CHF and arrhythmias:
Indications for: Quinapril
Heart failure inadequately controlled by diuretics and/or digitalis.
Adult Dosage:
Initially 5mg twice daily; if well-tolerated, increase weekly to 20–40mg daily in 2 equally divided doses. In CHF with hyponatremia or renal impairment: initially 2.5–5mg once daily based on CrCl (see full labeling), if needed titrate dose under supervision.
Children Dosage:
Not established.
Quinapril Contraindications:
History of ACEI-associated angioedema. Concomitant aliskiren in patients with diabetes. Concomitant neprilysin inhibitor (eg, sacubitril): avoid within 36hrs of switching to or from sacubitril/valsartan.
Boxed Warning:
Fetal toxicity.
Quinapril Warnings/Precautions:
Fetal toxicity may develop; discontinue if pregnancy is detected. Salt/volume depletion. Renal or hepatic impairment. Severe CHF. Dialysis (esp. high-flux membrane). Monitor renal function in severe CHF, hypertension, or renal artery stenosis. Monitor WBCs in renal or collagen vascular disease. Monitor for hyperkalemia in diabetes or renal insufficiency. Surgery. Discontinue if angioedema, laryngeal edema or stridor, jaundice or marked elevation in liver enzymes occurs. Give SC epinephrine for airway obstruction if indicated. Reduce dose or discontinue quinapril or concomitant diuretic if symptomatic hypotension develops. Black patients: increased risk of angioedema, possibly less effective. Neonates. Pregnancy (Cat.D); monitor. Nursing mothers.
Quinapril Classification:
ACE inhibitor.
Quinapril Interactions:
See Contraindications. Concomitant K+ supplements, K+-sparing diuretics, K+-containing salt substitutes may cause hyperkalemia; monitor serum levels. May increase lithium levels; monitor frequently. Antagonizes tetracycline. Potentiated by diuretics. May be antagonized by NSAIDs including COX-2 inhibitors. May be antagonized by, and renal toxicity potentiated by NSAIDs, including selective COX-2 inhibitors; monitor renal function periodically in elderly and/or volume-depleted. Nitritoid reactions with concomitant injectable gold (eg, sodium aurothiomalate); rare. Dual inhibition of the renin-angiotensin system with ARBs, ACEIs, or aliskiren may increase risk of hypotension, hyperkalemia, renal function changes; monitor closely. Concomitant aliskiren in renal impairment (CrCl <60mL/min): not recommended. Increased risk of angioedema with concomitant mTOR inhibitor (eg, temsirolimus) or neprilysin inhibitor.
Adverse Reactions:
Headache, dizziness, fatigue, cough, nausea, vomiting, abdominal pain, hypotension, hyperkalemia, back pain, tachycardia, dry mouth, somnolence, sweating; rare: angioedema, anaphylactoid reactions, excessive hypotension, hepatic failure, neutropenia, agranulocytosis.
Note:
Formerly known under the brand name Accupril.
Drug Elimination:
Following multiple oral dosing of quinapril hydrochloride, there is an effective accumulation half-life of quinaprilat of approximately 3 hours. Quinaprilat is eliminated primarily by renal excretion, up to 96% of an IV dose, and has an elimination half-life in plasma of approximately 2 hours and a prolonged terminal phase with a half-life of 25 hours. In patients with renal insufficiency, the elimination half-life of quinaprilat increases as creatinine clearance decreases.
Generic Drug Availability:
YES
How Supplied:
Contact supplier
Hypertension:
Indications for: Quinapril
Hypertension.
Adult Dosage:
Initially and if not on diuretics: 10 or 20mg once daily; may adjust dose at intervals of ≥2 weeks. Usual maintenance: 20–80mg daily in 1–2 divided doses. If on diuretics: suspend diuretic for 2–3 days before starting; resume diuretic if BP not controlled by quinapril alone. If diuretic cannot be discontinued, or if CrCl 30–60mL/min: initially 5mg daily. CrCl 10–30mL/min: initially 2.5mg daily. Elderly: initially 10mg once daily.
Children Dosage:
Not established.
Quinapril Contraindications:
History of ACEI-associated angioedema. Concomitant aliskiren in patients with diabetes. Concomitant neprilysin inhibitor (eg, sacubitril): avoid within 36hrs of switching to or from sacubitril/valsartan.
Boxed Warning:
Fetal toxicity.
Quinapril Warnings/Precautions:
Fetal toxicity may develop; discontinue if pregnancy is detected. Salt/volume depletion. Renal or hepatic impairment. Severe CHF. Dialysis (esp. high-flux membrane). Monitor renal function in severe CHF, hypertension, or renal artery stenosis. Monitor WBCs in renal or collagen vascular disease. Monitor for hyperkalemia in diabetes or renal insufficiency. Surgery. Discontinue if angioedema, laryngeal edema or stridor, jaundice or marked elevation in liver enzymes occurs. Give SC epinephrine for airway obstruction if indicated. Reduce dose or discontinue quinapril or concomitant diuretic if symptomatic hypotension develops. Black patients: increased risk of angioedema, possibly less effective. Neonates. Pregnancy (Cat.D); monitor. Nursing mothers.
Quinapril Classification:
ACE inhibitor.
Quinapril Interactions:
See Contraindications. Concomitant K+ supplements, K+-sparing diuretics, K+-containing salt substitutes may cause hyperkalemia; monitor serum levels. May increase lithium levels; monitor frequently. Antagonizes tetracycline. Potentiated by diuretics. May be antagonized by NSAIDs including COX-2 inhibitors. May be antagonized by, and renal toxicity potentiated by NSAIDs, including selective COX-2 inhibitors; monitor renal function periodically in elderly and/or volume-depleted. Nitritoid reactions with concomitant injectable gold (eg, sodium aurothiomalate); rare. Dual inhibition of the renin-angiotensin system with ARBs, ACEIs, or aliskiren may increase risk of hypotension, hyperkalemia, renal function changes; monitor closely. Concomitant aliskiren in renal impairment (CrCl <60mL/min): not recommended. Increased risk of angioedema with concomitant mTOR inhibitor (eg, temsirolimus) or neprilysin inhibitor.
Adverse Reactions:
Headache, dizziness, fatigue, cough, nausea, vomiting, abdominal pain, hypotension, hyperkalemia, back pain, tachycardia, dry mouth, somnolence, sweating; rare: angioedema, anaphylactoid reactions, excessive hypotension, hepatic failure, neutropenia, agranulocytosis.
Note:
Formerly known under the brand name Accupril.
Drug Elimination:
Following multiple oral dosing of quinapril hydrochloride, there is an effective accumulation half-life of quinaprilat of approximately 3 hours. Quinaprilat is eliminated primarily by renal excretion, up to 96% of an IV dose, and has an elimination half-life in plasma of approximately 2 hours and a prolonged terminal phase with a half-life of 25 hours. In patients with renal insufficiency, the elimination half-life of quinaprilat increases as creatinine clearance decreases.
Generic Drug Availability:
YES
How Supplied:
Contact supplier
