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ACCUPRIL
CHF and arrhythmias
Hypertension
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Drug Name:

ACCUPRIL Rx

Generic Name and Formulations:
Quinapril (as HCl) 5mg+, 10mg, 20mg, 40mg; tabs; +scored.

Company:
Pfizer Inc.

Therapeutic Use:

Indications for ACCUPRIL:

Heart failure inadequately controlled by diuretics and/or digitalis.

Adult:

Initially 5mg twice daily; if well-tolerated, increase weekly to 20–40mg daily in 2 equally divided doses. In CHF with hyponatremia or renal impairment: initially 2.5–5mg once daily based on CrCl (see full labeling), if needed titrate dose under supervision.

Children:

Not established.

Contraindications:

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.

Warnings/Precautions:

Fetal toxicity may develop; discontinue if pregnancy is detected. Salt/volume depletion. Renal or hepatic impairment. Severe CHF. Dialysis (esp. high-flux membrane). Monitor renal function in severe CHF, hypertension, or renal artery stenosis. Monitor WBCs in renal or collagen vascular disease. Monitor for hyperkalemia in diabetes or renal insufficiency. Surgery. Discontinue if angioedema, laryngeal edema or stridor, jaundice or marked elevation in liver enzymes occurs. Give SC epinephrine for airway obstruction if indicated. Reduce dose or discontinue quinapril or concomitant diuretic if symptomatic hypotension develops. Black patients: increased risk of angioedema, possibly less effective. Neonates. Pregnancy (Cat.D); monitor. Nursing mothers.

Interactions:

See Contraindications. Concomitant K+ supplements, K+-sparing diuretics, K+-containing salt substitutes may cause hyperkalemia; monitor serum levels. May increase lithium levels; monitor frequently. Antagonizes tetracycline. Potentiated by diuretics. May be antagonized by NSAIDs including COX-2 inhibitors. 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. 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. Increased risk of angioedema with concomitant mTOR inhibitor (eg, temsirolimus) or neprilysin inhibitor.

Pharmacological Class:

ACE inhibitor.

Adverse Reactions:

Headache, dizziness, fatigue, cough, nausea, vomiting, abdominal pain, hypotension, hyperkalemia, back pain, tachycardia, dry mouth, somnolence, sweating; rare: angioedema, anaphylactoid reactions, excessive hypotension, hepatic failure, neutropenia, agranulocytosis.

Metabolism:

Hepatic. 97% protein bound.

Elimination:

Renal.

Generic Availability:

YES

How Supplied:

Tabs—90

Indications for ACCUPRIL:

Hypertension.

Adult:

Monotherapy: initially 10 or 20mg once daily; may adjust dose every ≥2 weeks. Usual maintenance: 20–80mg daily in 1–2 divided doses. Elderly: initially 10mg once daily. Patients on diuretic: suspend diuretic for 2–3 days before starting; resume diuretic if BP not controlled by quinapril alone. If diuretic cannot be discontinued, or if creatinine clearance (CrCl) 30–60mL/min: initially 5mg daily. CrCl 10–30mL/min: initially 2.5mg daily.

Children:

Not established.

Contraindications:

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.

Warnings/Precautions:

Fetal toxicity may develop; discontinue if pregnancy is detected. Salt/volume depletion. Renal or hepatic impairment. Severe CHF. Dialysis (esp. high-flux membrane). Monitor renal function in severe CHF, hypertension, or renal artery stenosis. Monitor WBCs in renal or collagen vascular disease. Monitor for hyperkalemia in diabetes or renal insufficiency. Surgery. Discontinue if angioedema, laryngeal edema or stridor, jaundice or marked elevation in liver enzymes occurs. Give SC epinephrine for airway obstruction if indicated. Reduce dose or discontinue quinapril or concomitant diuretic if symptomatic hypotension develops. Black patients: increased risk of angioedema, possibly less effective. Neonates. Pregnancy (Cat.D); monitor. Nursing mothers.

Interactions:

See Contraindications. Concomitant K+ supplements, K+-sparing diuretics, K+-containing salt substitutes may cause hyperkalemia; monitor serum levels. May increase lithium levels; monitor frequently. Antagonizes tetracycline. Potentiated by diuretics. May be antagonized by NSAIDs including COX-2 inhibitors. 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. 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. Increased risk of angioedema with concomitant mTOR inhibitor (eg, temsirolimus) or neprilysin inhibitor.

Pharmacological Class:

ACE inhibitor.

Adverse Reactions:

Headache, dizziness, fatigue, cough, nausea, vomiting, abdominal pain, hypotension, hyperkalemia, back pain, tachycardia, dry mouth, somnolence, sweating; rare: angioedema, anaphylactoid reactions, excessive hypotension, hepatic failure, neutropenia, agranulocytosis.

Metabolism:

Hepatic. 97% protein bound.

Elimination:

Renal.

Generic Availability:

YES

How Supplied:

Tabs—90

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