Renal Dose Adjustment (Based on CrCl)
<40 mL/min: Initiate 10 mg PO daily- 30-60 mL/min: Initiate 5 mg PO daily
- 10-30 mL/min: Initiate 2.5 mg PO daily
- <10 mL/min: Dose adjustments not defined
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined
- ACE inhibitors can cause fetal/neonatal morbidity/mortality when used in pregnancy during the second and third trimesters. Discontinue drug as soon as possible once pregnancy detected [US Black Box Warning]
- Angioedema involving the extremities, face, lips, mucous membranes, tongue, glottis or larynx has been reported in patients treated with ACE inhibitors. If airway obstruction occurs, institute emergency therapy with epinephrine. Use with extreme caution in patients with hereditary angioedema
- Increased risk for angioedema has been reported in patients taking concomitant mTOR inhibitor therapy
- Significant hypotension may occur after first dose, especially in patients with severe salt or volume depletion or those with CHF. Start therapy under close medical supervision in these patient groups
- ACE inhibitors can cause fetal morbidity/mortality if administered to pregnant women. When pregnancy is detected, discontinue therapy as soon as possible
- Quinapril, another angiotensin converting enzyme inhibitor, has been shown to cause agranulocytosis and bone marrow depression. Risk increases with renal function impairment, CHF, SLE or other collagen vascular disease; significance unknown for quinapril. Monitor WBCs in patients with collagen-vascular disease, especially if the disease is associated with impaired renal function
- Rarely, ACE inhibitors can cause cholestatic jaundice progressing to fulminant hepatic necrosis and (sometimes) death. Discontinue therapy if marked elevations of hepatic enzymes occur
- Monitor BUN/Cr at baseline, then periodically, or more frequently if CHF, renal artery stenosis
- Monitor electrolytes and BP periodically
- Monitor WBC with differential count at baseline if collagen vascular disease and renal impairment
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Renal artery stenosis
- CAD
- Hypotension
- Aortic stenosis
- Cerebrovascular disease
- Collagen vascular disease
- Hypotension
- Hyponatremia
- Volume depletion
- Severe CHF
- Hypertrophic cardiomyopathy
- Black patients
- Elderly patients
Pregnancy Category:C (first trimester); D (second and third trimesters)
Breastfeeding: Safety unknown. Manufacturer advises caution.
Pricing data from www.DrugStore.com in U.S.A.
- Accupril 20 MG TABS [Bottle] (PFIZER U.S.)
30 mg = $67.99
90 mg = $182.97 - Accupril 10 MG TABS [Bottle] (PFIZER U.S.)
30 mg = $62.99
90 mg = $179.97 - Accupril 5 MG TABS [Bottle] (PFIZER U.S.)
30 mg = $69.27
90 mg = $176.24 - Quinapril HCl 40 MG TABS [Bottle] (LUPIN PHARMACEUTICALS)
30 mg = $21.99
90 mg = $50.97 - Quinapril HCl 20 MG TABS [Bottle] (LUPIN PHARMACEUTICALS)
30 mg = $26.97
90 mg = $59.97 - Accupril 40 MG TABS [Bottle] (PFIZER U.S.)
30 mg = $67.99
90 mg = $185.97
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.
