Quinapril

Quinapril is an angiotensin converting enzyme (ACE) inhibitor used for treating high blood pressure and heart failure.

Quinapril is available under the following different brand names: Accupril.

Adult and Pediatric Dosage Forms and Strengths

Tablet

• 5 mg
• 10 mg
• 20 mg
• 40 mg

Dosage Considerations – Should be Given as Follows:

Hypertension

• Adult, initial: 10-20 mg orally once/day; may administer 5 mg in patients receiving diuretic therapy if the diuretic is continued
• Adult, maintenance: 20-80 mg orally once/day or divided every 12 hours
• Pediatric, off-label: 5-10 mg orally once/day initially

Dosing Modifications

Renal impairment

• Dose adjustment not necessary

Congestive Heart Failure

• Initial: 5 mg orally every 12 hours
• Maintenance: 20-40 mg orally once/day or divided every 12 hours

Diabetic Nephropathy (Off-Label)

• Slows rate of progression of renal disease in patients with hypertension, diabetes mellitus, and microalbuminuria
• Initial: 10-20 mg orally once/day
• Maintenance: 20-80 mg orally once/day or divided every 12 hours

Dosage Modification

Renal impairment with hypertension

• CrCl greater than 60 mL/minute: 10 mg/day
• CrCl 30-60 mL/minute: 5 mg/day
• CrCl 10-30 mL/minute: 2.5 mg/day
• CrCl less than 10 mL/minute: Insufficient data

Renal impairment with congestive heart failure (CHF)

• CrCl greater than 30 mL/minute: 5 mg/day
• CrCl 10-30 mL/minute: 2.5 mg/day
• CrCl less than 10 mL/minute: Insufficient data

Geriatric: 2.5-5 mg/day initially; increase dose by increments of 2.5-5 mg at 1-2 week intervals; adjust for renal impairment

Common side effects of Accupril include:

• Dizziness
• Coughing
• Fatigue
• Nausea and/or vomiting
• Low blood pressure (hypotension)
• Shortness of breath
• Diarrhea
• Headache
• Muscle pain
• Skin itching or rash
• Back pain
• Lightheadedness
• Tiredness
• Stomach discomfort

Less common side effects of quinapril include:

• Skin swelling
• General: Back pain, feeling unwell (malaise), viral infections, severe allergic reaction (anaphylaxis)
• Cardiovascular: Palpitations, vasodilation, fast heart rate, heart failure, high blood potassium (hyperkalemia), heart attack (myocardial infarction), cerebrovascular accident, hypertensive crisis, chest pain (angina pectoris), low blood pressure and dizziness upon standing (orthostatic hypotension), cardiac rhythm disturbances, cardiogenic shock
• Hematology: Hemolytic anemia
• Gastrointestinal: Gas (flatulence), dry mouth or throat, constipation, gastrointestinal hemorrhage, pancreatitis, abnormal liver function tests, indigestion
• Metabolism and nutrition disorders: Low blood sodium (hyponatremia)
• Nervous/psychiatric: Drowsiness, spinning sensation (vertigo), fainting, nervousness, depression, insomnia, numbness and tingling
• Integumentary: Hair loss, increased sweating, pemphigus, itching, exfoliative dermatitis, sensitivity to sunlight (photosensitivity reaction), dermatopolymyositis
• Urogenital: Urinary tract infection, impotence, acute renal failure, worsening renal failure
• Respiratory: Eosinophilic pneumonitis
• Other: Lazy eye, swelling (edema), joint pain, pharyngitis, agranulocytosis, hepatitis, low blood platelets (thrombocytopenia)

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Severe interactions of quinapril include:
  • aliskiren
  • protein A column
• Quinapril has serious interactions with at least 38 different drugs.
• Quinapril has moderate interactions with at least 102 different drugs.
• Quinapril has mild interactions with at least 30 different drugs.

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

Warnings

Discontinue as soon as possible when pregnancy is detected; affects renin-angiotensin system causing oligohydramnios, which may result in fetal injury and/or death.

This medication contains quinapril. Do not take Accupril if you are allergic to quinapril or any ingredients contained in this drug.

This medication contains accupril. Do not take Effient if you are allergic to accupril or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Hypersensitivity
• History of hereditary or angioedema associated with previous ACE inhibitor treatment
• Bilateral renal artery stenosis
• Do not coadminister with aliskiren in patients with diabetes mellitus or with renal impairment (i.e., GFR less than 60 mL/minute/1.73 m²)
• Pregnancy (2nd and 3rd trimesters): Significant risk of fetal/neonatal morbidity and mortality

Effects of Drug Abuse

• Translation content

Short-Term Effects

• Dry hacking nonproductive cough may occur within few months of treatment; consider other causes of cough prior to discontinuation.
• See "What Are Side Effects Associated with Using Accupril?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Accupril?"

Cautions

• Excessive low blood pressure (hypotension) if concomitant diuretics, hypovolemia, hyponatremia
• Discontinue STAT if pregnant (see Contraindications and Warnings)
• Less effective in blacks
• Renal impairment may occur
• Cough may occur within the first few months
• Cholestatic jaundice may occur
• Use caution in severe aortic stenosis
• Risk of high blood potassium (hyperkalemia), especially with renal impairment, diabetes mellitus, or those taking concomitant potassium-elevating drugs
• Dual blockade of the renin angiotensin system with angiotensin receptor blockers (ARBs), angiotensin converting enzyme (ACE) inhibitors, or aliskiren associated with increased risk for hypotension, hyperkalemia, and renal function changes (including acute renal failure) compared to monotherapy
• 25-30% decreased absorption with high-fat meal
• ACE inhibition also causes increased bradykinin levels which putatively mediates angioedema
• Skin swelling (angioedema) of the face, extremities, lips, tongue, glottis, and larynx has been reported in patients treated with angiotensin-converting enzyme inhibitors
• If laryngeal stridor or angioedema of the face, tongue, or glottis occurs discontinue therapy and institute appropriate therapy immediately
• Patients receiving coadministration of ACE inhibitor and mTOR (mammalian target of rapamycin) inhibitor (e.g. temsirolimus, sirolimus, everolimus) therapy may be at increased risk for angioedema
• Intestinal angioedema has been reported in patients treated with ACE inhibitors
• Dry hacking nonproductive cough may occur within few months of treatment; consider other causes of cough prior to discontinuation
• Agranulocytosis, neutropenia, or leukopenia with myeloid hypoplasia reported with other ACE inhibitor; patients with renal impairment are at high risk; monitor complete blood count (CBC) with differential in these patients

Pregnancy and Lactation

• Use quinapril with caution during the first trimester of pregnancy if benefits outweigh risks. Animal studies show risk and human studies are not available or neither animal nor human studies were done. Use quinapril during the second and third trimesters of pregnancy only in LIFE-THREATENING emergencies when no safer drug is available. There is positive evidence of human fetal risk.
• Discontinue quinapril as soon as pregnancy is detected. During the second and third trimesters of pregnancy, drugs that act directly on the renin-angiotensin have been associated with fetal injury that includes low blood pressure (hypotension), neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death.
• Quinapril is excreted in breast milk. Use caution if breastfeeding.