quinapril hydrochloride

quin·a·pril hydrochloride (kwn-prl)

n.

An ACE inhibitor drug used to treat hypertension and congestive heart failure.

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quinapril hydrochloride

Accupril, Accupro (UK), Quinil (UK)

Pharmacologic class: Angiotensin-converting 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 as soon as pregnancy is detected.

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
• Pregnancy (second and third trimesters)

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
• concurrent immunosuppressant or diuretic therapy
• black patients
• elderly patients
• pregnant (first trimester) 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.

Route	Onset	Peak	Duration
P.O.	0.5-1 hr	2-6 hr	Up to 24 hr

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. Allopurinol: increased risk of hypersensitivity reactions

Antacids: decreased quinapril absorption

Digoxin, lithium: increased blood levels and risk of toxicity of these drugs

Diuretics, other antihypertensives: increased hypotension

Indomethacin: decreased hypotensive effect of quinapril

Phenothiazines: increased pharmacologic effect of quinapril

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

Drug-herbs. Capsaicin: increased incidence of cough

Ephedra (ma huang): decreased drug efficacy, exacerbation of hypertension

Yohimbe: interference with drug's antihypertensive effect

Drug-behaviors. Alcohol use: increased hypotension

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.

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 herbal products and 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.