quinapril/hydrochlorothiazide (Rx)

  • Print
Brand and Other Names:Accuretic

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

quinapril/hydrochlorothiazide

tablet

  • 10mg/12.5mg
  • 20mg/12.5mg
  • 20mg/25mg
more...

Hypertension

Initial: 10 mg/12.5 mg or 20 mg/12.5 mg PO qDay

Increase either or both components based on clinical response

Do not increase hydrochlorothiazide component more often than q 2-3 weeks

To minimize dose-independent side effects, it is usually appropriate to initiate combination therapy only after inadequate response to quinapril monotherapy or significant potassium loss resulting from hydrochlorothiazide monotherapy

Renal Impairment

CrCl ≥30 mL/min: No dosage adjustment

CrCl <30 mL/min/1.73 m² or serum creatinine ≥3 mg/dL: Not recommended

<18 years: Safety and efficacy not established

Next:

Interactions

Interaction Checker

and quinapril/hydrochlorothiazide

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 
            Previous
            Next:

            Adverse Effects

            No adverse effects specific to the combination have been observed; adverse effects limited to those previously reported with quinapril and hydrochlorothiazide

            Quinapril

            1-10%

            • Dizziness (4-8%)
            • Headache (2-6%)
            • Cough (2-4%)
            • Hyoptension (3%)
            • Fatigue (3%)
            • Hyperkalemia (2%)
            • Chest pain (2%)
            • Nausea/vomiting (1-2%)
            • Rash (1%)
            • Hyperkalemia (2%)
            • Myalagia (2-5%)
            • Back pain (1%)

            Frequency Not Defined

            • Angioedema
            • Acute renal failure
            • Alopecia
            • Angina
            • Pancreatitis
            • Hyperkalemia

            Hydrochlorothiazide

            Frequency Not Defined

            • Anorexia
            • Epigastric distress
            • Hypotension
            • Orthostatic hypotension
            • Photosensitivity
            • Anaphylaxis
            • Anemia
            • Confusion
            • Erythema multiforme
            • Stevens-Johnson syndrome
            • Exfoliative dermatitis including toxic epidermal necrolysis
            • Hypomagnesemia
            • Dizziness
            • Headache
            • Hyperuricemia
            Previous
            Next:

            Warnings

            Black Box Warnings

            Quinapril: Discontinue as soon as possible when pregnancy is detected; affects renin-angiotensin system causing oligohydramnios, which may result in fetal injury and/or death

            Contraindications

            Hypersensitivity to either component or sulfonamides

            History of hereditary or angioedema associated with previous ACE inhibitor treatment

            Do not coadminister with aliskiren in patients with diabetes mellitus or with renal impairment (ie, GFR <60 mL/min/1.73 m²)

            Pregnancy (2nd and 3rd trimesters): significant risk of fetal/neonatal morbidity and mortality

            Cautions

            Dual blockade of the renin angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for hypotension, hyperkalemia, and renal function changes (including acute renal failure) compared to monotherapy

            May aggravate digitalis toxicity

            Sensitivity reactions may occur with or without history of allergy or asthma

            Risk of male sexual dysfunction

            Renal impairment may occur

            Acute transient myopia and acute angle-closure glaucoma has been reported, particularly with history of sulfonamide or penicillin allergy (hydrochlorothiazide is a sulfonamide)

            Angioedema of the face, extremities, lips, tongue, glottis, and larynx has been reported in patients treated with angiotensin-converting enzyme inhibitors

            If laryngeal stridor or angioedema of the face, tongue, or glottis occurs discontinue therapy and institute appropriate therapy immediately

            Patients receiving coadministration of ACE inhibitor and mTOR (mammalian target of rapamycin) inhibitor (eg, temsirolimus, sirolimus, everolimus) therapy may be at increased risk for angioedema

            Intestinal angioedema has been reported in patients treated with ACE inhibitors

            Cholestatic jaundice may occur, which may progress to fulminant hepatic necrosis; discontinue

            Dry hacking nonproductive cough may occur within few months of treatment; consider other causes of cough prior to discontinuation

            Hyperkalemia may occur with ACE inhibitors; risk factors include renal dysfunction, diabetes mellitus, and concomitant use of potassium sparing diuretics and potassium supplements; use cautiously if at all with these agents

            Thiazide diuretics may cause hypokalemia, hypochloremic alkalosis, hypomagnesemia, and hyponatremia

            Hydrochlorothiazide may precipitate gout in patients with familial predisposition to gout or chronic renal failure

            Symptomatic hypotension with or without syncope can occur with ACE inhibitors; mostly observed in volume depleted patients, correct volume depletion prior to initiation; monitor closely when initiating and increasing dosing

            Agranulocytosis, neutropenia, or leukopenia with myeloid hypoplasia reported with other ACE inhibitor; patients with renal impairment are at high risk; monitor CBC with differential in these patients

            Photosensitization may occur

            Hydrochlorothiazide may cause acute transient myopia and acute angle-closure glaucoma that may occur within hours of initiating therapy; discontinue therapy immediately in patients with acute decreases in visual acuity or ocular pain; additional treatment may be needed if uncontrolled intraocular pressure persists

            Use caution in patients with severe aortic stenosis; may reduce coronary perfusion resulting in ischemia

            Use hydrochlorothiazide with caution in patients with diabetes or at risk of diabetes; may see increase in glucose

            Use caution in patients collagen vascular disease, especially in patients with concomitant renal impairment

            Thiazide diuretics may decrease renal calcium excretion; consider avoiding use in patients with hypercalcemia

            Previous
            Next:

            Pregnancy & Lactation

            Pregnancy Category: C (1st trimester); D (2nd & 3rd trimester)

            Lactation: Excreted in breast milk, use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
            Previous
            Next:

            Pharmacology

            Mechanism of Action

            Accuretic is a fixed-combination tablet that combines an angiotensin-converting enzyme (ACE) inhibitor, quinapril hydrochloride, and a thiazide diuretic, hydrochlorothiazide

            Quinapril competitively inhibits angiotensin-converting enzymes resulting in decreased plasma angiotensin II concentrations and consequently, blood pressure may be reduced in part through decreased vasoconstriction, increase renin activity, and decrease aldosterone secretion

            Hydrochlorothiazide is a thiazide diuretic that inhibits Na reabsorption in distal renal tubules resulting in increased excretion of Na+ and water, also K+ and H+ ions

            Pharmacokinetics

            Quinapril

            • Half-Life: 0.8 hr (quinapril); 3 hr (quinaprilat)
            • Onset: 1 hr
            • Duration: 24 hr
            • Peak Plasma Time: 1 hr (quinapril); 2 hr (quinaprilat)
            • Bioavailability: ≥60%
            • Protein Bound: 97%
            • Metabolite: Quinaprilat (active)
            • Metabolism: Liver
            • Excretion: Urine (50-60% primarily as quinaprilat)
            • Dialyzable: Minimally

            Hydrochlorothiazide

            • Half-Life: 6-15 hr
            • Bioavailability: 70%
            • Onset: 2 hr (diuresis); 4-6 hr (peak effect)
            • Duration: 6-12 hr (diuresis); 1 wk (HTN)
            • Vd: 3.6-7.8 L/kg
            • Peak Plasma:1.5-2.5 hr
            • Protein Bound: 68%
            • Metabolism: Minimally metabolized
            • Clearance: 335 mL/min
            • Excretion: Urine 50-70%
            • Dialyzable: No
            Previous
            Next:

            Images

            Previous
            Next:

            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous