From the Guidelines
The maximum daily dose of perindopril for advanced elderly patients with normal renal function is 8 mg once daily, as indicated by the EUROPA trial 1.
Key Considerations
- Advanced elderly patients are more susceptible to the hypotensive effects of ACE inhibitors like perindopril due to age-related changes in pharmacokinetics and pharmacodynamics.
- Even with normal renal function, elderly patients may experience more pronounced blood pressure lowering effects at lower doses.
- Close monitoring for orthostatic hypotension, dizziness, and changes in renal function is essential during treatment.
- Adequate hydration should be maintained, and caution is warranted when combining perindopril with other antihypertensive medications in this population.
Dosing Recommendations
- Treatment should begin with a lower starting dose, with careful upward titration if needed based on blood pressure response and tolerability.
- The target dose of perindopril in the EUROPA trial was 8 mg/d, which was associated with a 20% relative risk reduction in the primary end point, a composite of cardiovascular death, MI, or cardiac arrest 1.
Important Notes
- Dose adjustments may be necessary if renal function declines over time, which is common in advanced age.
- The EUROPA trial provides the most relevant evidence for the use of perindopril in advanced elderly patients with normal renal function, and its findings should guide clinical decision-making in this population 1.
From the FDA Drug Label
Use in the Elderly Patients: As in younger patients, the recommended initial daily dosage of perindopril erbumine tablets for the elderly (>65 years) is 4 mg daily, given in one or two divided doses The daily dosage may be titrated upward until blood pressure, when measured just before the next dose, is controlled, but experience with perindopril erbumine tablets is limited in the elderly at doses exceeding 8 mg. Dosages above 8 mg should be administered with caution and under close medical supervision. The maximum perindopril daily dose in advanced elderly patients with normal renal function is 8 mg. This dose should not be exceeded without caution and close medical supervision, as experience with the drug is limited at higher doses in this population 2.
From the Research
Maximum Perindopril Daily Dose in Advanced Elderly Patients with Normal Renal Function
- The maximum perindopril daily dose in advanced elderly patients with normal renal function is not explicitly stated in the provided studies.
- However, according to the study 3, a dose reduction of approximately 50% is suggested for elderly patients, with further adjustment proportional to any preexisting diminished renal function.
- The study 4 mentions that perindopril was administered at a dose of 4 mg once daily, and if necessary, the dose was increased to 8 mg/day.
- Another study 5 states that perindopril was started at 2 or 4 mg once daily, and if supine DBP remained > 90 mm Hg, the daily dose could be doubled after 1 or 3 months (or a diuretic added if perindopril titration reached 8 mg).
- It is essential to note that these studies do not specifically address the maximum daily dose for advanced elderly patients with normal renal function, but rather provide guidance on dosage adjustments based on age and renal function 3, 5, 4.