Quinapril

What is Quinapril?

• Quinapril (Accupril) is an angiotensin-converting enzyme (ACE) inhibitor used in the therapy of hypertension and stable coronary artery disease.

Quinapril structure

What are the uses of this medicine?

Quinapril (Accupril) is used:

• For the treatment of hypertension. It may be used alone or in combination with thiazide diuretics.
• in the management of heart failure as adjunctive therapy when added to conventional therapy including diuretics and/or digitalis.
• Angioedema in black patients.

How does this medicine work?

• Quinapril is deesterified to the principal metabolite, quinaprilat, which is an inhibitor of ACE activity.
• ACE is a peptidyl dipeptidase that catalyzes the conversion of angiotensin I to the vasoconstrictor, angiotensin II.
• The effect of quinapril in hypertension and in congestive heart failure (CHF) appears to result primarily from the inhibition of circulating and tissue ACE activity, thereby reducing angiotensin II formation.

Who Should Not Use this medicine ?

This medicine cannot be used in patients who:

• hypersensitive to this product and in patients with a history of angioedema related to previous treatment with an ACE inhibitor.
• in combination with a neprilysin inhibitor (e.g., sacubitril).
• Do not co-administer quinapril with aliskiren in patients with diabetes.

What drug interactions can this medicine cause?

Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following:

• aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as indomethacin (Indocin)
• diuretics ('water pills')
• lithium (Lithobid)
• potassium supplements
• tetracycline (Achromycin V, in Pylera)

• Tell your doctor or pharmacist if you are taking valsartan and sacubitril (Entresto) or if you have stopped taking it within the last 36 hours. Your doctor will probably tell you not to take quinapril, if you are also taking valsartan and sacubitril.
• Also, tell your doctor if you have diabetes and you are taking aliskiren (Tekturna, in Amturnide, Tekamlo, Tekturna HCT). Your doctor will probably tell you not to take quinapril if you have diabetes and you are also taking aliskiren.

Is this medicine FDA approved?

• Quinapril was patented in 1980 and came into medical use in 1989.
• It is available as a generic medication.

How should this medicine be used?

Recommended dosage:

• The recommended initial dosage of quinapril in patients not on diuretics is 10 or 20 mg once daily.
• Generally, dosage adjustments should be made at intervals of at least 2 weeks.
• Most patients have required dosages of 20, 40, or 80 mg/day, given as a single dose or in two equally divided doses.
• If blood pressure is not adequately controlled with quinapril monotherapy, a diuretic may be added.

Elderly (≥65 years):

• The recommended initial dosage of quinapril in elderly patients is 10 mg given once daily.

Heart Failure:

• The recommended starting dose is 5 mg twice daily.
• If the initial dosage of quinapril is well tolerated, patients should then be titrated at weekly intervals until an effective dose, usually 20 to 40 mg daily given in two equally divided doses.

Administration:

• Quinapril comes as a tablet to take by mouth.
• It is usually taken once or twice a day.
• To help you remember to take quinapril, take it around the same time(s) every day.
• Your doctor will probably start you on a low dose of quinapril and gradually increase your dose, not more than once every 1 or 2 weeks.
• Quinapril controls high blood pressure and heart failure but does not cure them.
• Continue to take quinapril even if you feel well.
• Do not stop taking quinapril without talking to your doctor.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As Quinapril tablets, USP contain quinapril hydrochloride equivalent to 5 mg, 10 mg, 20 mg, or 40 mg of quinapril for oral administration.

This medicine is available in fallowing brand namesː

• Accupril

What side effects can this medication cause?

The most common side effects of this medicine include: In Hypertension:

• Headache
• dizziness
• fatigue
• coughing
• nausea and vomiting
• abdominal pain

In Heart Failure:

• Dizziness
• Coughing
• Fatigue
• Nausea and/or Vomiting
• Chest Pain
• Hypotension
• Dyspnea
• Diarrhea
• Headache
• Myalgia
• Rash
• Back Pain

What special precautions should I follow?

• Angioedema, including laryngeal edema can occur with treatment with ACE inhibitors, especially following the first dose. Advise patients and tell them to immediately report any signs or symptoms suggesting angioedema.
• As a consequence of inhibiting the renin-angiotensin-aldosterone system, changes in renal function may be anticipated in susceptible individuals. Evaluation of patients with hypertension or heart failure should always include assessment of renal function.
• Hyperkalemia (serum potassium ≥5.8 mmol/L) occurred in approximately 2% of patients receiving quinapril. Monitor serum potassium in such patients.
• Presumably due to the inhibition of the degradation of endogenous bradykinin, persistent non-productive cough has been reported with all ACE inhibitors, always resolving after discontinuation of therapy.
• Tell patients planning to undergo any surgery and/or anesthesia to inform their physician that they are taking an ACE inhibitor.
• Caution patients that lightheadedness can occur, especially during the first few days of quinapril therapy, and that it should be reported to a physician.
• Tell patients not to use potassium supplements or salt substitutes containing potassium without consulting their physician.
• Tell patients to promptly report any indication of infection (eg, sore throat, fever) which could be a sign of neutropenia.
• Because quinapril is secreted in human milk, caution should be exercised when this drug is administered to a nursing woman.

What to do in case of emergency/overdose?

Symptoms of overdosage may include:

• severe hypotension

Treatment of overdosage:

• Hemodialysis and peritoneal dialysis have little effect on the elimination of quinapril and quinaprilat.
• Angiotensin II could presumably serve as a specific antagonist-antidote in the setting of quinapril overdose.
• Because the hypotensive effect of quinapril is achieved through vasodilation and effective hypovolemia, it is reasonable to treat quinapril overdose by infusion of normal saline solution.

Can this medicine be used in pregnancy?

• Pregnancy Category D.
• Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death.

Can this medicine be used in children?

• The safety and effectiveness of quinapril in pediatric patients have not been established.

What are the active and inactive ingredients in this medicine?

• Quinapril tablets, USP contain quinapril hydrochloride equivalent to 5 mg, 10 mg, 20 mg, or 40 mg of quinapril for oral administration.
• Each tablet also contains lactose monohydrate, magnesium carbonate, magnesium stearate, crospovidone, povidone and opadry brown (hypromellose, titanium dioxide, iron oxide and macrogol).

Who manufactures and distributes this medicine?

Manufactured by:

• InvaGen Pharmaceuticals, Inc.
• (a subsidiary of Cipla Ltd.)
• Hauppauge, NY

Manufactured for:

• Cipla USA Inc.
• 10 Independence Boulevard, Suite 300
• Warren, NJ

What should I know about storage and disposal of this medication?

• Dispense in well-closed containers as defined in the USP.
• Store at 20° to 25°C (68° to 77°F).

Common ACE inhibitors include the following:

• Benazepril
• Captopril
• Enalapril
• Fosinopril
• Lisinopril
• Moexipril
• Perindopril
• Quinapril
• Ramipril
• Trandolapril

• Dailymed label info on Quinapril
• FDA Quinapril

Quinapril Resources
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