QUINAPRIL

Indications & Dose:

Adult and Child >l6 yr

Hypertension:

initially 10 mg once daily; with a diuretic, in elderly, or in renal impairment initially 2.5 mg daily; maintenance dose 20- 40 mg daily in single or 2 divided doses; upto 80 mg daily has been given.

Heart failure:

(adjunct) initial dose 2.5 mg under close medical supervision, usual maintenance 10-20 mg daily in 2 divided doses; upto 40 mg daily has been given

Renal insufficiency:

Usual dosing for CrCl >60 ml/min; 5 mg qd for CrCl 30-60 ml/min; 2.5 mg qd for CrCl 10-30 ml/min

Contraindications:

Side Effects:

CNS: Dizziness, fatigue, headache

CV: Angina, palpitations, postural hypotension,syncope (especially with lst dose)

GI: Abdominal pain, constipation, nausea, vomiting

GU: Decreased libido, impotence, increased BUN,creatinine 

,HEME:  Agranulocytosis, neutropenia thrombocytopenia

METAB:Hyperkalemia,hyponatremia,hypoglycemia

MS: Arthralgia, arthritis, myalgia

RESP: Asthma, bronchitis, cough

SKIN: Angioedema,pruritus,rash, sweating

Cautions:

Precautions:

History of anaphylaxis, renal insufficiency (<30 ml/min), hypotension (CHF,elderly, volume depletion-diuretics, dialysis, cirrhosis), aortic stenosis, hyperkalemia (potassium supplements, potassium sparing diuretics, renaldisease, diabetes), neutropenia (autoimmun diseases, collagen vascular diseases, febrile illness, immunosuppressant drug therapy), proteinuria,renal artery stenosis, surgery/anesthesia (excessive hypotension, correctable with fluids)

BREAST FEEDING Avoid in the first few weeks after delivery, particularly in preterm infants, due to the risk of profound neonatal hypotension; if essential, may be used in mothers breast-feeding older infants—the infant’s blood pressure should be monitored.

HEPATIC IMPAIRMENT Quinapril is a prodrug and requires close monitoring in patients with hepatic impairment.

RENAL IMPAIRMENT Max. initial dose 2.5 mg once daily if eGFR less than 40 mL/minute/1.73m2.

Interaction:

Drugs

Allopurinol: Predisposition to hypersensitivity reactions

A adrenergic blockers: Exaggerated 1st dose hypotensive response

Aspirin: Reduced hemodynamic effects; less likely with nonacetylated salicylates

Azathioprine: Increased myelosuppression

Cyclosporine: Renal insufficiency

Insulin: Enhanced hypoglycemic response Iron (parenteral): Increased risk systemic reaction

Lithium: Increased risk of serious lithium toxicity

Loop diuretics: Initiation of ACE inhibitor therapy may cause hypotension and renal insufficiency

NSAIDs: Inhibition of the antihypertensive response

Potassium, potassium-sparing diuretics: Increased risk for hyperkalemia

Trimethoprim: Additive risk of hyperkalemia, especially  in  patient  predisposed  to  renal insufficiency

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: