Google Answers Logo
View Question
Q: neuropathy and high blood pressure medications. ( Answered 5 out of 5 stars,   1 Comment )
Subject: neuropathy and high blood pressure medications.
Category: Health
Asked by: robert22-ga
List Price: $100.00
Posted: 30 May 2004 15:16 PDT
Expires: 29 Jun 2004 15:16 PDT
Question ID: 353998
I have been diagnosed with neuropathy 3 months after taking
perindopril (coversyl).I would like to know if there is a link?

Request for Question Clarification by librariankt-ga on 31 May 2004 09:58 PDT

I know you're looking for negative effects of perindopril, but the
only article I've found is one that finds that perindopril ameliorates
(lessens) diabetic neuropathy in mice.  Are you interested in that as
an answer?


Request for Question Clarification by librariankt-ga on 31 May 2004 10:03 PDT
I have two things to add:

- searching for links between ACE inhibitors in general and neuropathy
finds several more articles, all of which (that I've glanced at) agree
that the drug is useful for countering peripheral nerve dysfunction. 
Again, would that be of interest?

- a little more information on why you were taking that perindopril
(diabetes?) and what kind of neuropathy (what part of your body is
affected) would also help.


Request for Question Clarification by pafalafa-ga on 31 May 2004 11:30 PDT
Hello robert22-ga,

Like my colleague, librariankt-ga, I have been looking into your
question as well, and do not see any reports that link perindopril to

However, there have been, over the years, reports that link other ACE
inhibitors such as enalapril and captopril with side efects including
neuropathy.  There does not appear to be a great deal of information
on this topic -- so far, I've located only a few dated studies -- but
it does seem as if you and your doctor should be aware of the
possibility of a link between ACE inhibitors and neuropathy.

Let us know how you would like us to proceed.

And of course, best of luck with your prognosis.  


Clarification of Question by robert22-ga on 31 May 2004 14:30 PDT
Just to give you some additional information- I am 58 years old. The
reason why I'm taking Perindopril is to control my blood pressure
which is slightly over the limit. I do think that I am a bearer of the
Charcot Marie Tooth disease because of my high arched feet and hammer
toes. (Although all the genitical tets have been negative.) My mother
had the same problem however she stayed valid until her death at 85.
Since two years (three months after starting to take Perindopril I
noticed that my limbs became thinner and my muscles weakened. I had
EMG and nerve velocites exams that showed an abnormal result. The
nerves conductions velocites seems to be reduced.
I hope that these complementary informations will help you to find the answer.

Clarification of Question by robert22-ga on 31 May 2004 14:39 PDT
Pafalafa-ga is talking about some studies linking ACE inhibitors with
neuropathy, could he please inform me about those?
Thank you,
Subject: Re: neuropathy and high blood pressure medications.
Answered By: pafalafa-ga on 31 May 2004 17:12 PDT
Rated:5 out of 5 stars

I hope the information I have provided here will be helpful to you
deciding on your next steps for your medical condition.

Bear in mind that I am not a medical professional, and you should
certainly consult with your doctor before acting on any of the
information I've provided here.

As I said earlier, there is not a great deal of information in the
medical literature connecting perindopril and related medicines to
neuropathy.  But there is some pertinent information, which I've
summarized in my answer, below.

Before rating this answer, please let me know if anything here is
unclear, or if you need additional information.  Just post a Request
for Clarification, and I'll be happy to assist you further.

Best of luck.




As you noted in your original question, the medication perindopril 
has other names.  It is sometimes  referred to outside the U.S. by the
trade name Coversyl  and is also referred to as Aceon (largely in the
US, I believe).  It has numerous other trade names in different
countries around the world.
The formal medical name for the active ingredient in these drugs is
perindopril erbumine.

There is a good general fact sheet  on Coversyl at this Australian
health information site:

The fact sheet contains the standard list of side effects for
perindopril, which you are probably familiar with already:


With Coversyl, the side effects can include:

* cough, often described as dry and irritating

* headache

* feeling tired or lethargic

* feeling faint, light-headed or dizzy

* nausea or stomach pain

These side effects when they occur are usually mild.


A more detailed fact sheet is the package insert that is used for
Aceon, a common trade name in the U.S. for perindopril.  You can view
the fact sheet at the Food And Drug Administration site:

The fact sheet includes a fairly detailed write-up of side effects and
adverse reactions that have been reported in patients taking

Of course, the mention of an adverse effect does not necessarily mean
that the effect was caused by the drug.  Conversely, the fact that a
particular effect is not mentioned does not mean the drug could not
cause that particular effect.

Neuropathy is not mentioned explicitly as one of the possible side
effects of  perindopril.  However, there are several adverse events
noted that involve generalized pain in limbs, joints, muscles, etc.

back Pain

upper Extremity Pain

low extremity pain

paresthesia (burning or tingling skin)

myalgia (muscular pain or tenderness)

arthralgia (joint pain)

If you haven't already, I would recommend thoroughly reading the Aceon
fact sheet to familiarize yurself with the type of adverse effects
that have been reported in association  with this drug.


I mentioned that there were a small number of studies that direclty
associated neuropathy and the use of ACE inhibitors, the class of
drugs that includes perindopril.

The studies were identified at the very valuable medical research
site, PubMed, which is hosted by the National Library of Medicine, and
can be found at:

where a search on the terms:

ACE inhibitor AND neuropathy

identified a number of relevant studies.

I have cited the studies below and summarized available information on
them.  Note that the first citation includes email contact information
for the primary author of the study:


Neurochem Res. 2003 May;28(5):711-4

Influence of temocapril on cultured ventral spinal cord neurons.

Iwasaki Y, Ichikawa Y, Igarash O, Ikeda K, Kinoshita M.

Toho University Ohashi Hospital, 2-17-6 Ohashi Meguro-Ku, Tokyo
153-8515, Japan.

[This study demonstrated that temocapril, an ACE inhibitor, has a
dramatic effect on nerve cell cultures in the laboratory, spurring
growth.  While not connected directly to neuropathy, the study shows
that ACE inhibitors can certainly effect nerve cells, and may have
biologically relevant effects in human patients]


Lancet.  1998 Dec 19-26;352(9145):1978-81

Effect of angiotensin-converting-enzyme (ACE) inhibitor trandolapril
on human diabetic neuropathy: randomised double-blind controlled trial

"The ACE inhibitor trandolapril may improve peripheral neuropathy in
normotensive patients with diabetes. Larger clinical trials are needed
to confirm these data before changes to clinical practice can be

[This is one of a number of studies -- I haven't included the others
-- that demonstrated the role that ACE inhibitors can sometimes have
as a treatment in alleviating neuropathy, especially in patients with
diabetes.  The fact that this class of drugs can be used as a
treatment for neuropathy is a clear an obvious indicator that the
drugs do have an effect on pathways in the body that affect
neuropathy.  Possibly, the drugs can act in some circumstances to
alleviated neuropathic conditions, while in other circumstances, they
may aggravate or initiate neuropathy.  This may be what happened in
some of studies mentioned below -- however, this is pure speculation
on my part, so take it with many, many grains of salt.]


Postgrad Med J.  1987 Mar;63(737):221-2

Guillain-Barre neuropathy during treatment with captopril.

Chakraborty TK, Ruddell WS.

Falkirk and District Royal Infirmary, UK.

"A patient is described who developed acute peripheral neuropathy of
Guillain-Barre type occurring shortly after commencement of captopril
for moderately severe hypertension and resolving after discontinuation
of the drug."

[This report seems to bear a resemblance to your situation, from what
I can tell from the limited summary provided.  Note that the symptoms
of neuropathy resolved after discontinuing use of the drug, an option
you may want to discuss with your doctor. ]


BMJ.  1992 Nov 28;305(6865):1332.  

Peripheral neuropathy in a patient receiving enalapril.

Hormigo A, Alves M.

Instituto Portugues de Oncologia, Lisbon

[This study appears to be reporting a similar case of neuropathy after
administration of an ACE inhibitor, but in the absence of a report
summary, it is difficult to evaluate.  Your doctor may be able to
obtain a copy of the full study.]


Nouv Presse Med.  1981 Apr 30;10(19):1551-5.  

Treatment of severe arterial hypertension with captopril 

Di Giulio S, Perez-Ramirez JL, Jamoun P, Grunfeld JP, Meyer P.

"Captopril, an inhibitor of the angiotensin-converting enzyme, was
administered for 9 to 13 months to 11 patients with severe arterial
hypertension and/or hypertension resistant to conventional treatments.
The drug had to be discontinued in 2 patients on account of skin rash
or peripheral neuropathy."

[Again, a report of patients reacting to an ACE inhibitor with
symptoms of neuropathy].


I searched two other medical databases in addition to the PubMed
database, but did not uncover any additional articles relevant to the
search terms I described.

In sum, ACE inhibitors appear to play a significant role in
alleviating the symptoms of neuropathy in same patients, especially in
diabetics.  However, there are a few scattered reports of patients
reportings the onset of neuropathy after beginning treatment with an
ACE inhibitor.

None of the studies I reviewed revealed any connection between
neuropathy and ACE inhibitors as it pertained to patients with Charcot
Marie Tooth disease, although the presence of this disease would
certainly be a factor to consider regarding any neuropathic symptoms.

I hope this information is helpful to you and your doctor in assesing
your current condition.  As I said earlier, let me know if there is
anything else I can provide...just post a Request for Clarification to
let me know how I can help.

All the best.


Request for Answer Clarification by robert22-ga on 02 Jun 2004 09:18 PDT
Pafalafa-ga, thank you so much for your valuable information. But I do
have some complementary questions: Could you please forward me the
complete studies concerning ACE inhibitors and neuropathy that you are
talking about on the Pubmed site? (I'm lost on that site) Where could
I find the report written by Chakraborty and Ruddell that you think is
describing a cas resembling mine? I would also appreciate if you could
try to find other similar cases. Then you are on your way to a great

Clarification of Answer by pafalafa-ga on 02 Jun 2004 15:35 PDT
Hello Robert,

I'll be glad to help you out as best I can, but I want to start by
explaining one thing.  I cannot provide you the full copies of the
articles I cited, as they are protected by copyright.

However, I can certainly point you directly to the article summaries,
which may be helpful to you.

These are:


Influence of temocapril on cultured ventral spinal cord neurons


Effect of angiotensin-converting-enzyme (ACE) inhibitor trandolapril
on human diabetic neuropathy


[This is the article I mentioned that seemed to bear a resemblence to
your circumstances]

Guillain-Barre neuropathy during treatment with captopril


[I've provided the link, but there is no summary available for this
particular article...your doctor or a librarian should be able to get
a copy of it for you, though]

Peripheral neuropathy in a patient receiving enalapril


Treatment of severe arterial hypertension with captopril


Here are some additional materials that may be of interest to you:

Table 2: 

Drugs that May Induce Polyneuropathies
[long list of drugs that include some ACE inhibitors]


[a fact sheet listing neuropathy as a known side effect of enalapril]


Case Study: Peripheral Neuropathy in Diabetes: Is It Diabetic Neuropathy? 

[A good discussion of the variety of factors to consider when
evaluating a case of neuropathy]


I wish it were possible to provide you with the full text of these
articles, but I'm afraid copyright rules prohibit this.

I hope this additional information is what you need, and again, I wish
you all the best.

Let me know if there is anything else I can do to assist you.

robert22-ga rated this answer:5 out of 5 stars and gave an additional tip of: $25.00
Your research was done in a very professional way. Your answer has
been very helpful to me. Thank you very much for your help.

Subject: Re: neuropathy and high blood pressure medications.
From: pafalafa-ga on 04 Jun 2004 15:06 PDT

Thank you very much.  It's gratifying to be able to provide
information that can be genuinely helpful to someone.  All the best...


Important Disclaimer: Answers and comments provided on Google Answers are general information, and are not intended to substitute for informed professional medical, psychiatric, psychological, tax, legal, investment, accounting, or other professional advice. Google does not endorse, and expressly disclaims liability for any product, manufacturer, distributor, service or service provider mentioned or any opinion expressed in answers or comments. Please read carefully the Google Answers Terms of Service.

If you feel that you have found inappropriate content, please let us know by emailing us at with the question ID listed above. Thank you.
Search Google Answers for
Google Answers  

Google Home - Answers FAQ - Terms of Service - Privacy Policy