Fixed-dose combination: ACE inhibitor plus thiazide-like diuretic
ATC code: C09BX01 (Perindopril and indapamide)
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.
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.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Contraindicated from the 2nd trimester (ACE inhibitor fetopathy). Switch to methyldopa, labetalol, or slow-release nifedipine.
Perindopril breastfeeding data are limited. If an ACE inhibitor is needed during nursing, prefer enalapril (RID 0.2%) or captopril (RID 0.02%).
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
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.
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.
FDA category D. Contraindicated from the 2nd trimester (ACE inhibitor fetopathy). Switch to methyldopa, labetalol, or slow-release nifedipine.
Perindopril breastfeeding data are limited. If an ACE inhibitor is needed during nursing, prefer enalapril (RID 0.2%) or captopril (RID 0.02%).
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.