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Pharmacologic class: Angiotensin-converting enzyme (ACE) inhibitor
Therapeutic class: Antihypertensive
Pregnancy risk category C (first trimester), D (second and third trimesters)
FDA Box 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.
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.
Tablets: 7.5 mg, 15 mg
Indications and dosages
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.
• Renal impairment
• Concurrent diuretic therapy
• Hypersensitivity to drug
• Angioedema secondary to ACE inhibitor use
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).
• Give 1 hour before meals (food reduces drug absorption).
• Adjust dosage, as ordered, according to blood pressure response.
CNS: dizziness, fatigue
CV: chest pain, peripheral edema
EENT: pharyngitis, sinusitis
GI: nausea, diarrhea
GU: urinary frequency
Respiratory: upper respiratory infection, increased cough
Skin: rash, flushing, angioedema
Other: fever, flulike symptoms, hypersensitivity reaction
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
• 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.
• 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.