Moexipril

Oral
Hypertension

CrCl (mL/min)	Dosage
≤40	Initially, 3.75 mg once daily. Max: 15 mg daily.

Should be taken on an empty stomach. Take 1 hr before meals.

History of angioedema related to previous treatment with ACE inhibitor. Pregnancy. Concomitant use with aliskiren-containing products in patients with diabetes mellitus or renal impairment (GFR <60 mL/min).

Patient with salt and volume depletion, CHF with or without renal insufficiency; ischaemic heart disease, aortic stenosis, cerebrovascular disease, renal artery stenosis, collagen vascular disease (e.g. SLE, scleroderma), ascites due to cirrhosis, hypertrophic cardiomyopathy with left ventricular outflow tract obstruction. Patients undergoing desensitisation treatment with hymenoptera venom, haemodialysis with high-flux membranes, LDL apheresis with dextran sulfate, and major surgery. Black race. Renal impairment. Elderly. Lactation.

Significant: Anaphylactoid reactions, symptomatic hypotension with or without syncope, hyperkalaemia, persistent non-productive cough.
Cardiac disorders: Chest pain.
Gastrointestinal disorders: Diarrhoea, dyspepsia, nausea.
General disorders and administration site conditions: Fatigue, peripheral oedema, pain.
Investigations: Increased serum creatinine, increased BUN.
Musculoskeletal and connective tissue disorders: Myalgia.
Nervous system disorders: Dizziness, headache.
Renal and urinary disorders: Urinary frequency.
Respiratory, thoracic and mediastinal disorders: Pharyngitis, flu syndrome, URTI, rhinitis, sinusitis.
Skin and subcutaneous tissue disorders: Rash.
Vascular disorders: Flushing.
Potentially Fatal: Angioedema involving the tongue, glottis, or larynx.

PO: D

Monitor blood pressure; serum creatinine, BUN, K (especially in patients taking K-sparring diuretics, K supplements or salts); CBC periodically in patients with collagen vascular disease or renal impairment. Correct and monitor volume depletion prior to treatment initiation. Assess the risk of airway obstruction if angioedema is suspected.

Symptoms: Hypotension. Management: Infuse normal saline solution. Monitor renal function and serum K.

Enhanced hypotensive effect with diuretics. Increased risk of hyperkalaemia with K-sparing diuretics (e.g. spironolactone, triamterene, amiloride), K supplements or K-containing salt substitutes. May increase serum lithium levels and symptoms of lithium toxicity. May cause nitritoid reactions (e.g. facial flushing, nausea, vomiting, hypotension) when used concomitantly with injectable gold (Na aurothiomalate). Coadministration with NSAIDs, including selective COX-2 inhibitors, may result in deterioration of renal function, including acute renal failure and may attenuate the antihypertensive effect of moexipril.
Potentially Fatal: Increased risk of hypotension, hyperkalaemia, and acute renal failure with aliskiren.

Reduced absorption with food.

May cause a false-positive urine test for acetone using Na nitroprusside reagent. May lead to false-negative aldosterone/renin ratio.

Description:
Mechanism of Action: Moexipril, a nonsulfhydryl ACE inhibitor, is a prodrug of moexiprilat which inhibits conversion of angiotensin I to angiotensin II (a potent vasoconstrictor) resulting in increased plasma renin activity and reduced angiotensin II-induced vasoconstriction and aldosterone secretion.
Onset: Within 2 hours.
Duration: 24 hours.
Pharmacokinetics:
Absorption: Rapidly but incompletely absorbed in the gastrointestinal tract. Bioavailability: Approx 13% (moexiprilat); reduced with food. Time to peak plasma concentration: Approx 1.5 hours (moexiprilat).
Distribution: Volume of distribution: Approx 183 L (moexiprilat). Plasma protein binding: Approx 50% (moexiprilat). 
Metabolism: Metabolised in the liver and gastrointestinal mucosa into active metabolite moexiprilat.
Excretion: Via faeces (52%); urine (approx 7%). Elimination half-life: 1.3 hours (moexipril); 2-9.8 hours (moexiprilat).

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 91270, Moexipril. https://pubchem.ncbi.nlm.nih.gov/compound/Moexipril. Accessed Feb. 27, 2023.

Store between 20-25°C. Protect from excessive moisture.

ACE Inhibitors/Direct Renin Inhibitors

C09AA13 - moexipril ; Belongs to the class of ACE inhibitors. Used in the treatment of cardiovascular disease.

Anon. Moexipril. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 15/11/2022.

Anon. Moexipril. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 15/11/2022.

Buckingham R (ed). Moexipril Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 15/11/2022.

Moexipril Hydrochloride Tablet, Film Coated (Glenmark Pharmaceuticals Inc., USA). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 15/11/2022.