Serious side effects
Avoid use in pregnancy
When pregnancy is detected, this product should be discontinued as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury to or death of the developing fetus.

1. What Tenoryl is and what it is used for 
Tenoryl is an angiotensin converting enzyme (ACE) inhibitor. These work by widening the blood vessels, which makes it easier for your heart to pump blood through them.
Tenoryl is used:
- To treat high blood pressure (hypertension).
- To treat heart failure (a condition where the heart is unable to pump enough blood to meet the body’s needs).
- To reduce the risk of cardiac events, such as heart attack, in patients with stable coronary artery disease (a condition where the blood supply to the heart is reduced or blocked) and who have already had a heart attack and/or an operation to improve the blood supply to the heart by widening the vessels that supply it.

2. Before you take Tenoryl
Do not take Tenoryl
- If you are allergic (hypersensitive) to perindopril, to any other ACE inhibitor or to any of the other ingredients of Tenoryl.
- If you are more than 3 months pregnant. (It is also better to avoid Tenoryl in early pregnancy).
- If you have experienced symptoms such as wheezing, swelling of the face, tongue or throat, intense itching or severe skin rashes with previous ACE inhibitor treatment or if you or a member of your family have had these symptoms in any other circumstances (a condition called angioedema).
Take special care with Tenoryl
If any of the following apply to you please talk to your doctor before taking Tenoryl:
- If you have aortic stenosis (narrowing of the main blood vessel leading from the heart) or hypertrophic cardiomyopathy (heart muscle disease) or renal artery stenosis (narrowing of the artery supplying the kidney with blood).
- If you have any other heart problems.
- If you have liver problems.
- If you have kidney problems or if you are receiving dialysis.
- If you suffer from a collagen vascular disease (disease of the connective tissue) such as systemic lupus erythematosus or scleroderma.
- If you have diabetes.
- If you are on a salt restricted diet or use salt substitutes which contain potassium.
- If you are to undergo anaesthesia and/or major surgery.
- If you are to undergo LDL apheresis (which is removal of cholesterol from your blood by a machine).
- If you are going to have desensitisation treatment to reduce the effects of an allergy to bee or wasp stings.
- If you have recently suffered from diarrhea or vomiting, or are dehydrated.
- If you have been told by your doctor that you have an intolerance to some sugars.
You must tell your doctor if you think that you are (or might become) pregnant. Tenoryl is not recommended in early pregnancy, and must not be taken if you are more than 3 months pregnant, as it may cause serious harm to your baby if used at that stage. 
Tenoryl is not recommended for use in children and adolescents.
Taking other medicines
Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.
Treatment with Tenoryl can be affected by other medicines. These include:
- Other medicines for high blood pressure, including diuretics (medicines which increase the amount of urine produced by the kidneys).
- Potassium-sparing diuretics (spironolactone, triamterene, amiloride), potassium supplements or potassium-containing salt substitutes.
- Lithium for mania or depression.
- Non-steroidal anti-inflammatory drugs (e.g. ibuprofen) for pain relief or high dose aspirin.
- Medicines to treat diabetes (such as insulin or metformin).
- Medicines to treat mental disorders such as depression, anxiety, schizophrenia etc. (e.g. tricyclic antidepressants, antipsychotics).
- Immunosuppressants (medicines which reduce the defence mechanism of the body) used for the treatment of auto-immune disorders or following transplant surgery (e.g. ciclosporin).
- Allopurinol (for the treatment of gout).
- Procainamide (for the treatment of an irregular heart beat).
- Vasodilators including nitrates (products that make the blood vessels become wider).
- Heparin (medicines used to thin blood).
- Medicines used for the treatment of low blood pressure, shock or asthma (e.g. ephedrine, noradrenaline or adrenaline).
Taking Tenoryl with food and drink
It is preferable to take Tenoryl before a meal.
Pregnancy and breast-feeding
Ask your doctor or pharmacist for advice before taking any medicine.
Pregnancy
You must tell your doctor if you think that you are (or might become) pregnant. Your doctor will normally advise you to stop taking Tenoryl before you become pregnant or as soon as you know you are pregnant and will advise you to take another medicine instead of Tenoryl. 
Tenoryl is not recommended in early pregnancy, and must not be taken when more than 3 months pregnant, as it may cause serious harm to your baby if used after the third month of pregnancy.
Breast-feeding
Tell your doctor if you are breast-feeding or about to start breast-feeding. Tenoryl is not recommended for mothers who are breast-feeding, and your doctor may choose another treatment for you if you wish to breast-feed, especially if your baby is newborn, or was born prematurely.
Driving and using machines
Tenoryl usually does not affect alertness but dizziness or weakness due to low blood pressure may occur in certain patients. If you are affected in this way, your ability to drive or to operate machinery may be impaired.
Important information about some of the ingredients of Tenoryl
If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.

3. How to take Tenoryl
Always take Tenoryl exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure.
Swallow your tablet with a glass of water, preferably at the same time each day, in the morning, before a meal. Your doctor will decide on the correct dose for you.
The usual dosages are as follows:
High blood pressure: The usual starting and maintenance dose is 5 mg once daily. After one month, this can be increased to 10 mg once a day if required. 10 mg a day is the maximum recommended dose for high blood pressure.
If you are 65 or older, the usual starting dose is 2.5 mg once a day. After a month this can be increased to 5 mg once a day and then if necessary to 10 mg once daily.
Heart failure: The usual starting dose is 2.5 mg once daily. After two weeks, this can be increased to 5 mg once a day, which is the maximum recommended dose for heart failure.
Stable coronary artery disease: The usual starting dose is 5 mg once daily. After two weeks, this can be increased to 10 mg once daily, which is the maximum recommended dose in this indication.
If you are 65 or older, the usual starting dose is 2.5 mg once a day. After a week this can be increased to 5 mg once
a day and after a further week to 10 mg once daily.
If you take more Tenoryl than you should
If you take too many tablets, contact your nearest accident and emergency department or tell your doctor immediately. The most likely effect in case of overdose is low blood pressure which can make you feel dizzy or faint. If this happens, lying down with the legs raised can help.
If you forget to take Tenoryl
It is important to take your medicine every day as regular treatment works better. However, if you forget to take a dose of Tenoryl, take the next dose at the usual time. Do not take a double dose to make up for a forgotten dose.
If you stop taking Tenoryl
As the treatment with Tenoryl is usually life-long, you should discuss with your doctor before stopping this medicinal product.
If you have any further questions on the use of this product, ask your doctor or pharmacist.

4. Possible side effects 
Like all medicines, Tenoryl can cause side effects, although not everybody gets them.
If you experience any of the following, stop taking the medicinal product at once and tell your doctor immediately:
- Swelling of the face, lips, mouth, tongue or throat, difficulty in breathing.
- Severe dizziness or fainting.
- Unusual fast or irregular heart beat.
In decreasing order of frequency, side effects can include:
Common (occur in fewer than 1 in 10 users but in more than 1 in 100 users): 
Headache, dizziness, vertigo, pins and needles, vision disturbances, tinnitus (sensation of noises in the ears), light-headedness due to low blood pressure, cough, shortness of breath, gastrointestinal disorders (nausea, vomiting, abdominal pain, taste disturbances, dyspepsia or difficulty of digestion, diarrhea, constipation), allergic reactions (such as skin rashes, itching), muscle cramps, feeling of tiredness.
Uncommon (occur in fewer than 1 in 100 users but in more than 1 in 1000 users):
Mood swings, sleep disturbances, bronchospasm (tightening of the chest, wheezing and shortness of breath), dry mouth, angioedema (symptoms such as wheezing, swelling of the face, tongue or throat, intense itching or severe skin rashes), kidney problems, impotence, sweating.
Very rare (occur in fewer than 1 in 10,000 users):
Confusion, cardiovascular disorders (irregular heart beat, angina, heart attack and stroke), eosinophilic pneumonia        (a rare type of pneumonia), rhinitis (blocked up or runny nose), erythema multiforme, disorders of the blood, pancreas or liver.
In case of diabetic patients, hypoglycaemia (very low blood sugar level) can occur.
Vasculitis (inflammation of blood vessels) have been reported.
If any of the side effects get serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

5. How to store Tenoryl
Keep out of reach of children.
Store below 30°C.
After opening, it should be used within 3 months.
Store the tablets in the original container.
Do not use beyond the expiry date or if the product shows any sign of deterioration.
Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away the medicines you no longer use. These measures will help to protect the environment.