Quinapril

Oral
Heart failure

Oral
Hypertension

HTN:

CrCl	Dosage
10-30	Initial: 2.5 mg once daily.
31-60	Initial: 5 mg once daily.
>60	Initial: 10 mg once daily.

Heart Failure:

CrCl	Dosage
10-30	Initial: 2.5 mg once daily.
>30	Initial: 5 mg once daily.

Should be taken on an empty stomach. Take before meals at about the same time of day.

History of angioedema related to previous ACE inhibitor treatment, hereditary or idiopathic angioedema. Concomitant use w/ aliskiren in patients w/ diabetes and renal impairment. Pregnancy.

Patients w/ diarrhoea, severe volume and/or salt depletion due to prolonged use of diuretics and unilateral or bilateral renal artery stenosis. Patients on dietary salt restriction and dialysis. Severe CHF. Increased risk of angioedema in black patients. Renal and hepatic impairment. Lactation.

Dizziness, headache, fatigue, persistent dry cough and other upper resp tract symptoms, skin rashes, hyperkalaemia, chest pain, cholestatic jaundice, nausea, vomiting, neutropenia, agranulocytosis, dyspnoea, diarrhoea, myalgia, back pain, increased serum creatinine and BUN.
Potentially Fatal: Anaphylactic reactions including angioedema. Pronounced hypotension. Fulminant hepatic necrosis.

PO: D

Monitor BP prior and throughout therapy. Periodically monitor serum creatinine, K levels and CBC.

Symptoms: Severe hypotension. Management: Supportive treatment and IV volume expansion.

Additive hyperkalaemic effects w/ K-sparing diuretics, K supplements, other drugs that can cause hyperkalaemia. Increased lithium concentrations and toxicity. May decrease absorption of tetracyclines. May increase nitritoid reactions of gold Na thiomalate.
Potentially Fatal: Increased risk of hypotension, hyperkalaemia and nephrotoxicity w/ concomitant aliskiren in renally impaired and diabetic patients.

Avoid use of licorice as it may worsen HTN.

Description: Quinapril is a prodrug of quinaprilat. It is a competitive inhibitor of ACE. It prevents conversion of angiotensin I to angiotensin II (a potent vasoconstrictor) resulting in lower levels of angiotensin II which causes an increase in plasma renin activity and a reduction in aldosterone (a hormone that causes water and Na retention) secretion. This promotes vasodilation and BP reduction.
Onset: 1 hr.
Duration: Approx 24 hr.
Pharmacokinetics:
Absorption: High fat meal reduces absorption. Approx 60% of an oral dose is absorbed. Time to peak plasma concentration: Approx 2 hr (as quinaprilat).
Distribution: Enters breast milk (small amounts). Plasma protein binding: Approx 97%.
Metabolism: Hepatically hydrolysed to form quinaprilat (active metabolite) and inactive metabolites.
Excretion: Via urine (50-60% as quinaprilat) and faeces. Terminal half-life: 3 hr (quinaprilat).

Store between 15-30°C.

ACE Inhibitors/Direct Renin Inhibitors

Accupril (Parke-Davis; Pfizer). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 20/11/2013.

Accupril Tablets. U.S. FDA. https://www.fda.gov. Accessed 20/11/2013.

Anon. Quinapril. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 20/11/2013.

Buckingham R (ed). Quinapril. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 20/11/2013.

Joint Formulary Committee. Quinapril. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 20/11/2013.

McEvoy GK, Snow EK, Miller J et al (eds). Quinapril. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 20/11/2013.