Indicated for the treatment of hypertension, to lower blood pressure. This fixed combination is not indicated for the initial therapy of hypertension.

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.

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.

Hydrochlorothiazide can cause hypokalemia and hyponatremia. Hypomagnesemia can result in hypokalemia which appears difficult to treat despite potassium repletion.

Thiazide diuretics have been reported to cause exacerbation or activation of systemic lupus erythematosus.

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

Hydrochlorothiazide may alter glucose tolerance and raise serum levels of cholesterol and triglycerides.

Hydrochlorothiazide may raise the serum uric acid level due to reduced clearance of uric acid and may cause or exacerbate hyperuricemia and precipitate gout in susceptible patients.

Because of the hydrochlorothiazide components, this product is contraindicated in patients with anuria or hypersensitivity to other sulfonamide-derived drugs.

Rarely, ACE inhibitors have been associated with a syndrome that starts with cholestatic jaundice and progresses to fulminant hepatic necrosis and (sometimes) death. The mechanism of this syndrome is not understood.

ACCURETIC can cause symptomatic hypotension, probably not more frequently than either monotherapy.

ACCURETIC should be used with caution in patients with severe renal disease. Thiazides may precipitate azotemia in such patients, and the effects of repeated dosing may be cumulative.

Hydrochlorothiazide, a sulfonamide, can cause an idiosyncratic reaction, resulting in acute transient myopia and acute angle-closure glaucoma.

Hydrochlorothiazide decreases urinary calcium excretion and may cause elevations of serum calcium. Monitor calcium levels in patients with hypercalcemia receiving ACCURETIC.

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

In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, co-administration of NSAIDs, including selective COX-2 inhibitors, with ACE inhibitors, including quinapril, may result in deterioration of renal function, including possible acute renal failure.

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

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

ACCURETIC and lithium should be co-administered with caution, and frequent monitoring of serum lithium levels is recommended.

Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren is associated with increased risks of hypotension, hyperkalemia, and changes in renal function (including acute renal failure) compared to monotherapy.

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

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

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.

Digoxin: Thiazide-induced electrolyte disturbances, i.e. hypokalemia, hypomagnesemia, increase the risk of digoxin toxicity, which may lead to fatal arrhythmic events.

Alcohol, Barbiturates, or Narcotics: potentiation of orthostatic hypotension may occur.

Corticosteroids, ACTH: intensified electrolyte depletion, particularly hypokalemia.

Cholestyramine and Colestipol Resin: absorption of hydrochlorothiazide is impaired in the presence of anionic exchange resins.

Non-steroidal Anti-inflammatory Drugs: the diuretic, natriuretic, and antihypertensive effects of thiazide diuretics may be reduced by concurrent administration of nonsteroidal anti-inflammatory agents.

When pregnancy is detected, discontinue ACCURETIC as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.

Because of the potential for serious adverse reactions in nursing infants from hydrochlorothiazide and the unknown effects of quinapril in infants, a decision should be made whether to discontinue nursing or to discontinue ACCURETIC, taking into account the importance of the drug to the mother.

GoToSource

• Use in patients under the age of 18. GoToSource

• Heart failure with preserved ejection fraction. GoToSource

Birth defects. GoToSource

Hypokalemia (low potassium level). GoToSource

Hyponatremia (low sodium level). GoToSource

Gout. GoToSource

Acute kidney failure. GoToSource

Visceral fat redistribution, liver fat accumulation, low-grade inflammation, and aggravated insulin resistance, hyperuricemia (high uric acid level in blood), hypercholesterolemia (high fat or lipid levels in blood) and glucose intolerance, increasing a patient’s likelihood of developing diabetes and worsening glycemic control in diabetic patients. GoToSource

Angioedema. GoToSource

Lawsuits filed for birth defects.