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quinapril hydrochloride
Accupril, Accupro§, Asig‡

Pregnancy Risk Category C (D in second and third trimesters)

How supplied
Tablets:
5 mg, 10 mg, 20 mg, 40 mg

Action
Unknown. Thought to be involved with inhibiting conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Reduced formation of angiotensin II decreases peripheral arterial resistance, thus decreasing aldosterone secretion.

Indications & dosage
Hypertension
--
Adults:
initially, 10 to 20 mg P.O. daily. Dosage adjusted based on patient response at intervals of about 2 weeks. Most patients are controlled at 20, 40, or 80 mg daily as a single dose or in two divided doses. If patient is taking a diuretic, initiate therapy with 5 mg daily.
Elderly:
for patients over age 65, initiate therapy at 10 mg P.O. daily.
Heart failure--

Adults:
initially, 5 mg P.O. b.i.d. if patient is receiving a diuretic and 10 to 20 mg P.O. b.i.d. if patient isn't receiving a diuretic. Dosage increased at weekly intervals. Usual effective dose is 20 to 40 mg b.i.d. in equally divided doses.
Adjust-a-dose:
For renally impaired patients with creatinine clearance over 60 ml/minute, give 10 mg daily; if clearance is 30 to 60 ml/minute, give 5 mg daily; and if clearance is 10 to 30 ml/minute, give 2.5 mg daily.

Adverse reactions
CNS:
somnolence, vertigo, nervousness, headache, dizziness, fatigue, depression.
CV:
palpitations, tachycardia, angina, hypertensive crisis, orthostatic hypotension, rhythm disturbances.
GI:
dry mouth, abdominal pain, constipation, vomiting, nausea, hemorrhage.
Hepatic:
elevated liver enzyme levels.
Metabolic:
hyperkalemia.
Respiratory
: dry, persistent, tickling, nonproductive cough.
Skin:
pruritus, photosensitivity, diaphoresis.

Interactions
Drug-drug.
Diuretics, other antihypertensives: risk of excessive hypotension. Discontinue diuretic or lower dose of quinapril as needed.
Lithium:
increased serum lithium levels and lithium toxicity. Monitor serum lithium levels.
Potassium-sparing diuretics, potassium supplements:
risk of hyperkalemia. Monitor closely during concomitant use.
Tetracycline:
absorption decreased with administration of quinapril. Avoid concomitant use.
Drug-food.
Salt substitutes containing potassium: risk of hyperkalemia. Monitor closely during concomitant use.

Effects on diagnostic tests
None reported.

Contraindications
Contraindicated in patients with hypersensitivity to ACE inhibitors or history of angioedema related to treatment with an ACE inhibitor.

Nursing considerations

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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