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Perindopril is a medication associated with certain safety risks and precautions. Below is essential information to ensure safe use and to understand potential interactions and side effects. Always consult with your healthcare provider if you have any concerns or questions about taking perindopril.

• Harm to Unborn Baby: If taken during pregnancy, especially in the second and third trimesters, perindopril can cause serious birth defects, including small skull size, low blood pressure, and kidney failure, which may be fatal to the unborn baby. It is crucial to avoid pregnancy while on this medication, and if you become pregnant, inform your healthcare provider immediately to explore safer alternatives.

• Angioedema (Swelling): Perindopril may cause angioedema, a rare but serious condition characterized by swelling of the face, throat, tongue, and internal organs. This can lead to difficulty breathing and can be life-threatening. Seek immediate medical help if you experience such symptoms. Individuals of African descent or those with a history of angioedema are at increased risk.

• Low Blood Pressure: Some patients may experience a significant drop in blood pressure, causing dizziness or lightheadedness. This effect is more common during the first two weeks of treatment or after a dosage increase. Stay hydrated and avoid sudden movements from sitting or lying positions to prevent episodes. Contact your provider if symptoms persist.

• Worsening Kidney Problems: Although perindopril can improve kidney function in some patients, it may exacerbate kidney issues in others, particularly those with severe heart failure or blocked kidney arteries. Regular monitoring of kidney function is recommended. Report symptoms like reduced urination, fatigue, or nausea to your healthcare provider.

• Low Blood Cell Count: Rarely, perindopril can lead to a lower white blood cell count or bone marrow suppression, especially in individuals with kidney issues or lupus. Discuss your complete medical history with your provider before starting treatment.

• High Potassium Levels: Perindopril may cause elevated potassium levels, which can be harmful. Patients with diabetes, kidney problems, or those taking medications that increase potassium should be cautious. Signs of high potassium include nausea, muscle weakness, or abnormal heartbeat. Inform your provider if these occur.

• Dry Cough: A persistent dry cough may develop as a side effect due to the inhibition of bradykinin. This usually resolves after discontinuation of the medication. Notify your provider if you experience this symptom.

• Liver Problems: In rare cases, perindopril may cause severe liver issues, potentially due to a blocked bile duct. Be alert for symptoms like abdominal pain, fatigue, or jaundice, and seek medical advice if they appear, especially if you have a history of liver problems.

Contraindications:

• Do not use perindopril if you have a history of angioedema.
• Avoid use with aliskiren (Tekturna) if you have diabetes.
• Do not take it within 36 hours of using Entresto (sacubitril/valsartan).

In case of overdose or any emergency, seek immediate medical attention. Always keep your healthcare provider informed about your medical history and any other medications you are taking.

Common side effects:

• Persistent dry cough
• Dizziness
• Back pain

Serious side effects:

• Angioedema
• Dangerously low blood pressure
• Kidney problems
• Elevated blood potassium levels
• Severe liver issues

Interactions with high risk of serious adverse effects and should be avoided:

• Aliskiren
• Sacubitril

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Amiloride
• Azathioprine
• Azilsartan
• Cyclosporine
• Eplerenone
• Lithium
• Everolimus
• Sirolimus
• ARBs (e.g., Losartan, Valsartan)
• Drospirenone
• Bee/wasp sting allergy desensitization injections

Interactions with low risk that usually do not require a change in therapy:

• Ibuprofen
• Naproxen
• Bumetanide
• Furosemide