Quinapril 20mg 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
Oct 1991
DEA Schedule
Not Controlled
Overview
What is this medicine?
Quinapril is a medicine that helps lower high blood pressure. It works by relaxing your blood vessels, making it easier for your heart to pump blood. This can help prevent strokes, heart attacks, and kidney problems.
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 your medication is no longer needed or has 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 the best way to dispose of your medication, consult with your pharmacist. 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 resume 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 your medication is no longer needed or has 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 the best way to dispose of your medication, consult with your pharmacist. 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 resume 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
- Take your medication exactly as prescribed, usually once or twice a day.
- Do not stop taking quinapril without talking to your doctor, even if you feel well.
- Limit your intake of sodium (salt) in your diet.
- Engage in regular physical activity as advised by your doctor.
- Maintain a healthy weight.
- Limit or avoid alcohol consumption.
- Avoid potassium supplements or salt substitutes containing potassium unless specifically advised by your doctor.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
Hypertension: 20-40 mg once daily; Heart Failure: 5-20 mg twice daily
Dose Range:
5 - 80 mg
Condition-Specific Dosing:
Hypertension (initial):
10-20 mg once daily
Heart Failure (initial):
5 mg twice daily
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Limited data; for hypertension in children 6-16 years, initial 5 mg once daily, titrate up to 40 mg/day. Not recommended for routine use.
Adolescent:
Limited data; for hypertension in children 6-16 years, initial 5 mg once daily, titrate up to 40 mg/day. Not recommended for routine use.
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 <30 mL/min: Initial 2.5 mg once daily
Dialysis:
Quinaprilat is dialyzable; administer after dialysis on dialysis days. Initial 2.5 mg once daily.
Hepatic Impairment:
Mild:
No specific adjustment, but use with caution due to metabolism to active quinaprilat.
Moderate:
No specific adjustment, but use with caution due to metabolism to active quinaprilat.
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 increased bradykinin levels (a vasodilator). The net effect is a reduction in systemic vascular resistance and blood pressure.
Pharmacokinetics
Absorption:
Bioavailability:
Approximately 60% (of quinaprilat)
Tmax:
Quinapril: ~1 hour; Quinaprilat: ~2 hours
FoodEffect:
Food may decrease the rate and extent of absorption, but not clinically significant.
Distribution:
Vd:
Quinaprilat: Approximately 100 L
ProteinBinding:
Quinapril: ~97%; Quinaprilat: ~97%
CnssPenetration:
Limited
Elimination:
HalfLife:
Quinaprilat: ~2-3 hours (terminal elimination half-life); Effective accumulation half-life: ~10 hours
Clearance:
Not available
ExcretionRoute:
Renal (approximately 60%), Fecal/Biliary (approximately 40%)
Unchanged:
<5%
Pharmacodynamics
OnsetOfAction:
Approximately 1 hour
PeakEffect:
2-6 hours
DurationOfAction:
24 hours (for once-daily dosing)
Safety & Warnings
BLACK BOX WARNING
FETAL TOXICITY: 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
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
Other Possible Side Effects
Most people experience no side effects or only mild 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 a comprehensive list of all 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.
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
Other Possible Side Effects
Most people experience no side effects or only mild 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 a comprehensive list of all 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.
Seek Immediate Medical Attention If You Experience:
- 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.
- Signs of high potassium (e.g., muscle weakness, slow or irregular heartbeat).
- Signs of kidney problems (e.g., decreased urination, swelling in ankles/feet).
- Yellowing of skin or eyes (jaundice).
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. 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 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 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. This will help ensure your safety while taking this medication. Never start, stop, or adjust the dosage of any medication without first 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. 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 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 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. This will help ensure your safety while taking this medication. Never start, stop, or adjust 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
Regularly 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 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
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 symptoms 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 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 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
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 symptoms 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 or bradycardia
- Electrolyte disturbances (e.g., hyperkalemia)
- Renal failure
What to Do:
Call 1-800-222-1222 (Poison Control). Treatment is symptomatic and supportive. If ingestion is recent, gastric lavage may be considered. Intravenous saline infusion may be used to correct hypotension. Quinaprilat can be removed by hemodialysis.
Drug Interactions
Contraindicated Interactions
- Aliskiren (in patients with diabetes or renal impairment)
- Sacubitril/valsartan (Entresto) - concurrent use or within 36 hours of switching
Major Interactions
- Potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride) - increased risk of hyperkalemia
- Potassium supplements - increased risk of hyperkalemia
- NSAIDs (e.g., ibuprofen, naproxen) - may reduce antihypertensive effect and increase risk of renal impairment
- Lithium - increased serum lithium levels and toxicity
- mTOR inhibitors (e.g., sirolimus, everolimus, temsirolimus) - increased risk of angioedema
- Injectable gold (sodium aurothiomalate) - nitritoid reactions (facial flushing, nausea, vomiting, hypotension)
Moderate Interactions
- Diuretics (thiazide, loop) - risk of excessive hypotension (first-dose effect)
- Antidiabetic agents (insulin, oral hypoglycemics) - increased risk of hypoglycemia
- Allopurinol - increased risk of hypersensitivity reactions
- Immunosuppressants (e.g., azathioprine, cyclosporine) - increased risk of leukopenia
- Tetracyclines - reduced absorption of tetracyclines due to magnesium in quinapril formulation
Minor Interactions
- Alcohol - may enhance hypotensive effect
Monitoring
Baseline Monitoring
Blood Pressure (BP)
Rationale: To establish baseline and guide initial dosing.
Timing: Prior to initiation
Serum Creatinine (Cr) 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
Liver Function Tests (LFTs)
Rationale: To assess baseline hepatic function, as quinapril is a prodrug metabolized in the liver.
Timing: Prior to initiation
Routine Monitoring
Blood Pressure (BP)
Frequency: Regularly, especially after dose changes and during maintenance therapy.
Target: <130/80 mmHg (or individualized target)
Action Threshold: Persistent hypotension (<90/60 mmHg) or uncontrolled hypertension (>140/90 mmHg)
Serum Creatinine (Cr) and Blood Urea Nitrogen (BUN)
Frequency: Periodically (e.g., 1-2 weeks after initiation/dose change, then every 3-6 months), more frequently in patients with pre-existing renal impairment or on concomitant nephrotoxic drugs.
Target: Within normal limits or stable from baseline
Action Threshold: Increase in Cr >30% from baseline or significant decline in GFR
Serum Potassium (K+)
Frequency: Periodically (e.g., 1-2 weeks after initiation/dose change, then every 3-6 months), more frequently in patients with renal impairment, diabetes, or on concomitant potassium-sparing drugs.
Target: 3.5-5.0 mEq/L
Action Threshold: >5.5 mEq/L
Symptom Monitoring
- Angioedema (swelling of face, lips, tongue, throat, extremities)
- Persistent dry cough
- Dizziness or lightheadedness (especially upon standing)
- Fatigue or weakness
- Signs of hyperkalemia (e.g., muscle weakness, irregular heartbeat)
- Signs of infection (e.g., fever, sore throat) due to potential neutropenia (rare)
Special Patient Groups
Pregnancy
CONTRAINDICATED in 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 generally avoided due to potential risks, though less severe than later trimesters.
Trimester-Specific Risks:
First Trimester:
Potential for major congenital malformations (cardiovascular, CNS) has been suggested by some studies, though data are conflicting. Generally, use is avoided.
Second Trimester:
Significant risk of fetal renal dysfunction, oligohydramnios, fetal lung hypoplasia, skeletal deformations, and death.
Third Trimester:
High risk of fetal renal failure, anuria, oligohydramnios, skull hypoplasia, lung hypoplasia, intrauterine growth restriction, and death. Neonatal hypotension, hyperkalemia, and renal failure may occur.
Lactation
Quinapril and its active metabolite quinaprilat are excreted in human milk in low concentrations. Use with caution, especially in preterm or sick infants. Monitor the infant for adverse effects (e.g., hypotension).
Infant Risk:
Low risk for healthy, full-term infants, but potential for hypotension or other effects. L3 (Moderately Safe) per Hale's classification.
Pediatric Use
Safety and effectiveness have not been fully established in pediatric patients. Limited data for hypertension in children 6-16 years, but generally not recommended for routine use. Not recommended for children under 6 years or for heart failure in any pediatric age group.
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., 10 mg once daily) and titrate carefully due to increased risk of hypotension and renal impairment.
Clinical Information
Clinical Pearls
- A common side effect of ACE inhibitors like quinapril is a persistent, dry, hacking cough, which usually resolves upon discontinuation of the drug.
- Angioedema is a rare but potentially life-threatening side effect. Patients should be educated on the signs and symptoms and advised to seek immediate medical attention if it occurs.
- First-dose hypotension can occur, especially in patients who are volume-depleted (e.g., on diuretics, heart failure patients). Consider discontinuing diuretics 2-3 days prior to initiation or starting with a very low dose.
- Quinapril contains magnesium carbonate, which can interact with tetracyclines, reducing their absorption. Administer tetracyclines at least 2 hours before or 4 hours after quinapril.
- Regular monitoring of blood pressure, renal function (creatinine, BUN), and serum potassium is crucial, especially during initiation and dose adjustments.
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)
Cost & Coverage
Average Cost:
Varies, typically $10-$30 per 30 tablets (20mg generic)
Generic Available:
Yes
Insurance Coverage:
Tier 1 (Generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe and effective treatment, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it's a good idea 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, including the amount taken and the time it happened, to facilitate prompt and appropriate care.