Clinical experience and pharmacokinetic data points to non-porphyrinogenicity. Risk for gastrointestinal adverse events in the form of nausea, vomiting, abdominal pain, dyspepsia, diarrhoea and obstipation motivates vigilance against insufficient intake of food, especially of carbohydrate.

(2S,3aS,7aS)-1-{N-[(S)-1-Ethoxycarbonylbutyl]-l-alanyl}perhydroindole-2-carboxylic acid. M= 368.5

Perindopril is an angiotensin-converting enzyme (ACE) inhibitor used in hypertension, heart failure, and myocardial infarction. Common side effects that can be potentially porphyrinogenic through reduction in carbohydrate intake and that also can be confused with an acute porphyria attack are nausea, vomiting, abdominal pain, dyspepsia, diarrhoea and obstipation.

The prodrug perindopril is extensively metabolised, mainly in the liver, to the active perindoprilat and inactive metabolites including glucuronides. Perindoprilat and its metabolites are excreted principally in urine. The ACE inhibitors do not appear to undergo interactions via cytochrome P450 isoenzymes.

Uneventful use reported in 23 patients with acute porphyria.