Accupril

Name: Accupril

Quinapril Dosage

Quinapril comes as a tablet to take by mouth, usually once or twice daily.

Your dosage will depend on your medical condition and response to treatment.

Try to take this medicine around the same time each day.

Follow the instructions on your prescription label carefully. Don't use more or less quinapril than is recommended.

Don't stop taking this drug without first talking to your doctor.

Quinapril Overdose

Signs of a quinapril overdose may include:

  • Fainting
  • Severe dizziness
  • Lightheadedness

If you suspect an overdose, contact a poison control center or emergency room immediately.

You can get in touch with a poison control center at 800-222-1222.

Missed Dose of Quinapril

If you miss a dose of quinapril, take it as soon as possible.

But if it's almost time for your next scheduled dose, skip the missed dose and continue with your regular medication schedule.

Don't take extra medicine to make up for a missed dose.

What is quinapril, and how does it work (mechanism of action)?

Quinapril belongs in a class of drugs called angiotensin converting enzyme (ACE) inhibitors. ACE inhibitors are used for treating high blood pressure and heart failure and for preventing kidney failure due to high blood pressure and diabetes. Other drugs in this class are enalapril (Vasotec), ramipril (Altace), captopril (Capoten), fosinopril (Monopril), benazepril (Lotensin), lisinopril (Zestril, Prinivil), moexipril (Univasc) and trandolapril (Mavik). ACE is important because it produces angiotensin II. Angiotensin II contracts the muscles of the arteries in the heart and the rest of the body, narrowing the arteries and thereby elevating blood pressure. In the kidney, the narrowing caused by angiotensin II decreases blood flow and increases the arterial filtration pressure in the kidney. ACE inhibitors such as quinapril lower blood pressure by inhibiting the formation of angiotensin II, thereby relaxing the arterial muscles and enlarging the arteries. This increases the flow of blood and oxygen to the heart so that it can pump blood more efficiently. The enlargement of the arteries elsewhere in the body also makes it easier for the heart to pump blood. This is particularly beneficial when there is heart failure. In the kidneys ACE inhibitors increase blood flow and reduce the filtration pressure in the kidneys. Quinapril was approved by the FDA in November 1991.

What are the side effects of quinapril?

Quinapril is generally well tolerated, and side effects are usually mild and transient. A dry, persistent cough has been reported with the use of quinapril and other ACE inhibitors. Coughing resolves after discontinuing the medication.

Other side effects include:

  • abdominal pain,
  • constipation,
  • diarrhea,
  • rash,
  • dizziness,
  • fatigue,
  • headache,
  • loss of taste,
  • loss of appetite,
  • nausea, vomiting,
  • fainting, and
  • numbness or tingling in the hands or feet.

Quinapril and other ACE inhibitors may also cause kidney failure and increased levels of potassium in the blood. The most serious but very rare side effects are liver failure and angioedema (swelling of lips and throat).

What other drugs will affect quinapril?

Other drugs may interact with quinapril, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Uses for Accupril

Hypertension

Management of hypertension (alone or in combination with other classes of antihypertensive agents).1 2 4 28 47 500

ACE inhibitors are recommended as one of several preferred agents for the initial management of hypertension; other options include angiotensin II receptor antagonists, calcium-channel blockers, and thiazide diuretics.501 502 503 504 While there may be individual differences with respect to specific outcomes, these antihypertensive drug classes all produce comparable effects on overall mortality and cardiovascular, cerebrovascular, and renal outcomes.500 501 502 504 Individualize choice of therapy; consider patient characteristics (e.g., age, ethnicity/race, comorbidities, cardiovascular risk) as well as drug-related factors (e.g., ease of administration, availability, adverse effects, cost).500 501 502 503 504 515

ACE inhibitors may be preferred in hypertensive patients with heart failure, ischemic heart disease, diabetes mellitus, chronic kidney disease, or cerebrovascular disease or post-MI.500 501 502 504 520 523 524 525 526 527 534 535 536 543

Black hypertensive patients generally tend to respond better to monotherapy with calcium-channel blockers or thiazide diuretics than to ACE inhibitors.24 28 63 64 500 501 504 However, diminished response to an ACE inhibitor is largely eliminated when administered concomitantly with a calcium-channel blocker or thiazide diuretic.24 26 27 28 47 500 504

The optimum BP threshold for initiating antihypertensive drug therapy is controversial.501 504 505 506 507 508 515 523 530 Further study needed to determine optimum BP thresholds/goals; individualize treatment decisions.501 503 507 515 526 530

JNC 7 recommends initiation of drug therapy in all patients with uncomplicated hypertension and BP ≥140/90 mm Hg;500 JNC 8 panel recommends SBP threshold of 150 mm Hg for patients ≥60 years of age.501 Although many experts agree that SBP goal of <150 mm Hg may be appropriate for patients ≥80 years of age,502 504 505 530 application of this goal to those ≥60 years of age is controversial, especially for those at higher cardiovascular risk.501 502 505 506 508 511 515

In the past, initial antihypertensive drug therapy was recommended for patients with diabetes mellitus or chronic kidney disease who had BP ≥130/80 mm Hg;500 503 current hypertension management guidelines generally recommend a BP threshold of 140/90 mm Hg for these individuals (same as for the general population of patients without these conditions), although a goal of <130/80 mm Hg may still be considered.501 502 503 504 520 530 535 536 541

Heart Failure

Management of heart failure, usually in conjunction with other agents such as cardiac glycosides, diuretics, and β-adrenergic blocking agents (β-blockers).1 2 12 18 524 800

Some evidence indicates that therapy with an ACE inhibitor (enalapril) may be less effective than angiotensin receptor-neprilysin inhibitor (ARNI) therapy (e.g., sacubitril/valsartan) in reducing cardiovascular death and heart failure-related hospitalization.702 800

ACCF, AHA, and the Heart Failure Society of America (HFSA) recommend that patients with chronic symptomatic heart failure and reduced left ventricular ejection fraction (LVEF) (NYHA class II or III) who are able to tolerate an ACE inhibitor or angiotensin II receptor antagonist be switched to therapy containing an ARNI to further reduce morbidity and mortality.701 703 800

Diabetic Nephropathy

A recommended agent in the management of patients with diabetes mellitus and persistent albuminuria† who have modestly elevated (30–300 mg/24 hours) or higher (>300 mg/24 hours) levels of urinary albumin excretion; slows rate of progression of renal disease in such patients.57 58 59 60 61 520 535 536

Stability

Storage

Oral

Tablets

Conventional tablets: 15–30°C.1 Protect from light.1

Fixed combination tablets: 20–25°C.47

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Quinapril Hydrochloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets, film-coated

5 mg (of quinapril)*

Accupril (scored)

Pfizer

Quinapril Hydrochloride Tablets

10 mg (of quinapril)*

Accupril

Pfizer

Quinapril Hydrochloride Tablets

20 mg (of quinapril)*

Accupril

Pfizer

Quinapril Hydrochloride Tablets

40 mg (of quinapril)*

Accupril

Pfizer

Quinapril Hydrochloride Tablets

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Quinapril Hydrochloride Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets, film-coated

10 mg (of quinapril) with Hydrochlorothiazide 12.5 mg*

Accuretic (scored)

Pfizer

Quinapril Hydrochloride and Hydrochlorothiazide Tablets

Quinaretic

Amide

20 mg (of quinapril) with Hydrochlorothiazide 12.5 mg*

Accuretic

Pfizer

Quinapril Hydrochloride and Hydrochlorothiazide Tablets

Quinaretic

Amide

20 mg (of quinapril) with Hydrochlorithiazide 25 mg*

Accuretic

Pfizer

Quinapril Hydrochloride and Hydrochlorothiazide Tablets

Quinaretic

Amide

Commonly used brand name(s)

In the U.S.

  • Accupril

Available Dosage Forms:

  • Tablet

Therapeutic Class: Antihypertensive

Pharmacologic Class: ACE Inhibitor

How do I store and/or throw out Accupril?

  • Store at room temperature.
  • Protect from light.
  • Store in a dry place. Do not store in a bathroom.
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Check with your pharmacist about how to throw out unused drugs.

PRINCIPAL DISPLAY PANEL - 5 mg Tablet Bottle Label

Pfizer

NDC 0071-0527-23

Accupril®
(Quinapril HCl Tablets)

5 mg*

90 Tablets
Rx only

How supplied

ACCUPRIL tablets are supplied as follows:

5-mg tablets: brown, film-coated, elliptical scored tablets, coded “PD 527’’ on one side and “5’’ on the other.

NDC 0071-0527-23 bottles of 90 tablets
NDC
0071-0527-40 10 x 10 unit dose blisters

10-mg tablets: brown, film-coated, triangular tablets, coded “PD 530’’ on one side and “10’’ on the other.

NDC 0071-0530-23 bottles of 90 tablets
NDC
0071-0530-40 10 x 10 unit dose blisters

20-mg tablets: brown, film-coated, round tablets, coded “PD 532’’ on one side and “20’’ on the other.

NDC 0071-0532-23 bottles of 90 tablets
NDC 0071-0532-40 10 x 10 unit dose blisters

40-mg tablets: brown, film-coated, elliptical tablets, coded “PD 535’’ on one side and “40’’ on the other.

NDC 0071-0535-23 bottles of 90 tablets

Dispense in well-closed containers as defined in the USP.

Storage

Store at controlled room temperature 15°–30°C (59°–86°F). Protect from light.

Distributed by : pfizer Parke-Davis,Division of pfizer Inc,NY 10017. Revised : Feb 2017.

Accupril Interactions

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

  • potassium-sparing diuretics such as:
    • spironolactone (Aldactone)
    • triamterene (Dyrenium)
    • amiloride (Midamor)
  • other diuretics such as:
    • furosemide (Lasix)
    • hydrochlorothiazide
    • torsemide (Demadex)
  • aliskiren (Tekturna)
  • angiotensin receptor blockers such as candesartan (Atacand), losartan (Cozaar), and telmisartan (Micardis, Twynsta)
  • aspirin and other NSAIDs (non-steroidal anti-inflammatory drugs) such as:
    • celecoxib (Celebrex)
    • diclofenac (Cambia, Cataflam, Flector, Voltaren, Zipsor and others)
    • etodolac (Lodine)
    • ibuprofen (Advil, Motrin, Nuprin)
    • indomethacin (Indocin, Indocin SR)
    • ketoprofen (Orudis, Actron, Oruvail)
    • ketorolac (Toradol)
    • meloxicam (Mobic)
    • nabumetone (Relafen)
    • naproxen (Naprosyn)
    • naproxen sodium (Aleve, Anaprox, Naprelan)
    • oxaprozin (Daypro)
    • piroxicam (Feldene)
  • lithium (Eskalith, Lithobid)
  • potassium supplements
  • injectable gold (sodium aurothiomalate)

This is not a complete list of Accupril drug interactions. Ask your doctor or pharmacist for more information.

Important information

Do not use Accupril if you are pregnant. If you become pregnant, stop taking this medicine and tell your doctor right away.

If you have diabetes, do not use Accupril together with any medication that contains aliskiren (such as Amturnide, Tekturna, Tekamlo).

For Healthcare Professionals

Applies to quinapril: oral tablet

General

The most commonly reported side effects were dizziness, increased serum creatinine, increased blood urea nitrogen, cough, dyspnea, nausea, vomiting, and diarrhea.[Ref]

Cardiovascular

Uncommon (0.1% to 1%): Chest pain, hypotension, palpitations, vasodilation, tachycardia, heart failure, myocardial infarction, hypertensive crisis, angina pectoris, orthostatic hypotension, cardiac rhythm disturbances, cardiogenic shock[Ref]

Renal

Common (1% to 10%): Increased serum creatinine, increased blood urea nitrogen
Uncommon (0.1% to 1%): Urinary tract infection, acute renal failure/dysfunction, worsening renal failure, proteinuria
Frequency not reported: Increases in blood urea nitrogen and serum creatinine[Ref]

Metabolic

Uncommon (0.1% to 1%): Hyperkalemia, hyponatremia[Ref]

Hematologic

Uncommon (0.1% to 1%): Hemolytic anemia, agranulocytosis, thrombocytopenia
Frequency not reported: Neutropenia, decreased hemoglobin, decreased hematocrit[Ref]

Hypersensitivity

Uncommon (0.1% to 1%): Angioedema of the head, neck, face, extremities, lips, tongue, glottis and/or larynx, intestines; anaphylactoid reactions[Ref]

Hepatic

Uncommon (0.1% to 1%): Abnormal liver function tests, hepatitis
Rare (less than 0.1%): Hepatic failure (characterized by cholestatic jaundice with progression to fulminant hepatic necrosis and sometimes death)
Frequency not reported: Cholestatic icterus[Ref]

Nervous system

Common (1% to 10%): Dizziness
Uncommon (0.1% to 1%): Headache, cerebrovascular accident/cerebral hemorrhage, somnolence, vertigo, syncope, nervousness, paresthesia, transient ischemic attacks, tinnitus
Rare (less than 0.1%): Balance disorder[Ref]

Gastrointestinal

Common (1% to 10%): Nausea, vomiting, diarrhea, dyspepsia, abdominal pain
Uncommon (0.1% to 1%): Flatulence, dry mouth or throat, constipation, gastrointestinal hemorrhage, pancreatitis
Rare (less than 0.1%): Glossitis
Very rare (less than 0.01%): Ileus[Ref]

Respiratory

Common (1% to 10%): Cough, pharyngitis, dyspnea, rhinitis
Uncommon (0.1% to 1%): Eosinophilic pneumonitis, sinusitis, upper respiratory tract infection, bronchitis
Frequency not reported: Bronchospasm[Ref]

Musculoskeletal

Uncommon (0.1% to 1%): Myalgia, back pain, arthralgia

Genitourinary

Uncommon (0.1% to 1%): Impotence[Ref]

Psychiatric

Uncommon (0.1% to 1%): Depression, insomnia, confusion[Ref]

Other

Common (1% to 10%): Fatigue, asthenia
Uncommon (0.1% to 1%): Fever, malaise, generalized/peripheral edema[Ref]

Immunologic

Uncommon (0.1% to 1%): Viral infection[Ref]

Dermatologic

Uncommon (0.1% to 1%): Rash, alopecia, increased sweating, pemphigus, pruritus, exfoliative dermatitis, photosensitivity reaction, dermatopolymyositis
Rare (less than 0.1%): Urticaria, erythema multiforme, pemphigus
Very rare (less than 0.01%): Psoriasis-like efflorescence
Frequency not reported: Stevens Johnson syndrome, epidermal necrolysis[Ref]

Ocular

Uncommon (0.1% to 1): Amblyopia
Very rare (less than 0.01%): Blurred vision[Ref]

Some side effects of Accupril may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

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