Quinapril/Hydrochlorothiazide Dosage & Rx Info

Quinapril/hydrochlorothiazide Generic Name & Formulations

Legal Class

General Description

Quinapril (as HCl), hydrochlorothiazide; 10mg/12.5mg+, 20mg/12.5mg+, 20mg/25mg; tabs; +scored; contains magnesium.

Pharmacological Class

ACE inhibitor + diuretic (thiazide).

How Supplied

Contact supplier

Manufacturer

Various generic manufacturers

Mechanism of Action

The effect of quinapril in hypertension results primarily from the inhibition of circulating and tissue ACE activity, thereby reducing angiotension II formation. Thiazide diuretics affect the renal tubular mechanisms of electrolyte reabsorption, directly increasing excretion of sodium and chloride in approximately equivalent amounts. Indirectly, they reduce plasma volume, with consequent increases in plasma renin activity, increases in aldosterone secretion, increases in potassium loss, and decreases in serum potassium.

Quinapril/hydrochlorothiazide Indications

Indications

Hypertension.

Quinapril/hydrochlorothiazide Dosage and Administration

Adult

Not for initial therapy. Switching from quinapril monotherapy: initially 10mg/12.5mg or 20mg/12.5mg once daily; allow 2–3 weeks before increasing hydrochlorothiazide component. Switching from hydrochlorothiazide 25mg/day monotherapy: initially 10mg/12.5mg or 20mg/12.5mg once daily. Adjust based on response and serum potassium. Or, substitute for individually titrated components. Renal impairment (CrCl ≤30mL/min): not recommended.

Children

Not established.

Nursing Considerations

Patients should be cautioned that inadequate fluid intake or excessive perspiration, diarrhea, or vomiting can lead to an excessive fall in BP because of reduction in fluid volume, with the consequences of lightheadedness and possible syncope. Advise patients to report signs/symptoms of angioedema (swelling of the face, extremities, eyes, lips, tongue, difficulty swallowing or breathing) immediately.

Quinapril/hydrochlorothiazide Contraindications

Contraindications

Anuria. Sulfonamide allergy. History of ACEI-associated angioedema. Concomitant aliskiren in patients with diabetes. Concomitant neprilysin inhibitor (eg, sacubitril): avoid within 36hrs of switching to or from sacubitril/valsartan.

Quinapril/hydrochlorothiazide Boxed Warnings

Boxed Warning

Fetal toxicity.

Quinapril/hydrochlorothiazide Warnings/Precautions

Warnings/Precautions

Fetal toxicity may develop; discontinue if pregnancy is detected. Correct salt/volume depletion prior to initiation. Ischemic heart disease. Cerebrovascular disease. Reduce dose or discontinue if symptomatic hypotension develops. Renal or hepatic impairment. Dialysis (esp. high-flux membrane). Postsympathectomy. Surgery. SLE. Acute angle-closure glaucoma. Acute myopia and choroidal effusions. History of angioedema. Severe CHF. Cirrhosis. Diabetes. Gout. Black patients may have a higher risk of angioedema than non-Blacks. Monitor for hyperkalemia in diabetes or renal insufficiency. Monitor renal function in severe CHF, hypertension, or renal artery stenosis. Monitor WBCs in renal or collagen vascular disease. Monitor calcium levels in hypercalcemia. Discontinue if angioedema, laryngeal edema or stridor, jaundice or marked elevation in liver enzymes occurs. Give SC epinephrine for airway obstruction if indicated. Elderly. Neonates. Pregnancy (esp. 2^nd & 3^rd trimester). Nursing mothers: not recommended.

Quinapril/hydrochlorothiazide Pharmacokinetics

Metabolism

Quinapril: hepatic

Elimination

Renal.

Quinapril/hydrochlorothiazide Interactions

Interactions

See Contraindications. Orthostatic hypotension potentiated by alcohol, barbiturates, narcotics. Concomitant K+ supplements, K+-sparing diuretics, K+-containing salt substitutes may cause hyperkalemia; monitor serum levels. Hypokalemia more likely with corticosteroids, ACTH. Potentiates nondepolarizing muscle relaxants. Reduces tetracycline absorption. May increase lithium levels; monitor frequently. May potentiate other antihypertensives (eg, ganglionic or peripheral adrenergic-blocking drugs). May antagonize pressor amines. May be antagonized by, and renal toxicity potentiated by NSAIDs, including selective COX-2 inhibitors; monitor renal function periodically in elderly and/or volume-depleted. May be antagonized by cholestyramine, colestipol resins. Monitor antidiabetic agents. May interfere with parathyroid tests; interrupt for few days before testing. Nitritoid reactions with concomitant injectable gold (eg, sodium aurothiomalate); rare. Dual inhibition of the renin-angiotensin system with ARBs, ACEIs, or aliskiren may increase risk of hypotension, hyperkalemia, renal function changes; monitor closely. Concomitant aliskiren in renal impairment (CrCl <60mL/min): not recommended. Monitor for digoxin toxicity.

Quinapril/hydrochlorothiazide Adverse Reactions

Adverse Reactions

Cough, somnolence, orthostatic hypotension; rare: angioedema, anaphylactoid reactions, electrolyte disturbances, excessive hypotension, hepatic failure, neutropenia, agranulocytosis; HCTZ: increased risk for non-melanoma skin cancer.

Quinapril/hydrochlorothiazide Clinical Trials

See Literature

Quinapril/hydrochlorothiazide Note

Notes

Formerly known under the brand name Accuretic.

Quinapril/hydrochlorothiazide Patient Counseling