Quinapril


Generic Medicine Info
Indications and Dosage
Oral
Heart failure
Adult: As adjunct: Initially, 5 mg bid. Dosage may be adjusted at wkly intervals to 20-40 mg in 2 divided doses if initial dose is tolerated.

Oral
Hypertension
Adult: Initially, 10 or 20 mg once daily, 1st dose preferably at bedtime or alternatively in 2 divided doses. Maintenance: 20-80 mg/day as a single dose or in 2 divided doses. Patients on diuretics: Initially, 5 mg once daily. Close monitoring is required until BP has stabilised. If possible, diuretic should be discontinued 2-3 days before starting therapy w/ ACE inhibitor.
Elderly: Initially, 10 mg once daily or in 2 divided doses. Titrate to optimal response.
Renal Impairment
HTN:
CrCl Dosage
10-30 Initial: 2.5 mg once daily.
31-60 Initial: 5 mg once daily.
>60 Initial: 10 mg once daily.

Heart Failure:
CrCl Dosage
10-30 Initial: 2.5 mg once daily.
>30 Initial: 5 mg once daily.
Administration
Should be taken on an empty stomach. Take before meals at about the same time of day.
Contraindications
History of angioedema related to previous ACE inhibitor treatment, hereditary or idiopathic angioedema. Concomitant use w/ aliskiren in patients w/ diabetes and renal impairment. Pregnancy.
Special Precautions
Patients w/ diarrhoea, severe volume and/or salt depletion due to prolonged use of diuretics and unilateral or bilateral renal artery stenosis. Patients on dietary salt restriction and dialysis. Severe CHF. Increased risk of angioedema in black patients. Renal and hepatic impairment. Lactation.
Adverse Reactions
Dizziness, headache, fatigue, persistent dry cough and other upper resp tract symptoms, skin rashes, hyperkalaemia, chest pain, cholestatic jaundice, nausea, vomiting, neutropenia, agranulocytosis, dyspnoea, diarrhoea, myalgia, back pain, increased serum creatinine and BUN.
Potentially Fatal: Anaphylactic reactions including angioedema. Pronounced hypotension. Fulminant hepatic necrosis.
MonitoringParameters
Monitor BP prior and throughout therapy. Periodically monitor serum creatinine, K levels and CBC.
Overdosage
Symptoms: Severe hypotension. Management: Supportive treatment and IV volume expansion.
Drug Interactions
Additive hyperkalaemic effects w/ K-sparing diuretics, K supplements, other drugs that can cause hyperkalaemia. Increased lithium concentrations and toxicity. May decrease absorption of tetracyclines. May increase nitritoid reactions of gold Na thiomalate.
Potentially Fatal: Increased risk of hypotension, hyperkalaemia and nephrotoxicity w/ concomitant aliskiren in renally impaired and diabetic patients.
Food Interaction
Avoid use of licorice as it may worsen HTN.
Action
Description: Quinapril is a prodrug of quinaprilat. It is a competitive inhibitor of ACE. It prevents conversion of angiotensin I to angiotensin II (a potent vasoconstrictor) resulting in lower levels of angiotensin II which causes an increase in plasma renin activity and a reduction in aldosterone (a hormone that causes water and Na retention) secretion. This promotes vasodilation and BP reduction.
Onset: 1 hr.
Duration: Approx 24 hr.
Pharmacokinetics:
Absorption: High fat meal reduces absorption. Approx 60% of an oral dose is absorbed. Time to peak plasma concentration: Approx 2 hr (as quinaprilat).
Distribution: Enters breast milk (small amounts). Plasma protein binding: Approx 97%.
Metabolism: Hepatically hydrolysed to form quinaprilat (active metabolite) and inactive metabolites.
Excretion: Via urine (50-60% as quinaprilat) and faeces. Terminal half-life: 3 hr (quinaprilat).
Storage
Store between 15-30°C.
References
Accupril (Parke-Davis; Pfizer). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 20/11/2013.

Accupril Tablets. U.S. FDA. https://www.fda.gov. Accessed 20/11/2013.

Anon. Quinapril. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 20/11/2013.

Buckingham R (ed). Quinapril. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 20/11/2013.

Joint Formulary Committee. Quinapril. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 20/11/2013.

McEvoy GK, Snow EK, Miller J et al (eds). Quinapril. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 20/11/2013.

Disclaimer: This information is independently developed by MIMS based on Quinapril from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2021 MIMS. All rights reserved. Powered by MIMS.com
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