initial dosing 2
- Headache is reported in 23.8% of patients 1
- Fatigue/asthenia affects approximately 7-8% of patients 2, 1
Musculoskeletal Symptoms Specifically
When body aches do occur with perindopril:
- Back pain was reported in 5.8% of perindopril patients versus 3.1% on placebo, though investigators did not consider this drug-related 1
- Myalgia (muscle pain) occurs in approximately 1.1% of patients 1
- Arthralgia (joint pain) occurs in approximately 1.1% of patients 1
- Upper extremity pain was noted in 2.8% versus 1.4% on placebo 1
The key distinction is that these musculoskeletal complaints were generally NOT considered causally related to perindopril by investigators - only 0-0.2% of these events were deemed possibly or probably drug-related. 1
Clinical Context
This contrasts sharply with other drug classes where body aches are prominent adverse effects. For example, BRAF/MEK inhibitors used in melanoma treatment cause arthralgia in 5-9% and myalgia in 10% of patients as clearly drug-related toxicities. 3 With perindopril, the musculoskeletal symptom rates barely exceed placebo.
Practical Management Approach
If your patient reports body aches on perindopril:
- First, consider alternative explanations - the symptom may be coincidental rather than drug-related given the low attribution rate 1
- Evaluate for hypotension - dizziness and weakness from blood pressure reduction may be misinterpreted as generalized body aches 2, 1
- Check renal function and electrolytes - perindopril can cause creatinine elevation and electrolyte disturbances that might contribute to muscle symptoms 4, 2
- Review concomitant medications - particularly statins, which commonly cause myalgias and are often co-prescribed in cardiovascular patients 3
If body aches are truly bothersome and other causes are excluded, the symptom alone would not typically warrant discontinuation given the substantial cardiovascular benefits of perindopril (20% reduction in cardiovascular death/MI in high-risk patients). 3, 5 However, if symptoms are severe or affecting quality of life, switching to an angiotensin receptor blocker (ARB) is reasonable, as ARBs provide similar cardiovascular benefits without the bradykinin-mediated effects of ACE inhibitors. 3