quinapril/hydrochlorothiazide (Rx)

Brand and Other Names:Accuretic
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Dosing & Uses


Dosage Forms & Strengths



  • 10mg/12.5mg
  • 20mg/12.5mg
  • 20mg/25mg


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



Interaction Checker

and quinapril/hydrochlorothiazide

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            Adverse Effects

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



            • 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


            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

            Postmarketing Reports


            • Non-melanoma skin cancer


            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


            Hypersensitivity to either component or sulfonamides

            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

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


            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 or a neprilysin inhibitor 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; instruct patients taking hydrochlorothiazide to protect skin from sun and undergo regular skin cancer screening

            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

            Angle-closure glaucoma

            • Hydrochlorothiazide can cause acute angle-closure glaucoma and elevated intraocular pressure with or without noticeable acute myopic shift and/or choroidal effusions
            • May occur within hours of initiating therapy; discontinue therapy immediately in patients with acute decreases in visual acuity or ocular pain
            • Additional medical or surgical treatments may be needed if intraocular pressure remains uncontrolled
            • Untreated angle-closure glaucoma may result in permanent visual field loss
            • Risk factors for developing acute angle-closure glaucoma may include a history of sulfonamide or penicillin allergy

            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.



            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



            • 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


            • 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




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            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.
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