Pronunciation:

(KWIN a pril & hye droe klor oh THYE a zide)

U.S. Brand Names:

Synonyms:

Generic Available:

Canadian Brand Names:

Use:

Pregnancy Risk Factor:

Pregnancy Implications:

Lactation:

Contraindications:

Warnings/Precautions:

Based on quinapril component: Anaphylactic reactions can occur. Angioedema can occur at any time during treatment (especially following first dose). Angioedema may involve head and neck (potentially affecting the airway) or the intestine (presenting with abdominal pain). 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. Rare toxicities associated with ACE inhibitors include cholestatic jaundice (which may progress to hepatic necrosis) and neutropenia/agranulocytosis with myeloid hyperplasia. If patient has renal impairment, 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). Patients receiving ACE inhibitors have experienced rare life-threatening anaphylactoid reactions during desensitization. Rare hepatic reactions, progressing from cholestatic jaundice to hepatic necrosis, have been reported with ACE inhibitors. Discontinue if marked elevation of hepatic transaminases or jaundice occurs. Use with caution in unilateral renal artery stenosis and pre-existing renal insufficiency. Deterioration in renal function can occur with initiation.

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:

1% to 10%:

Central nervous system: Dizziness (5%), somnolence (1%)

Neuromuscular & skeletal: Weakness (1%)

Renal: Serum creatinine increase (3%), blood urea nitrogen increase (4%)

Respiratory: Cough (3%), bronchitis (1%)

<1%: Acute renal failure, agranulocytosis, alopecia, anaphylactoid reaction, angina pectoris, angioedema, arrhythmia, arthralgia, calcium increase (serum), cerebrovascular accident, cholesterol increase (serum), diaphoresis increased, dyspnea, erythema multiforme, exfoliative dermatitis, gastrointestinal hemorrhage, glucose increase (serum), heart failure, hypercalcemia, hyperkalemia, hypertensive crisis, impotence, liver function test abnormalities, magnesium increase (serum), malaise, MI, nervousness, orthostatic hypotension, palpitation, pancreatitis, paresthesia, pemphigus, photosensitivity, pruritus, sinusitis, tachycardia, uric acid increase (serum), thrombocytopenia, triglyceride increase (serum), vertigo, xerostomia

Postmarketing and/or case reports: Abnormal gait, abnormal vision, albuminuria, amnesia, anemia, arthritis, ascites, asthma, bradycardia, cellulitis, cholestatic jaundice, cor pulmonale, deep thrombosis, diarrhea, esophagitis, generalized edema, hematuria, hemiplegia, hepatitis, kidney function abnormality, macropapular rash, meningism, myopathy, myositis, nephrosis, paralysis, petechiae, pneumonia, pyuria, shock, urticaria, vasculitis, weight loss

Drug Interactions:

Stability:

Pharmacodynamics/Kinetics:

Dosage:

Children: Safety and efficacy have not been established.

Adults: Initial:

Patients who have failed quinapril monotherapy:

Quinapril 10 mg/hydrochlorothiazide 12.5 mg or

Quinapril 20 mg/hydrochlorothiazide 12.5 mg once daily

Patients with adequate blood pressure control on hydrochlorothiazide 25 mg/day, but significant potassium loss:

Quinapril 10 mg/hydrochlorothiazide 12.5 mg or

Quinapril 20 mg/hydrochlorothiazide 12.5 mg once daily

Note: Clinical trials of quinapril/hydrochlorothiazide combinations used quinapril doses of 2.5-40 mg/day and hydrochlorothiazide doses of 6.25-25 mg/day.

Elderly: If previous response to individual components is unknown, initial dose selection should be cautious, at the low end of adult dosage range; titration should occur at 1- to 2-week intervals.

Dosage adjustment in renal impairment: Clcr<30 mL/minute/1.73 m² or serum creatinine 3 mg/dL: Use is not recommended.

Dietary Considerations:

Patient Education:

Dental Health: Effects on Dental Treatment:

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Mental Health: Effects on Mental Status:

Mental Health: Effects on Psychiatric Treatment:

Dosage Forms:

10/12.5: Quinapril 10 mg and hydrochlorothiazide 12.5 mg

20/12.5: Quinapril 20 mg and hydrochlorothiazide 12.5 mg

20/25: Quinapril 20 mg and hydrochlorothiazide 25 mg

International Brand Names: