Drug Interaction Report

Perindopril and Icatibant: Interaction Details

A pharmacist-reviewed analysis of the Perindopril and Icatibant interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 9, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Perindopril

Aceon Aceon® Prestalia® (as a combination product containing Amlodipine, Perindopril)
+

Icatibant

Firazyr Sajazir
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 9, 2026
Editorial policy · Data sources
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Interaction severity
Moderate
Can be significant — usually manageable with monitoring.
How we grade severity & evidence

Severity levels

  • Contraindicated: These should generally not be used together.
  • Major: Potentially serious — often needs a change or close monitoring.
  • Moderate: Can be significant — usually manageable with monitoring.
  • Minor: Usually limited clinical impact.

Evidence grades

  • Established: Well documented — supported by controlled studies or strong clinical data.
  • Probable: Good supporting evidence, though not definitively proven.
  • Suspected: Some evidence suggests this interaction, but it is not well established.
  • Possible: Limited or conflicting evidence; the interaction may occur.
  • Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.

Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.

Of 195 documented Perindopril interactions, 154 are rated moderate — including this one.
Onset
unspecified
Evidence
theoretical
Severity
Moderate

What happens

Reduced perindopril effectiveness

Interaction Deep Dive

Concomitant use of icatibant with an ACE inhibitor (eg, perindopril) may attenuate the antihypertensive effect of the ACE inhibitor via the antagonism of bradykinin B2 receptor by icatibant1. A clinical trial (n=27) found the maximum decrease in mean arterial blood pressure was -14 +/- 1 mmHg following administration of captopril, an ACE inhibitor, compared with -10.5 +/- 1 mmHg for administration of captopril plus icatibant (p less than 0.001) 2. Consider monitoring for lack of blood pressure control when icatibant is coadministered with perindopril.

Why it happens (mechanism)

Antagonism of bradykinin B2 receptors by icatibant

Literature reports

1 report — tap to read

a) In a single-blind, randomized, crossover study, administration of captopril, an ACE inhibitor, decreased mean arterial blood pressure slightly more than coadministration of icatibant and captopril. All participants (n=27) received 4 treatments in random order at 2-day intervals: captopril 25 mg orally plus IV NS, captopril 25 mg orally plus 100 mcg/kg IV icatibant, losartan 75 mg orally plus IV NS, and placebo orally plus IV NS. The maximum decrease in mean arterial blood pressure was -14 +/- 1 mmHg following administration of captopril compared with -10.5 +/- 1 mmHg after administration of captopril plus icatibant (p=0.001) 2.

Common questions

Can I take Perindopril and Icatibant together?

Reduced perindopril effectiveness Always confirm with your pharmacist or prescriber before making any change.

How serious is the Perindopril and Icatibant interaction?

It is rated moderate. Can be significant — usually manageable with monitoring.

How quickly could this interaction happen?

The documented onset is "unspecified". The timing of this interaction is not well characterized.

How strong is the evidence for this interaction?

The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.

From our Q&A

Real reader questions about these medications, each personally answered by our pharmacist:

Questions for your pharmacist

  • Does my dose of Perindopril or Icatibant need adjusting while I take them together?
  • What symptoms should prompt me to call you or my prescriber right away?
  • Does the timing of my doses matter for this combination?
  • Is there anything you'd monitor while I'm on both?

References (2)

  1. Product Information: FIRAZYR(R) subcutaneous injection solution, icatibant subcutaneous injection solution. Shire Orphan Therapies (per Manufacturer), Lexington, MA, 2011. DailyMed
  2. Gainer JV, Morrow JD, Loveland A, et al: Effect of bradykinin-receptor blockade on the response to angiotensin-converting-enzyme inhibitor in normotensive and hypertensive subjects. N Engl J Med 1998; 339(18):1285-1292. PubMed
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Perindopril

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All Perindopril interactions (195) Perindopril drug information
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Icatibant

Keep reading about Icatibant

All Icatibant interactions (7)

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.