Coversyl (Perindopril Erbumine)
Also sold as: Coversyl, Acertil, Perindo, Prexum, Biopress
Pregnancy
Cat D
Lactation
Avoid
Schedule
H
Forms
Tablet 2mg, 4mg, 8mg; Perindopril arginine 5mg, 10mg (equivalent formulations)
Indications
- Hypertension
- Stable coronary artery disease (reduces CV events — EUROPA trial)
- Heart failure (with HF specialists)
- Secondary stroke prevention (with indapamide — PROGRESS trial)
Adult Dosing
Hypertension
4 mg PO once daily (morning, before food)
Titrate to 8 mg once daily after 1 month. Elderly: start 2 mg.
Stable CAD
8 mg PO once daily (after titration from 4 mg)
Ongoing — cardiovascular risk reduction
Heart failure
2–4 mg once daily; titrate slowly to 8 mg
Specialist supervised
Pediatric Dosing
Limited paediatric data — specialist use
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl 30–60 mL/min | 2 mg once daily |
| CrCl 15–30 mL/min | 2 mg every other day |
| CrCl < 15 mL/min | Haemodialysis patients: 2 mg on day of dialysis |
Hepatic Adjustment
No dose adjustment for mild-moderate hepatic impairment; use cautiously in severe impairment
Pregnancy & Lactation
Pregnancy: Category D
CONTRAINDICATED in 2nd and 3rd trimesters — causes foetal renal dysplasia, oligohydramnios, limb contractures, skull hypoplasia, neonatal death. Stop immediately when pregnancy detected.
Lactation: Avoid
Insufficient data; avoid — use alternative ACE inhibitor with better lactation data or switch to methyldopa/labetalol
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Potassium-sparing diuretics / K+ supplements | Hyperkalaemia — serious risk | Major |
| NSAIDs | Reduced antihypertensive effect; acute kidney injury risk | Moderate |
| Sacubitril/valsartan | CONTRAINDICATED — angioedema; 36-hour washout required | Major |
| Aliskiren (diabetes/CKD) | Dual RAAS — contraindicated | Major |
| Lithium | Elevated lithium levels — toxicity | Major |
| Indapamide | Synergistic BP reduction (PROGRESS combination — beneficial) | Minor |
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Side Effects
Common
- Dry cough (bradykinin — class effect)
- Hypotension (first dose, especially if dehydrated)
- Dizziness
- Hyperkalaemia
- Fatigue
Serious / Discontinue If
- Angioedema (rare but life-threatening)
- Acute kidney injury (bilateral RAS, dehydration)
- Foetal toxicity in pregnancy
- Neutropenia (rare)
Contraindications
- Previous ACE inhibitor angioedema
- Hereditary angioedema
- Bilateral renal artery stenosis
- Pregnancy (2nd/3rd trimester)
- Concurrent sacubitril/valsartan
- Concurrent aliskiren in DM/CKD
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Coversyl 4mg | Serdia (Servier) | 30 tab ₹195 |
| Perindo 4mg | Cipla | 30 tab ₹125 |
| Acertil 4mg | Sanofi | 30 tab ₹165 |
| Biopress 4mg | Intas | 30 tab ₹115 |
Monitoring Required
- Blood pressure
- Serum creatinine and potassium (1–2 weeks after dose changes)
- Cough assessment
- eGFR (renal function monitoring)
Patient Counseling Points
- Take in the morning before breakfast — food reduces absorption
- Dry cough is common — tell your doctor; switching to an ARB resolves it
- First dose: dizziness possible — sit quietly for 2 hours
- ⚠️ Throat or face swelling → emergency immediately (angioedema)
- ⚠️ Absolutely not safe in pregnancy — stop and call doctor if pregnant
- Do not take with potassium-containing salt substitutes
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Clinically reviewed by: Dr. Meenakshi Iyer, DM (Cardiology), Consultant Cardiologist
Last reviewed: 2026-04-01
References
- ESC Hypertension Guidelines 2023
- EUROPA Trial (Lancet 2003)
- PROGRESS Trial (Lancet 2001)
- BNF — Perindopril