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ESRU

Perindopril + Indapamide

Fixed-dose combination: ACE inhibitor plus thiazide-like diuretic

ATC code: C09BX01(Perindopril and indapamide)

Updated · Methodology

Indications

A

Hypertension

Second line

Essential hypertension uncontrolled on perindopril monotherapy. Per ESH/ 2023 and SEH-LELHA 2023 – second-line. Per HYVET 2008, particularly useful in patients over 80 (21% mortality reduction over 1.8 years). Dose: 2.5/0.625, 5/1.25, 10/2.5 mg once daily in the morning on an empty stomach. Full effect at 4 weeks.

Sources

  1. AEMPS: Ficha técnica de Perindopril + Indapamida (2024)
  2. ESC: 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. (2024)

ICD-10: I10 · ICD-11: BA00

How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

Perindopril inhibits ACE through the active metabolite perindoprilat with T½ 25 h, giving 24-hour BP control. Indapamide is a thiazide-like diuretic with minimal lipid or glucose effects and intrinsic vasodilator action. Evidence base – HYVET in patients ≥80 (NEJM 2008) and PROGRESS in stroke survivors.

Safety

Contraindications

  • Hypersensitivity
  • History of angioedema
  • Pregnancy (2nd-3rd trimester)
  • Severe hepatic and renal impairment
  • Hypokalemia
  • Concomitant aliskiren in diabetes or CrCl <60

Serious adverse effects

  • Angioedema
  • Acute kidney injury
  • Severe hypokalemia (arrhythmia risk)
  • Hyponatremia with neurologic symptoms

Common adverse effects

  • Dry cough
  • Dizziness
  • Hypotension
  • Hypokalemia
  • Hyponatremia
  • Hyperuricemia

Pregnancy: can you take Perindopril + Indapamide?

Contraindicated from the 2nd trimester (ACE inhibitor fetopathy). Switch to methyldopa, labetalol, or slow-release nifedipine.

Breastfeeding: can you take Perindopril + Indapamide?

Perindopril breastfeeding data are limited. If an ACE inhibitor is needed during nursing, prefer enalapril (RID 0.2%) or captopril (RID 0.02%).

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Practical notes

Timing and administration

Morning on an empty stomach – food reduces perindopril bioavailability by 35%.

Monitoring

K+ and creatinine at 1–2 weeks after start, yearly thereafter. In patients ≥80, more frequent monitoring; pause for 1–3 days during dehydration (diarrhea, fever) to prevent AKI.

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Frequently asked

What is Perindopril + Indapamide used for?

Perindopril + Indapamide is evaluated for the following indications with varying evidence strength: Hypertension (evidence tier A). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Perindopril + Indapamide?

Common side effects of Perindopril + Indapamide (≥ 1 in 100): Dry cough, Dizziness, Hypotension, Hypokalemia, Hyponatremia, Hyperuricemia. See the Safety section for uncommon and serious reactions.

Is Perindopril + Indapamide safe during pregnancy?

Contraindicated from the 2nd trimester (ACE inhibitor fetopathy). Switch to methyldopa, labetalol, or slow-release nifedipine.

Is Perindopril + Indapamide compatible with breastfeeding?

Perindopril breastfeeding data are limited. If an ACE inhibitor is needed during nursing, prefer enalapril (RID 0.2%) or captopril (RID 0.02%).

Who should not take Perindopril + Indapamide?

Perindopril + Indapamide is contraindicated in: Hypersensitivity; History of angioedema; Pregnancy (2nd-3rd trimester); Severe hepatic and renal impairment; Hypokalemia. Full list in the Safety section.

Other drugs in this group

Ramipril, Sacubitril + Valsartan, Telmisartan, Telmisartan + Hydrochlorothiazide, Valsartan, Amlodipine + Valsartan + Hydrochlorothiazide, Candesartan + Hydrochlorothiazide, Irbesartan + Hydrochlorothiazide