moexipril/hydrochlorothiazide (Rx)

Brand and Other Names:Uniretic
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Dosing & Uses


Dosage Forms & Strengths



  • 7.5mg/12.5mg
  • 15mg/12.5mg
  • 15mg/25mg


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

<18 years: Safety and efficacy not established



Interaction Checker

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            Adverse Effects



            • 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


            Frequency Not Defined

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


            • 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


            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



            Hypersensitivity to either component or sulfonamides

            History of angioedema

            Hereditary or idiopathic angioedema

            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


            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


            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


            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.



            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



            • 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)


            • 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


            Oral 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 hr before meal





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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.
            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.
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            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.