Adult: As monotherapy: Initially, 10 mg or 20 mg once daily, then adjust the dose at intervals of at least 2 weeks according to response. Maintenance: 20-80 mg daily given as a single dose or in 2 divided doses. In combination with a diuretic: Initially, 2.5 mg or 5 mg once daily, then adjust according to response. Maintenance: 20-80 mg daily given as a single dose or in 2 divided doses. Dosing recommendations may vary among individual products and between countries (refer to specific product guidelines). Elderly: Initially, 10 mg once daily, then adjust dose according to response.
Oral Heart failure
Adult: As an adjunct to diuretic and/or cardiac glycoside: Initially, 2.5 mg daily or 5 mg bid; if tolerated, may adjust dose at weekly intervals according to response. Maintenance: 10-40 mg daily given as a single dose or in 2 divided doses. Dosing recommendations may vary among individual products and between countries (refer to specific product guidelines).
Renal Impairment
Hypertension:
CrCl (mL/min)
Dosage
10-30
Initially, 2.5 mg once daily, then adjust dose according to response.
31-60
Initially, 5 mg once daily, then adjust dose according to response.
>60
Initially, 10 mg once daily, then adjust dose according to response.
Dosing recommendations may vary among individual products and between countries (refer to specific product guidelines).
Heart failure:
CrCl (mL/min)
Dosage
10-30
Initially, 2.5 mg once daily, then adjust dose according to response.
>30
Initially, 5 mg once daily, then adjust dose according to response.
Dosing recommendations may vary among individual products and between countries (refer to specific product guidelines).
Administration
May be taken with or without food.
Contraindications
History of angioedema related to previous ACE inhibitor treatment, hereditary or idiopathic angioedema, dynamic left ventricular outflow obstruction. Pregnancy. Concomitant use with aliskiren in patients with diabetes mellitus or renal impairment (GFR <60 mL/min/1.73 m2). Concomitant use with or within 36 hours of switching to or from a neprilysin inhibitor (e.g. sacubitril).
Special Precautions
Patient with aortic stenosis, history of angioedema unrelated to ACE inhibitor therapy, Na or volume depletion, diabetes, ischaemic heart or cerebrovascular disease, ascites due to cirrhosis, renal artery stenosis, collagen vascular disease, hypertrophic cardiomyopathy. Patients undergoing major surgery, desensitisation treatment with hymenoptera venom, LDL apheresis with dextran sulfate or haemodialysis with high-flux dialysis membranes. Black race. Renal and hepatic impairment. Elderly. Lactation.
Adverse Reactions
Significant: Sensitivity reactions (e.g. purpura, photosensitivity, urticaria, necrotising angiitis, respiratory distress [including pneumonitis and pulmonary oedema]); cough, intestinal angioedema; symptomatic hypotension, hyperkalaemia, SIADH, hyponatraemia; increased BUN or serum creatinine, acute kidney injury. Rarely, agranulocytosis, bone marrow depression. Cardiac disorders: Tachycardia, palpitations. Ear and labyrinth disorders: Vertigo, tinnitus. Eye disorders: Amblyopia. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, abdominal pain, dyspepsia, flatulence. General disorders and administration site conditions: Fatigue, asthenia. Musculoskeletal and connective tissue disorders: Back pain, myalgia. Nervous system disorders: Headache, dizziness, paraesthesia. Psychiatric disorders: Insomnia, confusional state, depression, nervousness. Respiratory, thoracic and mediastinal disorders: Dyspnoea, dry throat, pharyngitis, rhinitis. Skin and subcutaneous tissue disorders: Rash, pruritus, hyperhidrosis Potentially Fatal: Angioedema associated with laryngeal involvement, anaphylactoid reactions. Rarely, cholestatic jaundice that may progress to fulminant hepatic necrosis; pancreatitis.
This drug may cause dizziness or weariness, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor blood pressure, electrolytes, serum creatinine, BUN), CBC with differentials. Assess for signs and symptoms of angioedema.
Overdosage
Symptoms: Symptoms attributable to severe hypotension. Management: Symptomatic and supportive treatment. Administer IV volume expansion for severe hypotension.
Drug Interactions
Increased risk of hypotension, hyperkalaemia and decreased renal function with other ACE inhibitors or ARBs. Increased hypotensive effect with diuretics. Increased risk of hyperkalaemia with K-sparing diuretics (e.g. spironolactone, triamterene), K supplements, K-containing salts, or other drugs associated with increases in serum K (e.g. sulfamethoxazole/trimethoprim). Increased risk of angioedema with mTOR inhibitors (e.g. temsirolimus), neutral endopeptidase (NEP) inhibitors (e.g. racecadotril) and dipeptidyl peptidase-IV (DPP-IV) inhibitors (e.g. vildagliptin). Increases the serum concentration of lithium. Increased risk of renal function deterioration (including acute renal failure) with NSAIDs, including COX-2 inhibitors. May decrease bioavailability with antacids. Increased risk of leucopenia with allopurinol, cytostatic and immunosuppressive agents, systemic corticosteroids or procainamide. Enhanced orthostatic hypotensive effect with narcotics or barbiturates. Enhanced insulin sensitivity leading to hypoglycaemia with oral antidiabetic agents and insulin. Nitritoid reactions (e.g. facial flushing, nausea, vomiting, hypotension) may occur when used concomitantly with injectable gold (Na aurothiomalate). Potentially Fatal: Increased risk of angioedema with a neprilysin inhibitor (e.g. sacubitril). Increased risk of hypotension, hyperkalaemia and decreased renal function (including acute renal failure) with aliskiren.
Food Interaction
Enhanced orthostatic hypotensive effect with alcohol.
Lab Interference
May result in false-negative aldosterone/renin ratio (ARR).
Action
Description: Mechanism of Action: Quinapril is rapidly de-esterified into quinaprilat which is a potent angiotensin-converting enzyme (ACE) inhibitor. It prevents the conversion of angiotensin I to angiotensin II (a potent vasoconstrictor) thereby decreasing the levels of angiotensin II which leads to increased plasma renin activity and reduced aldosterone secretion. Onset: 1 hour. Duration: 24 hours. Pharmacokinetics: Absorption: Time to peak plasma concentration: 1 hour (quinapril); approx 2 hours (quinaprilat). Distribution: Crosses the placenta and enters breast milk (small amount). Plasma protein binding: Approx 97%. Metabolism: Mainly metabolised in the liver via hydrolysis into quinaprilat (major active metabolite) and minor inactive metabolites. Excretion: Via urine (50-60% mainly as quinaprilat). Elimination half-life: 0.8 hours (quinapril); 3 hours (quinaprilat).
Chemical Structure
Quinapril Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 54892, Quinapril. https://pubchem.ncbi.nlm.nih.gov/compound/Quinapril. Accessed Nov. 23, 2023.
Storage
Store between 15-30°C. Protect from light and moisture.
C09AA06 - quinapril ; Belongs to the class of ACE inhibitors. Used in the treatment of cardiovascular disease.
References
Accupril 5 mg, 10 mg and 20 mg Tablet (Pfizer, Inc). MIMS Philippines. http://www.mims.com/philippines. Accessed 20/11/2023.Accupril Tablet, Film Coated (Parke-Davis Div of Pfizer Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 07/07/2023.Accupro 20 mg Film-coated Tablets (Pfizer United Kingdom Limited). MHRA. https://products.mhra.gov.uk. Accessed 07/07/2023.Anon. Quinapril. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 07/07/2023.Anon. Quinapril. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 07/07/2023.Buckingham R (ed). Quinapril Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/07/2023.Joint Formulary Committee. Quinapril. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/07/2023.Teva Pharma (New Zealand) Limited. Arrow - Quinapril 5 mg, 10 mg and 20 mg Film-coated Tablets data sheet 11 June 2019. Medsafe. http://www.medsafe.govt.nz. Accessed 07/07/2023.
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