Perindopril
Prescription ·Exploratory record · not publication-reviewed ·Updated July 13, 2026
Perindopril is a long-acting angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension and stable coronary artery disease. It is administered as a prodrug that is hydrolyzed in the liver to its active metabolite, perindoprilat. Once-daily dosing reflects its long duration of action.
Exploratory record, not a reviewed medical publication.
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What the research says.
A quick, data-only summary. The full evidence, dosing, and sources are below.
Perindopril is a long-acting angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension and stable coronary artery disease. NutriStack rates the supporting evidence as strong. Common adult dosing is Hypertension (perindopril arginine): 5 mg once daily initially, titrated up to 10 mg once daily; perindopril erbumine: 4 mg once daily, up to 8 mg once daily. Stable CAD (erbumine): 4 mg once daily for 2 weeks, then 8 mg once daily as tolerated. Lower starting doses are used in the elderly and in renal impairment., though a prescriber sets the actual dose. With long-term use it can deplete zinc, sodium. This profile indexes 3 sources.
The bottom line
Evidence rating strong. Most-documented uses: hypertension, stable coronary artery disease (reduction of cardiovascular events), reduction of risk of cardiovascular mortality and nonfatal myocardial infarction in stable cad. 3 sources indexed (2001–2019), with 0 interaction records on file.
How it works, mechanistically.
Core mechanism
Perindopril is a prodrug converted to the active diacid perindoprilat, which inhibits angiotensin-converting enzyme. ACE inhibition blocks the conversion of angiotensin I to the potent vasoconstrictor angiotensin II, leading to vasodilation, reduced aldosterone secretion, and lower blood pressure. Decreased aldosterone promotes sodium and water excretion while potassium is retained, which underlies the risk of hyperkalemia. ACE inhibition also reduces the degradation of bradykinin, contributing to vasodilation as well as the characteristic dry cough and risk of angioedema.1,2
Dosing & protocol.
Food reduces conversion of perindopril to active perindoprilat, lowering bioavailability of the active metabolite; perindopril is therefore recommended to be taken before a meal, typically once daily in the morning. The parent drug itself is rapidly absorbed.
What it depletes.
Nutrients this medication can lower over time, and what to replace.
Zinc
MildACE inhibitors can increase urinary zinc excretion and chelate zinc, potentially lowering plasma and intracellular zinc concentrations over prolonged use.
Sodium
MildACE inhibitors reduce angiotensin II and aldosterone, decreasing renal sodium reabsorption and promoting natriuresis, which can lower serum sodium especially with concurrent diuretic use.
Full safety detail.
Side effects
- Dry persistent cough
- Hypotension and dizziness
- Hyperkalemia
- Headache
- Fatigue
- Elevated serum creatinine / decline in renal function
- Angioedema (uncommon but potentially serious)
- Dysgeusia (altered taste)
- Rash
Contraindications
- History of angioedema (including hereditary or idiopathic angioedema, or ACE inhibitor-associated angioedema)3
- Pregnancy (drugs acting on the renin-angiotensin system can cause fetal harm)3
- Concomitant use of aliskiren in patients with diabetes
- Co-administration with a neprilysin inhibitor (e.g., sacubitril) or within 36 hours of switching from such therapy3
- Bilateral renal artery stenosis1,3
- Known hypersensitivity to perindopril or other ACE inhibitors1,2
Sources, by evidence tier.
Numbered references. Citations throughout the page link here.
Randomized controlled trials
2- 1Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study)PMIDFox KM; European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease Investigators · The Lancet · 2003
In patients with stable coronary disease without heart failure, perindopril 8 mg daily significantly reduced the composite of cardiovascular death, myocardial infarction, or cardiac arrest compared with placebo.
- 2Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack (PROGRESS)PMIDPROGRESS Collaborative Group · The Lancet · 2001
A perindopril-based regimen reduced the risk of recurrent stroke in patients with prior stroke or TIA, with greater benefit when combined with indapamide.
Reference material
1- 3FDA Prescribing Information for perindopril (ACEON / perindopril erbumine)U.S. Food and Drug Administration · FDA Label · 2019
The product label documents hyperkalemia risk (increased with potassium supplements, potassium-sparing diuretics, and salt substitutes), dry cough, angioedema, renal effects, and a boxed warning for fetal toxicity.
Common questions.
Quick answers about Perindopril, drawn from the data on this page.
What is Perindopril?
Perindopril is a long-acting angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension and stable coronary artery disease. It is administered as a prodrug that is hydrolyzed in the liver to its active metabolite, perindoprilat. Once-daily dosing reflects its long duration of action.
What is Perindopril used for?
Commonly cited benefits of Perindopril include: Hypertension; Stable coronary artery disease (reduction of cardiovascular events); Reduction of risk of cardiovascular mortality and nonfatal myocardial infarction in stable CAD. NutriStack rates the overall evidence as strong.
What is a typical dose of Perindopril?
A typical adult dose of Perindopril is Hypertension (perindopril arginine): 5 mg once daily initially, titrated up to 10 mg once daily; perindopril erbumine: 4 mg once daily, up to 8 mg once daily. Stable CAD (erbumine): 4 mg once daily for 2 weeks, then 8 mg once daily as tolerated. Lower starting doses are used in the elderly and in renal impairment.. The commonly recommended form is Oral tablet, taken once daily. These are general ranges, not personalized advice; confirm the right dose with a clinician.
What are the side effects of Perindopril?
Reported side effects include dry persistent cough, hypotension and dizziness, hyperkalemia, headache, fatigue, elevated serum creatinine / decline in renal function. This is educational information; check with a healthcare professional before use.
How strong is the evidence for Perindopril?
NutriStack rates this as Strong, meaning multiple high-quality meta-analyses or systematic reviews converge on the same finding. Full tier criteria are at https://nutristackapp.com/methodology/evidence-tiers.
Use this with your stack
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