Do not take Perindopril

• If you are allergic (hypersensitive) to perindopril or to any of the other ingredients of this medicine (listed in Section 6), or to any other ACE inhibitor,
• If you have experienced symptoms such as wheezing, swelling of the face, tongue or throat, intense itching or severe skin rashes with previous ACE inhibitor treatment or if you or a member of your family have had these symptoms in any other circumstances (a condition called angioedema),
• If you are more than 3 months pregnant. (It is also better to avoid Perindopril in early pregnancy – see pregnancy section.)
• If you have diabetes or impaired kidney function and you are treated with a blood pressure lowering medicine containing aliskiren.
• if you are having dialysis or any other type of blood filtration. Depending on the machine that is used may not be suitable for you.
• If you have kidney problems where the blood supply to your kidneys is reduced (renal artery stenosis).
• If you have taken or are currently taking sacubitril/valsartan, a medicine used to treat a type of long-term (chronic) heart failure in adults, the risk of angioedema (rapid swelling under the skin in an area such as the throat) is increased.

Warnings and precautions

Talk to your doctor, pharmacist or nurse before taking Perindopril if:

• you have aortic stenosis (narrowing of the main blood vessel leading from the heart) or hypertrophic cardiomyopathy (heart muscle disease) or renal artery stenosis (narrowing of the artery supplying the kidney with blood)
• you have any other heart problems
• you have liver problems
• you have kidney problems, or if you are receiving dialysis
• you have abnormally increased levels of a hormone called aldosterone in your blood (primary aldosteronism).
• you suffer from a collagen vascular disease (disease of the connective tissue) such as systemic lupus erythematosus or scleroderma
• you have diabetes
• you are on a salt restricted diet or use salt substitutes which contain potassium,
• you are to undergo anaesthesia and/or major surgery,
• are to undergo LDL apheresis (which is removal of cholesterol from your blood by a machine),
• you are going to have desensitization treatment to reduce the effects of an allergy to bee or wasp stings
• you have recently suffered from diarrhoea or vomiting, or are dehydrated
• you have been told by your doctor that you have an intolerance to some sugars.
• you are taking any of the following medicines used to treat high blood pressure:
  • an angiotensin II receptor blocker (ARBs) (also known as sartans – for example valsartan, telmisartan, irbesartan), in particular if you have diabetes-related kidney problems.
  • aliskiren

Your doctor may check your kidney function, blood pressure, and the amount of electrolytes (e.g. potassium) in your blood at regular intervals. See also information under the heading “Do not take Perindopril”.

• you are of black origin since you may have a higher risk of angioedema and this medicine may be less effective in lowering your blood pressure than in non-black patients.
• you are taking any of the following medicines, the risk of angioedema may be increased:
  • racecadotril (a medicine used to treat diarrhea)
  • Medicines used to prevent organ transplant rejection and for cancer (e.g. sirolimus, everolimus, temsirolimus)
  • Vildagliptin, a medicine used to treat diabetes
  • sacubitril (available as fixed-dose combination with valsartan), used to treat long-term heart failure.

Angioedema

Angioedema (a severe allergic reaction with swelling of the face, lips, tongue or throat with difficulty in swallowing or breathing) has been reported in patients treated with ACE inhibitors, including Perindopril. This may occur at any time during treatment. If you develop such symptoms, you should stop taking Perindopril and see a doctor immediately. See also section 4.

You must tell your doctor if you think you are (or might become) pregnant. Perindopril is not recommended in early pregnancy, and must not be taken if you are more than 3 months pregnant, as it may cause serious harm to your baby if used at that stage (see pregnancy section).

Children and adolescents

Perindopril is not recommended for use in children and adolescents up to the age of 18 years.

Other medicines and Perindopril

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines.

Treatment with Perindopril can be affected by other medicines. Your doctor may need to change your dose and/or to take other precautions. These include:

• other medicines for high blood pressure, including angiotensin II receptor blockers (ARB), aliskiren (see also information under the headings “Do not take Perindopril” and “Warnings and precautions”) or diuretics (medicines which increase the amount of urine produced by the kidneys)
• potassium supplements (including salt substitutes), potassium-sparing diuretics and other medicines that can increase the amount of potassium in your blood (e.g. trimethoprim and co-trimoxazole for infections caused by bacteria; ciclosporin, an immunosuppressant medicine used to prevent organ transplant rejection; and heparin, a medicine used to thin blood to prevent clots).
• non-steroidal anti-inflammatory drugs (e.g. ibuprofen) for pain relief or high dose aspirin,
• medicines to treat diabetes (such as insulin or metformin)
• baclofen (used to treat muscle stiffness in diseases such as multiple sclerosis) ,
• medicines to treat mental disorders such as depression, anxiety, schizophrenia etc (e.g. tricyclic antidepressants, antipsychotics),
• lithium for mania or depression
• allopurinol for treatment of gout
• immunosupressants (medicines which reduce the defence mechanism of the body) used to treat auto-immune disorders or following transplant surgery (e.g. ciclosporin, tacrolimus).
• trimethoprim (for the treatment of infections)
• estramustine (used in cancer therapy)
• procainamide (for treatment of irregular heartbeat)
• medicines for the treatment of low blood pressure, shock or asthma (including ephedrine, noradrenaline or adrenaline)
• vasodilators including nitrates(products that make the blood vessels become wider).
• gold salts, especially with intravenous administration (used to treat symptoms of rheumatoid arthritis)
• medicines which are most often used to treat diarrhea (racecadotril)
• medicines which are most often used to avoid rejection of transplanted organs (sirolimus, everolimus and other medicines belonging to the class of mTOR inhibitors). See sections “Do not take Perindopril” and “Warnings and precautions”.
• sacubitril/valsartan (used to treat long-term heart failure). See sections “Do not take Perindopril” and “Warnings and precautions”)

Perindopril with food and drink

It is recommended to take Perindopril tablets in the morning before a meal

Pregnancy and breastfeeding:

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine

Pregnancy:

You must tell your doctor if you think you are (or might become) pregnant. Your doctor will normally advise you to stop taking Perindopril before you become pregnant or as soon as you know you are pregnant and will advise you to take another medicine instead of Perindopril. Perindopril is not recommended in early pregnancy, and must not be taken when more than 3 months pregnant, as it may cause serious harm to your baby if used after the third month of pregnancy.

Breastfeeding:

Tell your doctor if you are breast-feeding or about to start breast-feeding. Perindopril is not recommended for mothers who are breast-feeding, and your doctor may choose another treatment for you if you wish to breast-feed, especially if your baby is newborn, or was born prematurely.

Driving and using machines:

Perindopril Tablets usually does not affect alertness but dizziness or weakness due to low blood pressure may occur in certain patients. If you are affected in this way, your ability to drive or operate machinery may be impaired.

Perindopril tablets contain lactose

The tablets contain lactose. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine