quinapril

Absorption: 60% absorbed following oral administration (high-fat meal may ↓ absorption).

Distribution: Widely distributed to tissues..

Protein Binding: 97%.

Metabolism/Excretion: Converted by the liver, GI mucosa, and tissue to quinaprilat, the active metabolite: 96% eliminated by the kidneys.

Half-Life: Quinapril:0.8 hrQuinaprilat: 3 hr (↑ in renal impairment).

Time/Action Profile ⬆ ⬇

(effect on BP—single dose‡)

ROUTE	ONSET	PEAK	DURATION
PO	within 1 hr	2–4 hr	up to 24 hr

‡Full effects may not be noted for several wk.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
History of angioedema with previous use of ACE inhibitors;
Concurrent use with sacubitril;
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Patients with renal impairment, hypovolemia, hyponatremia, and concurrent diuretic therapy—initial dose reduction recommended;
Black patients (monotherapy for hypertension less effective, may require additional therapy; higher risk for angioedema);
Surgery/anesthesia (hypotension may be exaggerated);
Rep: Women of reproductive potential;
Pedi: Children <6 yr (safety and effectiveness not established);
Geri: Initial dose ↓ recommended in older adults.

Exercise Extreme Caution in:

Family history of angioedema.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension, chest pain

Derm: rash

F and E: hyperkalemia

GI: abdominal pain, diarrhea, nausea, vomiting

GU: renal impairment

MS: back pain, myalgia

Neuro: dizziness, fatigue, headache

Resp: cough, dyspnea

Misc: ANGIOEDEMA

Interactions ⬆ ⬇

Drug-drug:

Concurrent use with sacubitril may ↑ risk of angioedema and is contraindicated; do not administer within 36 hr of switching to/from sacubitril/valsartan.
Excessive hypotension may occur with concurrent use of diuretics.
Additive hypotension with other antihypertensive agents.
↑risk of hyperkalemia with concurrent use of potassium supplements, potassium-sparing diuretics, or potassium-containing salt substitutes.
↑risk of hyperkalemia, renal dysfunction, hypotension, and syncope with concurrent use of angiotensin II receptor blockers or aliskiren; avoid concurrent use with aliskiren in patients with diabetes or CCr <60 mL/min; avoid concurrent use with angiotensin II receptor blockers.
NSAIDs and selective COX-2 inhibitors may blunt the antihypertensive effect and ↑ the risk of renal dysfunction.
↑levels and may ↑ the risk of lithium toxicity.
May ↓ absorption of tetracycline,doxycycline, and fluoroquinolone antibiotics (due to magnesium in tablets).
↑risk of angioedema with temsirolimus, sirolimus, or everolimus.

Route/Dosage ⬆ ⬇

Hypertension

PO (Adults ): 10–20 mg once daily initially, may be titrated every 2 wk up to 80 mg/day in single or two divided daily doses (initiate therapy at 5 mg/day in patients receiving diuretics).

Renal Impairment

PO (Adults ): CCr >60 mL/min: Initiate therapy at 10 mg/day; CCr 30–60 mL/min: Initiate therapy at 5 mg/day;CCr 10–30 mL/min: Initiate therapy at 2.5 mg/day.

Heart Failure

PO (Adults ): 5 mg twice initially, may be titrated at weekly intervals up to 20 mg twice daily.

Renal Impairment

PO (Adults ): CCr 30–60 mL/min: Initiate therapy at 5 mg/day; if tolerated, increase to 5 mg twice daily on following day. CCr 10–30 mL/min: Initiate therapy at 2.5 mg/day; if tolerated, increase to 2.5 mg twice daily on following day.

Availability ⬆ ⬇

(Generic available)

Tablets: 5 mg; 10 mg; 20 mg; 40 mg
In combination with: hydrochlorothiazide.

Assessment ⬆ ⬇

Hypertension: Monitor BP and pulse frequently during initial dose adjustment and periodically during therapy. Notify health care professional of significant changes.
- Monitor frequency of prescription refills to determine compliance.
Assess patient for signs of angioedema (swelling of face, extremities, eyes, lips, tongue, difficulty in swallowing or breathing); may occur at any time during therapy. Discontinue medication and provide supportive care.
HF: Monitor weight and assess patient routinely for resolution of fluid overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention).

Lab Test Considerations:

Monitor BUN, serum creatinine, and electrolyte levels periodically. Serum potassium, BUN, and creatinine may be ↑, whereas sodium levels may be ↓. If ↑ BUN or serum creatinine concentrations occur, dose reduction or withdrawal may be required.
- May cause hyperkalemia.
- Monitor CBC periodically during therapy in patients with collagen vascular disease and/or renal disease. May rarely cause agranulocytosis.
- May cause ↑ AST, ALT, alkaline phosphatase, and serum bilirubin.

Implementation ⬆ ⬇

Do not confuse Accupril with Aciphex.
Correct volume depletion, if possible, before initiation of therapy. Precipitous drop in BP during first 1–3 hr following first dose may require volume expansion with normal saline. Discontinuing diuretic therapy or cautiously increasing salt intake 2–3 days prior to initiation may decrease risk. Monitor closely for at least 1 hr after BP has stabilized. Resume diuretics if BP is not controlled.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed at the same time each day, even if feeling well. Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses. Warn patient not to discontinue ACE inhibitor therapy unless directed by health care professional.
- Caution patient to avoid salt substitutes containing potassium or foods high in potassium or sodium unless directed by health care professional. See Food Sources for Specific Nutrients.
- Caution patient to change positions slowly to minimize orthostatic hypotension. Use of alcohol, standing for long periods, exercising, and hot weather may increase orthostatic hypotension.
- Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications, especially NSAIDs and cough, cold, or allergy medications.
- May cause dizziness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
- Advise patient to inform health care professional of medication regimen prior to treatment or surgery.
- Instruct patient to notify health care professional immediately if rash; mouth sores; sore throat; fever; swelling of hands or feet; irregular heartbeat; chest pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; or difficulty swallowing or breathing occurs. Persistent dry cough may occur and may not subside until medication is discontinued. Consult health care professional if cough becomes bothersome. Also notify health care professional if nausea, vomiting, or diarrhea occurs and continues.
- Advise diabetic patients to monitor blood glucose closely, especially during first mo of therapy; may cause hypoglycemia.
- Advise females of reproductive potential to use contraception and notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding. If pregnancy is detected, discontinue medication as soon as possible.
- Emphasize the importance of follow-up examinations to evaluate effectiveness of medication.
Hypertension: Encourage patient to comply with additional interventions for hypertension (weight reduction, low sodium diet, discontinuation of smoking, moderation of alcohol consumption, regular exercise, and stress management). Medication controls but does not cure hypertension.
- Instruct patient and family on correct technique for monitoring BP. Advise them to check BP at least weekly and to report significant changes to health care professional.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇