Servier has announced that their branded versions of perindopril erbumine, (Coversyl® and Coversyl Plus®), also known as perindopril tert-butylamine, have been discontinued and replaced with a different salt called perindopril arginine (Coversyl arginine® and Coversyl arginine Plus®). This change to the perindopril salt means that there is potential for confusion and error because doses of the two salts are not directly equivalent. Perindopril arginine 2.5mg, 5mg and 10mg per day, correspond to perindopril erbumine 2mg, 4mg and 8mg per day ,respectively.
As reported by the National electronic Library for Medicines (NELM), the patent on perindopril erbumine expired in June 2003, and generic versions have been available in the UK since July 2007. These generic versions of perindopril erbumine meet Medicines and Healthcare products Regulatory Agency (MHRA) requirements for bioequivalence and can therefore be safely used in patients previously taking Coversyl®.
At present (Drug Tariff, April 2008), it costs £10.29 to treat a patient for 30 days using a generic version of perindopril erbumine 2mg, 4mg or 8mg, compared with £10.95 for Coversyl®. It is likely that this price differential will increase as more generic companies enter the market.
There is no need to alter prescriptions for patients who are currently receiving generic versions of perindopril erbumine. However, caution is necessary when clinical prescribing systems are updated as it is possible that errors may be made when the new perindopril salt is added: busy clinicians may inadvertently select perindopril arginine instead of perindopril erbumine.
Patients who are currently receiving Coversyl® as a branded prescription will need to have their prescription altered. It would seem sensible to change the brand to the generic version, perindopril erbumine, so that patients are maintained on the same dose.
For patients currently receiving Coversyl Plus® (perindopril 4mg with indapamide 1.25mg) there are two options. The first is to prescribe perindopril erbumine 4mg daily generically plus an appropriate diuretic as a separate component. Indapamide is not available in a separate 1.25mg formulation so this may mean switching to an alternative, such as bendroflumethiazide (bendrofluazide) 2.5mg. The second option is to prescribe the branded combination product (Coversyl Arginine Plus®). However, this means that the dose will need to be altered and patients should be advised accordingly.
The change of formulation and packaging of Coversyl® is likely to be seen over the next few weeks as stocks of the existing formulation are exhausted. Health care professionals should be aware of the potential for error, and confusion to patients, and act quickly to ensure that problems are avoided.
We would like to thank the NPC Trainers, in particular Nigel Barnes, Sue Faulding, Shivaun Gammie, Jenny Lunn, Jonathan Simms, Sue Smith, Fiona Walker, Mike Wilcock and Andrew White, for their help in preparing this blog.