perindopril and diclofenac

MajorAvoid this combination where possible.

Mechanism

Pharmacodynamic interaction: diclofenac inhibits prostaglandin synthesis, reducing renal blood flow and opposing the vasodilatory effects of perindopril. This can blunt the antihypertensive action. Both drugs raise serum potassium: perindopril reduces aldosterone, diclofenac reduces renal potassium excretion.

What it means clinically

In patients taking perindopril, diclofenac may reduce the antihypertensive effect and precipitate acute kidney injury, particularly in the elderly or those with heart failure, chronic kidney disease, or volume depletion. Hyperkalaemia may also occur.

What to do

Avoid the combination if possible; consider paracetamol or a non-NSAID analgesic. If diclofenac is necessary, use the lowest effective dose for the shortest duration, and monitor blood pressure, serum creatinine, and potassium within a few days of starting, and periodically thereafter.

Evidence

Well-established in clinical practice and supported by kidney and hypertension guidelines.

The two drugs

perindoprilACE inhibitorRead the monograph diclofenacnonsteroidal anti-inflammatory drugRead the monograph

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Other interactions involving perindopril or diclofenac

Educational reference for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.