• Alone or with other agents in the management of hypertension.
• Management of heart failure.

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)
• Concurrent use with sacubitril
• OB: Can cause injury or death of fetus – if pregnancy occurs, discontinue immediately
• Lactation: Discontinue or use formula.

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)
• Women of childbearing potential
• Pedi: Children <6 yr (safety not established)
• Geri: Initial dose ↓ recommended.

Exercise Extreme Caution in:

• Family history of angioedema.

CNS: dizziness, fatigue, headache.

Resp: cough.

CV: hypotension, chest pain.

GI: abdominal pain, diarrhea, nausea, vomiting.

GU: impaired renal function.

Derm: rash.

F and E: hyperkalemia.

MS: back pain, myalgia.

Resp: dyspnea.
Misc: ANGIOEDEMA.

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.

(Generic available)

• Tablets: 5 mg; 10 mg; 20 mg; 40 mg;
• In combination with: hydrochlorothiazide (Accuretic, Quinaretic). See Appendix [not included in this PDA edition].

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).

Heart Failure

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

Accupril

• Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins. ACE inhibitors also ↑ plasma renin levels and ↓ aldosterone levels. Net result is systemic vasodilation.

• Lowering of BP in hypertensive patients.
• Decreased afterload and symptoms in patients with heart failure.

Therapeutic Classification: antihypertensives

Pharmacologic Classification: ace inhibitors

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

Distribution: Crosses the placenta; enters breast milk.

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).

(effect on BP — single dose†)

†Full effects may not be noted for several weeks.

• 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 Appendix M.
  • 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 heart beat; chest pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; or if 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 women of childbearing age to use contraception and notify health care professional if pregnancy is planned or suspected or if 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.

KWIN-a-pril