Coversyl Novum
ACE Inhibitor for High Blood Pressure, Heart Failure and Coronary Artery Disease
Quick Facts About Coversyl Novum
Key Takeaways
- Coversyl Novum (perindopril arginine) is an ACE inhibitor that effectively lowers blood pressure by preventing the formation of angiotensin II, a potent vasoconstrictor.
- It is proven to reduce the risk of heart attack, stroke, and cardiovascular death in patients with stable coronary artery disease, as demonstrated in the landmark EUROPA trial.
- The most common side effect is a persistent dry cough (affecting 5–10% of patients), which is a class effect of all ACE inhibitors and resolves after stopping the medication.
- ACE inhibitors are strictly contraindicated during the second and third trimesters of pregnancy due to the risk of serious foetal harm, including renal failure and death.
- Coversyl Novum is taken once daily in the morning before food, and its long-acting profile provides stable 24-hour blood pressure control.
What Is Coversyl Novum and What Is It Used For?
Coversyl Novum belongs to the class of medicines known as angiotensin-converting enzyme (ACE) inhibitors. The active substance, perindopril arginine, is a prodrug that is converted in the body to its active form, perindoprilat. This active metabolite blocks ACE, the enzyme responsible for converting angiotensin I into angiotensin II. Angiotensin II is one of the most potent vasoconstrictors in the body, meaning it causes blood vessels to narrow and increases blood pressure. By inhibiting its production, Coversyl Novum helps blood vessels relax and widen, reducing blood pressure and easing the workload on the heart.
In addition to lowering blood pressure, perindopril reduces the secretion of aldosterone, a hormone that causes the kidneys to retain sodium and water. This contributes to further blood pressure reduction. ACE inhibition also increases levels of bradykinin, a peptide that promotes vasodilation and has cardioprotective properties. The combination of these effects makes Coversyl Novum a versatile cardiovascular medication with benefits extending well beyond simple blood pressure reduction.
Coversyl Novum is prescribed for several important clinical indications. In hypertension, it is used either alone or in combination with other antihypertensive agents to lower elevated blood pressure and reduce the long-term risk of stroke, heart attack, and kidney damage. For patients with symptomatic heart failure, perindopril helps reduce symptoms such as shortness of breath and fluid retention by decreasing the afterload on the heart. In patients with stable coronary artery disease, the EUROPA trial demonstrated that perindopril significantly reduces the risk of cardiovascular death, non-fatal heart attack, and cardiac arrest compared to placebo.
The PROGRESS trial also showed that perindopril-based blood pressure lowering regimens reduce the risk of recurrent stroke in patients with a history of cerebrovascular disease. Furthermore, the ADVANCE trial demonstrated cardiovascular and renal benefits in patients with type 2 diabetes when perindopril was combined with indapamide. These landmark clinical trials have established perindopril as one of the most evidence-based ACE inhibitors available, with proven outcomes across a wide range of cardiovascular conditions.
How Does Perindopril Work in the Body?
Perindopril arginine is a prodrug, meaning it must be converted to its active form before it can exert its therapeutic effect. After oral ingestion, approximately 27% of the dose reaches the bloodstream as the parent compound. The liver then converts perindopril to perindoprilat through hydrolysis, which is the active ACE inhibitor. Peak plasma concentrations of perindoprilat are reached approximately 3 to 4 hours after dosing, and the effective half-life of the active metabolite is approximately 25 hours, allowing for convenient once-daily dosing.
Perindoprilat has a high affinity for tissue ACE, particularly in the vascular endothelium, heart, kidneys, and lungs. This tissue-level ACE inhibition is thought to contribute to the sustained cardiovascular protection observed in clinical trials. Unlike some other ACE inhibitors, perindopril demonstrates a trough-to-peak ratio that ensures consistent blood pressure control throughout the entire 24-hour dosing interval, reducing the morning surge in blood pressure that is associated with increased cardiovascular risk.
What Should You Know Before Taking Coversyl Novum?
Contraindications
Coversyl Novum must not be used in certain clinical situations due to the risk of serious adverse effects. Patients who have previously experienced angioedema (sudden swelling of the face, lips, tongue, or throat) in connection with prior ACE inhibitor therapy must not use perindopril, as the risk of recurrence is high and can be life-threatening. Similarly, patients with hereditary or idiopathic angioedema are at increased risk and should avoid all ACE inhibitors.
The combination of Coversyl Novum with sacubitril/valsartan (Entresto) is contraindicated due to an increased risk of angioedema. Patients must wait at least 36 hours after stopping sacubitril/valsartan before starting perindopril, and vice versa. In patients with diabetes mellitus or renal impairment (GFR < 60 mL/min/1.73 m²), concomitant use of aliskiren with Coversyl Novum is contraindicated because of the risk of hyperkalaemia, hypotension, and renal impairment from dual renin-angiotensin-aldosterone system (RAAS) blockade.
Coversyl Novum is also contraindicated in patients with bilateral renal artery stenosis or stenosis of the artery to a solitary kidney, as ACE inhibition in these patients can precipitate acute renal failure. The use of extracorporeal treatments such as haemodialysis with high-flux membranes (e.g., AN69) or LDL apheresis with dextran sulphate while on ACE inhibitors can cause severe anaphylactoid reactions and is contraindicated.
ACE inhibitors, including Coversyl Novum, are strictly contraindicated during the second and third trimesters of pregnancy. Exposure during this period has been associated with foetotoxicity (decreased renal function, oligohydramnios, skull ossification retardation) and neonatal toxicity (renal failure, hypotension, hyperkalaemia). If pregnancy is detected, Coversyl Novum should be discontinued as soon as possible. Use during the first trimester is not recommended unless absolutely necessary and no alternative is available.
Warnings and Precautions
Hypotension: Excessive blood pressure reduction may occur, particularly in patients who are volume-depleted due to diuretic therapy, salt restriction, dialysis, diarrhoea, or vomiting. In heart failure patients, ACE inhibitor therapy should be initiated at a low dose and under close medical supervision due to the risk of severe hypotension. Diuretic dose reduction or salt supplementation may be considered before initiating therapy.
Renal function: Impairment of renal function may occur in susceptible patients, particularly those with heart failure, renal artery stenosis, or pre-existing kidney disease. Regular monitoring of serum creatinine and potassium is recommended, especially during the first months of therapy. In patients with renal artery stenosis, ACE inhibitors can cause elevation of blood urea nitrogen and serum creatinine, usually reversible upon discontinuation.
Hyperkalaemia: ACE inhibitors can cause an increase in serum potassium levels by reducing aldosterone secretion. Risk factors include renal impairment, diabetes mellitus, concurrent use of potassium-sparing diuretics or potassium supplements, and use of other drugs that raise serum potassium (such as trimethoprim, heparin, or NSAIDs). Regular monitoring of serum potassium is essential.
Cough: A persistent, non-productive dry cough has been reported with all ACE inhibitors, affecting approximately 5 to 10% of patients. The cough is more common in women and non-smokers and is attributed to increased bradykinin levels in the lung tissue. It typically resolves within 1 to 4 weeks of stopping treatment. If the cough is intolerable, switching to an angiotensin II receptor blocker (ARB) may be considered as these agents do not increase bradykinin levels.
Pregnancy and Breastfeeding
As noted above, Coversyl Novum is contraindicated during the second and third trimesters of pregnancy. The European Society of Cardiology (ESC) and the World Health Organization (WHO) both classify ACE inhibitors as category D medications in pregnancy, meaning there is positive evidence of human foetal risk. Women of childbearing potential should use effective contraception while taking Coversyl Novum. If pregnancy is planned, the physician should switch to an alternative antihypertensive medication with an established safety profile in pregnancy, such as methyldopa, labetalol, or nifedipine.
Perindopril is excreted in breast milk in small amounts. Due to the potential for adverse effects in nursing infants, including hypotension and renal impairment, Coversyl Novum is not recommended during breastfeeding. If treatment is deemed essential, breastfeeding should be discontinued.
How Does Coversyl Novum Interact with Other Drugs?
Drug interactions with Coversyl Novum are primarily related to its mechanism of action on the renin-angiotensin-aldosterone system and its effects on potassium balance and renal function. Understanding these interactions is crucial for safe prescribing and for patients to recognise potential risks when taking other medications alongside perindopril.
Major Interactions
| Drug / Drug Class | Interaction | Clinical Significance |
|---|---|---|
| Sacubitril/valsartan | Increased risk of angioedema due to dual neprilysin and ACE inhibition | Contraindicated – 36-hour washout required |
| Aliskiren (in diabetes/renal impairment) | Dual RAAS blockade increases risk of hyperkalaemia, hypotension, renal failure | Contraindicated in diabetic or renally impaired patients |
| Potassium-sparing diuretics (spironolactone, eplerenone, amiloride, triamterene) | Additive hyperkalaemic effect due to reduced aldosterone | Monitor potassium closely; avoid unless specifically indicated (e.g., heart failure with low-dose spironolactone) |
| Lithium | Reduced renal lithium clearance leading to lithium toxicity | Monitor lithium levels frequently; combination not recommended |
| NSAIDs (ibuprofen, naproxen, diclofenac) | Reduced antihypertensive effect; increased risk of renal impairment and hyperkalaemia | Use with caution; monitor renal function and blood pressure |
Other Notable Interactions
| Drug / Drug Class | Interaction | Clinical Advice |
|---|---|---|
| Potassium supplements | Increased risk of hyperkalaemia | Avoid unless serum potassium is low; monitor levels |
| Trimethoprim / Co-trimoxazole | Trimethoprim reduces renal potassium excretion, additive hyperkalaemic risk | Monitor potassium, especially in elderly or renally impaired patients |
| Diuretics (thiazides, loop diuretics) | Enhanced hypotensive effect, especially first-dose hypotension | Consider reducing diuretic dose or stopping 2–3 days before starting perindopril |
| Gold (sodium aurothiomalate) | Nitritoid reactions (flushing, nausea, hypotension) reported | Rare but be aware of this interaction in patients receiving injectable gold |
| mTOR inhibitors (temsirolimus, sirolimus, everolimus) | Increased risk of angioedema | Monitor for signs of angioedema; use with caution |
| Antidiabetic agents (insulin, oral hypoglycaemics) | ACE inhibitors may enhance hypoglycaemic effect | Monitor blood glucose, particularly during initial weeks of combined therapy |
Patients should always inform their healthcare provider about all prescription and non-prescription medications, herbal products, and supplements they are taking before starting Coversyl Novum. This includes common over-the-counter pain relievers such as ibuprofen and naproxen, which can significantly reduce the blood pressure-lowering effect of perindopril and increase the risk of kidney problems.
What Is the Correct Dosage of Coversyl Novum?
Coversyl Novum is formulated as perindopril arginine, and it is important to note that the dosing of perindopril arginine differs from the older perindopril erbumine (tert-butylamine) formulation. Coversyl Novum 2.5 mg (arginine salt) is approximately equivalent to 2 mg of the erbumine salt. All dosing information below refers specifically to the perindopril arginine formulation. The tablets should be taken once daily in the morning, before a meal, as food reduces the conversion of perindopril to its active metabolite perindoprilat.
Adults
Hypertension
The recommended starting dose is 5 mg once daily. If blood pressure is not adequately controlled after one month, the dose may be increased to 10 mg once daily, which is the maximum recommended dose. In patients with a highly activated renin-angiotensin-aldosterone system (e.g., renovascular hypertension, salt/volume depletion, cardiac decompensation, or severe hypertension), the starting dose should be reduced to 2.5 mg once daily under close medical supervision due to the risk of first-dose hypotension.
Stable Coronary Artery Disease
The initial dose is 5 mg once daily for the first two weeks. If tolerated, the dose may be increased to 10 mg once daily, based on renal function and individual response. This dosing regimen mirrors the one used in the EUROPA trial, which demonstrated a 20% relative risk reduction in cardiovascular events.
Symptomatic Heart Failure
Treatment should be initiated at a low dose of 2.5 mg once daily under close medical supervision. After 2 weeks, the dose may be increased to 5 mg once daily if tolerated. Treatment should ideally be initiated in hospital or under conditions where blood pressure, renal function, and electrolytes can be closely monitored. The maximum dose for heart failure is 5 mg daily.
Elderly Patients
Elderly (≥ 65 years)
Treatment should be started at a dose of 2.5 mg once daily. The dose may be titrated upward after one month to 5 mg once daily if required and tolerated, and subsequently to a maximum of 10 mg once daily based on renal function. Elderly patients are more susceptible to first-dose hypotension and hyperkalaemia, and renal function should be monitored before and during treatment.
Patients with Renal Impairment
| Creatinine Clearance | Recommended Starting Dose | Maximum Daily Dose |
|---|---|---|
| > 60 mL/min | 5 mg once daily | 10 mg once daily |
| 30–60 mL/min | 2.5 mg once daily | 5 mg once daily |
| 15–30 mL/min | 2.5 mg every other day | 2.5 mg once daily |
| < 15 mL/min (dialysis) | 2.5 mg on dialysis days | 2.5 mg on dialysis days |
Children and Adolescents
Coversyl Novum is not recommended for use in children and adolescents under 18 years of age due to insufficient data on safety and efficacy in this population. If antihypertensive treatment is needed in paediatric patients, other medication classes with established paediatric evidence should be considered, following current ESC and American Academy of Pediatrics guidelines.
Missed Dose
If you forget to take a dose of Coversyl Novum, take it as soon as you remember, provided it is still the same day. If it is already close to the time for your next dose, skip the missed dose and take your next dose at the regular scheduled time. Do not take a double dose to make up for the missed one. Missing occasional doses is unlikely to cause significant problems, but consistently missing doses will reduce the effectiveness of the medication in controlling your blood pressure.
Overdose
In case of overdose, seek emergency medical attention immediately. Symptoms of perindopril overdose may include severe hypotension (dangerously low blood pressure), circulatory shock, electrolyte disturbances (particularly hyperkalaemia), renal failure, hyperventilation, rapid heartbeat (tachycardia), slow heartbeat (bradycardia), dizziness, anxiety, and cough. Treatment is primarily supportive: the patient should be placed in a supine position with legs elevated, and intravenous saline infusion should be given to restore blood volume. In severe cases, angiotensin II infusion or catecholamines may be required. Perindoprilat can be removed from the circulation by haemodialysis.
What Are the Side Effects of Coversyl Novum?
Like all medicines, Coversyl Novum can cause side effects, although not everybody gets them. The side effects of ACE inhibitors are well characterised and generally predictable based on their mechanism of action. Most common side effects are mild and may improve as your body adjusts to the medication. However, some side effects require immediate medical attention.
Common
- Dry, persistent cough (non-productive)
- Dizziness and light-headedness
- Headache
- Altered taste (dysgeusia) or loss of taste
- Nausea and digestive discomfort
- Abdominal pain
- Diarrhoea or constipation
- Skin rash or itching (pruritus)
- Muscle cramps
- Feeling of weakness (asthenia)
Uncommon
- Excessive blood pressure drop (hypotension)
- Mood or sleep disturbances
- Drowsiness or insomnia
- Bronchospasm (wheezing, shortness of breath)
- Dry mouth
- Urticaria (hives)
- Elevated blood urea nitrogen and creatinine
- Hyperkalaemia (raised potassium levels)
- Visual disturbances
- Tinnitus (ringing in the ears)
Rare
- Angioedema (swelling of face, lips, tongue, and/or throat – seek immediate medical help)
- Severe hypotension with syncope (fainting)
- Acute renal failure
- Pancreatitis
- Hepatitis (liver inflammation)
- Erythema multiforme (severe skin reaction)
- Photosensitivity (increased skin sensitivity to sunlight)
- Blood disorders (neutropenia, agranulocytosis, thrombocytopenia)
Very Rare / Frequency Not Known
- Stevens-Johnson syndrome or toxic epidermal necrolysis
- Pemphigus (autoimmune blistering skin disease)
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- Eosinophilic pneumonia
- Vasculitis
- Confusion
Contact your doctor or go to the nearest emergency department immediately if you experience: swelling of the face, lips, mouth, tongue, or throat that may cause difficulty breathing or swallowing (angioedema); severe dizziness or fainting (which may indicate dangerously low blood pressure); chest pain or signs of a heart attack; or yellowing of the skin and eyes (jaundice) which may indicate liver problems.
The ACE inhibitor cough deserves particular attention as it is the most common reason patients discontinue treatment. The cough is caused by the accumulation of bradykinin and substance P in the airways, which stimulate sensory nerve fibres in the bronchial epithelium. It is typically dry, tickling, and non-productive, and tends to be worse at night or when lying down. The cough usually develops within the first few months of treatment but can occur at any time. It resolves completely within 1 to 4 weeks of stopping the medication. If the cough is intolerable, your doctor may switch you to an angiotensin II receptor blocker (ARB), which provides similar cardiovascular benefits without the cough.
Hyperkalaemia (elevated potassium levels) is another important side effect to be aware of, particularly in patients with renal impairment, diabetes, or those taking potassium-sparing diuretics or potassium supplements. Mild hyperkalaemia may be asymptomatic, but severe hyperkalaemia (above 6.0 mmol/L) can cause dangerous cardiac arrhythmias. Regular monitoring of serum potassium is essential, especially during the first weeks of treatment and after any dose adjustment.
How Should You Store Coversyl Novum?
Coversyl Novum film-coated tablets should be stored at a temperature not exceeding 30°C. The tablets should be kept in the original container or blister packaging to protect them from moisture, as perindopril arginine is sensitive to humidity. Do not transfer the tablets to a separate pill organiser for extended periods unless it is sealed and moisture-proof.
Keep Coversyl Novum out of the sight and reach of children. Store the medication away from direct sunlight and heat sources. Do not use the tablets after the expiry date (marked as "EXP" on the packaging). The expiry date refers to the last day of the stated month. Once opened, multi-dose containers should be used within the timeframe specified by the manufacturer, typically within 6 months.
Do not dispose of unused medications via household waste or wastewater. Return any unused medicine to your pharmacy for safe disposal. This helps protect the environment and prevents accidental ingestion by others.
What Does Coversyl Novum Contain?
The active ingredient in Coversyl Novum is perindopril arginine. The arginine salt formulation was developed to improve the stability and shelf life of the product compared to the older erbumine (tert-butylamine) salt. Each 2.5 mg tablet contains 2.5 mg of perindopril arginine, which is equivalent to approximately 1.6975 mg of perindopril free acid. This corresponds to approximately 2 mg of the older perindopril erbumine formulation in terms of therapeutic equivalence.
The inactive ingredients (excipients) in the tablet core typically include lactose monohydrate, magnesium stearate, maltodextrin, colloidal anhydrous silica, and sodium starch glycolate (type A). Patients with known lactose intolerance should be aware that the tablets contain lactose. The film-coating typically contains glycerol, hypromellose, macrogol, magnesium stearate, and titanium dioxide (E171). The specific coating composition may give the tablets their characteristic appearance.
Coversyl Novum does not contain gluten, but patients with severe food allergies should check the detailed excipient list provided in the manufacturer’s product information or consult their pharmacist for the most current formulation details.
Frequently Asked Questions About Coversyl Novum
Coversyl Novum (perindopril arginine) is prescribed to treat high blood pressure (hypertension), symptomatic heart failure, and to reduce the risk of cardiovascular events (heart attack, stroke, cardiac death) in patients with stable coronary artery disease. It belongs to the ACE inhibitor class and works by relaxing blood vessels and reducing the workload on the heart. It may be used alone or in combination with other cardiovascular medications.
The most frequently reported side effects are a persistent dry cough (affecting 5–10% of patients), dizziness, headache, and altered taste (dysgeusia). Most side effects are mild and tend to improve with continued use. The dry cough is a well-known class effect of all ACE inhibitors, caused by increased bradykinin levels, and resolves within a few weeks of stopping the medication. Serious side effects such as angioedema are rare but require immediate medical attention.
No. ACE inhibitors including Coversyl Novum are contraindicated during the second and third trimesters of pregnancy because they can cause serious harm to the unborn baby, including kidney failure, low amniotic fluid, and skull development problems. Use during the first trimester is also not recommended. If you become pregnant while taking Coversyl Novum, stop the medication and contact your doctor immediately. Alternative blood pressure medications that are safer in pregnancy, such as methyldopa or labetalol, can be prescribed instead.
Coversyl Novum starts lowering blood pressure within 4 to 6 hours of the first dose. However, the full therapeutic effect develops gradually over 4 to 6 weeks of regular daily use. It is important to continue taking the medication as prescribed even if you feel well, because high blood pressure often has no symptoms. Your doctor will check your blood pressure regularly and may adjust the dose to achieve optimal control.
The cough is caused by the build-up of bradykinin in the airways. Normally, ACE breaks down bradykinin, but when the enzyme is blocked by perindopril, bradykinin accumulates and irritates sensory nerves in the lungs, triggering the cough reflex. This affects approximately 5 to 10% of patients, is more common in women and non-smokers, and typically resolves within 1 to 4 weeks of stopping the medication. If the cough is bothersome, your doctor may switch you to an angiotensin receptor blocker (ARB), which provides similar blood pressure control without the cough.
Coversyl Novum contains perindopril arginine, which has one of the longest half-lives among ACE inhibitors, providing consistent 24-hour blood pressure control. Perindopril has a particularly strong evidence base from large clinical trials: EUROPA (coronary artery disease), PROGRESS (stroke prevention), and ADVANCE (diabetes). It is characterised by high tissue ACE affinity, meaning it penetrates deeply into vascular and cardiac tissue. The arginine salt formulation also offers improved stability compared to the older erbumine salt.
References
- Fox KM; EUROPA Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). The Lancet. 2003;362(9386):782-788. doi:10.1016/S0140-6736(03)14286-9
- PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. The Lancet. 2001;358(9287):1033-1041. doi:10.1016/S0140-6736(01)06178-5
- ADVANCE Collaborative Group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial). The Lancet. 2007;370(9590):829-840. doi:10.1016/S0140-6736(07)61303-8
- Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021-3104. doi:10.1093/eurheartj/ehy339
- Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. J Am Coll Cardiol. 2018;71(19):e127-e248. doi:10.1016/j.jacc.2017.11.006
- National Institute for Health and Care Excellence (NICE). Hypertension in adults: diagnosis and management. NICE guideline [NG136]. Updated March 2022.
- European Medicines Agency. Summary of Product Characteristics: Coversyl (perindopril arginine). EMA product information.
- World Health Organization. WHO Model List of Essential Medicines – 23rd List (2023). Geneva: WHO; 2023.
- Brugts JJ, Ferrari R, Simoons ML. Angiotensin-converting enzyme inhibition by perindopril in the treatment of cardiovascular disease. Expert Rev Cardiovasc Ther. 2009;7(4):345-360. doi:10.1586/erc.09.2
- Pilote L, Bhatt DL, Eagle KA, et al. A comprehensive view of ACE inhibitor use in clinical practice: evidence from randomized controlled trials and population-based studies. Am Heart J. 2004;148(4):S52-S64.
About the Medical Editorial Team
This article has been written and reviewed by the iMedic Medical Editorial Team, comprising licensed physicians specialising in cardiology, clinical pharmacology, and internal medicine. Our team follows the GRADE evidence framework and adheres to international guidelines from the European Society of Cardiology (ESC), American Heart Association (AHA), National Institute for Health and Care Excellence (NICE), and the World Health Organization (WHO).
Content created by medical professionals with clinical experience in cardiovascular medicine and hypertension management. All medical claims are supported by peer-reviewed evidence from randomised controlled trials and systematic reviews.
Independently reviewed by the iMedic Medical Review Board to ensure accuracy, completeness, and adherence to current evidence-based guidelines. Last reviewed: .