From the FDA Drug Label
In patients with essential hypertension, the recommended initial dose is 4 mg once a day The dosage may be titrated upward until blood pressure, when measured just before the next dose, is controlled or to a maximum of 16 mg per day. 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 upper limit of perindopril daily dose in advanced elderly (> 95 years old) with normal renal function is 16 mg. However, it is recommended that dosages above 8 mg should be administered with caution and under close medical supervision 1.
From the Research
For elderly patients over 95 years old with normal renal function, the recommended upper limit of perindopril is typically 8 mg once daily, as supported by the study 2. However, it's advisable to start at a lower dose of 2-4 mg daily and titrate gradually based on blood pressure response and tolerability. Despite normal renal function, very elderly patients often have altered pharmacokinetics and increased sensitivity to medications. Close monitoring for hypotension, especially orthostatic hypotension, is essential when using perindopril in this age group. Some key points to consider when using perindopril in this population include:
- Kidney function should be regularly assessed even if baseline values are normal, as the elderly are at higher risk for acute changes in renal function.
- Electrolytes, particularly potassium levels, should be monitored due to the risk of hyperkalemia with ACE inhibitors.
- If the patient is also taking other antihypertensives, diuretics, or NSAIDs, dose adjustments may be necessary to prevent adverse effects from drug interactions. It's also worth noting that combination therapy with other antihypertensive agents, such as calcium channel blockers, may be effective in achieving blood pressure goals, as discussed in the study 3. Ultimately, the goal of treatment should be to improve the patient's quality of life while minimizing the risk of adverse effects, as emphasized in the study 4.