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Coversyl Plus

(perindopril - indapamide)



How does this medication work? What will it do for me?

This combination product contains 2 medications: perindopril and indapamide. It is used to treat adults with mild to moderate high blood pressure.

Perindopril belongs to the class of medications called angiotensin converting enzyme (ACE) inhibitors. It works by relaxing blood vessels and helping the heart to pump blood that carries oxygen to the different parts of the body more efficiently. Indapamide belongs to the class of medications called diuretics or "water pills," which help control blood pressure by getting rid of excess salt and water.

This combination medication is prescribed when your doctor feels it is appropriate for you to be taking both medications.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

How should I use this medication?

This combination medication is used to make dosing more convenient for people who need to take both of these medications (perindopril and indapamide). The dose of the combination medication depends on the doses of the individual medications the person needs.

The usual recommended dose of this medication is one tablet taken once a day, preferably in the morning before a meal.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

What form(s) does this medication come in?

Coversyl Plus
Each white, rod-shaped tablet contains perindopril 4 mg and indapamide 1.25 mg. Nonmedicinal ingredients: microcrystalline cellulose, lactose monohydrate, hydrophobic colloidal silica, and magnesium stearate.

Coversyl Plus LD
Each white, rod-shaped, scored tablet contains perindopril erbumine 2 mg and indapamide 0.625 mg. Nonmedicinal ingredients: hydrophobic colloidal silica, lactose monohydrate, magnesium stearate, and microcrystalline cellulose.

Coversyl Plus HD
Each white, round tablet contains perindopril 8 mg and indapamide 2.5 mg. Nonmedicinal ingredients: microcrystalline cellulose, lactose monohydrate, hydrophobic colloidal silica, and magnesium stearate.

Who should NOT take this medication?

Do not use perindopril - indapamide if you:

  • are allergic to perindopril, indapamide, or any ingredients of the medication
  • are allergic to sulfa (sulfonamide) medications (e.g., sulfamethoxazole)
  • are pregnant
  • are breast-feeding
  • have decreased kidney function or are unable to pass urine
  • have untreated high or low potassium
  • have had angioedema (a serious allergic reaction that causes the area around the throat and tongue to swell) after taking any ACE inhibitors (e.g., captopril, ramipril)
  • have diabetes or kidney disease and are taking aliskiren
  • have galactose intolerance (a rare hereditary disease)
  • have hereditary angioedema (a serious allergic reaction which causes swelling of the hands, feet, ankles, face, lips, tongue, or throat) or have angioedema with no known cause
  • have lactose intolerance
  • have severely decreased liver function or have hepatic encephalopathy
  • have untreated heart failure

This medication should not be given to anyone who is in a coma due to reduced liver function.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • abdominal pain
  • cold-like symptoms
  • constipation
  • cough (dry, persistent)
  • diarrhea
  • dizziness
  • dry mouth
  • headache
  • heartburn
  • nausea
  • sweating
  • taste changes (e.g., metallic taste)
  • tiredness
  • vomiting
  • weakness

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • dizziness, lightheadedness, or fainting (signs of low blood pressure)
  • fast or irregular heartbeat
  • joint pain (e.g., toe pain may be a sign of gout)
  • muscle cramps or unexplained muscle pain
  • signs of anemia (low red blood cells; e.g., dizziness,  pale skin, unusual tiredness or weakness, shortness of breath)
  • signs of bleeding (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood,  bleeding gums, cuts that don't stop bleeding)
  • signs of infection (symptoms may include fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness)
  • signs of kidney problems (e.g., decreased urination, nausea, vomiting, swelling of legs, hands, fatigue)
  • signs of liver problems such as abdominal pain, nausea or vomiting, itching of skin, yellow eyes or skin
  • signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, swollen abdomen)
  • signs of too much or too little potassium in the body (e.g., dry mouth; increased thirst; irregular heartbeat; mood or mental changes; muscle cramps or pain; numbness or tingling in hands, feet, or lips; weak pulse; weakness or heaviness of legs)
  • skin rash, with or without itching, fever, or joint pain
  • stomach pain (severe) with nausea and vomiting
  • swelling of hands, ankles or feet
  • symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)
  • tingling or burning sensation

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • chest pain
  • symptoms of a serious allergic reaction, including angioedema (e.g., hives; swelling of the face, mouth, hands, or feet; and difficulty breathing)
  • severe skin rash, including skin blistering and peeling (possibly with headache, fever, coughing, or aching before the rash begins)
  • symptoms of increased pressure in the eyes (e.g., decreased or blurred vision, eye pain, red eye, swelling of the eye)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

HEALTH CANADA ADVISORY

February 4, 2014

Health Canada has issued new restrictions concerning the use of perindopril. To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.

Abnormal heart rhythms: This medication can cause abnormal heart rhythms. Certain medications (e.g., sotalol, quinidine, thioridazine, chlorpromazine, droperidol, pimozide, moxifloxacin, mefloquine, pentamidine, arsenic trioxide, dolasetron mesylate, tacrolimus) can increase the risk of a type of abnormal heart rhythm called torsades de pointes and should be used with caution with indapamide.

If you are taking medication for abnormal heart rhythms, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Allergic reaction: This medication may cause a serious allergic reaction called angioedema, which may be fatal if not treated promptly. If you have difficulty breathing, notice hives or swelling of the face, lips, tongue, or throat, stop taking this medication and get emergency medical help at once.

Other ACE inhibitors should not be taken in the future. People who have had angioedema caused by other substances may be at increased risk of angioedema while receiving this medication.

Blood disorders: In rare cases, a low white blood cell count has been reported by people taking this medication. Your doctor may occasionally monitor your level of white blood cells by performing blood tests. Low white blood cell levels may increase your risk for infection. If you notice any signs of infection (e.g., fever, sore throat), contact your doctor as soon as possible.

Cough: People taking perindopril may develop a dry, persistent cough that usually disappears only after stopping this medication.

Decreased blood pressure: Occasionally, blood pressure drops too low after taking this medication, especially when getting up from a sitting or lying position. This may lead to fainting. It is more common after the first or second dose, when the dose is increased, or when a person is dehydrated. To reduce the risk of dizziness, get up slowly from a lying down or sitting position. If low blood pressure causes you to faint or feel lightheaded, contact your doctor.

Diabetes: Indapamide may make it more difficult for people with diabetes to control their blood sugar. Your doctor will monitor you while you are taking this medication and may need to adjust your doses of antidiabetes medications.

Fluid and electrolyte balance: Your levels of electrolytes, such as potassium, sodium, calcium, magnesium, and chloride, may change due to this medication. Your doctor may periodically ask for tests to check that these are in balance. If you experience symptoms of fluid and electrolyte imbalance such as muscle pains or cramps; dry mouth; numb hands, feet, or lips; or racing heartbeat, contact your doctor as soon as possible. Salt substitutes containing potassium should be avoided.

Gout: High levels of uric acid may occur in the blood or gout (a type of arthritis that causes sudden, severe attacks of joint pain with redness, warmth, and swelling in the affected area) may be brought on in certain people receiving indapamide.

Kidney function: This medication may change the kidney function in certain people. Your doctor will monitor you closely while you are taking this medication. Let your doctor know if you notice any decrease in urine production, or increased swelling of the lower limbs, suggesting accumulation of fluid due to decreased urination.

Liver function:  Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. This medication can also worsen liver function. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication. If you notice any signs of liver problems (e.g., abdominal pain, itching of skin, or yellow eyes or skin, loss of appetite, vomiting), contact your doctor immediately.

Surgery: Tell your doctor and anesthesiologist that you are taking this medication before you undergo any surgical procedures requiring general anesthesia.

Pregnancy: ACE inhibitors such as perindopril have the potential to cause serious problems during pregnancy. This medication should not be used by pregnant women. If you become pregnant while taking this medication, stop taking it immediately and contact your doctor.

Breast-feeding: Perindopril passes into breast milk. It is not known if indapamide passes into breast milk. Do not breast-feed if you are taking this medication.

Children: The safety and effectiveness of using this medication have not been established for children. It is not recommended for children.

What other drugs could interact with this medication?

There may be an interaction between perindopril - indapamide and any of the following:

  • alcohol
  • alfuzosin
  • aliskiren
  • allopurinol
  • aliskiren
  • allopurinol
  • alpha agonists (e.g., clonidine, methyldopa)
  • amifostine
  • amiodarone
  • amphetamines (e.g., dextroamphetamine, lisdexamphetamine)
  • anagrelide
  • angiotensin receptor blockers (ARBs; e.g., candasartan, irbesartan, losartan)
  • antacids (e.g., aluminum hydroxide, calcium carbonate, magnesium hydroxide)
  • antiarrhythmics (e.g., amiodarone, quinidine)
  • anticholinergics (e.g., benztropine, disopyramide, ipratropium, oxybutynin)
  • other angiotensin converting enzyme inhibitors (ACEIs; e.g., captopril, lisinopril, ramipril)
  • antihistamines (e.g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
  • antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, pimozide, quetiapine, risperidone, thioridazine, ziprasidone)
  • azathioprine
  • barbiturates (e.g., phenobarbital, secobarbital, butalbital)
  • beta-adrenergic blockers (e.g., metoprolol, propranolol)
  • beta 2 agonists (e.g., formoterol, salmeterol)
  • brimonidine
  • calcitriol
  • calcium channel blockers (e.g., amlodipine, diltiazem, nifedipine)
  • carbamazepine
  • cholestyramine
  • colestipol
  • oral corticosteroids (e.g., dexamethasone, hydrocortisone, prednisone)
  • inhaled corticosteroids (e.g., budesonide, ciclesonide, fluticasone)
  • cyclosporine
  • diabetes medications (e.g., insulin, glyburide, metformin, glipizide, metformin, nateglinide, rosiglitazone)
  • diuretics (water pills; e.g., furosemide, amiloride, spironolactone, triamterene)
  • dofetilide
  • dronedarone
  • everolimus
  • gold salts (e.g., sodium aurothiomalate)
  • ginger
  • ginseng
  • granisetron
  • heparin
  • iron dextran
  • iron supplements
  • licorice
  • lithium
  • lopinavir
  • low molecular weight heparins (LMWH) (e.g., dalteparin, enoxaparin, tinzaparin)
  • macrolide antibiotics (e.g., azithromycin, clarithromycin,, erythromycin)
  • medications that increase blood levels of potassium (e.g., potassium supplements, salt replacements containing potassium, spironolactone, triamterene, amiloride)
  • multivitamins/minerals with ADE
  • monoamine oxidase inhibitors (MAOIs; e.g., moclobemide, phenelzine, rasagiline, selegiline, tranylcypromine)
  • narcotic pain relievers (e.g., morphine, codeine)
  • nilotinib
  • nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen, indomethacin, naproxen)
  • ondansetron
  • oxcarbazepine
  • phosphodiesterase 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
  • procainamide
  • quinolone antibiotics (e.g., ciprofloxacin)
  • quinidine
  • quinine
  • rituximab
  • salicylates (e.g., acetylsalicylic acid)
  • selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, duloxetine, fluoxetine, paroxetine, sertraline)
  • sodium phosphate
  • temsirolimus
  • tetrabenazine
  • topiramate
  • tricyclic antidepressants (e.g., amitriptyline, imipramine)
  • trimethoprim
  • vandetanib
  • vemurafenib
  • vitamin D
  • yohimbine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material © 1996-2014 MediResource Inc. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Mackenzie Health / 10 Trench St. Richmond Hill, On. L4C 4Z3 / Main Hospital Site: (905) 883-1212 / TTY Service: (905) 883-2123