Quinapril

Therapeutic Class
 Angiotensin-Converting Enzyme (ACE) Inhibitor
Indications

Treatment of hypertension; treatment of heart failure,  left ventricular dysfunction after myocardial infarction; pediatric hypertension; to delay the progression of nephropathy and reduce risks of cardiovascular events in hypertensive patients with type 1 or 2 diabetes mellitus
Adult Doses

Usual dose range : 10-40 mg once daily

Heart failure: Oral: Initial: 5 mg once or twice daily, titrated at weekly intervals to 20-40 mg daily in 2 divided doses; target dose (heart failure): 20 mg twice daily

Hypertension: Oral: Initial: 10-20 mg once daily, adjust according to blood pressure response at peak and trough blood levels; initial dose may be reduced to 5 mg in patients receiving diuretic therapy if the diuretic is continued.

Special Populations: Patients receiving diuretics, elderly or with renal impairment in the treatment of hypertension: Initially, 2.5 mg daily.
Pediatric Doses

Hypertension (unlabeled use): Oral: Initial 5-10 mg once daily; maximum: 80 mg/day
Doses in Renal impairment

Lower initial doses should be used; after initial dose (if tolerated), administer initial dose twice daily; may be increased at weekly intervals to optimal response:

Heart failure: Oral: Initial:

Clcr >30 mL/minute: Administer 5 mg/day

Clcr 10-30 mL/minute: Administer 2.5 mg/day

Hypertension: Oral: Initial:

Clcr >60 mL/minute: Administer 10 mg/day

Clcr 30-60 mL/minute: Administer 5 mg/day

Clcr 10-30 mL/minute: Administer 2.5 mg/day
Doses in Hepatic impairment

In patients with alcoholic cirrhosis, hydrolysis of quinapril to quinaprilat is impaired; however, the subsequent elimination of quinaprilat is unaltered
Contraindications

Aortic stenosis or outflow tract obstruction; renovascular disease. Pregnancy.
Boxed Warning

Pregnancy: Based on human data, ACEIs can cause injury and death to the developing fetus when used in the second and third trimesters. ACEIs should be discontinued as soon as possible once pregnancy is detected.
Warnings / Precautions

Symptomatic hypertension, peripheral vascular diseases, generalised atherosclerosis, idiopathic or hereditary angioedema, heart failure; patients likely to be salt or water depleted; monitor renal function before and during therapy; monitor WBC counts regularly; liver cirrhosis; surgery; anaesthesia. Lactation, elderly.
Adverse Reactions

Dizziness, headache, fatigue, GI disturbances, taste disturbances, persistent dry cough and other upper resp tract symptoms, skin rashes, angioedema, hypersensitivity reactions, renal impairment, hyperkalaemia, hyponatraemia, blood disorders, proteinuria, chest pain, palpitations, tachycardia, stomatitis, pancreatitis, cholestatic jaundice; alopoecia; muscle cramps; paraesthesias, mood and sleep disturbances, impotence.
Potentially Fatal: Pronounced hypotension which could result in MI or stroke in patients with ischaemic heart disease or cerebrovascular disease. Anaphylactic reactions including angioedema of the face, extremities, lips, tongue, glottis and larynx.
Overdose Reactions

Hypotension. Supportive treatment and volume expansion may be necessary.
Drug Interactions

Additive hyperkalaemic effects with potassium-sparing diuretics, potassium supplements, other drugs that can cause hyperkalaemia. Increased risk of renal impairment and reduced antihypertensive effect when used with NSAIDs.
Potentially Fatal: Excessive hypotension with diuretics, other antihypertensives, alcohol, other agents that lower BP.
See Below for More quinapril Drug Interactions
Food Interactions

Herb/Nutraceutical: Avoid bayberry, blue cohosh, cayenne, ephedra, ginger, ginseng (American), kola, licorice (may worsen hypertension). Avoid black cohosh, California poppy, coleus, golden seal, hawthorn, mistletoe, periwinkle, quinine, shepherd's purse (may have increased antihypertensive effect)
Mechanism of Actions

Competitive inhibitor of angiotensin-converting enzyme (ACE); prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor; results in lower levels of angiotensin II which causes an increase in plasma renin activity and a reduction in aldosterone secretion; a CNS mechanism may also be involved in hypotensive effect as angiotensin II increases adrenergic outflow from CNS; vasoactive kallikreins may be decreased in conversion to active hormones by ACE inhibitors, thus reducing blood pressure.
Pharmacodynamics

Onset of action: 1 hour

Duration: 24 hours

Absorption: Quinapril: ≥60%

Protein binding: Quinapril: 97%; Quinaprilat: 97%

Metabolism: Rapidly hydrolyzed to quinaprilat, the active metabolite

Half-life elimination: Quinapril: 0.8 hours; Quinaprilat: 3 hours; increases as Clcr decreases

Time to peak, serum: Quinapril: 1 hour; Quinaprilat: ~2 hours

Excretion: Urine (50% to 60% primarily as quinaprilat).
Monitoring

Blood pressure; serum creatinine and potassium; if patient has collagen vascular disease and/or renal impairment, periodically monitor CBC with differential.
Administration

Should be taken on an empty stomach. (Take before meals at about the same time of day.)
Pregnancy Category

D: Drug Pregnancy Category There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Lactation

Enters breast milk/use caution
Storage Conditions

Oral: Store below 30°C.
ATC Classification
 C09AA06 - quinapril ; Belongs to the class of ACE inhibitors. Used in the treatment of cardiovascular disease.
GenericPedia Classification
    • Storage

    Oral: Store below 30°C.
    Available As
  • Quinapril 10 mg
  • Quinapril 20 mg
  • Quinapril 40 mg
  • Quinapril 5 mg

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