Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes Viacoram. If you are concerned about side effects, discuss the risks and benefits of Viacoram with your doctor.

The following side effects have been reported by at least 1% of people taking Viacoram. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• cough (dry, persistent)
• Diarrhea
• dizziness
• headache
• itchiness
• nausea
• swelling of the hands, feet, or ankles
• unusual tiredness

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• abnormal heartbeat (e.g., pounding heartbeat, slow heartbeat, fast heartbeat)
• increased frequency of infections
• signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don’t stop bleeding)
• signs of kidney problems (e.g., increased need to urinate, nausea, vomiting, fatigue, swelling of the feet, legs and hands)
• signs of Low Blood Pressure (e.g., dizziness, lightheadedness, fainting)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• signs of too much potassium in the body (e.g., confusion; irregular heartbeat; nervousness; numbness or tingling in hands, feet, or lips; shortness of breath or difficulty breathing; weakness or heaviness of legs)
• symptoms of low sodium levels in the blood (e.g., achy, stiff or uncoordinated muscles, confusion, tiredness, weakness)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of angioedema (e.g., swollen mouth, lips, tongue, difficulty swallowing or breathing)
• signs of a serious allergic reaction (i.e., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• signs of Heart Attack (e.g., sudden chest pain or pain radiating to back, down arm, jaw; sensation of fullness of the chest; nausea; vomiting; sweating; anxiety)
• signs of pancreatitis (e.g., abdominal pain on the upper left side, back pain, nausea, Fever, chills, rapid heartbeat, swollen abdomen)
• signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort
• signs of Stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)
• skin blisters
• symptoms of Angina (e.g., chest pain, sudden wheeziness, difficulty breathing or shortness of breath)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking Viacoram.

3.5 mg/2.5 mg
Each white, round tablet 5 mm in diameter contains 3.5 mg of perindopril arginine and 2.5 mg of amlodipine. Nonmedicinal ingredients: lactose monohydrate, magnesium stearate, cellulose microcrystalline, and colloidal anhydrous silica.

7 mg/5 mg 
Each white, round tablet, 6 mm in diameter, engraved with a version of the Servier logo on one face, contains 7 mg of perindopril arginine and 5 mg of amlodipine. Nonmedicinal ingredients: lactose monohydrate, magnesium stearate, cellulose microcrystalline, and colloidal anhydrous silica.

14 mg/10 mg 
Each white, round tablet, 8 mm in diameter, engraved with 14/10 on one face and a version of the Servier logo on the other face, contains 14 mg of perindopril arginine and 10 mg of amlodipine. Nonmedicinal ingredients: lactose monohydrate, magnesium stearate, cellulose microcrystalline, and colloidal anhydrous silica.

Do not take Viacoram if you:

• are allergic to perindopril, amlodipine, or any ingredients of the medication
• are allergic to other ACEIs (e.g., Captopril, Ramipril)
• are allergic to other calcium channel blockers
• are pregnant or planning to get pregnant
• are breast-feeding
• are taking Aliskiren and have Diabetes or moderately to severely decreased kidney function
• are taking the combination medication sacubitril - Valsartan
• are receiving certain blood treatments such as dialysis or apherisis
• have reduced kidney function
• have had angioedema (a serious allergic reaction that causes the area around the throat and tongue to swell) after taking any angiotensin II receptor blockers (ARBs; e.g., Candesartan, Losartan) or angiotensin converting enzyme inhibitors (ACEIs)
• have been diagnosed with hereditary or idiopathic angioedema
• have poor heart output because of a serious heart problem (e.g., mitral valve stenosis)
• have heart failure
• have galactose intolerance, glucose-galactose malabsorption, or the Lapp lactase deficiency (hereditary problems with digesting and absorbing lactose)
• have narrowing of the arteries in the kidneys

There may be an interaction between amlodipine - perindopril and any of the following:

• acetylsalicylic acid (Asa)
• Aldesleukin
• alpha agonists (e.g., Clonidine, methyldopa)
• alpha blockers (e.g., Alfuzosin, Doxazosin, Tamsulosin)
• aliskiren
• Allopurinol
• amifostine
• Amiodarone
• amphetamines (e.g., Dextroamphetamine, Lisdexamfetamine)
• other angiotensin converting enzyme inhibitors (ACEIs; captopril, ramipril)
• angiotensin receptor blockers (ARBs; e.g., candasartan, Irbesartan, losartan)
• antipsychotics (e.g., Clozapine, Haloperidol, Olanzapine, Quetiapine, Risperidone)
• Aprepitant
• Azathioprine
• "azole" antifungals (e.g., itraconazole, ketoconazole, Voriconazole)
• Baclofen
• barbiturates (e.g., butalbital, pentobarbital, Phenobarbital)
• beta-adrenergic blockers (e.g., Atenolol, Propranolol, Sotalol)
• beta2-agonists (e.g., formoterol, salbutamol, salmeterol, terbutaline)
• Bosentan
• other calcium channel blockers (e.g., Diltiazem, Nifedipine, Verapamil)
• calcium supplements (e.g., calcium carbonate, calcium citrate)
• Carbamazepine
• Clopidogrel
• Cobicistat
• conivaptan
• corticosteroids (e.g., Dexamethasone, Hydrocortisone, Prednisone)
• Crizotinib
• Cyclosporine
• Dabrafenib
• decongestant cold medications (e.g., phenylephrine, Pseudoephedrine)
• decongestant eye drops and nose sprays (e.g., naphazoline, oxymetazoline, xylometazoline)
• Deferasirox
• diabetes medications (e.g., chlorpropamide, Glyburide, insulin, Metformin, Rosiglitazone)
• diuretics (water pills; e.g., Furosemide, Hydrochlorothiazide, triamterene)
• dofetilide
• Dronedarone
• drospirenone
• Duloxetine
• Enzalutamide
• Eplerenone
• Everolimus
• gold salts
• grapefruit juice
• grass pollen allergen extract
• Guanfacine
• Heparin
• Hepatitis C antiviral combinations (e.g., ombitasvir - paritaprevir - ritonavir - dasabuvir, ombitasvir - paritaprevir - ritonavir)
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• Idelalisib
• imatinib
• levodopa
• lithium
• Lomitapide
• Lovastatin
• low-molecular-weight heparins (e.g., Dalteparin, Enoxaparin, Tinzaparin)
• macrolide antibiotics (e.g., clarithromycin, erythromycin)
• magnesium supplements (magnesium hydroxide, magnesium-containing antacids)
• medications that increase the level of potassium in the blood (e.g., Spironolactone, Amiloride, triamterene, or salt substitutes that contain potassium)
• mifepristone
• Mitotane
• melatonin
• Methylphenidate
• Minoxidil
• Modafinil
• nefazodone
• nitrates (isosorbide dinitrate, Nitroglycerin)
• non-steroidal anti-inflammatory medications (NSAIDs; e.g., Diclofenac, Ibuprofen, Naproxen)
• Obinutuzumab
• Pentoxifylline
• phenobarbital
• Phenytoin
• phosphodiesterase-5 inhibitors (e.g., Sildenafil, Tadalafil, Vardenafil)
• Pregabalin
• primidone
• quinidine
• quinine
• Rasagiline
• rifabutin
• rifampin
• Ropinirole
• sacubitril
• St. John's wort
• siltuximab
• simeprevir
• Simvastatin
• Sirolimus
• sodium phosphates
• Tacrolimus
• Temsirolimus
• Tizanidine
• Tocilizumab
• tolcapone
• Tolvaptan
• tricyclic antidepressants (e.g., Amitriptyline, Clomipramine, Desipramine, Trimipramine)
• Trimethoprim
• Yohimbine

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Viacoram. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Viacoram.

Angioedema: Although not common, angioedema (a serious allergic reaction that causes the area around the throat and tongue to swell) may occur with ACE inhibitors, including perindopril. If you experience swelling of the face, tongue, or glottis, or experience abdominal pain that may be accompanied by nausea or vomiting, stop taking amlodipine - perindopril at once and seek immediate medical attention. People who have had angioedema caused by other substances may be at increased risk of angioedema while taking an ACE inhibitor such as perindopril.

Blood counts: Viacoram can decrease the number of neutrophils (a type of white blood cell that helps fight infection), red blood cells (which carry oxygen), and platelets (which help your blood to clot). Your doctor will do blood tests to monitor this. If you notice more frequent signs of infection (e.g., fever, chills, or sore throat) or unusual bleeding or bruising, contact your doctor.

Cough: People taking perindopril may develop a dry, persistent cough that usually disappears only after stopping or lowering the perindopril dose. Be sure to tell your doctor of any cough that does not seem to be related to a usual cause.

Diabetes: Perindopril may affect blood sugar control. If you have diabetes, discuss with your doctor how Viacoram may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Viacoram, and whether any special monitoring is needed. You may need to test your blood sugar more often when you first start taking Viacoram.

Drowsiness/dizziness: Amlodipine - perindopril may cause drowsiness or dizziness, affecting the mental or physical abilities needed to drive or operate machinery. Avoid driving, operating machinery, or performing other hazardous tasks until you have determined how Viacoram affects you.

Fluid and electrolyte balance: Increases in levels of potassium in the blood may occur as a result of taking amlodipine - perindopril. This is more likely to occur if you are using certain other medications, have kidney problems or diabetes, or are taking potassium supplements or salt substitutes that contain potassium. Although this doesn’t usually cause problems, your doctor will probably want to monitor your potassium levels regularly with blood tests.

Grapefruit juice: Grapefruit juice may increase the effects of amlodipine. Avoid grapefruit juice while taking Viacoram.

Heart problems: Heart attack and worsening symptoms of angina may occur when starting or increasing the dose of Viacoram. If you experience any new or increasing chest pain, contact your doctor. If you develop symptoms of a heart attack (e.g., chest pain, pressure, or heaviness; nausea; shortness of breath; anxiety; cool, clammy skin), get immediate medical attention .

Kidney function:  Changes in kidney function have been seen in certain people who take Viacoram. Certain people may be more likely to experience changes in kidney function (e.g., people with narrowed blood vessels in their kidneys, or those with severe Congestive Heart Failure). The use of diuretics (water pills) or aliskiren may further increase the risk of kidney problems for those already at risk for this problem. If you have Kidney Disease or renal artery stenosis (narrowing of blood vessels in the kidneys), discuss with your doctor how Viacoram may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Viacoram, and whether any special monitoring is needed.

Liver function: Rarely, people taking Viacoram experience decreases in liver function, possibly leading to liver failure. Your doctor will do blood tests to monitor this. If you notice any signs of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Amlodipine is removed from the body by the liver. Reduced liver function or liver disease may cause Viacoram to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how Viacoram may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Viacoram, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking Viacoram.

Low blood pressure: Occasionally, blood pressure drops too low after amlodipine - perindopril is taken. This usually happens after the first or second dose or when the dose is increased. It is more likely to occur if you take aliskiren, water pills, have a salt-restricted diet, are on dialysis, are suffering from diarrhea or vomiting, or have been sweating excessively and not taking in enough fluids. To reduce the risk of dizziness, get up slowly from a lying or sitting position. If low blood pressure causes you to faint or feel lightheaded, contact your doctor.

Surgery: Certain anaesthetics (medications to put you to sleep) used during surgery cause decreased blood pressure. Perindopril blocks the body’s natural response to these sudden reductions in blood pressure, which may be dangerous during surgery. If you are scheduled to have surgery and are taking perindopril - amlodipine, talk to your doctors about stopping the medications for surgery.

Pregnancy: ACE inhibitors such as perindopril may cause severe harm or death to a developing baby if taken by the mother during pregnancy. Viacoram should not be used during pregnancy. If you become pregnant while taking Viacoram, contact your doctor immediately.

Breast-feeding: Medications in the ACEI family have been reported to pass into breast milk. If you are a breast-feeding mother and are taking amlodipine - perindopril, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using Viacoram have not been established for children.

Seniors: Amlodipine - perindopril has not been studied for use by seniors and should not be prescribed for seniors.