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Accupril

Generic Name: Quinapril Hydrochloride
Drug Category: ACE Inhibitor
Litigation Alert Level: Low
This drug has been approved for use by males and females over the age of 18 years old for a maximum duration of 3 years.

Approved Uses

Indicated for:

Hypertension:

• The treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions. ACCUPRIL may be used alone or in combination with thiazide diuretics.

Heart Failure:

• The management of heart failure as adjunctive therapy when added to conventional therapy including diuretics and/or digitalis.

In using ACCUPRIL, consideration should be given to the fact that another ACE inhibitor, captopril, has caused agranulocytosis, particularly in patients with renal impairment or collagen vascular disease. Available data are insufficient to show that ACCUPRIL does not have a similar risk.

In using ACCUPRIL, consideration should be given to the risk of angioedema.

Intestinal angioedema has been reported in patients treated with ACE inhibitors. These patients presented with abdominal pain (with or without nausea or vomiting); in some cases there was no prior history of facial angioedema and C-1 esterase levels were normal.

ACCUPRIL should normally be used in those patients in whom treatment with a diuretic or a beta-blocker was found ineffective or has been associated with unacceptable adverse effects.

ACCUPRIL can also be tried as an initial agent in those patients in whom use of diuretics and/or beta-blockers is contraindicated or in patients with medical conditions in which these drugs frequently cause serious adverse effects.

The safety and efficacy of ACCUPRIL in renovascular hypertension has not been established; therefore, use in this condition is not recommended.

Black patients receiving ACE inhibitor monotherapy have been reported to have a higher incidence of angioedema compared to non-blacks. It should also be noted that in controlled clinical trials ACE inhibitors have an effect on blood pressure that is less in black patients than in non-blacks.

ACE inhibitors have been associated with a syndrome that starts with cholestatic jaundice and progresses to fulminant hepatic necrosis and (sometimes) death.

Excessive hypotension is rare in patients with uncomplicated hypertension treated with ACCUPRIL alone.

Presumably due to the inhibition of the degradation of endogenous bradykinin, persistent non-productive cough has been reported with all ACE inhibitors, always resolving after discontinuation of therapy.

Tell patients to promptly report any indication of infection (eg, sore throat, fever) which could be a sign of neutropenia.

Do not co-administer ACCUPRIL with aliskiren in patients with diabetes.

ACCUPRIL is contraindicated in combination with a neprilysin inhibitor (e.g., sacubitril). Do not administer ACCUPRIL within 36 hours of switching to or from sacubitril/valsartan, a neprilysin inhibitor.

Patients taking concomitant mammalian target of rapamycin (mTOR) inhibitor (e.g., temsirolimus) therapy or a neprilysin inhibitor may be at increased risk for angioedema.

In general, avoid combined use of RAS inhibitors. Closely monitor blood pressure, renal function and electrolytes in patients on ACCUPRIL and other agents that affect the RAS.

Simultaneous administration of tetracycline with ACCUPRIL reduced the absorption of tetracycline by approximately 28% to 37%, possibly due to the high magnesium content in ACCUPRIL tablets.

Increased serum lithium levels and symptoms of lithium toxicity have been reported in patients receiving concomitant lithium and ACE inhibitor therapy.

Nitritoid reactions (symptoms include facial flushing, nausea, vomiting, and hypotension) have been reported rarely in patients on therapy with injectable gold (sodium aurothiomalate) and concomitant ACE inhibitor therapy.

Nitritoid reactions (symptoms include facial flushing, nausea, vomiting, and hypotension) have been reported rarely in patients on therapy with injectable gold (sodium aurothiomalate) and concomitant ACE inhibitor therapy.

The antihypertensive effect of ACE inhibitors, including quinapril may be attenuated by NSAIDs.

When used in pregnancy, angiotensin converting enzyme (ACE) inhibitors can cause injury or even death of the developing fetus. When pregnancy is detected, ACCUPRIL should be discontinued as soon as possible.

Because ACCUPRIL is secreted in human milk, caution should be exercised when this drug is administered to a nursing woman.

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Off-label Uses

• Prevention of vascular damage in scleroderma and autoimmune raynaud’s phenomenon. GoToSource

• Diabetic nephropathy. GoToSource 

• Use in patients under the age of 18. GoToSource

• Intermittent claudication associated with peripheral arterial disease. GoToSource 

• Therapy for insulin resistant, hyperleptinemic and low-grade inflammatory state in hypertension. GoToSource

• Arthritis. GoToSource

Adverse Events

Angioedema (swelling). GoToSource

Cardiovascular death, resuscitated cardiac arrest, nonfatal myocardial infarction, coronary revascularization, unstable angina or heart failure requiring hospitalization, angina and stroke with Accupril therapy after coronary artery bypass surgery. GoToSource

Reported no beneficial effect of Accupril on exercise tolerance and quality of life in elderly heart failure patients with preserved systolic function. GoToSource

Kidney failure, hyperkalemia (high blood potassium level) and birth defects. GoToSource

Exacerbation of congestive heart failure and arrhythmia. GoToSource

Litigation

Lawsuits filed for birth defects. 

The material contained in GoToPills is for informational purposes only and not intended to replace the judgment, evaluation and treatment of physicians, pharmacists and other healthcare providers. GoToPills does not provide medical advice, diagnoses or treatment. Always seek the advice of your physician or other qualified health provider regarding a medical condition or treatment.

 

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Site Last Updated March 29, 2024