Perindopril and Nesiritide: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 9, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Perindopril
Nesiritide
No brand names on record
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.
What happens
Increase in symptomatic hypotension
Interaction Deep Dive
An increase in symptomatic hypotension occurred in patients receiving oral angiotensin converting enzyme inhibitors. In the Vasodilation in the Management of Acute Congestive Heart Failure (VMAC) trial in patients treated with either nesiritide or nitroglycerin therapy, the frequency of symptomatic hypotension in patients receiving an oral ACE inhibitor was 6%, compared to a frequency of symptomatic hypotension of 1% in patients who did not receive an oral ACE inhibitor1.
Why it happens (mechanism)
Additive hypotensive response
Common questions
Can I take Perindopril and Nesiritide together?
Increase in symptomatic hypotension Always confirm with your pharmacist or prescriber before making any change.
How serious is the Perindopril and Nesiritide interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
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 Nesiritide 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 (1)
- Product Information: Natrecor(R), Nesiritide. Scios Inc. Sunnyvale, CA, 2001.
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