Accupril

 

Generic name: quinapril 
Name of the brand: Accupril
The class of drug: Angiotensin Converting Enzyme Inhibitors

What is Accupril?

Accupril
Accupril

Accupril is an ACE inhibitor. ACE stands for angiotensin-converting enzyme.

Accupril helps treat blood pressure that is high (hypertension). The reduction in blood pressure can reduce your chance of suffering a heart attack or stroke.

Accupril is also combined with other medicines to treat heart failure.

Warnings and precautions

Do not take Accupril when you are expecting. If you find yourself pregnant discontinue taking this medication and notify your doctor immediately.

Quinapril should not be used if you’ve ever suffered from angioedema. Don’t use Accupril within the first 36 hours of or after taking a medicine that has sacubitril(such as Entresto).

If you suffer from diabetes don’t make use of Accupril in conjunction with any other medicine that contains aliskiren, which is a blood pressure medication (brand names are Tekturna or Tekamlo).

General

 

Insufficiency in kidney function

As a consequence of inhibiting the renin-angiotensin-aldosterone system, changes in renal function may be anticipated in susceptible individuals. In patients with severe heart failure whose renal function may depend on the activity of the renin-angiotensin-aldosterone system, treatment with ACE inhibitors, including Accupril, may be associated with oliguria and/or progressive azotemia and rarely acute renal failure and/or death.

In studies of clinical hypertensive patients suffering from either bilateral or unilateral renal arterial stenosis, the levels of blood urea nitrogen, as well as serum creatinine levels, have been noted in some patients receiving ACE inhibitor treatment.

These elevations were generally and were reversible after discontinuation of the ACE inhibitor or diuretic treatment. In these individuals, the renal functions must be assessed during an initial couple of weeks of therapy.

Certain patients suffering from hypertension or heart failure who have no preexisting renal disease have experienced increased blood urea and serum creatinine. These are usually small and temporary, especially when Accupril was administered in conjunction with diuretics. It is more likely to occur in patients suffering from existing kidney impairment. Reduction in dosage or stopping any diuretic or Accupril might be required.

The evaluation of patients suffering from hypertension or heart failure must always include a thorough assessment of kidney performance 

Hyperkalemia

In clinical studies in clinical trials, high levels of hyperkalemia (serum potassium >=5.8 mg/L) was seen in about 2percent of patients taking Accupril. In the majority of cases, the elevated levels of serum potassium were unrelated and were able to be cured despite the continued treatment. Less than 0.1% of patients quit treatment because of hyperkalemia.

The risk factors that contribute to developing hyperkalemia are diabetes mellitus, renal insufficiency as well as the usage of other drugs that increase the levels of potassium in the serum. Check the levels of potassium in these sufferers 

Cough

Most likely because of the suppression of the degradation of bradykinin endogenous, non-productive cough has been observed for all ACE inhibitors, and always resolved following the cessation of therapy. ACE inhibitor-related cough must be considered as a differentiating classification of the cough.

Surgery/anesthesia

For patients who undergo major surgery or under anesthesia using agents that cause hypotension, Accupril can block angiotensin II production due to the release of renin in response to compensatory. If hypotension develops and is thought to be the result of the mechanism mentioned above, then it may be corrected by expanding the volume.

Information for Patients

Pregnancy

Women who are pregnant should inform patients who are childbearing about the negative effects of being exposed to ACCUPRIL during pregnancy. Discuss possible treatment options with women who plan to get pregnant. Encourage patients to report the pregnancy to their doctors whenever they can.

Angioedema

Angioedema and laryngeal edema is common side effect of ACE inhibitors, particularly after initial dosage. Inform patients to report immediately any symptoms or signs that suggest angioedema (swelling of the face eyelids, extremities or lips, tongue difficulties swallowing, difficulty breathing) and to discontinue using the medication until they’ve spoken with their doctor

Hypotension that is symptomatic

Be aware that lightheadedness could occur, especially in the initial few days of treatment with ACCUPRIL and must be reported directly to a doctor. If syncope is observed then advise patients to stop taking the medication until they’ve consulted their doctor.

All patients should be aware that insufficient drinking of fluids or excessive sweating vomiting, diarrhea or perspiration could cause an extreme decrease in blood pressure because of the reduction in fluid volume and the resulting effects of syncope and lightheadedness.

If you are who plan to undergo any procedure or anesthesia inform their doctor who prescribes an ACE inhibitor.

Hyperkalemia

Do not advise patients to use sodium supplements, salt replacements or potassium that contain potassium without consulting with their doctor 

Neutropenia

Inform patients to immediately notify you of any signs of an infection (eg sore throat or fever) that could indicate neutropenia.

Notification: As with other medications, specific advice for patients who are treated with Accupril is advised. This information is designed to help ensure the safe and efficient usage of this medication. It is not a comprehensive list of every possible negative or desired adverse effect.

Diuretic therapy in conjunction with diuretic therapy.

Similar to similar ACE inhibitors, people taking diuretics, in particular, those on diuretic therapy that was recently initiated can occasionally suffer a drastic reduction in blood pressure following the introduction of treatment with Accupril. The risk of hypotensive reactions associated with Accupril could be mitigated by either stopping the diuretic or slowly increasing the intake of salt prior to starting the treatment using Accupril. If it’s not feasible to stop diuretics, the initial dose of quinapril must be decreased.

Agents that increase the level of potassium in the bloodstream.

The coadministration of Accupril and other medications that increase potassium levels in the serum can cause hyperkalemia. Monitor serum potassium in such patients.

Tetracycline and various other medications that are in a relationship with magnesium

The simultaneous administration of tetracycline and Accupril decreased the absorption rate of tetracycline from 28%-37%, which could be due to its high content of magnesium found in Accupril tablets. This interaction must be taken into consideration when prescribing Accupril in combination with tetracycline, or any other drug that is in a relationship with magnesium.

Lithium

Higher levels of serum lithium and signs of lithium-related toxicity have been documented in patients who are receiving concurrent lithium as well as ACE inhibitor treatment. The drugs must be administered with care and regular surveillance of the serum lithium levels is advised. If a diuretic is utilized, it can raise the chance of toxicity to lithium.

Gold

Nitritoid reactions (symptoms include facial flushing nausea vomiting, hypotension, and facial flushing) have been reported only in patients receiving treatment with injection-able gold (sodium aurothiomalate) as well as concomitant ACE inhibitor treatment.

Non-steroidal anti-inflammatory drugs

For patients who are old and depleted in their volume (including diuretic patients) or have impaired renal function, the co-administration of NSAIDs such as selective COX-2 inhibitors, along with ACE inhibitors, like quinapril can cause an impairment of renal function and even severe renal dysfunction. The effects of these are typically reversible. Check the renal function regularly in patients taking quinapril as well as NSAID treatment.

The antihypertensive action is a result of ACE inhibitors, such as quinapril could be reduced by NSAIDs.

Agents that block mTOR, or other drugs that cause angioedema.

Patients who are taking mTOR inhibitors in conjunction with (e.g. the Temsirolimus) treatment or a neprilysin antagonist could be at greater risk of angioedema.

Other agents

Studies of the drug interaction of Accupril and other agents revealed:

  • Multiple-dose therapy using propranolol and cimetidine have no impact on the pharmacokinetics of single doses of Accupril.
  • The anticoagulant action from dose warfarin (measured by prothrombin duration) was not significantly altered with quinapril coadministration twice daily.
  • Accupril treatment has not affected the dosage of digoxin’s pharmacokinetics.
  • No pharmacokinetic interactions were observed when individual doses of Accupril, as well as hydrochlorothiazide, were given concurrently.
  • The co-administration of multiple doses of 10 mg of atorvastatin in combination with the Accupril dosage of 80 mg produced little or no change in the pharmacokinetic parameters at steady-state of the atorvastatin.

Dual Blockade of the Renin-Angiotensin System (RAS)

Double blockade in the RAS using angiotensin-receptor blockers ACE inhibitors or Aliskiren is associated with a higher risk of hyperkalemia, hypotension and impairments in kidney function (including chronic renal impairment) in comparison to monotherapy. The majority of patients who receive 2 RAS inhibitors do not gain any benefit over monotherapy. It is generally recommended to avoid the combined usage of RAS inhibitors. Monitor blood pressure closely and electrolytes, as well as renal function for patients taking Accupril as well as other medications which affect the RAS.

Do not mix aliskiren and Accupril for patients suffering from diabetes. Avoid concurrent use of aliskiren and Accupril for patients suffering from kidney impairment (GFR<60 mL/min/1.73 per m2).

Carcinogenesis, Mutagenesis, Impairment of Fertility

Quinapril hydrochloride did not cause cancer in rodents or mice it was administered in doses of 75 and 100 mg/kg/day (50 -60 times the human maximum daily dose, based in mg/kg units as well as 3.8 up to 10 times maximum daily human dose based on a base of mg/m2) for up to 104 weeks.

Female rats receiving the highest dose levels were more likely to develop mesenteric lymph node hemangiomas as well as subcutaneous lipomas and skin lesions. Quinapril and quinaprilat are not mutationally mutagenic in the Ames test for bacterial growth that included metabolic activation or not.

Quinapril was also not mutagenic in the following studies of genetic toxicology including in vitro mammalian cells point mutation and sister chromatid exchange in mammalian cells grown in the culture micronucleus test in mice as well as in vitro chromosome alteration using V79 lung cells cultured and an in vivo cytogenetic test using rat bone marrow. The drug had no negative reproductive or fertility effects in rats with doses of up 100 mg/kg per day (60 to 10 times daily maximum human dose calculated using mg/kg or mg/m2 and mg/m2, respectively).

Nursing Mothers

Because Accupril is released in human milk, caution must be taken when the drug is given to a nursing mother.

Geriatric Use

The clinical studies conducted by Accupril didn’t include enough patients aged 65 or over to assess how they respond differently from younger patients. Other studies of clinical trials have not found any differences in response between older and younger patients. I

n general, the selection of doses for the elderly patient must be taken with caution, typically beginning at the lower portion of the dose range which is indicative of the higher incidence of a decline in renal, hepatic or cardiac activity as well as of a co-occurring disease or medication therapy.

The drug is believed to be extensively excreted from the kidney. The possibility of developing toxic reactions from this medication may be higher for patients who have impaired kidney function. Since elderly patients are more likely to suffer from impaired renal function, care must be taken when it comes to dosage selection and it is possible to observe the renal function.

Patients with a higher age showed larger areas beneath the plasma concentration-time curve and the highest levels of quinaprilat when compared with values seen in younger patients. This may be related to a decline in renal function, rather than the aging process itself.

Before you start taking this medicine, make sure to consult your doctor

It is not recommended to use Accupril If you have an allergy to quinapril or:

Do not consume Accupril within the first 36 hours of or after taking a medicine that has sacubitril (such as Entresto).

If you are diabetic take care not to take Accupril along with any medication which contains the ingredient aliskiren (such as Tekturna and Tekamlo).

It is also possible to stay clear of quinapril when taking aliskiren when you suffer from renal disease.

To ensure that Accupril is safe for you, ask your physician if you’ve previously had:

Don’t use it when you are pregnant. Stop taking the medication and notify your doctor immediately if you find yourself pregnant. Quinapril can cause injury or even death to a baby that is not born if you use the medication in the third or second trimester.

It might not be safe to breastfeed during quinapril. Consult your physician about any potential risks.

Accupril is not allowed for use by any person less than 18 years old.

How to take the Accupril?

Consume Accupril exactly as directed by your physician. Follow all instructions on the prescription label. The doctor could modify your dose. Don’t take this medication in greater or lesser quantities or for a longer time than prescribed.

Your blood pressure needs to be monitored regularly. Your liver or kidney function might also require to be examined.

Contact your physician if are suffering from persistent diarrhea or vomiting or if you’re sweating more than normal. It is possible to become dehydrated during the course of taking Accupril. This can result in poor blood pressure levels, electrolyte problems or kidney failure.

If you are going to undergo surgery, inform your surgeon beforehand that you’re using Accupril. You might have to stop taking the medication for a brief period of time.

If you’re receiving treatment with high blood pressure continue taking this medication even if you feel good. The presence of high blood pressure is often accompanied by no signs. You could need blood pressure medication throughout your life.

Maintain at room temperature, and free of heat, moisture and light.

Dosing information

Usual Adult Dose for Hypertension:

Initial dose: 10 to 20 mg once orally every day for patients who are not taking diuretics.
Maintenance dosage: 20 to 80 mg per day orally in one dosage or divided into two doses equally divided

Use:
Treatment of hypertension

Usual Adult Dose for Congestive Heart Failure:

Initial dosage: 5 mg orally every day, twice
Dosage for maintenance 20 to 40 mg daily, orally administered in two doses equally divided

Comments:
This dose can help alleviate signs of heart problems however, longer durations of exercise are generally associated with higher doses.
If the initial dose is tolerated well Patients should be gradually increased until they have reached an effective dose.

Use:
Management of heart failure an adjunctive therapy, when it is combined with traditional therapy, such as diuretics or digitalis

Usual Geriatric Dose for Congestive Heart Failure:

10 mg orally every day

Notes: Dose should be titrated in the same manner as the other patients of adulthood.

Uses:
Treatment of hypertension
Management of heart failure as an adjunctive therapy, when it is combined with conventional treatment, including diuretics or digitalis

Usual Geriatric Dose for Hypertension:

10 mg taken orally, once a day

Notes: Dose should be titrated exactly the same way as adults with other conditions.

Uses:
Treatment of hypertension
Management of heart failure as an adjunctive therapy, when it is combined with traditional therapy, such as diuretics or digitalis

If I do not take a dose?

You should take the dose missed as soon as you can remember. Avoid your missed dosage if you are close to the time of the next dose. Do not take any additional medicine to make up for the missed dose.

If I take too much?

For medical emergencies, seek emergency medical attention or contact for help at the Poison Help line at 1-800-222-1222.

What can you do to be aware of to

Drinking alcohol may increase your blood pressure and could cause an increase in the side effects of quinapril.

Don’t use potassium supplements or salt substitutes when taking Accupril unless your doctor has advised you to.

Do not get up too quickly from a lying or sitting posture, as you might be dizzy. Make sure to get up slowly and steadily to avoid falling.

Accupril side effects

Take immediate medical attention If you are experiencing symptoms of an allergy reaction with Accupril. symptoms of hives; stomach pain, difficulty breathing or breathing; swelling of your lips, face and tongue.

Consult your physician immediately If you are suffering from:

Common Accupril adverse effects could be:

This isn’t a complete list of all side effects. other side effects could occur. Contact your doctor for advice regarding medical effects. You can report any adverse reactions to the FDA at 1-800-FDA-1088.

What other medications can have an effect on Accupril?

Inform your doctor about all the medications you currently take and all you are about to start or stop taking, particularly:

This list isn’t comprehensive. Other medications can be incompatible with quinapril, such as prescription and over-the-counter medicines such as vitamins, herbal products.

 

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