Aceon

Aceon (perindopril erbumine) is an angiotensin-converting enzyme (ACE) inhibitor prescribed for the management of hypertension and stable coronary artery disease. As a prodrug, it is metabolized to its active form, perindoprilat, which exerts potent vasodilatory effects by inhibiting the conversion of angiotensin I to angiotensin II. This mechanism reduces peripheral arterial resistance, lowers blood pressure, and decreases cardiac afterload, making it a cornerstone therapy in cardiovascular risk reduction. Clinical evidence supports its efficacy in improving endothelial function and reducing cardiovascular events in high-risk patients.

Features

• Active ingredient: Perindopril erbumine
• Drug class: Angiotensin-converting enzyme (ACE) inhibitor
• Available strengths: 2 mg, 4 mg, and 8 mg tablets
• Administration: Oral, once-daily dosing
• Bioavailability: Approximately 75% following oral administration
• Half-life: Active metabolite perindoprilat has an elimination half-life of 3-10 hours
• Excretion: Primarily renal (75%) with some fecal elimination

Benefits

• Effectively lowers systolic and diastolic blood pressure through RAAS inhibition
• Reduces cardiovascular mortality and morbidity in patients with stable coronary artery disease
• Demonstrates protective effects on vascular endothelium and improves arterial elasticity
• Shows evidence of reducing left ventricular hypertrophy in hypertensive patients
• May slow progression of renal disease in hypertensive patients with diabetes
• Provides 24-hour blood pressure control with once-daily dosing convenience

Common use

Aceon is primarily indicated for the treatment of essential hypertension, either as monotherapy or in combination with other antihypertensive agents. It is also approved for use in patients with stable coronary artery disease to reduce the risk of cardiovascular mortality or nonfatal myocardial infarction. Additionally, it may be used off-label in certain cases of heart failure with reduced ejection fraction and for secondary prevention in post-myocardial infarction patients, though other ACE inhibitors may be preferred for these indications based on trial evidence.

Dosage and direction

The recommended initial dose for hypertension is 4 mg once daily, which may be increased to 8 mg once daily after at least two weeks of therapy based on blood pressure response. For elderly patients or those with renal impairment, starting with 2 mg once daily is advised. Doses may be titrated upward at intervals of at least two weeks. The maximum recommended daily dose is 16 mg, though most patients achieve adequate control with 8 mg daily. Administration should occur at approximately the same time each day, with or without food, though consistency in timing relative to meals is recommended. Tablets should be swallowed whole with a glass of water and not crushed or chewed.

Precautions

Patients should be monitored for hypotension, especially during initial titration and in volume-depleted states. Renal function should be assessed before initiation and periodically during therapy, particularly in patients with pre-existing renal impairment, diabetes, or congestive heart failure. Serum potassium levels require monitoring, especially when used concomitantly with potassium-sparing diuretics or potassium supplements. Angioedema may occur at any time during treatment, requiring immediate discontinuation and emergency management if involving the airway. Neutropenia/agranulocytosis has been reported with ACE inhibitors, particularly in patients with collagen vascular disease or renal impairment. Use during pregnancy should be avoided due to potential fetal harm, particularly in the second and third trimesters.

Contraindications

Aceon is contraindicated in patients with a history of angioedema related to previous ACE inhibitor therapy or hereditary/idiopathic angioedema. It should not be used in patients hypersensitive to perindopril or any component of the formulation. Concomitant use with aliskiren in patients with diabetes is contraindicated. The drug is contraindicated during pregnancy due to risk of fetal injury and mortality. It should not be administered to patients with bilateral renal artery stenosis or solitary kidney with renal artery stenosis.

Possible side effects

Common adverse reactions (≥2%) include cough (12%), dizziness (4%), headache (4%), fatigue (3%), and back pain (2%). Less frequent but clinically significant side effects may include angioedema (0.1-0.5%), hyperkalemia (2%), hypotension (1-2%), and renal impairment (1-2%). Rare but serious adverse events include neutropenia/agranulocytosis, hepatic failure, and pancreatitis. The characteristic dry, persistent cough associated with ACE inhibitors may necessitate discontinuation in some patients. Gastrointestinal effects such as nausea, diarrhea, or dyspepsia occur in less than 2% of patients.

Drug interaction

Concomitant use with diuretics may potentiate hypotension, particularly following the first dose. NSAIDs may diminish the antihypertensive effect and increase risk of renal impairment. Potassium-sparing diuretics, potassium supplements, or salt substitutes containing potassium may increase the risk of hyperkalemia. Lithium levels may increase with ACE inhibitor coadministration, requiring close monitoring. Dual blockade of the RAAS with ARBs or aliskiren increases risks of hypotension, hyperkalemia, and renal impairment. Antidiabetic agents may see enhanced hypoglycemic effects, particularly insulin and sulfonylureas. Gold injections may rarely cause nitritoid reactions.

Missed dose

If a dose is missed, it should be taken as soon as remembered on the same day. If it is near the time for the next scheduled dose, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed dose. Consistency in daily dosing is important for maintaining stable blood pressure control, so patients should be advised to establish a routine for medication administration.

Overdose

Symptoms of overdose may include severe hypotension, bradycardia, circulatory shock, electrolyte disturbances, and renal failure. Management involves supportive care with volume expansion with normal saline for hypotension. Perindopril is not effectively removed by hemodialysis due to high protein binding, though dialysis may be considered for managing associated electrolyte imbalances. Bradycardia may require atropine administration. Patients should be monitored in an intensive care setting with continuous blood pressure and ECG monitoring.

Storage

Store at controlled room temperature between 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C to 30°C (59°F to 86°F). Keep the container tightly closed and protect from moisture and light. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Do not transfer tablets to other containers, as the original packaging provides protection from light and moisture.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Aceon is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Dosage and treatment decisions must be made by a physician based on individual patient characteristics and medical history. Patients should not alter their dosage or discontinue medication without consulting their healthcare provider. The full prescribing information should be consulted before initiating therapy.

Reviews

Clinical trials demonstrate Aceon’s efficacy in blood pressure reduction, with mean reductions of 8-12 mmHg systolic and 5-8 mmHg diastolic at 8 mg daily dose. The EUROPA study showed a 20% relative risk reduction in cardiovascular death, myocardial infarction, or cardiac arrest in patients with stable coronary artery disease. Many clinicians note its favorable side effect profile compared to other antihypertensive classes, though the characteristic ACE inhibitor cough remains a limitation for some patients. Long-term users often report stable blood pressure control and good tolerability, particularly appreciating the once-daily dosing regimen. Some studies suggest potential pleiotropic effects beyond blood pressure control, including improved vascular function and reduced atherosclerosis progression.