Hypertension: Monotherapy: The recommended initial dosage of quinapril in patients not on diuretics is 10 mg or 20 mg once daily. Depending upon clinical response, the patient's dosage may be titrated (by doubling the dose) to a maintenance dosage of 20 mg/day or 40 mg/day, usually given as a single dose or may be divided in two doses. Generally, dosage adjustments should be made at intervals of 4 weeks. Long-term control is maintained in most patients with a single daily dosage regimen. Patients have been treated with dosages of quinapril up to 80 mg/day.
Concomitant Diuretics: In patients who must continue treatment with a diuretic, the initial recommended dosage of quinapril is 5 mg, which should subsequently be titrated (as described previously) to the optimal response (see Interactions).
Congestive Heart Failure: Quinapril is indicated as adjunctive therapy with diuretics and/or cardiac glycosides. The recommended initial dosage in patients with congestive heart failure is 5 mg once or twice daily, following which the patient should be monitored closely for symptomatic hypotension. If the initial dose of quinapril is well tolerated, patients may be titrated up to an effective dose, usually 10 mg/day to 40 mg/day given in two equally divided doses with concomitant therapy.
Renal Impairment: See Precautions. Kinetic data indicate that quinapril elimination is dependent on the level of renal function. The recommended initial dose of quinapril is 5 mg in patients with a creatinine clearance above 30 mL/min and 2.5 mg in patients with a creatinine clearance less than 30 mL/min. If the initial dose is well tolerated, quinapril may be administered the following day as a twice-daily regimen. In the absence of excessive hypotension or significant deterioration of renal function, the dose may be increased at weekly intervals based on clinical and hemodynamic response. Recommended starting dosages based on clinical and pharmacokinetic data from patients with renal impairment are as follows: See Table 1.
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Use in Elderly: Age alone does not appear to affect the efficacy or safety profile of quinapril. Therefore, the recommended initial dosage of quinapril in elderly patients is 10 mg given once daily followed by titration to the optimal response.
Use in Children: Safety and effectiveness of quinapril in pediatric patients have not been established.