Renal Dose Adjustment (Based on CrCl)
- <30 mL/min/1.73 m2: Not recommended
Hepatic Dose Adjustment
- Hepatic impairment: Caution advised, dose adjustments not defined
See Supplemental Patient Information
- Quinapril/hydrochlorothiazide cause fetal/neonatal morbidity/mortality when administered to a pregnant woman [US Black Box Warning]
- ACE inhibitor can cause anaphylactoid and possibly related reactions
- Anaphylactoid reactions including head, neck or intestinal angioedema has been reported in patients receiving ACE inhibitors. Angioedema involving tongue, glottis or larynx can lead to airway obstruction and can be fatal. Discontinue therapy and immediately provide emergency treatment including administration of subcutaneous epinephrine injection 1:1000 (0.3-0.5 mL)
- Life-threatening anaphylactoid reactions have occurred in patients undergoing desensitizing 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
- Cholestatic jaundice progressing to fulminant hepatic necrosis and sometimes death has occurred with ACE inhibitors; discontinue therapy and provide appropriate medical treatment
- Symptomatic hypotension sometimes associated with oliguria or progressive azotemia, and rarely acute renal failure and/or death can occur with quinapril/hydrochlorothiazide therapy especially who are volume and/or salt-depleted or receiving high doses of diuretics, correct the volume and salt depletion prior to administration of quinapril/hydrochlorothiazide, if excessive hypotension occurs place the patient in a supine position and, if necessary, given an intravenous infusion of normal saline
- Thiazides should be used cautiously in patients with renal disease, severe congestive heart failure, whose renal function depend on the activity of the renin-angiotensin aldosterone system. Treatment with angiotensin-converting enzyme can precipitate oliguria or progressive azotemia and (rarely) acute renal failure and/or death
- Hypertensive patients with renal artery stenosis may experience increase in blood urea nitrogen and serum creatinine with quinapril therapy, these increases were reversible upon discontinuation or dose reduction. Monitor renal function in these patients during the first few weeks of therapy
- Agranulocytosis and bone marrow depression has been reported with ACE inhibitor therapy, particularly in patients with renal impairment, especially those who also have collagen-vascular diseases such as systemic lupus erythematosus or scleroderma. Monitor WBC counts in patients with impaired renal function prior to starting treatment and at approximately two-week intervals for about three months, then periodically
- Exposure to ACE inhibitors in second and third trimesters of pregnancy has been associated with fetal and neonatal injury, including hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, oligohydramnios, intrauterine growth retardation, patent ductus arteriosus, fetal or neonatal jaundice, thrombocytopenia, and death
- Minor alterations of fluid and electrolyte balance may precipitate hepatic coma. Use with extreme caution in patients with impaired hepatic function
- Thiazide diuretics exacerbates or activates systemic lupus erythematosus
- Hydrochlorthiazide/quinapril therapy can cause an idiosyncratic reaction, resulting in acute transient myopia and acute angle-closure glaucoma. Symptoms manifested as decreased visual acuity or ocular pain occurs within hours to weeks of drug initiation. Treatments include discontinuation of drug and prompt medical or surgical treatments, if the intraocular pressure remains uncontrolled. Patient with history of sulfonamide or penicillin allergy are at higher risk
- Quinapril monotherapy causes hyperkalemia and conversely treatment with thiazide diuretics has been associated with hypokalemia. The opposite effects of quinapril and hydrochlorothiazide on serum potassium balance each other in some patients and one or the other effect may be dominant in some, monitor serum electrolytes to detect possible electrolyte imbalance periodically
- Dilutional hyponatremia manifested by dryness of the mouth, thirst, lethargy, and drowsiness and confirmed by a low serum sodium level can occur in edematous patients in hot weather. Appropriate therapy includes water restriction and sodium administration in life-threatening hyponatremia
- Pathologic changes in the parathyroid gland with hypercalcemia and hypophosphatemia have been reported in patients on prolonged thiazide therapy, as thiazides decreases the calcium excretion
- Thiazides increase the urinary excretion of magnesium, resulting into hypomagnesemia
- As thiazide diuretics tend to reduce glucose tolerance and raise serum levels of cholesterol, triglycerides, and uric acid, it can precipitate gout or diabetes in susceptible patients
- ACE inhibitors causes nonproductive cough, due to the inhibition of the degradation of endogenous bradykinin, which resolves on discontinuation of therapy
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Renal artery stenosis
- Volume depletion
- Congestive heart failure
- Severe CAD
- Diabetes mellitus
- Hypotension
- Postsympathectomy
- Collagen vascular disease
- Hyponatremia
- Black patients
- Antigen desensitization treatment
- Surgery/Anesthesia
- SLE
- History of gout
- Low-density lipoprotein apheresis with dextran sulfate
- Dialysis with high-flux membranes
- Geriatrics
Supplemental Patient Information
- Female patients of childbearing age should be warned about the consequences of second and third trimester exposure to ACE inhibitors and should be advised to report pregnancies to their physicians as soon as possible
- Patients should be advised not to use potassium supplements or salt substitutes containing potassium without consulting the prescribing physician
- Patients should be cautioned about the symptoms of hypotension, and should be advised to report their physician if any of the symptoms occurs
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. Quinapril is excreted in low level in breastmilk and small amount is ingested by the infants, hence is not expected to cause any adverse effects in breastfed infants. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 24 May 2011). Manufacturer advises caution. Hydrochlorothiazide maternal medication 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 24 May 2011).
US Trade Name(s)
US Availability
hydrochlorothiazide/quinapril (generic)
- TABS: 12.5 mg/10 mg
- TABS: 12.5 mg/20 mg
- TABS: 25 mg/20 mg
Accuretic, Quinaretic (hydrochlorothiazide/quinapril)
- TABS: 12.5 mg/10 mg
- TABS: 12.5 mg/20 mg
- TABS: 25 mg/20 mg
Canadian Trade Name(s)
Canadian Availability
Accuretic (hydrochlorothiazide/quinapril)
- TABS: 12.5 mg/10 mg
- TABS: 12.5 mg/20 mg
- TABS: 25 mg/20 mg
UK Trade Name(s)
UK Availability
Accuretic (hydrochlorothiazide/quinapril)
Australian Trade Name(s)
Australian Availability
Accuretic (hydrochlorothiazide/quinapril)
- TABS: 12.5 mg/10 mg
- TABS: 12.5 mg/20 mg
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Accuretic 20-25 MG TABS [Bottle] (PFIZER U.S.)
30 mg = $64.04
90 mg = $192.12 - Accuretic 20-12.5 MG TABS [Bottle] (PFIZER U.S.)
30 mg = $67.41
90 mg = $174.54 - Accuretic 10-12.5 MG TABS [Bottle] (PFIZER U.S.)
30 mg = $66.99
90 mg = $200.98
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.
