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Home > Medical Reference > Encyclopedia (English)



 

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U.S. Brand Names:

Uniretic®

Synonyms:

Hydrochlorothiazide and Moexipril

Generic Available:

No

Canadian Brand Names:

Uniretic®

Use:

Combination therapy for hypertension, however, not indicated for initial treatment of hypertension; replacement therapy in patients receiving separate dosage forms (for patient convenience); when monotherapy with one component fails to achieve desired antihypertensive effect, or when dose-limiting adverse effects limit upward titration of monotherapy

Pregnancy Risk Factor:

C/D (2nd and 3rd trimesters)

Pregnancy Implications:

See individual agents.

Lactation:

Enters breast milk/use caution

Contraindications:

Based on moexipril component: Hypersensitivity to moexipril, moexiprilat, or any component of the formulation; hypersensitivity or allergic reactions or angioedema related to previous treatment with an ACE inhibitor; pregnancy (2nd or 3rd trimester)

Based on hydrochlorothiazide component: Hypersensitivity to hydrochlorothiazide or any component of the formulation, thiazides, or sulfonamide-derived drugs; anuria; renal decompensation; pregnancy

Warnings/Precautions:

Based on moexipril component: Anaphylactic reactions can occur. Angioedema can occur at any time during treatment (especially following first dose). Careful blood pressure monitoring with first dose (hypotension can occur especially in volume depleted patients). Dosage adjustment needed in renal impairment. Use with caution in hypovolemia; collagen vascular diseases; valvular stenosis (particularly aortic stenosis); hyperkalemia; or before, during, or immediately after anesthesia. Avoid rapid dosage escalation which may lead to renal insufficiency. Neutropenia/agranulocytosis with myeloid hyperplasia can rarely occur. If patient has renal impairment then a baseline WBC with differential and serum creatinine should be evaluated and monitored closely during the first 3 months of therapy. Hypersensitivity reactions may be seen during hemodialysis with high-flux dialysis membranes (eg, AN69). Deterioration in renal function can occur with initiation. Use with caution in unilateral renal artery stenosis and pre-existing renal insufficiency.

Based on hydrochlorothiazide component: Avoid in severe renal disease (ineffective). Electrolyte disturbances (hypokalemia, hypochloremic alkalosis, hyponatremia) can occur. Use with caution in severe hepatic dysfunction; hepatic encephalopathy can be caused by electrolyte disturbances. Gout can be precipitate in certain patients with a history of gout, a familial predisposition to gout, or chronic renal failure. Cautious use in diabetics; may see a change in glucose control. Hypersensitivity reactions can occur. Can cause SLE exacerbation or activation. Use with caution in patients with moderate or high cholesterol concentrations. Photosensitization may occur. Correct hypokalemia before initiating therapy.

Chemical similarities are present among sulfonamides, sulfonylureas, carbonic anhydrase inhibitors, thiazides, and loop diuretics (except ethacrynic acid). Use in patients with sulfonamide allergy is specifically contraindicated in product labeling, however, a risk of cross-reaction exists in patients with allergy to any of these compounds; avoid use when previous reaction has been severe.

Adverse Reactions:

See individual agents.

Drug Interactions:

See individual agents.

Mechanism of Action:

See individual agents.

Pharmacodynamics/Kinetics:

See individual agents.

Dosage:

Adults: Oral: 7.5-30 mg of moexipril, taken either in a single or divided dose one hour before meals; hydrochlorothiazide dose should be 50 mg/day

Patient Education:

See individual agents. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.

Cardiovascular Considerations:

Combination therapy for the treatment of hypertension should be individualized for each patient. Potential advantages for moexipril and hydrochlorothiazide combination therapy may include improved compliance and synergistic reductions in blood pressure with an accompanied reduction in side effects. ACE inhibitors and thiazides are also standard therapy for left ventricular systolic dysfunction. See Special Cardiovascular Considerations for individual agents.

Dental Health: Effects on Dental Treatment:

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

No information available to require special precautions

Mental Health: Effects on Mental Status:

May cause drowsiness or dizziness; may rarely cause anxiety or mood changes

Mental Health: Effects on Psychiatric Treatment:

Thiazides and ACE inhibitors may decrease lithium clearance resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels; may cause neutropenia; use caution with clozapine and carbamazepine

Dosage Forms:

Tablet [film coated, scored]:

7.5/12.5: Moexipril hydrochloride 7.5 mg and hydrochlorothiazide 12.5 mg

15/12.5: Moexipril hydrochloride 15 mg and hydrochlorothiazide 12.5 mg

15/25: Moexipril hydrochloride 15 mg and hydrochlorothiazide 25 mg

International Brand Names:

Unireticâ„¢ (CA)

References

Chobanian AV, Bakris GL, Black HR, et al, "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report,"JAMA, 2003, 289(19):2560-71.

Kaplan NM and Sever PS, "Combination Therapy: A Key to Comprehensive Patient Care,"Am J Hypertens, 1997, 10(7 Pt 2):127S.

Moser M and Black HR, "The Role of Combination Therapy in the Treatment of Hypertension,"Am J Hypertens, 1998, 11(6 Pt 2):73S-8S, 95S-100S.

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