藥劑部參考美國 Johns Hopkins 大學研究團隊所建立的 NxP (Nephrotoxic Potential) 專家共識分級清單，本品具「顯著以上腎毒性風險」，被認定具中度至高度腎損傷潛勢，特別是同時合併其他腎毒性藥物、脫水、高齡或既有腎功能異常的患者族群，應更加注意。

■ Hypertension■ Congestive heart failure■ In patients with a history of myocardial infarction and/or revascularization, concomitant use of conventional anti-anginal therapy may reduce the risk of cardiac events. 【文字由仿單翻譯而來】

Angiotensin-Converting Enzyme (ACE) Inhibitor; Antihypertensive

■ Peak effect: 1 to 2 hours■ Protein binding: Perindopril: ~60%; Perindoprilat: 10% to 20%■ Metabolism: Hepatically hydrolyzed to active metabolite, perindoprilat (~17% to 20% of a dose) and other inactive metabolites■ Bioavailability: Perindopril: ~75%; Perindoprilat ~25% (~16% with food)■ Half-life elimination: Parent drug: 1.5 to 3 hours; Metabolite: Effective: 3 to 10 hours, Terminal: 30 to 120 hours■ Time to peak: Chronic therapy: Perindopril: ~1 hour; Perindoprilat: 3 to 7 hours (maximum perindoprilat serum levels are 2 to 3 times higher and Tmax is shorter following chronic therapy); CHF: Perindoprilat: 6 hours■ Excretion: Urine (75%, 4% to 12% as unchanged drug)

1.Hypersensitivity (eg, angioedema) to perindopril, other ACE inhibitors, or any component of the formulation2.Hereditary/idiopathic angioedema3.Concomitant use with aliskiren in patients with diabetes mellitus4.Concomitant use or within 36 hours of switching to or from a neprilysin inhibitor (eg, sacubitril).

1. Discontinue ACE inhibitors as soon as possible once pregnancy is detected. Agents other than ACE inhibitors are recommended for the treatment of chronic hypertension during pregnancy (ACOG 2019; ESC [Cifkova 2020]; SOGC [Magee 2022]). Consider the use of ACE inhibitors only for pregnant patients with hypertension refractory to other medications (ACOG 2019). Closely monitor pregnant patients on ACE inhibitors with serial ultrasounds. 2.ACE inhibitors are not recommended for the treatment of heart failure during pregnancy (AHA/ACC/HFSA [Heidenreich 2022]; ESC [Regitz-Zagrosek 2018]).

When postpartum treatment with an angiotensin-converting enzyme (ACE) inhibitor is needed, consider use of an agent other than perindopril (AHA/ACC/HFSA [Heidenreich 2022]; ESC [Cifkova 2020]). Avoid breastfeeding if high maternal doses of an ACE inhibitor are needed (ACOG 2019).

■ Asthenia (5% to 7%)■ Cough (2% to 6%)■ Lower extremity pain (5%)■ Rhinitis (5%), sinusitis (5%)■ Dermatologic disorder (4%)■ Nausea (?4%), stomach pain (?4%), upper abdominal pain (?4%), vomiting (?4%)pharyngitis (4%)

■ Hypertension:5 mg once daily (in the morning, before meals), the dose may be increased to 10 mg once daily after one month of treatment.For elderly patients, recommended starting dose is 2.5 mg once daily.The dosemay be gradually increased after one month to 5 mg → 10 mg once daily■ Congestive Heart FailureStarting dose: 2.5 mg once daily (in the morning)If well tolerated, the dose may be increased after 2 weeks to 5 mg once daily■ Patients with a history of myocardial infarction and/or revascularization:1.Concomitant use with conventional anti-anginal therapy may reduce the risk of cardiac events2.Start with 5 mg once daily for 2 weeks → if tolerated and based on renal function, increase to 10 mg once daily3.Elderly patients:Week 1: 2.5 mg once daily；Week 2: 5 mg once dailyDepending on renal function, may increase to a maximum of 10 mg once daily, provided the previous dose was well tolerated

The efficacy and safety in children and adolescents have not been established; therefore, use in this population is not recommended.

■ CrCl ? 60 mL/min: 5 mg once daily■ CrCl 30 to < 60 mL/min: 2.5 mg once daily■ CrCl 15 to < 30 mL/min: 2.5 mg every other day■ ESRD (CrCl < 15 mL/min): 2.5 mg on dialysis days■ In patients undergoing dialysis, the drug should be administered after dialysis.

No dosage adjustment

Keep the container tightly closed.