OVERDOSE
In animals, doses of perindopril up to 2500 mg/kg in
mice, 3000 mg/kg in rats and 1600 mg/kg in dogs were non-lethal.
Past experiences were scant but suggested that overdosage
with other ACE inhibitors was also fairly well tolerated
by humans. The most likely manifestation is hypotension,
and treatment should be symptomatic and supportive. Therapy
with the ACE inhibitor should be discontinued, and the
patient should be observed. Dehydration, electrolyte imbalance
and hypotension should be treated by established procedures.
However, of the reported cases of perindopril overdosage,
one (dosage unknown) required assisted ventilation and
the other developed hypothermia, circulatory arrest and
died following ingestion of up to 180 mg of perindopril.
The intervention for perindopril overdose may require
vigorous support (see below).
Laboratory determinations of serum levels of perindopril
and its metabolites are not widely available, and such
determinations have, in any event, no established role
in the management of perindopril overdose.
No data are available to suggest physiological maneuvers
(e.g., maneuvers to change the pH of the urine) that might
accelerate elimination of perindopril and its metabolites.
Perindopril can be removed by hemodialysis, with clearance
of 52 mL/min for perindopril and 67 mL/min for perindoprilat.
Angiotensin II could presumably serve as a specific antagonist-antidote
in the settling of perindopril overdose, but angiotensin
II is essentially unavailable outside of scattered research
facilities. Because the hypotensive effect of perindopril
is achieved through vasodilation and effective hypovolemia,
it is reasonable to treat perindopril overdose by infusion
of normal saline solution.
CONTRAINDICATIONS
ACEON® (perindopril erbumine) Tablets is contraindicated
in patients known to be hypersensitive to this product
or to any other ACE inhibitor. ACEON® Tablets is also
contraindicated in patients with a history of angioedema
related to previous treatment with an ACE inhibitor.
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