Quinapril 10mg 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
Pharmacologic Class
Angiotensin-Converting Enzyme (ACE) Inhibitor
Pregnancy Category
Not available
FDA Approved
Dec 1991
DEA Schedule
Not Controlled
Overview
What is this medicine?
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 blood flow more easily and lowers blood pressure. This reduces the workload on your heart.
How to Use This Medicine
Taking Your Medication
To get the most benefit from your medication, follow these guidelines:
Take your medication exactly as directed by your doctor.
Read all the information provided with your medication and follow the instructions carefully.
You can take your medication with or without food.
Take your medication at the same time every day to establish a routine.
Continue taking your medication as prescribed by your doctor or healthcare provider, even if you start to feel better.
Staying Hydrated
Drink plenty of non-caffeinated liquids, unless your doctor advises you to limit your fluid intake.
Storing and Disposing of Your Medication
Store your medication at room temperature, away from light and moisture.
Keep your medication in a dry place, such as a closet or drawer, and avoid storing it in the bathroom.
Keep all medications out of the reach of children and pets to ensure their safety.
Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your doctor or pharmacist.
If you have questions about disposing of your medication, consult with your pharmacist. You may also want to check if there are any drug take-back programs in your area.
Missing a Dose
If you miss a dose, take it as soon as you remember.
If it's almost time for your next dose, skip the missed dose and resume your regular schedule.
Do not take two doses at once or take extra doses to make up for a missed dose.
To get the most benefit from your medication, follow these guidelines:
Take your medication exactly as directed by your doctor.
Read all the information provided with your medication and follow the instructions carefully.
You can take your medication with or without food.
Take your medication at the same time every day to establish a routine.
Continue taking your medication as prescribed by your doctor or healthcare provider, even if you start to feel better.
Staying Hydrated
Drink plenty of non-caffeinated liquids, unless your doctor advises you to limit your fluid intake.
Storing and Disposing of Your Medication
Store your medication at room temperature, away from light and moisture.
Keep your medication in a dry place, such as a closet or drawer, and avoid storing it in the bathroom.
Keep all medications out of the reach of children and pets to ensure their safety.
Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so by your doctor or pharmacist.
If you have questions about disposing of your medication, consult with your pharmacist. You may also want to check if there are any drug take-back programs in your area.
Missing a Dose
If you miss a dose, take it as soon as you remember.
If it's almost time for your next dose, skip the missed dose and resume your regular schedule.
Do not take two doses at once or take extra doses to make up for a missed dose.
Lifestyle & Tips
- Take the medication exactly as prescribed, usually once or twice daily, with or without food.
- Do not stop taking quinapril without consulting your doctor, even if you feel well.
- Avoid potassium supplements or salt substitutes containing potassium unless advised by your doctor.
- Limit alcohol intake as it can further lower blood pressure.
- Maintain a healthy diet (low in sodium, rich in fruits and vegetables), regular exercise, and manage stress to support blood pressure control.
- Inform your doctor or dentist that you are taking quinapril before any surgery or dental procedures.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
Hypertension: Initial 10-20 mg once daily. Maintenance 20-80 mg/day in 1-2 doses. Heart Failure: Initial 5 mg twice daily. Maintenance 10-40 mg/day in 2 doses.
Dose Range:
5 - 80 mg
Condition-Specific Dosing:
hypertension:
Initial 10-20 mg once daily; maintenance 20-80 mg/day in 1-2 doses.
heart_failure:
Initial 5 mg twice daily; maintenance 10-40 mg/day in 2 doses.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established for routine use; limited data for specific conditions, generally not recommended as first-line.
Adolescent:
Not established for routine use; limited data for specific conditions, generally not recommended as first-line.
Dose Adjustments
Renal Impairment:
Mild:
CrCl > 60 mL/min: Initial 10 mg once daily.
Moderate:
CrCl 30-60 mL/min: Initial 5 mg once daily.
Severe:
CrCl 10-30 mL/min: Initial 2.5 mg once daily. CrCl < 10 mL/min: Not recommended or use with extreme caution at very low doses.
Dialysis:
Quinaprilat is dialyzable; supplemental dose after dialysis may be considered, but careful monitoring is essential. Start with 2.5 mg and titrate based on response.
Hepatic Impairment:
Mild:
No specific adjustment needed, but monitor closely.
Moderate:
No specific adjustment needed, but monitor closely as metabolism to active quinaprilat may be impaired.
Severe:
Use with caution; consider lower initial doses and careful monitoring due to potential for impaired conversion to active metabolite and reduced elimination.
Pharmacology
Mechanism of Action
Quinapril is a prodrug that is hydrolyzed to quinaprilat, its active metabolite. Quinaprilat is an angiotensin-converting enzyme (ACE) inhibitor. It prevents the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This leads to decreased angiotensin II levels, resulting in vasodilation, reduced aldosterone secretion (leading to decreased sodium and water reabsorption), and reduced sympathetic activity. It also inhibits the degradation of bradykinin, a vasodilator, which contributes to its antihypertensive effect and may be responsible for some side effects like cough and angioedema.
Pharmacokinetics
Absorption:
Bioavailability:
Approximately 60% (as quinaprilat)
Tmax:
Quinapril: ~1 hour; Quinaprilat: ~2 hours
FoodEffect:
Food may decrease the rate and extent of absorption, but this is generally not clinically significant for efficacy.
Distribution:
Vd:
Not available (for quinaprilat, approximately 100 L)
ProteinBinding:
Quinaprilat: ~97%
CnssPenetration:
Limited
Elimination:
HalfLife:
Quinapril: ~1 hour; Quinaprilat: ~2-3 hours (terminal elimination half-life), but effective accumulation half-life is ~10 hours.
Clearance:
Primarily renal and biliary/fecal
ExcretionRoute:
Renal (approximately 60% as quinaprilat and other metabolites), Fecal/Biliary (approximately 40%)
Unchanged:
Less than 5% (quinapril)
Pharmacodynamics
OnsetOfAction:
Within 1 hour
PeakEffect:
2-4 hours
DurationOfAction:
24 hours (allowing once-daily dosing for hypertension)
Safety & Warnings
BLACK BOX WARNING
When pregnancy is detected, discontinue quinapril as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.
Side Effects
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 help:
Cough
* Dizziness
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects not mentioned here. 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 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 help:
Cough
* Dizziness
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects not mentioned here. 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:
- Swelling of the face, lips, tongue, or throat (angioedema) - seek immediate medical attention.
- Difficulty breathing or swallowing - seek immediate medical attention.
- Severe dizziness or fainting (especially when standing up quickly) - report to your doctor.
- Persistent dry cough - report to your doctor.
- Yellowing of the skin or eyes (jaundice), dark urine, persistent nausea/vomiting - report to your doctor.
- Signs of infection (fever, sore throat) - report to your doctor.
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is crucial to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction you experienced, including any 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, swallowing problems, or unusual hoarseness.
If you are undergoing any of the following medical treatments: apheresis, dialysis, or hemofiltration.
If you are currently taking any of the following medications: Aliskiren, azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, or 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 essential to inform your doctor and pharmacist about all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you may have. This will enable your healthcare team to verify the safety of taking this medication in conjunction with your other medications and health conditions. Never start, stop, or modify the dosage of any medication without first consulting your doctor.
It is crucial to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction you experienced, including any 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, swallowing problems, or unusual hoarseness.
If you are undergoing any of the following medical treatments: apheresis, dialysis, or hemofiltration.
If you are currently taking any of the following medications: Aliskiren, azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, or 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 essential to inform your doctor and pharmacist about all your medications, including prescription and over-the-counter drugs, natural products, and vitamins, as well as any health problems you may have. This will enable your healthcare team to verify the safety of taking this medication in conjunction with your other medications and health conditions. Never start, stop, or modify the dosage of any medication without first 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
Follow your doctor's instructions for checking your blood pressure regularly. 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, talk to 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
- Certain natural products or aids
Alcohol Consumption
Discuss your alcohol consumption with your doctor before drinking.
Precautions in Hot Weather and Physical Activity
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 these conditions 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
Follow your doctor's instructions for checking your blood pressure regularly. 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, talk to 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
- Certain natural products or aids
Alcohol Consumption
Discuss your alcohol consumption with your doctor before drinking.
Precautions in Hot Weather and Physical Activity
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 these conditions 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
- Shock
What to Do:
If overdose is suspected, seek immediate medical attention. Call 911 or Poison Control at 1-800-222-1222. Treatment is supportive, including intravenous fluid administration to correct hypotension. Quinaprilat can be removed by hemodialysis.
Drug Interactions
Contraindicated Interactions
- Aliskiren (in patients with diabetes or renal impairment (CrCl < 60 mL/min))
- Sacubitril/valsartan (Neprilysin inhibitors - concomitant use or within 36 hours of switching due to increased risk of angioedema)
Major Interactions
- Potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride) - increased risk of hyperkalemia
- Potassium supplements - increased risk of hyperkalemia
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs) - may reduce antihypertensive effect and increase risk of renal impairment (especially in elderly, volume-depleted, or those with pre-existing renal dysfunction)
- Lithium - increased serum lithium levels and toxicity
- mTOR inhibitors (e.g., sirolimus, everolimus, temsirolimus) - increased risk of angioedema
- Racecadotril - increased risk of angioedema
Moderate Interactions
- Diuretics (thiazide or loop) - increased risk of symptomatic hypotension, especially with initial doses
- Antidiabetic agents (insulin, oral hypoglycemics) - increased risk of hypoglycemia
- Gold injections (sodium aurothiomalate) - nitritoid reactions (facial flushing, nausea, vomiting, hypotension)
- Allopurinol - increased risk of hypersensitivity reactions
- Tricyclic antidepressants, antipsychotics, anesthetics - enhanced hypotensive effect
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 changes and during maintenance therapy (e.g., weekly initially, then monthly or every 3-6 months)
Target: <130/80 mmHg (or individualized target)
Action Threshold: Persistent BP above target, or symptomatic hypotension
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), more frequently in patients with renal impairment or on concomitant nephrotoxic drugs.
Target: Stable or within acceptable limits (e.g., <30% increase from baseline)
Action Threshold: Significant increase in SCr (>30% from baseline or >0.5 mg/dL), especially if progressive; consider dose reduction or discontinuation.
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), more frequently in patients with renal impairment, diabetes, or on concomitant potassium-sparing agents.
Target: 3.5-5.0 mEq/L
Action Threshold: K+ > 5.5 mEq/L; consider dose reduction, discontinuation, or management of hyperkalemia.
Symptom Monitoring
- Signs of angioedema (swelling of face, lips, tongue, throat, difficulty breathing or swallowing)
- Persistent dry cough
- Symptoms of hypotension (dizziness, lightheadedness, fainting)
- Symptoms of hyperkalemia (muscle weakness, fatigue, irregular heartbeats)
- Signs of liver dysfunction (jaundice, dark urine, persistent nausea/vomiting)
Special Patient Groups
Pregnancy
Contraindicated in the second and third trimesters of pregnancy due to significant risk of fetal injury and death (renal failure, oligohydramnios, skull hypoplasia, lung hypoplasia, skeletal deformations, death). Should be discontinued as soon as pregnancy is detected. Avoid use in the first trimester if possible, as risks cannot be completely excluded.
Trimester-Specific Risks:
First Trimester:
Potential for fetal harm, but less established than later trimesters. Generally avoided if alternatives exist.
Second Trimester:
High risk of fetal injury (renal dysfunction, oligohydramnios, anuria, skull hypoplasia, lung hypoplasia, skeletal deformations, death).
Third Trimester:
High risk of fetal injury (renal dysfunction, oligohydramnios, anuria, skull hypoplasia, lung hypoplasia, skeletal deformations, death).
Lactation
Quinapril and its active metabolite quinaprilat are excreted in human milk in low concentrations. Generally considered to pose a low risk to a breastfed infant, especially if the infant is older than 2 months. Monitor the infant for signs of hypotension (lethargy, poor feeding) or other adverse effects.
Infant Risk:
Low risk
Pediatric Use
Safety and effectiveness have not been established in pediatric patients. Use is generally not recommended for routine hypertension in children. If used in specific circumstances, careful monitoring of blood pressure, renal function, and electrolytes is crucial.
Geriatric Use
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 slowly, monitoring renal function and potassium levels more frequently due to age-related decline in renal function and increased susceptibility to adverse effects.
Clinical Information
Clinical Pearls
- Quinapril is a prodrug; its active metabolite, quinaprilat, is responsible for its therapeutic effects.
- The most common side effect is a persistent dry cough, which is a class effect of ACE inhibitors and usually resolves upon discontinuation.
- Risk of angioedema, though rare, is a serious and potentially life-threatening adverse effect. Patients should be educated on its symptoms and to seek immediate medical attention.
- Hyperkalemia is a risk, especially in patients with renal impairment, diabetes, or those taking potassium-sparing diuretics or potassium supplements.
- First-dose hypotension can occur, particularly in volume-depleted patients or those on high-dose diuretics. Consider discontinuing diuretics 2-3 days prior to initiation if possible, or starting with a very low dose.
- Monitor renal function and potassium levels regularly, especially during initiation and dose titration.
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, chlorthalidone)
- Beta-blockers (e.g., metoprolol, carvedilol)
Cost & Coverage
Average Cost:
Varies widely, typically $10-$50 per 30 tablets
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 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 emergency medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.