moexipril

Absorption: 13% bioavailability as moexiprilat following oral administration (↓ by food).

Distribution: Crosses the placenta.

Protein Binding: Moexipril: 90%; Moexiprilat: 50–70%.

Metabolism/Excretion: Converted by liver and GI mucosa to moexiprilat, the active metabolite; 13% excreted in urine, 53% excreted in feces.

Half-Life: Moexipril: 1 hr; Moexiprilat: 2–9 hr (↑ in renal impairment).

Time/Action Profile ⬆ ⬇

(antihypertensive effect with chronic dosing)

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

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
History of angioedema with previous use of ACE inhibitors;
Concurrent use with aliskiren in patients with diabetes or moderate to severe renal impairment (CCr <60 mL/min);
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Renal impairment, hypovolemia, hyponatremia, and concurrent diuretic therapy;
Black patients (monotherapy for hypertension less effective, may require additional therapy; higher risk of angioedema);
Surgery/anesthesia (hypotension may be exaggerated);
Rep: Women of reproductive potential;
Geri: Initial dose ↓ recommended in older adults;
Pedi: Safety not established in children.

Exercise Extreme Caution in:

Family history of angioedema.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension, chest pain, edema

Derm: flushing, rash

F and E: hyperkalemia

GI: diarrhea, dyspepsia

GU: impaired renal function

MS: myalgia

Neuro: dizziness, fatigue, headache

Resp: cough

Misc: ANGIOEDEMA, flu-like symptoms

Interactions ⬆ ⬇

Drug-drug:

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-sharing diuretics, or potassium-containing salt substitutes.
↑risk of hyperkalemia, renal impairment, hypotension, and syncope with angiotensin II receptor antagonists or aliskiren; avoid concurrent use with aliskiren in patients with diabetes or CCr <60 mL/min.
NSAIDs and selective COX-2 inhibitors may blunt the antihypertensive effect and ↑ the risk of renal impairment.
May ↑ lithium levels and the risk of toxicity.
↑risk of angioedema with temsirolimus, sirolimus, or everolimus.

Drug-Food:

Food significantly ↓ absorption. Administer moexipril 1 hr before meals.

Route/Dosage ⬆ ⬇

PO (Adults ): 7.5 mg once daily; may ↑ up to 30 mg/day in 1–2 divided doses; initiate therapy with 3.75 mg/day in patients receiving diuretics.

Renal Impairment

PO (Adults ): CCr ≤40 mL/min: Initiate therapy at 3.75 mg once daily; may titrate upward carefully to 15 mg/day.

Availability ⬆ ⬇

(Generic available)

Tablets: 7.5 mg; 15 mg

Assessment ⬆ ⬇

Monitor BP and HR frequently during initial dosage adjustment and periodically throughout therapy. Notify health care professional of significant changes.
Assess for orthostatic hypotension at regular intervals, especially in at-risk patients (older or with postural symptoms).
Assess patient for signs of angioedema (swelling of face, extremities, eyes, lips, or tongue; difficulty in swallowing or breathing); may occur at any time during therapy. Discontinue medication and provide supportive care.

Lab Test Considerations:

Monitor BUN, serum creatinine, uric acid, and electrolyte levels periodically. Serum potassium, uric acid, BUN, and creatinine may be ↑; sodium levels may be ↓. If ↑ BUN or serum creatinine concentrations occur, dose ↓ or withdrawal may be required.
- Obtain urinalysis, lipid profile, CBC, and a comprehensive metabolic panel at baseline.
- 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, serum bilirubin, and uric acid.

Implementation ⬆ ⬇

Precipitous drop in BP during first 1–3 hr after first dose may require volume expansion with normal saline but is not normally considered an indication for stopping therapy. Discontinuing diuretic therapy or cautiously ↑ salt intake 2–3 days before initiation may ↓ risk of hypotension. Monitor closely for ≥1 hr after BP has stabilized. Resume diuretics if BP is not controlled.
PO: Administer moexipril on an empty stomach, 1 hr before a meal.

Patient/Family Teaching ⬆ ⬇

Explain the purpose and side effects of moexipril to patient. Instruct patient to take medication as directed at the same time each day ≥1 hr prior to meals, even if feeling well. Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses. Do not stop taking drug without consulting health care professional. Do not share medication with others, even if they have similar symptoms; may be harmful. Keep out of children's reach. Advise patient to read Patient Informationbefore starting and with each Rx refill in case of changes. Warn patient not to discontinue ACE inhibitor therapy unless directed by health care professional.
Encourage patient to comply with additional interventions for hypertension (weight loss, 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.
Caution patient to avoid salt substitutes containing potassium, or foods containing high levels of 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 ↑ risk of 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 remedies.
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 before 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 patients with diabetes to monitor blood glucose closely, especially during first mo of therapy; may cause hypoglycemia.
Rep: May cause fetal harm. Advise females of reproductive potential to use effective contraception and notify health care professional if pregnancy is planned or suspected or if breastfeeding. If pregnancy is detected, discontinue moexipril as soon as possible.
Emphasize the importance of follow-up examinations to evaluate effectiveness of medication.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇