Quinapril hydrochloride
Quinapril hydrochloride (Accupril)
Quinapril hydrochloride
( KWIN-ah-prill)
Pregnancy Category: D Accupril (Rx)

Classification: Angiotensin-converting enzyme inhibitor

See Also: See also Angiotensin-Converting Enzyme Inhibitors .

Action/Kinetics: Onset: 1 hr. Time to peak serum levels: 1 hr. Peak decrease in BP: 2-6 hr. Metabolized to quinaprilat, the active metabolite. t 1/2, quinaprilat: 2-3 hr. Duration: 18-24 hr. Significantly bound to plasma proteins. Food reduces absorption. Metabolized with approximately 60% excreted through the urine and 37% excreted in the feces. Also appears to improve endothelial function, an early marker of coronary atherosclerosis.

Uses: Alone or in combination with a thiazide diuretic for the treatment of hypertension. Adjunct with a diuretic or digitalis to treat CHF in those not responding adequately to diuretics or digitalis.

Special Concerns: Use with caution during lactation. Safety and effectiveness have not been determined in children. Geriatric clients may be more sensitive to the effects of quinapril and manifest higher peak quinaprilat blood levels.

Side Effects: CV: Vasodilation, tachycardia, heart failure palpitations, chest pain, hypotension, MI, CVA, hypertensive crisis angina pectoris, orthostatic hypotension, cardiac rhythm disturbances, cardiogenic shock. GI: Dry mouth or throat, constipation, diarrhea, N&V;, abdominal pain, hepatitis, pancreatitis, GI hemorrhage. CNS: Somnolence, vertigo, insomnia, sleep disturbances, paresthesias, nervousness, depression, headache, dizziness, fatigue. Hematologic: Agranulocytosis bone marrow depression, thrombocytopenia. Dermatologic: Angioedema of the lips, tongue, glottis, and larynx; sweating, pruritus, exfoliative dermatitis, photosensitivity, dermatopolymyositis, flushing, rash. Body as a whole: Malaise, back pain. GU: Oliguria and/or progressive azotemia and rarely acute renal failure and/or death in severe heart failure. Impotence. Worsening renal failure. Respiratory: Pharyngitis, cough, asthma, bronchospasm, dyspnea. Miscellaneous: Oligohydramnios in fetuses exposed to the drug in utero. Abnormal liver function tests, syncope, hyperkalemia, amblyopia, syncope, malagia, viral infections.

Overdose Management: Symptoms: Commonly, hypotension. Treatment: IV infusion of normal saline to restore blood pressure.

Drug Interactions: Potassium-containing salt substitutes / Risk of hyperkalemia Potassium-sparing diuretics / Risk of hyperkalemia Potassium supplements / Risk of hyperkalemia Tetracyclines / Absorption R/T high Mg ⁺⁺ content of quinapril tablets

How Supplied: Tablet: 5 mg, 10 mg, 20 mg, 40 mg

Dosage
?Tablets Hypertension, client not on diuretics.
Initial: 10 or 20 mg once daily; then, adjust dosage based on BP response at peak (2-6 hr) and trough (predose) blood levels. The dose should be adjusted at 2-week intervals. Maintenance: 20, 40, or 80 mg daily as a single dose or in two equally divided doses. With impaired renal function, the initial dose should be 10 mg if the C _CR is greater than 60 mL/min, 5 mg if the C _CR is between 30 and 60 mL/min, and 2.5 mg if the C _CR is between 10 and 30 mL/min. If the initial dose is well tolerated, the drug may be given the following day as a b.i.d. regimen.
CHF.
Initial: 5 mg b.i.d. If this dose is well tolerated, titrate clients at weekly intervals until an effective dose, usually 20-40 mg daily in two equally divided doses, is attained. Undesirable hypotension, orthostasis, or azotemia may prevent this dosage level from being reached.