Univasc

Univasc,

trademark for an angiotensin-converting enzyme inhibitor (moexipril).

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moexipril hydrochloride

Perdix (UK), Univasc

Pharmacologic class: Angiotensinconverting enzyme (ACE) inhibitor

Therapeutic class: Antihypertensive

Pregnancy risk category C (first trimester), D (second and third trimesters)

FDA Boxed Warning

• When used during second or third trimester of pregnancy, drug may cause fetal harm or death. Discontinue drug as soon as possible when pregnancy is detected.

Action

Inhibits conversion of angiotensin I to the vasoconstrictor angiotensin II, inactivates bradykinin and other vasodilatory prostaglandins, increases plasma renin levels, and reduces aldosterone levels. Net effect is systemic vasodilation.

Availability

Tablets: 7.5 mg, 15 mg

⊘Indications and dosages

➣ Hypertension

Adults: 7.5 mg P.O. daily 1 hour before a meal; may increase if blood pressure control is inadequate. Range is 7.5 mg to 30 mg/day in one or two divided doses given 1 hour before a meal.

Dosage adjustment

• Renal impairment
• Concurrent diuretic therapy

Contraindications

• Hypersensitivity to drug
• Angioedema secondary to ACE inhibitor use

Precautions

Use cautiously in:
• renal or hepatic impairment, hypovolemia, hyponatremia, aortic stenosis or hypertrophic cardiomyopathy, cardiac or cerebrovascular insufficiency
• family history of angioedema
• concurrent diuretic therapy
• black patients
• elderly patients
• pregnant or breastfeeding patients
• children (safety not established).

Administration

• Give 1 hour before meals (food reduces drug absorption).
• Adjust dosage, as ordered, according to blood pressure response.

Route	Onset	Peak	Duration
P.O.	30 min	6 hr	Up to 24 hr

Adverse reactions

CNS: dizziness, fatigue

CV: chest pain, peripheral edema

EENT: pharyngitis, sinusitis

GI: nausea, diarrhea

GU: urinary frequency

Metabolic: hyperkalemia

Musculoskeletal: myalgia

Respiratory: upper respiratory infection, increased cough

Skin: rash, flushing, angioedema

Other: fever, flulike symptoms, hypersensitivity reaction

Interactions

Drug-drug. Allopurinol: increased risk of hypersensitivity reaction

Antacids: decreased moexipril absorption

Antihypertensives, general anesthetics, nitrates, phenothiazines: additive hypotension

Cyclosporine, indomethacin, potassium-sparing diuretics, potassium supplements, salt substitutes: hyperkalemia

Digoxin, lithium: increased blood levels of these drugs

Diuretics: excessive hypotension

Nonsteroidal anti-inflammatory drugs: blunted antihypertensive response

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

Antinuclear antibody: positive titer

Sodium: decreased level

Drug-food. Salt substitutes containing potassium: hyperkalemia

Drug-behaviors. Acute alcohol ingestion: additive hypotension

Patient monitoring

• Monitor vital signs and neurologic and cardiovascular status.
• Assess respiratory status, staying alert for persistent dry cough.
• Evaluate for allergic reactions and angioedema.
• Know that moexipril monotherapy is less effective in black patients, who may need additional concurrent antihypertensives.

Patient teaching

• Instruct patient to take 1 hour before a meal.
• Tell patient to report persistent dry cough and signs or symptoms of infection (especially upper respiratory infection).
• Advise patient to change position slowly (especially during first few days of therapy), to minimize hypotension and dizziness.
• Instruct patient to limit foods high in potassium and avoid salt substitutes containing potassium.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and behaviors mentioned above.