Coversyl: Effective Blood Pressure Control for Cardiovascular Health
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Coversyl (perindopril) is an angiotensin-converting enzyme (ACE) inhibitor indicated for the treatment of essential hypertension and stable coronary artery disease. As a prodrug, it is hydrolyzed to perindoprilat, its active metabolite, which inhibits the ACE responsible for the conversion of angiotensin I to the vasoconstrictor angiotensin II. This mechanism results in decreased plasma angiotensin II levels, leading to increased plasma renin activity and reduced aldosterone secretion. The consequent vasodilation and reduction in vascular resistance contribute to its efficacy in managing hypertension and improving cardiovascular outcomes. Coversyl represents a well-established therapeutic option within its class, supported by extensive clinical evidence.
Features
- Active ingredient: Perindopril (as tert-butylamine salt)
- Pharmacological class: Angiotensin-converting enzyme (ACE) inhibitor
- Available formulations: 4 mg and 8 mg tablets
- Administration route: Oral
- Bioavailability: Approximately 65–75%
- Half-life: Perindoprilat elimination half-life is 3–10 hours
- Metabolism: Hepatic hydrolysis to active metabolite perindoprilat
- Excretion: Primarily renal
Benefits
- Provides sustained 24-hour blood pressure control with once-daily dosing
- Reduces peripheral arterial resistance without compensatory tachycardia
- Demonstrates cardioprotective effects in patients with stable coronary artery disease
- Shows nephroprotective properties in hypertensive patients with diabetes
- Improves endothelial function and vascular compliance
- May reduce left ventricular hypertrophy in hypertensive patients
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. Clinical guidelines frequently recommend ACE inhibitors like Coversyl as first-line therapy for hypertensive patients with compelling indications such as diabetes, chronic kidney disease, or heart failure. The medication is typically used as part of a comprehensive cardiovascular risk reduction strategy that may include lifestyle modifications and other pharmacological interventions.
Dosage and direction
The recommended initial dose for hypertension is 4 mg once daily, which may be increased to 8 mg after at least one month of therapy based on blood pressure response. For elderly patients or those with renal impairment, starting with 2 mg daily is recommended, with subsequent titration based on tolerability and response. 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 made at intervals of at least 2 weeks to allow full therapeutic effect to manifest.
Precautions
Patients should be monitored for hypotension, particularly following the initial dose and during dose titration. Renal function and serum potassium levels should be assessed before initiation and periodically during treatment, especially in patients with pre-existing renal impairment or those taking potassium supplements or potassium-sparing diuretics. Angioedema may occur at any time during treatment, requiring immediate discontinuation and appropriate medical management. Use with caution in patients with aortic stenosis or hypertrophic cardiomyopathy. Surgical patients should inform anesthesia providers of ACE inhibitor use due to potential intraoperative hypotension. Adequate hydration should be maintained, especially during periods of vomiting or diarrhea.
Contraindications
Coversyl is contraindicated in patients with known hypersensitivity to perindopril, other ACE inhibitors, or any component of the formulation. It must not be used during pregnancy, particularly in the second and third trimesters, due to risk of fetal injury and death. Additional contraindications include history of angioedema related to previous ACE inhibitor therapy and concomitant use with aliskiren in patients with diabetes. Patients with hereditary or idiopathic angioedema should avoid ACE inhibitor therapy. Severe renal impairment or anuria may constitute additional contraindications depending on clinical context.
Possible side effects
Common adverse reactions (≥1%) include cough, dizziness, headache, asthenia, and gastrointestinal disturbances. Less frequently reported effects include rash, taste disturbance, hypotension, hyperkalemia, and renal impairment. Serious but rare side effects may include angioedema, neutropenia/agranulocytosis, hepatic failure, and pancreatitis. The characteristic dry, persistent cough associated with ACE inhibitors typically resolves upon discontinuation of therapy. Patients should report any signs of infection (sore throat, fever) or symptoms suggesting angioedema (swelling of face, lips, tongue, or throat) immediately.
Drug interaction
Concomitant use with diuretics may potentiate hypotensive effects, particularly following initial dose administration. NSAIDs may reduce the antihypertensive effect of perindopril and increase risk of renal impairment. Potassium supplements or potassium-sparing diuretics may increase the risk of hyperkalemia. Lithium levels may increase with ACE inhibitor coadministration, requiring close monitoring. Dual blockade of the renin-angiotensin system with ARBs or aliskiren increases risks of hypotension, hyperkalemia, and renal impairment. Antidiabetic agents may see enhanced hypoglycemic effects. Gold injections have been associated with nitritoid reactions in patients receiving ACE inhibitors.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Doubling the dose to make up for a missed dose is not recommended. Patients should maintain consistency in dosing time to ensure stable blood pressure control throughout the 24-hour dosing interval. If multiple doses are missed, blood pressure should be monitored and healthcare provider consulted regarding appropriate management.
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. Perindoprilat may be removed by dialysis, though data on effectiveness are limited. Bradycardia may require atropine administration. Patients should be monitored for electrolyte imbalances and renal function. Angiotensin II infusion has been used investigationally in cases of ACE inhibitor overdose. Gastric lavage may be considered if ingestion occurred recently.
Storage
Store at room temperature (15–30°C/59–86°F) in the original container to protect from moisture and light. Keep the bottle tightly closed and out of reach of children. Do not use tablets that show signs of discoloration or deterioration. Do not transfer tablets to other containers that may not provide adequate protection from moisture. Proper storage conditions help maintain stability throughout the shelf life, which is typically 2–3 years from manufacturing date when stored appropriately.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Individual patient responses to medication may vary. Treatment decisions should be made by qualified healthcare professionals based on comprehensive patient assessment. The prescribing physician should be consulted for specific dosage recommendations and management of adverse effects. Patients should not discontinue or modify treatment without medical supervision. Full prescribing information should be reviewed before initiation of therapy.
Reviews
Clinical trials have demonstrated Coversyl’s efficacy in reducing both systolic and diastolic blood pressure with once-daily dosing. The EUROPA study established its benefit in stable coronary artery disease patients, showing significant reduction in cardiovascular mortality, myocardial infarction, and cardiac arrest. Meta-analyses of ACE inhibitors consistently show cardiovascular and renal protective effects, particularly in high-risk populations. Real-world evidence supports maintained efficacy in diverse patient populations with generally favorable tolerability profiles. The persistent cough remains the most frequently cited reason for discontinuation in clinical practice, though incidence varies among patient populations.