Low value prescribing - perindopril arginine

We divide the number of defined daily doses (DDDs) of perindopril arginine tablets by the total number of DDDs of perindopril arginine and perindopril erbumine tablets and then multiply that by 100 to obtain a percentage each month.

NHS England guidance identifies a number of items which provide low value when prescribed. This guidance has mainly been aimed at primary care but we think it is important to also monitor a selection of these in hospitals - read more about why in our blog.

NHS England guidance states:

Perindopril is an ACE inhibitor used in heart failure, hypertension, diabetic nephropathy, and prophylaxis of cardiovascular events. The perindopril arginine salt version is more stable in extremes of climate than the perindopril erbumine salt, which gives it a longer shelf-life. However, perindopril arginine is significantly more expensive than perindopril erbumine and a PrescQIPP CIC review of the topic found no clinical advantage for the arginine salt.

NICE guidance on hypertension in adults recommends that prescribing costs are minimised.

Due to the significant extra costs of the arginine salt and the availability of the erbumine salt, the joint clinical working group considered perindopril arginine suitable for inclusion in this guidance.

For guidance on when prescribing may be appropriate in some exceptional circumstances, please see the full NHS England guidance document.