Quinapril and Hydrochlorothiazide

Pronunciation

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

U.S. Brand Names

Accuretic®; Quinarectic

Synonyms

Hydrochlorothiazide and Quinapril

Generic Available

Yes

Canadian Brand Names

Accuretic®

Use

Treatment of hypertension (not for initial therapy)

Pregnancy Risk Factor

C (1st trimester); D (2nd and 3rd trimesters)

Pregnancy Implications

Cranial defects, hypocalvaria/acalvaria, oligohydramnios, persistent anuria following delivery, hypotension, renal defects, renal dysgenesis/dysplasia, renal failure, pulmonary hypoplasia, limb contractures secondary to oligohydramnios, and stillbirth reported. ACE inhibitors should be avoided during pregnancy, particularly in the 2nd and 3rd trimesters.

Lactation

Enters breast milk/use caution

Contraindications

Hypersensitivity to quinapril, hydrochlorothiazide, other thiazides, sulfonamide-derived drug, or any other component of the formulation; angioedema related to previous treatment with an ACE inhibitor; bilateral renal artery stenosis; patients with idiopathic or hereditary angioedema; anuria; renal decompensation; pregnancy (2nd and 3rd trimesters)

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

See individual agents.

Stability

Store at 20°C to 25°C (68°F to 77°F).

Pharmacodynamics/Kinetics

See individual agents.

Dosage

Oral:

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

May be taken without regard to meals.

Patient Education

See individual components listed in Related Information. Pregnancy/breast-feeding precautions: Do not get pregnant while taking this medication. Consult prescriber for appropriate contraceptive measures. Consult prescriber if breast-feeding.

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 dizziness or drowsiness; may rarely cause insomnia or depression

Mental Health: Effects on Psychiatric Treatment

May cause neutropenia; use caution with clozapine and carbamazepine. May decrease lithium clearance, resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels.

Dosage Forms

Tablet:

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

References

Chase MP, Fiarman GS, Scholz FJ, et al, "Angioedema of the Small Bowel Due to an Angiotensin-Converting Enzyme Inhibitor," J Clin Gastroenterol , 2000, 31(3):254-7.

Smoger SH and Sayed MA, "Simultaneous Mucosal and Small Bowel Angioedema Due to Captopril," South Med J , 1998, 91(11):1060-3.

International Brand Names

Accuretic™ (CA)

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process . A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2007 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Home > Medical Reference > Complementary Medicine