Coversyl (perindopril erbumine) is an angiotensin-converting enzyme (ACE) inhibitor indicated for the treatment of essential hypertension and stable coronary artery disease. As a once-daily medication, it offers physicians a well-established therapeutic option for managing cardiovascular risk through its hemodynamic and tissue effects. This product card provides comprehensive information for healthcare professionals regarding the appropriate use, pharmacological profile, and clinical considerations of Coversyl in medical practice.

Features

• Active ingredient: Perindopril erbumine (tertiary amine ester prodrug)
• Pharmacological class: Angiotensin-converting enzyme (ACE) inhibitor
• Available formulations: 2mg, 4mg, and 8mg tablets
• Administration: Oral, once daily dosing
• Bioavailability: Approximately 65-75% after oral administration
• Protein binding: Less than 30% for perindoprilat (active metabolite)
• Elimination half-life: Perindoprilat 3-10 hours (prolonged in renal impairment)
• Excretion: Primarily renal (75% as perindoprilat)

Benefits

• Provides 24-hour blood pressure control with single daily dosing
• Demonstrates proven cardiovascular risk reduction in clinical trials
• Shows vasodilatory effects on both arterial and venous systems
• Exhibits tissue ACE inhibition properties beyond plasma RAAS suppression
• Offers metabolic neutrality with no adverse effects on glucose or lipid metabolism
• Provides hemodynamic benefits in heart failure patients through afterload reduction

Common use

Coversyl is primarily prescribed for the management of essential hypertension, either as monotherapy or in combination with other antihypertensive agents. It is also indicated in stable coronary artery disease to reduce the risk of cardiovascular events in patients with a history of myocardial infarction or revascularization procedures. The medication finds additional application in the management of chronic heart failure as part of a comprehensive treatment regimen, particularly in patients with reduced ejection fraction. Clinical evidence supports its use in diabetic patients with hypertension or proteinuria for renal protection.

Dosage and direction

The recommended initial dose for hypertension is 4mg once daily, which may be increased to 8mg after one month if adequate blood pressure control is not achieved. For elderly patients or those with renal impairment, initiation at 2mg daily is recommended with careful titration. Administration should occur at approximately the same time each day, with or without food, though consistency in timing relative to meals is advised. Tablets should be swallowed whole with a glass of water and not crushed or chewed. Dose adjustments should be based on blood pressure response and tolerability, with monitoring of renal function and electrolytes during titration.

Precautions

Renal function should be assessed before initiation and periodically during treatment, particularly in patients with pre-existing renal impairment, heart failure, or volume depletion. Serum potassium levels require monitoring, especially when used concomitantly with potassium-sparing diuretics, potassium supplements, or salt substitutes containing potassium. Symptomatic hypotension may occur particularly in volume-depleted patients, those on diuretic therapy, or with the first several doses. Angioedema has been reported with ACE inhibitors and may occur at any time during treatment. Neutropenia/agranulocytosis has been reported with ACE inhibitors, particularly in patients with renal impairment or collagen vascular diseases.

Contraindications

Coversyl is contraindicated in patients with known hypersensitivity to perindopril or any other ACE inhibitor. It must not be used in patients with a history of angioedema related to previous ACE inhibitor therapy. The medication is contraindicated during the second and third trimesters of pregnancy due to risk of fetal injury and death. Concomitant use with aliskiren-containing products is contraindicated in patients with diabetes mellitus. Additional contraindications include hereditary or idiopathic angioedema and bilateral renal artery stenosis.

Possible side effects

The most commonly reported adverse reactions include persistent dry cough (up to 12% of patients), dizziness (4-12%), headache (5-14%), and fatigue (3-6%). Gastrointestinal effects such as nausea, vomiting, abdominal pain, and taste disturbance may occur in 2-5% of patients. Orthostatic hypotension has been reported particularly during initial dose titration. Less common but serious adverse effects include angioedema (0.1-0.5%), hyperkalemia, renal impairment, and neutropenia. Rash, photosensitivity, and decreased libido have been reported in rare instances.

Drug interaction

Concomitant use with diuretics may potentiate hypotensive effects, particularly following the first dose. Nonsteroidal anti-inflammatory drugs may reduce the antihypertensive effect and increase the risk of renal impairment. Lithium levels may increase due to reduced renal clearance when used with ACE inhibitors. Concurrent use with potassium-sparing diuretics, potassium supplements, or salt substitutes may lead to significant hyperkalemia. Antidiabetic agents may see enhanced hypoglycemic effects requiring dose adjustment. Dual blockade of the renin-angiotensin system with ARBs or aliskiren increases risks of hypotension, hyperkalemia, and renal impairment.

Missed dose

If a dose is missed, it should be taken as soon as remembered on the same day. If the missed dose is not remembered until the next day, the patient should skip the missed dose and resume the regular dosing schedule. Doubling the dose to make up for a missed dose is not recommended. Patients should be educated on maintaining consistent dosing patterns and setting reminders if adherence issues persist. Healthcare providers should assess adherence patterns during follow-up visits if blood pressure control is suboptimal.

Overdose

Symptoms of overdose may include pronounced hypotension, circulatory shock, bradycardia, electrolyte disturbances, and renal failure. Management should focus on supportive measures including volume expansion with intravenous normal saline for hypotension. Hemodialysis may be effective for removing perindoprilat, particularly in patients with renal impairment. Bradycardia may require atropine administration, and severe hypotension might necessitate vasopressor support. Continuous monitoring of vital signs, electrolyte status, and renal function is essential in overdose management.

Storage

Coversyl tablets should be stored at room temperature (15-30°C) in their original packaging to protect from light and moisture. The medication should be kept out of reach of children and pets. Tablets should not be used beyond the expiration date printed on the packaging. Proper disposal of unused medication should follow local regulations, typically through pharmacy take-back programs rather than flushing or household trash disposal.

Disclaimer

This information is intended for healthcare professionals and should not replace clinical judgment. Prescribing decisions must be based on the individual patient’s medical history, current medications, and specific clinical circumstances. Dosage adjustments may be necessary based on renal function, age, and concomitant conditions. Patients should be fully informed about potential side effects and warning signs requiring medical attention. Regular monitoring of blood pressure, renal function, and electrolytes is recommended during treatment.

Reviews

Clinical studies including the EUROPA trial have demonstrated Coversyl’s efficacy in reducing cardiovascular events in patients with stable coronary artery disease, showing a 20% relative risk reduction in the primary endpoint. The ADVANCE trial documented benefits in diabetic patients with reduced renal and cardiovascular events. Meta-analyses of hypertension trials confirm consistent blood pressure reduction across various patient populations. Real-world evidence supports the maintenance of antihypertensive efficacy with generally favorable tolerability profiles in long-term use. Specialist consensus guidelines frequently include perindopril among recommended ACE inhibitors for both hypertension and cardiovascular protection based on its evidence base.