quinapril (Rx)

Brand and Other Names:Accupril
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 5mg
  • 10mg
  • 20mg
  • 40mg
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Hypertension

Initial: 10-20 mg PO qDay; may administer 5 mg in patients receiving diuretic therapy if the diuretic is continued

Maintenance: 20-80 mg PO qDay or divided q12hr

Congestive Heart Failure

Initial: 5 mg PO q12hr

Maintenance: 20-40 mg PO qDay or divided q12hr

Diabetic Nephropathy (Off-Label)

Slows rate of progression of renal disease in patients with HTN, DM, and microalbuminuria

Initial: 10-20 mg PO qDay

Maintenance: 20-80 mg PO qDay or divided q12hr

Dosage Modification

Renal impairment with hypertension

  • CrCl >60 mL/min: 10 mg/day
  • CrCl 30-60 mL/min: 5 mg/day
  • CrCl 10-30 mL/min: 2.5 mg/day
  • CrCl <10 mL/min: Insufficient data

Renal impairment with CHF

  • CrCl >30 mL/min: 5 mg/day
  • CrCl 10-30 mL/min: 2.5 mg/day
  • CrCl <10 mL/min: Insufficient data

Dosage Forms & Strengths

tablet

  • 5mg
  • 10mg
  • 20mg
  • 40mg
more...

Hypertension (Off-label)

5-10 mg PO qDay initially

2.5-5 mg/day initially; increase dose by increments of 2.5-5 mg at 1-2 week intervals; adjust for renal impairment

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Interactions

Interaction Checker

and quinapril

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Dizziness (7.7%)

            Coughing (4.3%)

            Fatigue (2.6%)

            Nausea and/or vomiting (2.4%)

            Hypotension (2.9%)

            Dyspnea (1.9%)

            Diarrhea (1.7%)

            Headache (1.7%)

            Myalgia (1.5%)

            Rash (1.4%)

            Back pain (1.2%)

            <1%

            Angioedema

            General: Back pain, malaise, viral infections, anaphylactoid reaction

            Cardiovascular: Palpitation, vasodilation, tachycardia, heart failure, hyperkalemia, myocardial infarction, cerebrovascular accident, hypertensive crisis, angina pectoris, orthostatic hypotension, cardiac rhythm disturbances, cardiogenic shock

            Hematology: Hemolytic anemia

            Gastrointestinal: Flatulence, dry mouth or throat, constipation, gastrointestinal hemorrhage, pancreatitis, abnormal liver function tests, dyspepsia

            Metabolism and nutrition disorders: Hyponatremia

            Nervous/psychiatric: Somnolence, vertigo, syncope, nervousness, depression, insomnia, paresthesia

            Integumentary: Alopecia, increased sweating, pemphigus, pruritus, exfoliative dermatitis, photosensitivity reaction, dermatopolymyositis

            Urogenital: Urinary tract infection, impotence, acute renal failure, worsening renal failure

            Respiratory: Eosinophilic pneumonitis

            Other: Amblyopia, edema, arthralgia, pharyngitis, agranulocytosis, hepatitis, thrombocytopenia

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            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

            Hypersensitivity

            History of hereditary or angioedema associated with previous ACE inhibitor treatment

            Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan

            Bilateral renal artery stenosis

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

            Cautions

            Excessive hypotension if concomitant diuretics, hypovolemia, hyponatremia

            Discontinue STAT if pregnant (see Contraindications and Black Box Warnings)

            Less effective in blacks

            Renal impairment may occur

            Cough may occur within the first few months

            Cholestatic jaundice may occur

            Use caution in severe aortic stenosis

            Risk of hyperkalemia, especially 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

            25-30% decreased absorption with high-fat meal

            ACE inhibition also causes increased bradykinin levels which putatively mediates angioedema

            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 (e.g. temsirolimus, sirolimus, everolimus) therapy or a neprilysin inhibitor may be at increased risk for angioedema

            Intestinal angioedema has been reported in patients treated with ACE inhibitors

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

            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

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            Pregnancy & Lactation

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

            Discontinue as soon as pregnancy detected; during the second and third trimesters of pregnancy, drugs that act directly on the renin-angiotensin have been associated with fetal injury that includes hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death

            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.

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            Pharmacology

            Mechanism of Action

            Angiotensin converting enzyme (ACE) inhibitors dilate arteries and veins by competively inhibiting the conversion of angiotensin I to angiotensin II (a potent endogenous vasoconstrictor) and by inhibiting bradykinin metabolism; these actions result in preload and afterload reductions on the heart

            ACE inhibitors also promote sodium and water excretion by inhibiting angiotensin-II induced aldosterone secretion; elevation in potassium may also be observed

            ACE inhibitors also elicit renoprotective effects through vasodilation of renal arterioles

            ACE inhibitors reduce cardiac and vascular remodeling associated with chronic hypertension, heart failure, and myocardial infarction

            Pharmacokinetics

            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

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            Formulary

            FormularyPatient Discounts

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

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            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.
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