moexipril/hydrochlorothiazide (Rx)

  • Print
Brand and Other Names:Uniretic

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

moexipril/hydrochlorothiazide

tablet

  • 7.5mg/12.5mg
  • 15mg/12.5mg
  • 15mg/25mg
more...

Hypertension

Not for initial therapy

If blood pressure not controlled with moexipril or hydrochlorothiazide monotherapy: 7.5 mg/12.5 mg, 15 mg/12.5 mg OR 15 mg/ 25 mg PO qDay

Increase either or both components based on clinical response

Do not increase hydrochlorothiazide component more often than q2-3Weeks

Doses above moexipril 30 mg/hydrochlorothiazide 50 mg qDay have not been studied

Administration

Dosage adjustment may be required in geriatrics

To minimize dose-independent side effects, it is usually appropriate to begin combination therapy only after a patient has failed to achieve the desired effect with monotherapy

Minimize hydrochlorothiazide dose to minimize electrolyte disturbances

Less effective in African-Americans

Food decreases absorption; manufacturer recommends administration 1 hour before meal

<18 years: Safety & efficacy not established

Next:

Interactions

Interaction Checker

and moexipril/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

            Moexipril

            1-10%

            • Dizziness
            • Hypotension
            • Peripheral edema
            • Cough
            • Headache
            • Myalgia
            • Hyponatremia
            • Pharyngitis
            • Sinusitis
            • Rash
            • Nausea/vomiting
            • Hyperkalemia
            • Hyponatremia
            • Polyuria

            Frequency Not Defined

            • Angioedema
            • Arrhythmia
            • Chest pain
            • Pneumonitis
            • Syncope
            • Proteinuria
            • Agranulocytosis (especially if patient has CVD with or without renal impairment)
            • Hepatic failure (rare)
            • Renal failure

            Hydrochlorothiazide

            Frequency Not Defined

            • Anorexia
            • Epigastric distress
            • Hypotension
            • Orthostatic hypotension
            • Photosensitivity

            <1%

            • Anaphylaxis, anemia, confusion, erythema multiforme skin reactions including Stevens-Johnson syndrome, exfoliative dermatitis including toxic epidermal necrolysis, hypomagnesemia, hyponatremia, hypochloremia, dizziness, fatigue, headache, hypercalcemia, hyperuricemia, hyperglycemia, hyperlipidemia, hypercholesterolemia, muscle weakness or cramps, nausea, purpura, rash, vertigo, vomiting
            Previous
            Next:

            Warnings

            Black Box Warnings

            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

            Anuria

            Hypersensitivity to either component or sulfonamides

            History of angioedema

            Hereditary or idiopathic angioedema

            Bilateral renal artery stenosis

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

            Cautions

            Excessive hypotension if concomitant diuretics, hypovolemia, hyponatremia

            Risk of hyperkalemia, especially in patients with renal impairment, DM or those taking concomitant K+-elevating drugs

            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

            DM, fluid or electrolyte imbalance, hyperuricemia or gout, SLE, liver disease, renal disease

            May aggravate digitalis toxicity

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

            Biliary cirrhosis or biliary obstruction

            Apheresis (LDL) with dextran sulfate, hypertrophic cardiomyopathy, collagen vascular disease, hemodialysis with high flux membrane, aortic stenosis

            Myelosuppression

            Renal impairment may occur

            Neutropenia/agranulocytosis reported

            Cough may occur within the first few months

            Cholestatic jaundice may occur

            Risk of male sexual dysfunction

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

            Avoid concomitant use with lithium

            Previous
            Next:

            Pregnancy & Lactation

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

            Lactation: inconclusive evidence exists, 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

            Moexipril/hydrochlorothiazide is a fixed-combination tablet that combines an angiotensin-converting enzyme (ACE) inhibitor, moexipril, and a thiazide diuretic, hydrochlorothiazide

            Moexipril prevents the conversion of angiotensin I to angiotensin II (a potent vasoconstrictor) through inhibition of ACE by competing with physiologic substrate (angiotensin I) for active site of ACE; inhibition of ACE initially results in decreased plasma angiotensin II concentrations & consequently, blood pressure may be reduced in part through decreased vasoconstriction, increased renin activity, and decreased 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

            Moexipril

            • Half-life: 1 hr (moexepril); 2-9 hr (moexiprilat)
            • Duration: 24 hr
            • Onset: 1-2 hr (peak effect)
            • Total body clearance: 441 mL/min (Moexipril); 223 mL/min (moexiprilat)
            • Excretion: Feces (50%); urine (13%)
            • Peak plasma time: 1.5 hr
            • Bioavailability: 13-22%
            • Protein bound: 90% (moexepril); 50-70% (moexeprilat)
            • Vd: 180 L
            • Metabolism: extensively metabolized in liver, minimally metabolized at intestinal wall
            • Metabolites: Moexiprilat (active)

            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