Quinapril

Anaphylactoid and Possibly Related Reactions

• Discontinue and institute appropriate therapy immediately if laryngeal stridor or angioedema of the face, lips, mucous membranes, tongue, glottis, or extremities occur.

• If there is involvement of the tongue, glottis, or larynx likely to cause airway obstruction, promptly administer appropriate therapy with subcutaneous epinephrine solution 1:1000 (0.3mL or 0.5mL).

• Increased risk for angioedema in patients taking concomitant mTOR inhibitor (eg, temsirolimus).

Hepatic Failure

• Discontinue ACE inhibitor if patients develop jaundice or marked elevations of hepatic enzymes and administer appropriate medical follow-up.

Hypotension

• May cause excessive hypotension.

• Increased risk for excessive hypotension, sometimes associated with oliguria and/or progressive azotemia, and rarely with acute renal failure and/or death, include patients with the following conditions or characteristics:

• heart failure, hyponatremia, high dose diuretic therapy, recent intensive diuresis or increase in diuretic dose, renal dialysis, or severe volume and/or salt depletion of any etiology. 

• For patients at risk for excessive hypotension, initiate quinapril under close medical supervision and follow closely for the first 2 weeks of treatment and whenever dosage of quinapril and/or is increased.

• If excessive hypotension occurs, the patient should be placed in the supine position and, if necessary, given an intravenous infusion of normal saline.

• If symptomatic hypotension occurs, may need to reduce dose or discontinue quinapril or concomitant diuretic. 

Neutropenia/Agranulocytosis

• Consider periodically monitoring white blood cell counts in patients with collagen-vascular disease and/or renal disease.

Fetal Toxicity 

• Drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death.

• Resulting oligohydramnios can be associated with fetal lung hypoplasia and skeletal deformations.

• Potential neonatal adverse effects include skull hypoplasia, anuria, hypotension, renal failure, and death.

• Discontinue quinapril as soon as possible when pregnancy is detected.

• Perform serial ultrasound examinations to assess the intra-amniotic environment. If oligohydramnios is observed, discontinue quinapril unless it is considered lifesaving for the mother.

Impaired Renal Function

• In patients with severe HF whose renal function may depend on the renin-angiotensin-aldosterone system, treatment with ACE inhibitors, including quinapril, may be associated with oliguria and/or progressive azotemia and (rarely) with acute renal failure and/or death.

• In hypertensive patients with renal artery stenosis in a solitary kidney or bilateral renal artery stenosis, increases in BUN and serum creatinine may occur. In these patients, monitor renal function during the first few weeks of therapy.

Hyperkalemia

• Hyperkalemia may occur, particularly in patients with renal insufficiency, diabetes mellitus, and the concomitant use with other drugs that raise serum potassium levels. Monitor serum potassium in such patients.

Surgery/Anesthesia

• In patients undergoing major surgery or during anesthesia with agents that produce hypotension, quinapril will block the angiotensin II formation that could otherwise occur secondary to compensatory renin release. Hypotension that occurs as a result of this mechanism can be corrected by volume expansion.

Anaphylactoid and Possibly Related Reactions

• Discontinue and institute appropriate therapy immediately if laryngeal stridor or angioedema of the face, lips, mucous membranes, tongue, glottis, or extremities occur.

• If there is involvement of the tongue, glottis, or larynx likely to cause airway obstruction, promptly administer appropriate therapy with subcutaneous epinephrine solution 1:1000 (0.3mL or 0.5mL).

• Increased risk for angioedema in patients taking concomitant mTOR inhibitor (eg, temsirolimus).

Hepatic Failure

• Discontinue ACE inhibitor if patients develop jaundice or marked elevations of hepatic enzymes and administer appropriate medical follow-up.

Hypotension

• May cause excessive hypotension.

• Increased risk for excessive hypotension, sometimes associated with oliguria and/or progressive azotemia, and rarely with acute renal failure and/or death, include patients with the following conditions or characteristics:

• heart failure, hyponatremia, high dose diuretic therapy, recent intensive diuresis or increase in diuretic dose, renal dialysis, or severe volume and/or salt depletion of any etiology. 

• For patients at risk for excessive hypotension, initiate quinapril under close medical supervision and follow closely for the first 2 weeks of treatment and whenever dosage of quinapril and/or is increased.

• If excessive hypotension occurs, the patient should be placed in the supine position and, if necessary, given an intravenous infusion of normal saline.

• If symptomatic hypotension occurs, may need to reduce dose or discontinue quinapril or concomitant diuretic. 

Neutropenia/Agranulocytosis

• Consider periodically monitoring white blood cell counts in patients with collagen-vascular disease and/or renal disease.

Fetal Toxicity 

• Drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death.

• Resulting oligohydramnios can be associated with fetal lung hypoplasia and skeletal deformations.

• Potential neonatal adverse effects include skull hypoplasia, anuria, hypotension, renal failure, and death.

• Discontinue quinapril as soon as possible when pregnancy is detected.

• Perform serial ultrasound examinations to assess the intra-amniotic environment. If oligohydramnios is observed, discontinue quinapril unless it is considered lifesaving for the mother.

Impaired Renal Function

• In patients with severe HF whose renal function may depend on the renin-angiotensin-aldosterone system, treatment with ACE inhibitors, including quinapril, may be associated with oliguria and/or progressive azotemia and (rarely) with acute renal failure and/or death.

• In hypertensive patients with renal artery stenosis in a solitary kidney or bilateral renal artery stenosis, increases in BUN and serum creatinine may occur. In these patients, monitor renal function during the first few weeks of therapy.

Hyperkalemia

• Hyperkalemia may occur, particularly in patients with renal insufficiency, diabetes mellitus, and the concomitant use with other drugs that raise serum potassium levels. Monitor serum potassium in such patients.

Surgery/Anesthesia

• In patients undergoing major surgery or during anesthesia with agents that produce hypotension, quinapril will block the angiotensin II formation that could otherwise occur secondary to compensatory renin release. Hypotension that occurs as a result of this mechanism can be corrected by volume expansion.