Renal Dose Adjustment (Based on CrCl)
- Severe renal impairment (<40 mL/min): Avoid use
Hepatic Dose Adjustment:
- Hepatic impairment/progressive liver disease: Dose adjustments not defined, caution advised
See Supplemental Patient Information
- Suspend therapy immediately if pregnancy is detected because ACE inhibitors can cause injury and even death to the developing fetus when used in pregnancy during the second and third trimesters [US Black Box Warning]
- ACE inhibitors may cause anaphylactoid reactions such as angioedema of the head and neck, involving the face, extremities, tongue, lips, glottis, or larynx and intestinal angioedema. Discontinue therapy if angioedema occurs and observe patients carefully until the swelling disappears
- Angioedema involving the tongue, glottis, or larynx may be fatal due to airway obstruction. Discontinue therapy and immediately provide emergency treatment such as administration of subcutaneous epinephrine injection 1:1000 (0.3-0.5 mL)
- Life-threatening anaphylactoid reactions have been reported in patients undergoing desensitization therapy with hymenoptera venom while receiving ACE inhibitors. Patients dialyzed with high-flux membranes and concomitantly treated with an ACE inhibitor and patients undergoing low-density lipoprotein apheresis with dextran sulfate absorption are prone to anaphylactoid reactions
- Agranulocytosis and bone marrow depression have been reported with ACE inhibitor therapy, particularly in patients with renal impairment, especially those who also have a collagen-vascular disease such as systemic lupus erythematosus or scleroderma. Monitor WBC counts in such patients prior to starting treatment and at approximately two-week intervals for about three months, then periodically
- Closely monitor the infants with histories of in utero exposure to ACE inhibitors for hypotension, oliguria, and hyperkalemia. If oliguria occurs, attention should be directed toward support of blood pressure and renal perfusion
- Rarely, ACE inhibitors have been associated with a syndrome that starts with cholestatic jaundice and progresses to fulminant hepatic necrosis and sometimes death. Discontinue therapy and provide appropriate medical treatment
- Use hydrochlorothiazide/moexipril cautiously in patients with impaired hepatic function or progressive liver disease, as minor alterations of fluid and electrolyte balance may precipitate hepatic coma
- Assess renal and hepatic function prior and periodically throughout therapy. Monitor serum potassium levels
- Symptomatic hypotension may occur with hydrochlorothiazide/moexipril therapy, especially in patients who are volume- and/or salt-depleted or those with congestive heart failure. Correct the volume depletion prior to initiating therapy; if excessive hypotension occurs, place the patient in a supine position and give an intravenous infusion of physiological saline if required
- Hydrochlorothiazide/moexipril should be used cautiously in patients with severe renal disease, as thiazides may precipitate azotemia in such patients
- Hypertensive patients with renal artery stenosis may experience increases in blood urea nitrogen and serum creatinine with moexipril therapy; these increases were reversible upon discontinuation of ACE inhibitor therapy or concomitant diuretic therapy. Monitor renal function in these patients during the first few weeks of therapy
- Thiazide diuretics have been reported to cause exacerbation or activation of systemic lupus erythematosus
- Hydrochlorothiazide may cause an idiosyncratic reaction, resulting in acute transient myopia and acute angle-closure glaucoma
- Moexipril monotherapy may cause persistent hyperkalemia; conversely, treatment with thiazide diuretics has been associated with hypokalemia. The opposite effects of moexipril and hydrochlorothiazide on serum potassium will balance each other in many patients; while, in some patients, one or the other effect may be dominant. Periodically monitor serum electrolytes to detect possible electrolyte imbalance
- Prolonged use of thiazides can cause hypercalcemia, hypophosphatemia, and hypomagnesemia
- As thiazide diuretics tend to reduce glucose tolerance and raise serum levels of cholesterol, triglycerides, and uric acid, it can precipitate frank gout or overt diabetes in susceptible patients
- Elevated BUN and serum creatinine levels were observed during therapy; dosage reduction of hydrochlorothiazide/moexipril may be required
- ACE inhibitors may cause persistent nonproductive cough, possibly due to the inhibition of the degradation of endogenous bradykinin, which resolves on discontinuation of therapy
Cautions: Use cautiously in
- Renal impairment
- CAD
- Hyponatremia
- Post-sympathectomy
- Cerebrovascular disorders
- Elderly patients
- Black patients
- Hypertrophic cardiomyopathy
- Aortic stenosis
- CAD
- History of asthma
Supplemental Patient Information
- Instruct patients to promptly report any signs or symptoms suggesting angioedema to their physician
- Caution patients that lightheadedness or fainting can occur, particularly during the first days of therapy and should be told to report to the physician
- Advise patients receiving therapy not to use potassium supplements or salt substitutes containing potassium without consulting their physician
- Instruct patients to promptly report any signs or symptoms suggestive of infection, which could be a sign of neutropenia
- Inform patients that excessive perspiration and dehydration may lead to an excessive fall in blood pressure because of reduction in fluid volume; advise patients to consult their physician if they develop such conditions
Pregnancy Category:C (first trimester) and D (second and third trimesters)
Breastfeeding: Hydrochlorothiazide doses of 50 mg daily or less are acceptable during lactation. Intense diuresis with large doses may decrease breastmilk production. An alternate drug to moexipril might be preferred especially while nursing a newborn or preterm infant as no information is available regarding moexipril use during breastfeeding. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 19 May 2011). Maternal medication with hydrochlorothiazide is usually compatible with breastfeeding, no observable change was seen in the nursing infant while the mother was ingesting the compound. This information is based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776/T6 last accessed 19 May 2011). Due to the potential for serious adverse reactions in nursing infants, manufacturer recommends discontinuation of nursing or discontinuation of the drug, taking into account the importance of the drug to the mother.
US Trade Name(s)
US Availability
hydrochlorothiazide/moexipril (generic)
- TABS:
- 12.5 mg/7.5 mg
- 25 mg/15 mg
- 12.5 mg/15 mg
Uniretic (hydrochlorothiazide/moexipril)
- TABS:
- 12.5 mg/7.5 mg
- 25 mg/15 mg
- 12.5 mg/15 mg
Canadian Trade Name(s)
Canadian Availability
UK Trade Name(s)
UK Availability
Australian Trade Name(s)
Australian Availability
Pricing data from www.DrugStore.com in U.S.A.
- Uniretic 15-12.5 MG TABS [Bottle] (SCHWARZ PHARMA)
30 mg = $84.99
90 mg = $228.98 - Uniretic 7.5-12.5 MG TABS [Bottle] (SCHWARZ PHARMA)
30 mg = $84.99
90 mg = $231.97 - Uniretic 15-25 MG TABS [Bottle] (SCHWARZ PHARMA)
30 mg = $84.99
90 mg = $228.98
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.