Accupril 5mg Tablets
WARNING: Do not take if you are pregnant. Use during pregnancy may cause birth defects or loss of the unborn baby. If you get pregnant or plan on getting pregnant while taking this drug, call your doctor right away. @ COMMON USES: It is used to treat high blood pressure.It is used to treat heart failure (weak heart).It may be given to you for other reasons. Talk with the doctor.
Drug Class
Antihypertensive, Heart Failure Agent
Pharmacologic Class
Angiotensin-Converting Enzyme (ACE) Inhibitor
Pregnancy Category
Contraindicated in 2nd and 3rd trimesters
FDA Approved
Dec 1991
DEA Schedule
Not Controlled
Overview
What is this medicine?
Accupril (quinapril) is a medication used to treat high blood pressure (hypertension) and heart failure. It belongs to a class of drugs called ACE inhibitors. It works by relaxing blood vessels, which helps lower blood pressure and makes it easier for your heart to pump blood.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. You can take this medication with or without food, and it's best to take it at the same time every day. Continue taking your medication as directed by your doctor or healthcare provider, even if you're feeling well.
It's also important to stay hydrated by drinking plenty of non-caffeinated liquids, unless your doctor advises you to limit your fluid intake.
Storing and Disposing of Your Medication
To keep your medication effective and safe, store it at room temperature, protected from light, and in a dry place. Avoid storing it in a bathroom. Keep all medications in a secure location, out of the reach of children and pets. When you're finished with your medication or it's expired, dispose of it properly. Do not flush it down the toilet or pour it down the drain unless instructed to do so by your doctor or pharmacist. If you're unsure about how to dispose of your medication, ask your pharmacist for guidance. You may also want to check if there are any drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for a missed one.
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. You can take this medication with or without food, and it's best to take it at the same time every day. Continue taking your medication as directed by your doctor or healthcare provider, even if you're feeling well.
It's also important to stay hydrated by drinking plenty of non-caffeinated liquids, unless your doctor advises you to limit your fluid intake.
Storing and Disposing of Your Medication
To keep your medication effective and safe, store it at room temperature, protected from light, and in a dry place. Avoid storing it in a bathroom. Keep all medications in a secure location, out of the reach of children and pets. When you're finished with your medication or it's expired, dispose of it properly. Do not flush it down the toilet or pour it down the drain unless instructed to do so by your doctor or pharmacist. If you're unsure about how to dispose of your medication, ask your pharmacist for guidance. You may also want to check if there are any drug take-back programs in your area.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for a missed one.
Lifestyle & Tips
- Follow a low-sodium diet as recommended by your doctor.
- Engage in regular physical activity.
- Limit alcohol intake.
- Avoid smoking.
- Monitor your blood pressure regularly at home as instructed.
- Avoid potassium-rich salt substitutes unless advised by your doctor.
Available Forms & Alternatives
Available Strengths:
Generic Alternatives:
Dosing & Administration
Adult Dosing
Standard Dose:
Hypertension: Initial 10-20 mg once daily. Heart Failure: Initial 5 mg twice daily.
Dose Range:
5 - 80 mg
Condition-Specific Dosing:
hypertension:
Initial 10-20 mg once daily; maintenance 20-80 mg/day in 1-2 doses. For patients on diuretics, initial 5 mg once daily.
heart_failure:
Initial 5 mg twice daily; target 20-40 mg/day in 2 doses.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Limited data; generally not recommended for routine use. For hypertension in children >6 years, initial 5 mg once daily, titrate to response (max 40 mg/day).
Adolescent:
Limited data; generally not recommended for routine use. For hypertension, initial 5 mg once daily, titrate to response (max 40 mg/day).
Dose Adjustments
Renal Impairment:
Mild:
CrCl > 60 mL/min: No adjustment needed.
Moderate:
CrCl 30-60 mL/min: Initial 10 mg once daily.
Severe:
CrCl < 30 mL/min: Initial 5 mg once daily.
Dialysis:
Quinaprilat is dialyzable. Administer dose after dialysis on dialysis days.
Hepatic Impairment:
Mild:
No specific adjustment, but use with caution.
Moderate:
No specific adjustment, but use with caution.
Severe:
Not well studied; use with extreme caution or avoid.
Pharmacology
Mechanism of Action
Quinapril is a prodrug that is hydrolyzed to quinaprilat, its active metabolite. Quinaprilat competitively inhibits angiotensin-converting enzyme (ACE), preventing the conversion of angiotensin I to angiotensin II. This leads to decreased vasoconstriction, reduced aldosterone secretion (resulting in decreased sodium and water retention), and potentiation of bradykinin (a vasodilator). The overall effect is a reduction in systemic vascular resistance and blood pressure.
Pharmacokinetics
Absorption:
Bioavailability:
Approximately 40% (of quinaprilat)
Tmax:
Quinapril: ~1 hour; Quinaprilat: ~2 hours
FoodEffect:
Food may decrease the rate and extent of absorption, but is not clinically significant.
Distribution:
Vd:
Approximately 100 L
ProteinBinding:
Quinapril: ~97%; Quinaprilat: ~90%
CnssPenetration:
Limited
Elimination:
HalfLife:
Quinapril: ~1 hour; Quinaprilat: ~2-3 hours (effective half-life ~10 hours due to tight binding to ACE)
Clearance:
Not available
ExcretionRoute:
Renal (approximately 60%), Fecal/Biliary (approximately 40%)
Unchanged:
<5% (quinapril)
Pharmacodynamics
OnsetOfAction:
Within 1 hour
PeakEffect:
2-4 hours
DurationOfAction:
24 hours (for once-daily dosing)
Safety & Warnings
BLACK BOX WARNING
When used in pregnancy during the second and third trimesters, ACE inhibitors can cause injury and even death to the developing fetus. When pregnancy is detected, discontinue Accupril as soon as possible.
Side Effects
Serious Side Effects: Seek Medical Attention Immediately
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you experience any of the following symptoms, contact your doctor or seek medical help right away:
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
Less Severe Side Effects
Most people experience few or no side effects while taking this medication. However, if you experience any of the following side effects, contact your doctor or seek medical help if they bother you or do not go away:
Cough
* Dizziness
Reporting Side Effects
This is not an exhaustive list of potential 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.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you experience any of the following symptoms, contact your doctor or seek medical help right away:
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
Less Severe Side Effects
Most people experience few or no side effects while taking this medication. However, if you experience any of the following side effects, contact your doctor or seek medical help if they bother you or do not go away:
Cough
* Dizziness
Reporting Side Effects
This is not an exhaustive list of potential 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.
Seek Immediate Medical Attention If You Experience:
- Sudden swelling of the face, lips, tongue, or throat (angioedema) - seek emergency medical attention immediately.
- Difficulty breathing or swallowing.
- Severe dizziness or fainting.
- Persistent dry cough that does not go away.
- Signs of high potassium (hyperkalemia) such as muscle weakness, slow or irregular heartbeat.
- Signs of kidney problems (e.g., decreased urination, swelling in ankles/feet).
- Signs of liver problems (e.g., yellowing of skin/eyes, dark urine, persistent nausea/vomiting).
Before Using This Medicine
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
This list is not exhaustive, and it is crucial to discuss all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, with your doctor and pharmacist. They will help you determine if it is safe to take this medication with your existing medications and health conditions. Do not initiate, discontinue, or modify the dose of any medication without consulting 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
This list is not exhaustive, and it is crucial to discuss all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, with your doctor and pharmacist. They will help you determine if it is safe to take this medication with your existing medications and health conditions. Do not initiate, discontinue, or modify the dose of any medication without consulting your doctor.
Precautions & Cautions
Important Warnings and Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Caution with Daily Activities
Until you know how this medication affects you, avoid driving and other tasks that require alertness. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying position, and be cautious when climbing stairs.
Monitoring Your Condition
Regularly check your blood pressure as instructed by your healthcare provider. Additionally, have your blood work checked as directed 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 your doctor. Similarly, if you are on a low-salt or salt-free diet, discuss this with your doctor.
Over-the-Counter (OTC) Products and Interactions
If you have high blood pressure and are taking this medication, consult your doctor before using 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.
Alcohol Consumption
Discuss your alcohol consumption with your doctor before drinking.
Heat and Fluid Loss
Be cautious in hot weather or during physical activity, and drink plenty of fluids to prevent dehydration. If you experience excessive sweating, fluid loss, vomiting, or diarrhea, inform your doctor, as this may lead to low blood pressure.
Effectiveness in Black Patients
This medication may be less effective in lowering blood pressure in Black patients. In some cases, an additional medication may be necessary. If you have questions or concerns, discuss them with your doctor.
Risk of Angioedema
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 your doctor to discuss any potential risks to your baby.
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Caution with Daily Activities
Until you know how this medication affects you, avoid driving and other tasks that require alertness. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying position, and be cautious when climbing stairs.
Monitoring Your Condition
Regularly check your blood pressure as instructed by your healthcare provider. Additionally, have your blood work checked as directed 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 your doctor. Similarly, if you are on a low-salt or salt-free diet, discuss this with your doctor.
Over-the-Counter (OTC) Products and Interactions
If you have high blood pressure and are taking this medication, consult your doctor before using 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.
Alcohol Consumption
Discuss your alcohol consumption with your doctor before drinking.
Heat and Fluid Loss
Be cautious in hot weather or during physical activity, and drink plenty of fluids to prevent dehydration. If you experience excessive sweating, fluid loss, vomiting, or diarrhea, inform your doctor, as this may lead to low blood pressure.
Effectiveness in Black Patients
This medication may be less effective in lowering blood pressure in Black patients. In some cases, an additional medication may be necessary. If you have questions or concerns, discuss them with your doctor.
Risk of Angioedema
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 your doctor to discuss any potential risks to your baby.
Overdose Information
Overdose Symptoms:
- Severe hypotension (low blood pressure)
- Dizziness
- Lightheadedness
- Fainting
- Tachycardia (rapid heart rate)
- Bradycardia (slow heart rate)
- Renal failure
What to Do:
Seek immediate medical attention. Treatment is supportive and symptomatic. If ingestion is recent, gastric lavage may be considered. Intravenous saline infusion may be used to correct hypotension. Quinaprilat is dialyzable. Call 1-800-222-1222 (Poison Control Center).
Drug Interactions
Contraindicated Interactions
- Aliskiren (in patients with diabetes or renal impairment)
- Sacubitril/valsartan (Entresto) - requires 36-hour washout period
Major Interactions
- Potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride)
- Potassium supplements
- Lithium (increased lithium levels and toxicity)
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs) - reduced antihypertensive effect, increased risk of renal impairment
- mTOR inhibitors (e.g., sirolimus, everolimus, temsirolimus) - increased risk of angioedema
Moderate Interactions
- Diuretics (increased hypotensive effect, especially initial dose)
- Other antihypertensive agents (additive hypotensive effect)
- Gold therapy (nitritoid reactions, including flushing, nausea, vomiting, hypotension)
- Insulin and oral hypoglycemic agents (increased risk of hypoglycemia)
Minor Interactions
- Not available
Monitoring
Baseline Monitoring
Blood Pressure (BP)
Rationale: To establish baseline and guide initial dosing.
Timing: Prior to initiation
Serum Creatinine (SCr) and Blood Urea Nitrogen (BUN)
Rationale: To assess baseline renal function, as quinapril is renally eliminated and can affect renal function.
Timing: Prior to initiation
Serum Potassium (K+)
Rationale: To assess baseline potassium levels, as ACE inhibitors can cause hyperkalemia.
Timing: Prior to initiation
Routine Monitoring
Blood Pressure (BP)
Frequency: Regularly, especially after dose adjustments
Target: Individualized, typically <130/80 mmHg or as per guidelines
Action Threshold: Persistent hypotension (e.g., symptomatic or SBP <90 mmHg) or uncontrolled hypertension
Serum Creatinine (SCr) and BUN
Frequency: Within 1-2 weeks of initiation or dose increase, then periodically (e.g., every 3-6 months or as clinically indicated)
Target: Within normal limits or stable from baseline
Action Threshold: Significant increase (e.g., >30% above baseline or >0.5 mg/dL increase) or signs of acute kidney injury
Serum Potassium (K+)
Frequency: Within 1-2 weeks of initiation or dose increase, then periodically (e.g., every 3-6 months or as clinically indicated)
Target: 3.5-5.0 mEq/L
Action Threshold: Hyperkalemia (>5.5 mEq/L) or hypokalemia (<3.5 mEq/L)
Symptom Monitoring
- Persistent dry cough
- Swelling of face, lips, tongue, throat (angioedema)
- Dizziness or lightheadedness (especially upon standing)
- Fatigue or weakness
- Signs of infection (fever, sore throat) due to rare neutropenia
- Yellowing of skin or eyes (jaundice) due to rare hepatic dysfunction
Special Patient Groups
Pregnancy
Contraindicated during the second and third trimesters of pregnancy due to significant risk of fetal injury and death. Discontinue as soon as pregnancy is detected. Use in the first trimester is also generally avoided due to potential risks.
Trimester-Specific Risks:
First Trimester:
Potential for increased risk of major congenital malformations, though data are less conclusive than for later trimesters. Generally avoided.
Second Trimester:
Significant risk of fetal renal dysfunction, oligohydramnios, fetal lung hypoplasia, skeletal deformations, and death.
Third Trimester:
Significant risk of fetal renal dysfunction, oligohydramnios, fetal lung hypoplasia, skeletal deformations, and death.
Lactation
Quinapril and its active metabolite quinaprilat are excreted in human milk in low concentrations. While the risk to the infant appears low, caution is advised. Monitor breastfed infants for hypotension, hyperkalemia, and renal function.
Infant Risk:
Low to moderate risk; potential for hypotension, hyperkalemia, and renal effects in the infant. Use with caution, especially in preterm or neonates.
Pediatric Use
Safety and efficacy are not well established for routine pediatric use, especially in infants and young children. Limited data exist for hypertension in children >6 years, but generally not a first-line agent.
Geriatric Use
Start with lower doses (e.g., 5 mg once daily) due to potential for decreased renal function and increased sensitivity to hypotensive effects. Titrate dose carefully based on response and tolerability. Monitor renal function and electrolytes closely.
Clinical Information
Clinical Pearls
- ACE inhibitors like quinapril are often associated with a persistent dry cough, which is a class effect and may necessitate discontinuation.
- Angioedema (swelling of the face, lips, tongue, or throat) is a rare but potentially life-threatening side effect. Patients should be educated on symptoms and instructed to seek immediate medical attention if it occurs.
- Monitor renal function (SCr, BUN) and serum potassium levels regularly, especially at initiation, after dose changes, and in patients with pre-existing renal impairment or those on potassium-sparing diuretics.
- Advise patients to avoid potassium-containing salt substitutes and potassium supplements unless specifically instructed by their healthcare provider.
- First-dose hypotension can occur, especially in patients who are volume-depleted (e.g., on diuretics). Consider discontinuing diuretics 2-3 days prior to initiating quinapril, or start with a very low dose (e.g., 5 mg).
Alternative Therapies
- Other ACE inhibitors (e.g., lisinopril, enalapril, ramipril)
- Angiotensin Receptor Blockers (ARBs) (e.g., valsartan, losartan, candesartan)
- Calcium Channel Blockers (CCBs) (e.g., amlodipine, nifedipine)
- Thiazide diuretics (e.g., hydrochlorothiazide)
- Beta-blockers (e.g., metoprolol, carvedilol)
- Direct Renin Inhibitors (e.g., aliskiren - with caution due to interactions)
Cost & Coverage
Average Cost:
Varies widely, typically $10-$50 per 30 tablets (generic)
Generic Available:
Yes
Insurance Coverage:
Tier 1 or 2 (generic)
General Drug Facts
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 this 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, including the amount taken and the time it happened, to ensure you receive the best possible care.