Accupril


Also found in: Dictionary.
Related to Accupril: atenolol

quinapril hydrochloride

Accupril, Accupro, (UK) Quinil (UK)

Pharmacologic class: Angiotensin-converting enzyme (ACE) inhibitor

Therapeutic class: Antihypertensive

Pregnancy risk category D

Action

Inhibits conversion of angiotensin I to angiotensin II, a potent vasoconstrictor; decreases cardiac output. Increases plasma renin levels and reduces aldosterone levels, causing systemic vasodilation.

Availability

Tablets: 5 mg, 10 mg, 20 mg, 40 mg

Indications and dosages

Hypertension

Adults: Initially, 10 to 20 mg P.O. daily for patients not receiving diuretics, with subsequent dosages adjusted at 2-week intervals according to blood pressure response at peak (2 to 6 hours) and trough (predose) blood levels; for maintenance, 20 to 80 mg/day as a single dose or in two divided doses. In patients receiving diuretics, discontinue diuretic 2 to 3 days before starting quinapril; if blood pressure isn't controlled, resume diuretic. If diuretic can't be discontinued, start therapy with 5 mg/day quinapril.

Adjunct in heart failure

Adults: Initially, 5 mg P.O. b.i.d., titrated weekly until effective dosage is determined. For maintenance, 20 to 40 mg/day in two evenly divided doses.

Dosage adjustment

• Renal impairment
• Elderly patients

Off-label uses

• Aortic insufficiency
• Atherosclerosis
• Postoperative hypertension
• Myocardial infarction
• Diabetic or nondiabetic neuropathy

Contraindications

• Hypersensitivity to drug or other ACE inhibitors
• Angioedema caused by other ACE inhibitors

Precautions

Use cautiously in:
• autoimmune diseases, aortic stenosis, renal artery stenosis, hypertrophic cardiomyopathy, cerebrovascular or cardiac insufficiency, collagen vascular disease, hepatic or renal impairment, hypovolemia, hyponatremia, hypotension, neutropenia, chronic cough, proteinuria, febrile illness
• family history of angioedema
• risk factors for development of hyperkalemia, including renal insufficiency, diabetes mellitus, concurrent use of potassium-sparing diuretics, potassium supplements, or potassium-containing salt substitutes
• concurrent use of nonsteroidal antiinflammatory drugs (NSAIDs) in patients who are elderly, volume-depleted (including those on diuretics), or with compromised renal function
• concurrent immunosuppressant, lithium, or diuretic therapy
• black patients
• elderly patients
• pregnant or breastfeeding patients
• children (safety not established).

Administration

• Administer with or without food, but not with high-fat meal.
• Know that if quinapril alone doesn't adequately control blood pressure, a diuretic may be added.

Adverse reactions

CNS: dizziness, drowsiness, fatigue, headache, insomnia, depression, vertigo, paresthesia, asthenia, malaise, nervousness, syncope

CV: hypotension, angina pectoris, palpitations, chest pain, tachycardia, arrhythmias

EENT: amblyopia, sinusitis, pharyngitis

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, anorexia, dry mouth

GU: erectile dysfunction

Metabolic: hyperkalemia

Musculoskeletal: back pain

Respiratory: cough, dyspnea

Skin: rash, pruritus, alopecia, flushing, diaphoresis, photosensitivity

Other: taste disturbances, fever, viral infections, hypersensitivity reactions including anaphylaxis

Interactions

Drug-drug.

Diuretics, other antihypertensives: increased hypotension

Gold (sodium aurothiomalate): increased risk of rare nitritoid reactions (including facial flushing, nausea, vomiting, and hypotension)

Lithium: increased serum lithium level and lithium toxicity

NSAIDs: may result in deterioration of renal function, including acute renal failure and attenuated ACE inhibitor antihypertensive effect

Potassium-sparing diuretics, potassium supplements: increased risk of hyperkalemia

Tetracyclines: decreased tetracycline absorption

Drug-diagnostic tests.Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, potassium: increased levels

Drug-food.High-fat foods: decreased rate and extent of drug absorption

Salt substitutes containing potassium: increased risk of hyperkalemia

Patient monitoring

• Monitor vital signs and cardiovascular status. Be sure to ask patient if he's experiencing angina.
• Assess CBC and liver function tests.
• Monitor potassium level. Watch for evidence of hyperkalemia.

Watch closely for signs and symptoms of angioedema, especially in black patients after first dose.
• Assess for dry, nonproductive cough and signs and symptoms of infection.
• Monitor renal function periodically in patients receiving concurrent NSAID therapy.

Patient teaching

• Tell patient he may take with or with­out food, but not with high-fat meal.

Advise patient to immediately report facial or tongue swelling or difficulty breathing.
• Instruct patient to monitor and record his blood pressure.
• Tell patient to promptly report dry, nonproductive cough and signs and symptoms of infection.
• Instruct patient to move slowly when sitting up or standing, to avoid dizziness or light-headedness from sudden blood pressure decrease.
• Tell patient that excessive fluid loss (as from sweating, vomiting, or diarrhea) and inadequate fluid intake increase the risk of light-headedness (especially in hot weather).
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Advise patient to avoid salt substitutes containing potassium.
• Tell female patient to notify prescriber of possible pregnancy. Caution her not to breastfeed.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.

quinapril

(kwin-a-pril) ,

Accupril

(trade name)

Classification

Therapeutic: antihypertensives
Pharmacologic: ace inhibitors
Pregnancy Category: D

Indications

Alone or with other agents in the management of hypertension. Management of heart failure.

Action

Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins. ACE inhibitors also ↑ plasma renin levels and ↓ aldosterone levels. Net result is systemic vasodilation.

Therapeutic effects

Lowering of BP in hypertensive patients.
Decreased afterload and symptoms in patients with heart failure.

Pharmacokinetics

Absorption: 60% absorbed following oral administration (high-fat meal may ↓ absorption).
Distribution: Crosses the placenta; enters breast milk.
Protein Binding: 97%.
Metabolism and Excretion: Converted by the liver, GI mucosa, and tissue to quinaprilat, the active metabolite: 96% eliminated by the kidneys.
Half-life: Quinapril—0.8 hrQuinaprilat—3 hr (↑ in renal impairment).

Time/action profile (effect on BP—single dose†)

ROUTEONSETPEAKDURATION
POwithin 1 hr2–4 hrup to 24 hr
†Full effects may not be noted for several weeks

Contraindications/Precautions

Contraindicated in: Hypersensitivity; History of angioedema with previous use of ACE inhibitors; Concurrent use with aliskiren in patients with diabetes or moderate-to-severe renal impairment (CCr <60 mL/min) Obstetric: Can cause injury or death of fetus – if pregnancy occurs, discontinue immediately. Lactation: Discontinue or use formula.
Use Cautiously in: Patients with renal impairment, hypovolemia, hyponatremia, and concurrent diuretic therapy—initial dose reduction recommended; genetic implication Black patients (monotherapy for hypertension less effective, may require additional therapy; higher risk for angioedema); Surgery/anesthesia (hypotension may be exaggerated); Women of childbearing potential; Pediatric: Children <6 yr (safety not established); Geriatric: Initial dose ↓ recommended.
Exercise Extreme Caution in: Family history of angioedema.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • fatigue
  • headache

Respiratory

  • cough (most frequent)

Cardiovascular

  • hypotension (most frequent)
  • chest pain

Gastrointestinal

  • abdominal pain
  • diarrhea
  • nausea
  • vomiting

Genitourinary

  • impaired renal function

Dermatologic

  • rash

Fluid and Electrolyte

  • hyperkalemia

Musculoskeletal

  • back pain
  • myalgia

Respiratory

  • dyspnea

Miscellaneous

  • angioedema (life-threatening)

Interactions

Drug-Drug interaction

Excessive hypotension may occur with concurrent use of diuretics.Additive hypotension with other antihypertensive agents.↑ risk of hyperkalemia with concurrent use ofpotassium supplements, potassium-sparing diuretics, or potassium-containing salt substitutes.↑ risk of hyperkalemia, renal dysfunction, hypotension, and syncope with concurrent use of angiotensin II receptor antagonists or aliskiren ; avoid concurrent use with aliskiren in patients with diabetes or CCr <60 mL/minNSAIDs and selective COX-2 inhibitors may blunt the antihypertensive effect and ↑ the risk of renal dysfunction.↑ levels and may ↑ the risk of lithium toxicity.May ↓ absorption of tetracycline,doxycycline, and fluoroquinolone antibiotics (due to magnesium in tablets).↑ risk of angioedema with temsirolimus or everolimus.

Route/Dosage

Hypertension

Oral (Adults) 10–20 mg once daily initially, may be titrated every 2 wk up to 80 mg/day in single or two divided daily doses (initiate therapy at 5 mg/day in patients receiving diuretics).

Renal Impairment

Oral (Adults) CCr >60 mL/min—Initiate therapy at 10 mg/day; CCr 30–60 mL/min—Initiate therapy at 5 mg/day;CCr 10–30 mL/min—Initiate therapy at 2.5 mg/day.

Heart Failure

Oral (Adults) 5 mg twice initially, may be titrated at weekly intervals up to 20 mg twice daily.

Renal Impairment

Oral (Adults) CCr 30–60 mL/min—Initiate therapy at 5 mg/day; if tolerated, increase to 5 mg twice daily on following day. CCr 10–30 mL/min—Initiate therapy at 2.5 mg/day; if tolerated, increase to 2.5 mg twice daily on following day.

Availability (generic available)

Tablets: 5 mg, 10 mg, 20 mg, 40 mg
In combination with: hydrochlorothiazide (Accuretic, Quinaretic). See combination drugs.

Nursing implications

Nursing assessment

  • Hypertension: Monitor BP and pulse frequently during initial dose adjustment and periodically during therapy. Notify health care professional of significant changes.
    • Monitor frequency of prescription refills to determine compliance.
  • Assess patient for signs of angioedema (dyspnea, facial swelling).
  • Heart Failure: Monitor weight and assess patient routinely for resolution of fluid overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention).
  • Lab Test Considerations: Monitor renal function. May cause ↑ BUN and serum creatinine.
    • May cause hyperkalemia.
    • Monitor CBC periodically during therapy in patients with collagen vascular disease and/or renal disease. May rarely cause agranulocytosis.
    • May cause ↑ AST, ALT, alkaline phosphatase, and serum bilirubin.

Potential Nursing Diagnoses

Decreased cardiac output (Indications,  Side Effects)
Noncompliance (Patient/Family Teaching)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Do not confuse Accupril with Aciphex.
  • Correct volume depletion, if possible, before initiation of therapy. Precipitous drop in BP during first 1–3 hr following first dose may require volume expansion with normal saline. Discontinuing diuretic therapy or cautiously increasing salt intake 2–3 days prior to initiation may decrease risk. Monitor closely for at least 1 hr after BP has stabilized. Resume diuretics if BP is not controlled.

Patient/Family Teaching

  • Instruct patient to take medication as directed at the same time each day, even if feeling well. Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses. Warn patient not to discontinue ACE inhibitor therapy unless directed by health care professional.
    • Caution patient to avoid salt substitutes containing potassium or foods high in potassium or sodium unless directed by health care professional. See.
    • Caution patient to change positions slowly to minimize orthostatic hypotension. Use of alcohol, standing for long periods, exercising, and hot weather may increase orthostatic hypotension.
    • Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and consult health care professional before taking any new medications especially cough, cold, or allergy medications.
    • May cause dizziness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
    • Advise patient to inform health care professional of medication regimen prior to treatment or surgery.
    • Instruct patient to notify health care professional if rash; mouth sores; sore throat; fever; swelling of hands or feet; irregular heart beat; chest pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; or if difficulty swallowing or breathing occurs. Persistent dry cough may occur and may not subside until medication is discontinued. Consult health care professional if cough becomes bothersome. Also notify health care professional if nausea, vomiting, or diarrhea occurs and continues.
    • Advise women of childbearing age to use contraception and notify health care professional if pregnancy is planned or suspected.
    • Emphasize the importance of follow-up examinations to evaluate effectiveness of medication.
  • Hypertension: Encourage patient to comply with additional interventions for hypertension (weight reduction, low sodium diet, discontinuation of smoking, moderation of alcohol consumption, regular exercise, and stress management). Medication controls but does not cure hypertension.
    • Instruct patient and family on correct technique for monitoring BP. Advise them to check BP at least weekly and to report significant changes to health care professional.

Evaluation/Desired Outcomes

  • Decrease in BP without appearance of excessive side effects.
  • Decrease in signs and symptoms of heart failure.

Accupril

(ăk′yə-prĭl′)
A trademark for the drug quinapril hydrochloride.

Accupril®

Quinapril, see there.
References in periodicals archive ?
5 mg QD Perindopril Aceon 4 mg QD Quinapril Accupril 10-20 mg QD Ramipril Altace 2.
and Accupril and Accuretic (Pfizer) 122 Epilepsy 122 Market Overview 122 Leading Prescription Drugs for Epilepsy and Year of Patent Expiry 123 Rhinitis 123 Market Overview 123 Urinary Disorders 123 Market Overview 123
The settlement also resolves all patent litigation with Ranbaxy relating to Accupril in the United States and Viagra in Ecuador.
Teva Bags Approval to Market Accupril Generic II-113
generic competition to Neurontin, Diflucan, and Accupril.
Diflucan, and Accupril -- products that faced generic competition beginning in
Neurontin, Diflucan, and Accupril due to generic competition and Zithromax due
Accupril - Agrylin - Axid - Biaxin - Celexa - Cipro - Difl ucan - Duragesic - Effexor - Flonase - Floxin/Occufl ox - Glucophage XR - Glucotrol XL - Glucovance - Lotensin - Metaglip - Mobic - Monopril - Novantrone - Paraplatin - Paxil - Pravachol - Proscar - Retrovir - Rocephin - Romazicon - Tambocor - Ultram - Zaditor - Zestril/Prinivil - Zithromax - Zocor - Zofran - Zoloft
Agreement Also Resolves Caduet, Accupril Litigation in the US
Quinapril Tablets and Quinapril HCl and HCTZ Tablets are the generic versions of Pfizer's Accupril (R) and Accuretic(R) Tablets, respectively.
The company also warned that 2005 revenue and earnings would be tame, attributed to patent expirations for its Duflucan, Neurontin, Accupril, and Zithromax drugs.
was seeking approval to sell a generic version of Pfizer's blood pressure medicine Accupril (quinapril hydrochloride).