Formulary
Quinapril: Indications, Dosing, Side Effects and Interactions
Quinapril clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Quinapril: Indications, Dosing, Side Effects and Interactions
Quinapril clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Essential hypertension**
- **Adult** (By Mouth): Initially 10 mg once daily; maintenance 20-40 mg daily in up to 2 divided doses; maximum 80 mg per day.
- **Elderly** (By Mouth): Initially 2.5 mg once daily; maintenance 20-40 mg daily in up to 2 divided doses; maximum 80 mg per day.
**Essential hypertension if used in addition to diuretic**
- **Adult** (By Mouth): Initially 2.5 mg once daily; maintenance 20-40 mg daily in up to 2 divided doses; maximum 80 mg per day.
**Heart failure (adjunct) (under close medical supervision)**
- **Adult** (By Mouth): Initially 2.5 mg daily, increased if tolerated to 10-20 mg daily in 1-2 divided doses, doses to be increased gradually; maximum 40 mg per day.
Cautions
For all angiotensin-converting enzyme inhibitors Concomitant diuretics; diabetes (may lower blood glucose; increased risk of hyperkalaemia); first dose hypotension (especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with cerebrovascular disease, ischaemic heart disease, or heart failure); patients of black African or African-Caribbean origin (may respond less well to ACE inhibitors); peripheral vascular disease or generalised atherosclerosis (risk of clinically silent renovascular disease); primary aldosteronism (patients may respond less well to ACE inhibitors); the risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended); use with care in patients with aortic or mitral valve stenosis (risk of hypotension); use with care in patients with hypertrophic cardiomyopathy Cautions, further information Anaphylactoid reactions To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux membranes (e.g. polyacrylonitrile) and during low-density lipoprotein apheresis with dextran sulfate; they should also be withheld before desensitisation with wasp or bee venom. M Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: with hyperkalaemia with persistent postural hypotension i.e. recurrent drop in systolic blood pressure 20 mmHg (risk of syncope and falls)
Contraindications
For all angiotensin-converting enzyme inhibitors Hereditary or idiopathic angioedema; history of angioedema associated with prior ACE inhibitor therapy; the combination of an ACE inhibitor with aliskiren is contra-indicated in patients with an eGFR less than 60 mL/minute/1.73 m 2 ; the combination of an ACE inhibitor with aliskiren is contra-indicated in patients with diabetes mellitus
Side effects
For all angiotensin-converting enzyme inhibitors Common or very common Alopecia; angina pectoris; angioedema (can be delayed; more common in black patients); arrhythmias; asthenia; chest pain; constipation; cough; depression; diarrhoea; dizziness; drowsiness; dry mouth; dyspnoea; electrolyte imbalance; gastrointestinal discomfort; headache; hypotension; myalgia; nausea; palpitations; paraesthesia; renal impairment; rhinitis; skin reactions; sleep disorder; syncope; taste altered; tinnitus; vertigo; vomiting Uncommon Arthralgia; confusion; eosinophilia; erectile dysfunction; fever; haemolytic anaemia; hyperhidrosis; myocardial infarction; pancreatitis; peripheral oedema; photosensitivity reaction; respiratory disorders; stroke Rare or very rare Agranulocytosis; hepatitis; leucopenia; neutropenia; pancytopenia; Stevens-Johnson syndrome; thrombocytopenia Side-effects, further information In light of reports of cholestatic jaundice, hepatitis, fulminant hepatic necrosis, and hepatic failure, ACE inhibitors should be discontinued if marked elevation of hepatic enzymes or jaundice occur. Side-effects For quinapril Common or very common Back pain; increased risk of infection; insomnia Uncommon Dry throat; gastrointestinal disorders; generalised oedema; nervousness; proteinuria; transient ischaemic attack; vasodilation; vision disorders Rare or very rare Balance impaired; glossitis Frequency not known Arthritis; hypersensitivity; jaundice cholestatic; leucocytosis; pneumonitis; pulmonary oedema; serositis; toxic epidermal necrolysis; vasculitis necrotising
Interactions
**Other interactions (2):**
- Absorption of tetracyclines is possibly reduced by kaolin, quinapril tablets (quinapril tablets contain magnesium carbonate), strontium ranelate, sucralfate, tripotassium dicitratobismuthate.
- Simultaneous administration of iron preparations and anti-acids, magnesium/aluminium and calcium hydroxides, oxides, salts, cholestyramine, bismuth chelates, sucralfate and quinapril may decrease...
Pregnancy
Important safety information For all angiotensin-converting enzyme inhibitors MHRA/CHM advice: ACE inhibitors and angiotensin II receptor antagonists: not for use in pregnancy (December 2014) See Conception and contraception and Pregnancy . MHRA/CHM advice: ACE inhibitors and angiotensin II receptor antagonists: recommendations on how to use for breastfeeding (December 2014) See Breast feeding .
Breast feeding
For all angiotensin-converting enzyme inhibitors Information on the use of ACE inhibitors in breast-feeding is limited. Breast feeding For quinapril Avoid in the first few weeks after delivery, particularly in preterm infants-risk of profound neonatal hypotension;can be used in mothers breast-feeding older infants if essential but monitor infant's blood pressure. M
Hepatic impairment
Quinapril is a prodrug. Manufacturer advises caution when used in combination with a diuretic.
Renal impairment
For all angiotensin-converting enzyme inhibitors Caution (hyperkalaemia and other side-effects of ACE inhibitors are more common in those with impaired renal function). M Dose adjustments Start with low dose and adjust according to response. M Renal impairment For quinapril Dose adjustments Max. initial dose 2.5 mg once daily if creatinine clearance less than 40 mL/minute. M See Prescribing in renal impairment .
Medicinal forms
Medicinal forms No licensed medicines listed.
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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