Accupril 20mg Tablets

Quinapril is a prodrug that is hydrolyzed to quinaprilat, its active metabolite. Quinaprilat competitively inhibits angiotensin-converting enzyme (ACE), which is responsible for the conversion of angiotensin I to angiotensin II. Inhibition of ACE leads to decreased levels of angiotensin II, resulting in vasodilation (reduced peripheral vascular resistance), decreased aldosterone secretion (leading to increased sodium and water excretion and potassium retention), and reduced sympathetic nervous system activity. It also inhibits the degradation of bradykinin, a potent vasodilator, contributing to its antihypertensive effect and potentially to side effects like cough and angioedema.

Urgent Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical attention immediately:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of kidney problems, including:
+ Inability to pass urine
+ Changes in urine output
+ Blood in the urine
+ Sudden weight gain
Signs of high potassium levels, such as:
+ Abnormal heartbeat
+ Confusion
+ Weakness, lightheadedness, or dizziness
+ Feeling like passing out
+ Numbness or tingling
+ Shortness of breath
Severe dizziness or fainting
Persistent cough
Severe stomach pain
Severe nausea or vomiting
Signs of liver problems, including:
+ Dark urine
+ Fatigue
+ Decreased appetite
+ Stomach pain or upset
+ Light-colored stools
+ Vomiting
+ Yellow skin or eyes (jaundice)
Signs of infection, such as:
+ Fever
+ Chills
+ Sore throat

Other Possible Side Effects

Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms, contact your doctor or seek medical attention:

Cough
* Dizziness

Reporting Side Effects

This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reaction you experienced, including the symptoms that occurred.
If you have a history of angioedema, a severe and potentially life-threatening reaction characterized by symptoms such as:
+ Swelling of the hands, face, lips, eyes, tongue, or throat
+ Difficulty breathing
+ Trouble swallowing
+ Unusual hoarseness
If you are undergoing any of the following medical treatments:
+ Apheresis
+ Dialysis
+ Hemofiltration
If you are currently taking any of the following medications:
+ Aliskiren
+ Azilsartan
+ Candesartan
+ Eprosartan
+ Irbesartan
+ Losartan
+ Olmesartan
+ Telmisartan
+ Valsartan
* If you have taken a medication containing sacubitril within the last 36 hours

Please note that this is not an exhaustive list of all potential interactions. It is crucial to discuss all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems, with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions. Do not initiate, stop, or adjust the dosage of any medication without consulting your doctor.

Important Information to Share with Your Healthcare Team

Inform all of your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.

Precautions to Ensure Your Safety

To avoid accidents, do not drive or perform tasks that require alertness until you know how this medication affects you. When standing up from a sitting or lying down position, rise slowly to minimize the risk of dizziness or fainting. Be cautious when climbing stairs.

Monitoring Your Condition

Check your blood pressure as directed by your healthcare provider. Additionally, have your blood work checked as instructed by your doctor and discuss the results with them.

Interactions with Other Substances

If you are taking a salt substitute containing potassium, a potassium-sparing diuretic, or a potassium product, consult with your doctor. Similarly, if you are on a low-salt or salt-free diet, discuss this with your doctor.

Special Considerations

If you have high blood pressure and are taking this medication, talk to your doctor before using over-the-counter (OTC) products that may increase blood pressure, such as cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or aids. Also, consult with your doctor before consuming alcohol.

Staying Safe in Various Situations

In hot weather or during physical activity, be careful to avoid dehydration by drinking plenty of fluids. If you experience excessive sweating, fluid loss, vomiting, or diarrhea, inform your doctor, as these conditions may lead to low blood pressure.

Effectiveness and Potential Risks

It is essential to note that this medication may be less effective in lowering blood pressure in Black patients. In some cases, an additional medication may be necessary. Discuss any concerns with your doctor.

Rare but Serious Reaction

A severe and potentially life-threatening reaction called angioedema has been reported. The risk of angioedema may be higher in Black patients.

Breastfeeding

If you are breastfeeding, consult with your doctor to discuss any potential risks to your baby.

• Aliskiren (in patients with diabetes or renal impairment (GFR < 60 mL/min/1.73 m2))
• Sacubitril/Valsartan (Entresto) - concomitant use or within 36 hours of switching due to increased risk of angioedema.

• Potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride) - increased risk of hyperkalemia.
• Potassium supplements - increased risk of hyperkalemia.
• Lithium - increased serum lithium levels and toxicity.
• NSAIDs (Nonsteroidal Anti-inflammatory Drugs) - may reduce antihypertensive effect and increase risk of renal impairment.
• mTOR inhibitors (e.g., sirolimus, everolimus, temsirolimus) - increased risk of angioedema.
• Neprilysin inhibitors (e.g., sacubitril) - increased risk of angioedema.
• Gold (sodium aurothiomalate) - nitritoid reactions (facial flushing, nausea, vomiting, hypotension) reported rarely.

• Diuretics (thiazide or loop) - increased risk of symptomatic hypotension, especially with initial doses.
• Other antihypertensive agents - additive hypotensive effects.
• Insulin and oral hypoglycemic agents - increased risk of hypoglycemia.
• Trimethoprim - increased risk of hyperkalemia.
• Cyclosporine - increased risk of hyperkalemia and renal dysfunction.

• Antacids (e.g., magnesium hydroxide, aluminum hydroxide) - may decrease quinapril absorption (administer at least 1 hour apart).

• Persistent dry cough
• Swelling of face, lips, tongue, or throat (angioedema)
• Dizziness or lightheadedness (hypotension)
• Fatigue or weakness
• Signs of infection (fever, sore throat) - rare, but indicative of neutropenia
• Yellowing of skin or eyes, dark urine, abdominal pain (signs of liver dysfunction)

Contraindicated in pregnancy. ACE inhibitors can cause fetal and neonatal morbidity and death when administered to pregnant women. If pregnancy is detected, discontinue Accupril as soon as possible.

Quinapril and its active metabolite quinaprilat are present in human milk. While levels are low, caution should be exercised. The American Academy of Pediatrics considers ACE inhibitors compatible with breastfeeding. Monitor breastfed infant for hypotension and adverse effects.

Safety and effectiveness have not been established in pediatric patients. Use is generally not recommended.

No overall differences in effectiveness or safety have been observed between elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. Start with lower doses (e.g., 5 mg once daily) and titrate cautiously, especially if renal function is impaired.

• First-dose hypotension can occur, especially in patients who are volume-depleted (e.g., on diuretics, salt-restricted diet, or with heart failure). Consider discontinuing diuretics 2-3 days prior to initiation if possible, or starting with a very low dose.
• Persistent dry cough is a common side effect of ACE inhibitors, occurring in up to 20% of patients. It is usually non-productive and resolves within days to weeks after discontinuation. If bothersome, consider switching to an ARB.
• Angioedema is a rare but life-threatening side effect. Patients should be educated on the signs (swelling of face, lips, tongue, throat) and instructed to seek immediate medical attention if it occurs.
• Monitor renal function and serum potassium regularly, especially in patients with pre-existing renal impairment, heart failure, or those on potassium-sparing diuretics or supplements.
• Quinapril is a prodrug that requires hepatic activation. While severe hepatic impairment is rare, monitor liver function if clinically indicated.

• Angiotensin Receptor Blockers (ARBs) e.g., Valsartan, Losartan, Candesartan (often used if ACEI cough occurs)
• Beta-blockers e.g., Metoprolol, Carvedilol
• Calcium Channel Blockers (CCBs) e.g., Amlodipine, Diltiazem
• Thiazide diuretics e.g., Hydrochlorothiazide
• Loop diuretics e.g., Furosemide (for heart failure with fluid overload)
• Direct Renin Inhibitors e.g., Aliskiren (less common, contraindicated with ACEI in certain populations)

If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.