Hydrochlorothiazide + Quinapril

Hydrochlorothiazide + Quinapril is used for: Hypertension

Hypertension Initial: 10 mg/12.5 mg or 20 mg/12.5 mg PO qDay Increase either or both components based on clinical response Do not increase hydrochlorothiazide component more often than q 2-3 weeks To minimize dose-independent side effects, it is usually appropriate to initiate combination therapy only after inadequate response to quinapril monotherapy or significant potassium loss resulting from hydrochlorothiazide monotherapy

Renal Impairment CrCl >30 mL/min: No dosage adjustment CrCl <30 mL/min/1.73 m² or serum creatinine ?3 mg/dL: Not recommended

Hypersensitivity to either component or sulfonamides History of hereditary or angioedema associated with previous ACE inhibitor treatment Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan Do not coadminister with aliskiren in patients with diabetes mellitus or with renal impairment (ie, GFR <60 mL/min/1.73 m²)

Dual blockade of the renin angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for hypotension, hyperkalemia, and renal function changes (including acute renal failure) compared to monotherapy May aggravate digitalis toxicity Sensitivity reactions may occur with or without history of allergy or asthma Risk of male sexual dysfunction Renal impairment may occur Acute transient myopia and acute angle-closure glaucoma has been reported, particularly with history of sulfonamide or penicillin allergy (hydrochlorothiazide is a sulfonamide) Angioedema of the face, extremities, lips, tongue, glottis, and larynx has been reported in patients treated with angiotensin-converting enzyme inhibitors If laryngeal stridor or angioedema of the face, tongue, or glottis occurs discontinue therapy and institute appropriate therapy immediately Patients receiving coadministration of ACE inhibitor and mTOR (mammalian target of rapamycin) inhibitor (eg, temsirolimus, sirolimus, everolimus) therapy or a neprilysin inhibitor may be at increased risk for angioedema Intestinal angioedema has been reported in patients treated with ACE inhibitors Cholestatic jaundice may occur, which may progress to fulminant hepatic necrosis; discontinue Dry hacking nonproductive cough may occur within few months of treatment; consider other causes of cough prior to discontinuation Hyperkalemia may occur with ACE inhibitors; risk factors include renal dysfunction, diabetes mellitus, and concomitant use of potassium sparing diuretics and potassium supplements; use cautiously if at all with these agents Thiazide diuretics may cause hypokalemia, hypochloremic alkalosis, hypomagnesemia, and hyponatremia Hydrochlorothiazide may precipitate gout in patients with familial predisposition to gout or chronic renal failure Symptomatic hypotension with or without syncope can occur with ACE inhibitors; mostly observed in volume depleted patients, correct volume depletion prior to initiation; monitor closely when initiating and increasing dosing Agranulocytosis, neutropenia, or leukopenia with myeloid hypoplasia reported with other ACE inhibitor; patients with renal impairment are at high risk; monitor CBC with differential in these patients Photosensitization may occur Hydrochlorothiazide may cause acute transient myopia and acute angle-closure glaucoma that may occur within hours of initiating therapy; discontinue therapy immediately in patients with acute decreases in visual acuity or ocular pain; additional treatment may be needed if uncontrolled intraocular pressure persists Use caution in patients with severe aortic stenosis; may reduce coronary perfusion resulting in ischemia Use hydrochlorothiazide with caution in patients with diabetes or at risk of diabetes; may see increase in glucose Use caution in patients collagen vascular disease, especially in patients with concomitant renal impairment Thiazide diuretics may decrease renal calcium excretion; consider avoiding use in patients with hypercalcemia

Pregnancy Category: C (1st trimester); D (2nd & 3rd trimester) Lactation: Excreted in breast milk, use caution

Side effects of Hydrochlorothiazide + Quinapril : No adverse effects specific to the combination have been observed; adverse effects limited to those previously reported with quinapril and hydrochlorothiazide Quinapril 1-10% Dizziness (4-8%) Headache (2-6%) Cough (2-4%) Hyoptension (3%) Fatigue (3%) Hyperkalemia (2%) Chest pain (2%) Nausea/vomiting (1-2%) Rash (1%) Hyperkalemia (2%) Myalagia (2-5%) Back pain (1%) Frequency Not Defined Angioedema Acute renal failure Alopecia Angina Pancreatitis Hyperkalemia Hydrochlorothiazide Frequency Not Defined Anorexia Epigastric distress Hypotension Orthostatic hypotension Photosensitivity Anaphylaxis Anemia Confusion Erythema multiforme Stevens-Johnson syndrome Exfoliative dermatitis including toxic epidermal necrolysis Hypomagnesemia Dizziness Headache Hyperuricemia

Accuretic is a fixed-combination tablet that combines an angiotensin-converting enzyme (ACE) inhibitor, quinapril hydrochloride, and a thiazide diuretic, hydrochlorothiazide Quinapril competitively inhibits angiotensin-converting enzymes resulting in decreased plasma angiotensin II concentrations and consequently, blood pressure may be reduced in part through decreased vasoconstriction, increase renin activity, and decrease aldosterone secretion Hydrochlorothiazide is a thiazide diuretic that inhibits Na reabsorption in distal renal tubules resulting in increased excretion of Na+ and water, also K+ and H+ ions