quinapril

kwin-a-pril

Trade Name(s): (Accupril)

BLACK BOX ALERT May cause fetal injury, mortality. Discontinue as soon as possible once pregnancy detected.

Do not confuse Accupril with Accolate, Accutane, Aciphex, or Monopril.

FIXED-COMBINATION(S) Accuretic: quinapril/hydroCHLOROthiazide (a diuretic): 10 mg/12.5 mg, 20 mg/12.5 mg, 20 mg/25 mg.

• PHARMACOTHERAPEUTIC: Angiotensinconverting enzyme (ACE) inhibitor. CLINICAL: Antihypertensive.

Treatment of hypertension. Used alone or in combination with other antihypertensives. Adjunctive therapy in management of HF with reduced ejection fraction.

Contraindications: Hypersensitivity to quinapril. History of angioedema from previous treatment with ACE inhibitors, concomitant use with aliskiren in pts with diabetes. Concomitant use with neprilysin inhibitor (e.g., sacubitril) or within 36 hrs of switching to or from neprilysin inhibitor. Cautions: Renal impairment, hypertrophic cardiomyopathy with outflow tract obstruction, major surgery, HF, hypovolemia, unstented bilateral renal artery stenosis, hyperkalemia, concurrent potassium supplements, severe aortic stenosis, ischemic heart disease, cerebrovascular disease.

Suppresses renin-angiotensin-aldosterone system, preventing conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Lower angiotensin II causes an increase in plasma renin activity and decreased aldosterone secretion. Therapeutic Effect: Reduces peripheral arterial resistance, B/P.

Widely distributed. Protein binding: 97%. Rapidly hydrolyzed to active metabolite. Primarily excreted in urine. Minimal removal by hemodialysis. Half-life: 1–2 hrs; metabolite, 3 hrs (increased in renal impairment).

Pregnancy/Lactation: Crosses placenta. Unknown if distributed in breast milk. May cause fetal, neonatal mortality or morbidity. Children: Safety and efficacy not established. Elderly: May be more sensitive to hypotensive effects.

DRUG: Aliskiren may increase hyperkalemic effect. May increase potential for allergic reactions to allopurinol. Angiotensin receptor blockers (e.g., losartan, valsartan) may increase adverse effects. May increase adverse effects of lithium, sacubitril. HERBAL: Herbals with hypertensive properties (e.g., licorice, yohimbe) or hypotensive properties (e.g., garlic, ginger, ginkgo biloba) may alter effects. FOOD: None known. LAB VALUES: May increase serum BUN, alkaline phosphatase, bilirubin, creatinine, potassium, ALT, AST. May decrease serum sodium. May cause positive antinuclear antibody (ANA) titer.

Tablets: 5 mg, 10 mg, 20 mg, 40 mg.

PO

• Give without regard to food.

Hypertension PO: ADULTS: Initially, 10–20 mg/day. Evaluate response after 2–4 wks and titrate as needed up to 80 mg/day in one or two divided doses. ELDERLY: Initially, 10 mg once daily. Titrate to optimal response.

Adjunct to Manage HF

PO: ADULTS, ELDERLY: Initially, 5 mg twice daily. May titrate dose q1–2wks or longer. Target dose: 20 mg twice daily.

Dosage in Renal Impairment

Hypertension

HF

Dosage in Hepatic Impairment

No dose adjustment.

Frequent (7%–5%): Headache, dizziness. Occasional (4%–2%): Fatigue, vomiting, nausea, hypotension, chest pain, cough, syncope. Rare (less than 2%): Diarrhea, cough, dyspnea, rash, palpitations, impotence, insomnia, drowsiness, malaise.

Excessive hypotension (“first-dose syncope”) may occur in pts with HF, those who are severely salt/volume depleted. Angioedema, hyperkalemia occur rarely. Agranulocytosis, neutropenia may occur in pts with collagen vascular disease (scleroderma, systemic lupus erythematosus), renal impairment. Nephrotic syndrome may occur in pts with history of renal disease.

• BASELINE ASSESSMENTObtain renal function test. Obtain B/P immediately before each dose in addition to regular monitoring (be alert to fluctuations). In pts with prior renal disease, urine test for protein by dipstick method should be made with first urine of day before beginning therapy and periodically thereafter. In pts with renal impairment, autoimmune disease, or taking drugs that affect leukocytes or immune response, CBC, differential count should be performed before beginning therapy and q2wks for 3 mos, then periodically thereafter.INTERVENTION/EVALUATIONMonitor B/ P for hypotension; renal function, serum potassium, WBC. Assist with ambulation if dizziness occurs.PATIENT/ FAMILY TEACHING
• Go slowly from lying to standing.
• Full therapeutic effect may take 1–2 wks.
• Report any sign of infection (sore throat, fever).
• Skipping doses or voluntarily discontinuing drug may produce severe rebound hypertension.
• Avoid tasks that require alertness, motor skills until response to drug is established.
• Avoid alcohol.