Quinapril

Indications

Quinapril is used for: Hypertension, Congestive Heart Failure

Adult Dose

Hypertension Initial: 10-20 mg PO qDay; may administer 5 mg in patients receiving diuretic therapy if the diuretic is continued Maintenance: 20-80 mg PO qDay or divided q12hr Congestive Heart Failure Initial: 5 mg PO q12hr Maintenance: 20-40 mg PO qDay or divided q12hr Elderly: 2.5-5 mg/day initially; increase dose by increments of 2.5-5 mg at 1-2 week intervals; adjust for renal impairment

Child Dose

Renal Dose

Renal impairment with hypertension CrCl >60 mL/min: 10 mg/day CrCl 30-60 mL/min: 5 mg/day CrCl 10-30 mL/min: 2.5 mg/day CrCl <10 mL/min: Insufficient data Renal impairment with CHF CrCl >30 mL/min: 5 mg/day CrCl 10-30 mL/min: 2.5 mg/day CrCl <10 mL/min: Insufficient data

Administration

Contra Indications

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.

Precautions

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

Pregnancy-Lactation

Pregnancy Category: C (1st trimester); D (2nd & 3rd trimester) Discontinue as soon as pregnancy detected; during the second and third trimesters of pregnancy, drugs that act directly on the renin-angiotensin have been associated with fetal injury that includes hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death Lactation: excreted in breast milk; use caution

Interactions

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.

Side Effects

Side effects of Quinapril : 1-10% Dizziness (7.7%), Coughing (4.3%), Fatigue (2.6%), Nausea and/or vomiting (2.4%), Hypotension (2.9%), Dyspnea (1.9%), Diarrhea (1.7%), Headache (1.7%), Myalgia (1.5%), Rash (1.4%), Back pain (1.2%) <1% Angioedema General: Back pain, malaise, viral infections, anaphylactoid reaction Cardiovascular: Palpitation, vasodilation, tachycardia, heart failure, hyperkalemia, myocardial infarction, cerebrovascular accident, hypertensive crisis, angina pectoris, orthostatic hypotension, cardiac rhythm disturbances, cardiogenic shock Hematology: Hemolytic anemia Gastrointestinal: Flatulence, dry mouth or throat, constipation, gastrointestinal hemorrhage, pancreatitis, abnormal liver function tests, dyspepsia Metabolism and nutrition disorders: Hyponatremia Nervous/psychiatric: Somnolence, vertigo, syncope, nervousness, depression, insomnia, paresthesia Integumentary: Alopecia, increased sweating, pemphigus, pruritus, exfoliative dermatitis, photosensitivity reaction, dermatopolymyositis Urogenital: Urinary tract infection, impotence, acute renal failure, worsening renal failure Respiratory: Eosinophilic pneumonitis Other: Amblyopia, edema, arthralgia, pharyngitis, agranulocytosis, hepatitis, thrombocytopenia

Mode of Action

Angiotensin converting enzyme (ACE) inhibitors dilate arteries and veins by competively inhibiting the conversion of angiotensin I to angiotensin II (a potent endogenous vasoconstrictor) and by inhibiting bradykinin metabolism; these actions result in preload and afterload reductions on the heart ACE inhibitors also promote sodium and water excretion by inhibiting angiotensin-II induced aldosterone secretion; elevation in potassium may also be observed ACE inhibitors also elicit renoprotective effects through vasodilation of renal arterioles ACE inhibitors reduce cardiac and vascular remodeling associated with chronic hypertension, heart failure, and myocardial infarction