Quinapril and Hydrochlorothiazide (Accuretic) is a combination of angiotensin converting enzyme inhibitor and a thiazide diuretic. It is used in the treatement of patients with hypertension.
Quinapril and hydrochlorothiazide Uses:
-
Hypertension:
- Used in management of hypertension but not as initial therapy
Quinapril and Hydrochlorothiazide (Accuretic) Dose in Adults
Quinapril and Hydrochlorothiazide (Accuretic) Dose in the treatment of Hypertension:
- Oral: Note: Not for initial therapy. Volume and/or salt depletion states should be corrected before starting therapy.
-
Replacement therapy:
- May substitute with a combination product for individually titrated agents.
-
Initiation of combination therapy when monotherapy has failed to achieve desired effects:
- Patients who fail to show adequate response to quinapril monotherapy or patients who adequately respond to hydrochlorothiazide 25 mg/day, but undergo significant potassium loss:
- Initial: Quinapril 10 mg/hydrochlorothiazide 12.5 mg or quinapril 20 mg/hydrochlorothiazide 12.5 mg in OD dose; dose may be adjusted after 2 to 3 weeks of therapy initiation based on blood pressure response.
- Maintenance: Quinapril 5 to 40 mg/hydrochlorothiazide 6.25 to 25 mg OD.
Dose in Children:
Not indicated.
Pregnancy Risk Factor D
- [US Boxed Warning]Drugs that affect the renin angiotensin system may cause fetal injury or death.
- Use should be stopped immediately after a female becomes pregnant.
- You can also contact individual agents.
Use during breastfeeding:
- Breast milk contains thiazide and quinapril diuretics.
- The manufacturer recommends that the mother decide whether to breastfeed or discontinue the drug.
- This is in consideration of the potential for serious adverse reactions.
Dose in Kidney Disease:
- CrCl >30 mL/minute/1.73 m2 or serum creatinine ≤3 mg/dL: Dosage adjustment not necessary.
- CrCl ≤30 mL/minute/1.73 m2 or serum creatinine >3 mg/dL: Not recommended for use.
Dose in Liver disease:
No dosage adjustments provided in the manufacturer's labeling (has not been studied); use cautiously.
Side Effects of Quinapril and Hydrochlorothiazide (Accuretic):
-
Central Nervous System:
- Dizziness
- Drowsiness
-
Neuromuscular & Skeletal:
- Weakness
-
Renal:
- Increased Blood Urea Nitrogen
- Increased Serum Creatinine
-
Respiratory:
- Cough
- Bronchitis
Contraindications to Quinapril and Hydrochlorothiazide (Accuretic):
- Hypersensitivity to quinapril or hydrochlorothiazide, sulfonamides-derived drugs or any other part of the formulation
- Angioedema resulting from previous treatment with an ACE inhibitor
- Concomitant use with aliskiren in diabetic patients
- Concomitant use or within 36 hours of switching to or from a neprilysin inhibitor (eg, sacubitril)
- Anuria.
There is limited documentation on allergenic cross-reactivity between ACE inhibitors, thiazide, and related diuretics.
Cross-sensitivity is possible, however, as the chemical structure and/or the pharmacologic effects are similar.
Canadian labeling: Additional contraindications not in US labeling
- Pediatric patients under 6 years
- Children aged 6-16 years old with severe renal impairment (GFR 60mL/minute/1.73m).
- Planning for conception or pregnancy
- Women who are pregnant or have not used adequate contraception in the past three years.
- Breastfeeding
- Use aliskiren, angiotensin-receptor blockers (ARBs), and other ACE inhibitors concurrently in patients with moderate or severe renal impairment (GFR 60 mL/minute/1.73 m), hyperkalemia (5 mmol/L), heart failure (hypotensive) or hypotension
- Use of ARBs and other ACE inhibitors concurrently in diabetic patients suffering from end-organ damage
- Galactose intolerance patients
- Lapp lactase deficiency
- Glucose-galactose malabsorption syndromes
Warnings and precautions
-
Angioedema
- Angioedema can be caused by ACE inhibitors at any stage of treatment. It may affect the head and neck (potentially compromising your airway), or the intestine (presenting as abdominal pain).
- Long-term monitoring is necessary for any obstructions in the tongue, glottis or larynx.
- Previous airway surgery increases the obstruction risk.
- Angioedema risk is higher in black patients, patients suffering from idiopathic angioedema or hereditary angioedema and patients who have received ACE inhibitor therapy, combination therapy with m-tor inhibitor (eg everolimus), dipeptidyl peptidase-4 inhibitors (eg sitagliptin) or a neprilysin inhibit (eg sacubitril).
- It is crucial to manage the situation in a responsible manner.
- Patients with idiopathic angioedema, hereditary angioedema, or a history of angioedema caused by ACE inhibitors are not advised to take it.
- Cholestatic jaundice
- ACE inhibitors may cause hepatic fulminant neoplasm, which can lead to cholestatic jaundice. If there is an increase in hepatic transaminases and jaundice, therapy should be stopped.
-
Cough:
- Initial treatment with ACE inhibitors results in a dry, persistent cough that usually disappears within a month.
- Before stopping the drug, it is important to rule out other conditions like pulmonary congestion in patients suffering from heart failure.
-
Electrolyte disturbances:
- ACE inhibitors can cause hyperkalemia. Renal impairment, diabetes mellitus, renal impairment, and concomitant potassium-sparing diuretics and potassium supplements may also increase the risk.
- Use caution and strict supervision if you have to.
- Thiazide diuretics may cause hypokalemia, hypochloremic acidkalosis, hypomagnesemia and hyponatremia.
- Hypokalemia can be caused by cirrhosis, brisk urisis, and concomitant potassium-lowering medications.
-
Gout
- Hydrochlorothiazide may cause gout in some patients who have a history of gout or are at risk of developing it.
- Doses greater than 25 mg pose an increased risk
-
Hematologic effects
- Captopril, another ACE inhibitor, has been shown to cause neutropenia, myeloid hypoplasia, agranulocytosis, anemia and thrombocytopenia.
- Patients with renal impairment or collagen vascular disease, eg systemic lupus-erythematosus, are at significantly higher risk for neutropenia.
- These patients require regular CBC monitoring.
-
Hypersensitivity reactions
- ACE inhibitors can result in anaphylactic/anaphylactoid reactions.
- Anaphylactic reactions can occur during hemodialysis using high-flux dialysis membranes (eg polyacrylonitrile) and, rarely, during low density lipoprotein apheresis using dextran sulfatecellulose.
- Anaphylactoid reactions have been rare in patients who are subject to sensitization with Hymenoptera (bee or wasp) venom and receive ACE inhibitors.
-
Hypotension/syncope
- Hypotension and syncope can be caused by ACE inhibitors.
- Hypovolemia can increase the risk, so volume correction before beginning treatment is recommended.
- BP monitoring is important throughout therapy, particularly when dose escalation is involved.
- Hypotension should not be considered a reason to discontinue future ACE inhibitor treatment, especially for patients with heart disease. However, a reduction of systolic pressure might be desirable.
- It should not be used in patients with hemodynamic instability after acute MI.
-
Ocular effects
- Hydrochlorothiazide may cause acute transient myopia or acute angle-closure vision glaucoma. It can occur within hours to weeks after initiation. Patients with severe visual impairments or pain should stop using it immediately.
- Additional treatment may be required if the intraocular pressure is not controlled.
- The risk factors include a history of penicillin allergy or sulfonamide allergy.
-
Photosensitivity
- Photosensitization can occur.
-
Renal function deterioration:
- This can cause an increase in serum creatinine.
- Patients with low renal blood flow, such as those suffering from oliguria or acute renal failure, can experience complications like progressive azotemia and renal dysfunction.
- A significant impairment in renal function should not be considered a reason to stop taking the drug.
- Allergy to sulfonamide ("sulfa")
- FDA-approved product labels for medications that are part of the sulfonamide chemical family include a wide contraindication for patients who have had an allergic reaction to sulfonamides.
- There is a possibility of cross-reactivity between members from a particular class (eg 2 antibiotic sulfonamides).
- Crossreactivity concerns have been raised for all compounds with the sulfonamide structural.
- A deeper understanding of allergic mechanisms has shown that cross-reactivity between non-antibiotic sulfonamides and antibiotic sulfonamides is unlikely.
- Nonantibiotic sulfonamides are less likely to cause anaphylaxis (a mechanism of cross-reaction due primarily to antibody production).
- T-cell-mediated (type IV), reactions are not as well understood. This makes it difficult to exclude the possibility based on current knowledge.
- These classes are sometimes avoided by some clinicians in severe cases of reactions (Stevens Johnson syndrome/TEN).
-
Insufficiency of the adrenals:
- Patients with primary adrenal disease (Addison disease) should avoid diuretics for elevated blood pressure.
- It is preferred to adjust glucocorticoid/mineralocorticoid therapy and/or use alternate antihypertensive agents to treat hypertension.
-
Aortic stenosis
- Patients with aortic Stenosis may experience decreased coronary perfusion, which can lead to ischemia.
-
Bariatric surgery
- Dehydration: Avoid diuretics in the first 24 hours after bariatric surgery. There is a chance of electrolyte disturbances, and dehydration.
- If necessary, diuretics may be resumed once oral fluid intake goals have been met.
-
Cardiovascular disease
- Patients with ischemic heart disease, cerebrovascular disease or heart failure can experience hypotension. Therefore, it is important to be closely monitored.
- Once the fluid replacement has been completed, therapy can be resumed.
- Patients with hypotension recurrence should stop therapy.
-
Collagen vascular disease:
- Collagen vascular disease, especially when combined with renal impairment, can increase the risk of hematological toxicities. Therefore, caution should be taken.
-
Diabetes:
- Patients with diabetes mellitus or prediabetes should not use hydrochlorothiazide as it can affect their glycemic control.
-
Hepatic impairment
- LFTs must be examined before starting therapy.
- It should not be used in patients with severe hepatic impairment.
-
Hypercalcemia:
- Thiazide diuretics may decrease renal calcium excretion; patients with hypercalcemia should avoid their use.
-
Hypercholesterolemia:
- Patients with high or moderate cholesterol levels should not take hydrochlorothiazide.
-
Hypertrophic cardiomyopathy and outflow tract obstruction
- Reduced afterload can worsen hypertrophic cardiomyopathy symptoms and cause outflow obstruction. Therefore, it is important to use extreme caution.
-
Parathyroid disease
- Thiazide diuretics reduce calcium excretion; prolonged use can cause pathologic changes in parathyroid glands, including hypophosphatemia and hypercalcemia.
- Stop using thiazide before testing for parathyroid function.
-
Renal artery stenosis
- Patients with unstented unilateral/bilateral stenosis of the renal arteries should not take lisinopril.
- This should be avoided in the case of unstented bilateral kidney artery stenosis.
- There is a higher risk of renal dysfunction and it should not be used unless there are potential benefits.
-
Renal impairment
- Side effects can be more severe in those with renal impairment.
-
Systemic lupus, erythematosus
- Thiazides may be able to exacerbate or activate systemic lupus.
Quinapril and hydrochlorothiazide : Drug Interaction
|
Ajmaline |
Sulfonamides may enhance the adverse/toxic effect of Ajmaline. Specifically, the risk for cholestasis may be increased. |
|
Alcohol (Ethyl) |
May enhance the orthostatic hypotensive effect of Thiazide and Thiazide-Like Diuretics. |
|
Alfuzosin |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Aminolevulinic Acid (Topical) |
Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical). |
|
Amphetamines |
May diminish the antihypertensive effect of Antihypertensive Agents. |
|
Angiotensin II |
Angiotensin-Converting Enzyme Inhibitors may enhance the therapeutic effect of Angiotensin II. |
|
Angiotensin-Converting Enzyme Inhibitors |
Thiazide and Thiazide-Like Diuretics may enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Anticholinergic Agents |
May increase the serum concentration of Thiazide and Thiazide-Like Diuretics. |
|
Antidiabetic Agents |
Thiazide and Thiazide-Like Diuretics may diminish the therapeutic effect of Antidiabetic Agents. |
|
Antidiabetic Agents |
Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. |
|
Antipsychotic Agents (Second Generation [Atypical]) |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). |
|
Aprotinin |
May diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors. |
|
AzaTHIOprine |
Angiotensin-Converting Enzyme Inhibitors may enhance the myelosuppressive effect of AzaTHIOprine. |
|
Barbiturates |
May enhance the orthostatic hypotensive effect of Thiazide and Thiazide-Like Diuretics. |
|
Barbiturates |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Benazepril |
HydroCHLOROthiazide may enhance the hypotensive effect of Benazepril. HydroCHLOROthiazide may enhance the nephrotoxic effect of Benazepril. Benazepril may decrease the serum concentration of HydroCHLOROthiazide. |
|
Benperidol |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Beta2-Agonists |
May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. |
|
Brigatinib |
May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents. |
|
Brimonidine (Topical) |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Calcium Salts |
Thiazide and Thiazide-Like Diuretics may decrease the excretion of Calcium Salts. Continued concomitant use can also result in metabolic alkalosis. |
|
CarBAMazepine |
Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of CarBAMazepine. Specifically, there may be an increased risk for hyponatremia. |
|
Cardiac Glycosides |
Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Cardiac Glycosides. Specifically, cardiac glycoside toxicity may be enhanced by the hypokalemic and hypomagnesemic effect of thiazide diuretics. |
|
Corticosteroids (Orally Inhaled) |
May enhance the hypokalemic effect of Thiazide and ThiazideLike Diuretics. |
|
Corticosteroids (Systemic) |
May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. |
|
Cyclophosphamide |
Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Cyclophosphamide. Specifically, granulocytopenia may be enhanced. |
|
Dapoxetine |
May enhance the orthostatic hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Dexketoprofen |
May enhance the adverse/toxic effect of Sulfonamides. |
|
Dexmethylphenidate |
May diminish the therapeutic effect of Antihypertensive Agents. |
|
Diacerein |
May enhance the therapeutic effect of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased. |
|
Diazoxide |
Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Diazoxide. |
|
Diazoxide |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Dipeptidyl Peptidase-IV Inhibitors |
May enhance the adverse/toxic effect of AngiotensinConverting Enzyme Inhibitors. Specifically, the risk of angioedema may be increased. |
|
Drospirenone |
Angiotensin-Converting Enzyme Inhibitors may enhance the hyperkalemic effect of Drospirenone. |
|
DULoxetine |
Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. |
|
Eplerenone |
May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Everolimus |
May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. Specifically, the risk of angioedema may be increased. |
|
Ferric Gluconate |
Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Ferric Gluconate. |
|
Ferric Hydroxide Polymaltose Complex |
Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Ferric Hydroxide Polymaltose Complex. Specifically, the risk for angioedema or allergic reactions may be increased. |
|
Gelatin (Succinylated) |
Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Gelatin (Succinylated). Specifically, the risk of a paradoxical hypotensive reaction may be increased. |
|
Gold Sodium Thiomalate |
Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Gold Sodium Thiomalate. An increased risk of nitritoid reactions has been appreciated. |
|
Heparin |
May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Heparins (Low Molecular Weight) |
May enhance the hyperkalemic effect of AngiotensinConverting Enzyme Inhibitors. |
|
Herbs (Hypertensive Properties) |
May diminish the antihypertensive effect of Antihypertensive Agents. |
|
Herbs (Hypotensive Properties) |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
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Hypotension-Associated Agents |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. |
|
Icatibant |
May diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Ipragliflozin |
May enhance the adverse/toxic effect of Thiazide and Thiazide-Like Diuretics. Specifically, the risk for intravascular volume depletion may be increased. |
|
Ivabradine |
Thiazide and Thiazide-Like Diuretics may enhance the arrhythmogenic effect of Ivabradine. |
|
Levodopa-Containing Products |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Containing Products. |
|
Licorice |
May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. |
|
Loop Diuretics |
May enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Loop Diuretics may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Lormetazepam |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Methylphenidate |
May diminish the antihypertensive effect of Antihypertensive Agents. |
|
Molsidomine |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Multivitamins/Fluoride (with ADE) |
May enhance the hypercalcemic effect of Thiazide and Thiazide-Like Diuretics. |
|
Multivitamins/Minerals (with ADEK, Folate, Iron) |
Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Multivitamins/Minerals (with ADEK, Folate, Iron). |
|
Multivitamins/Minerals (with AE, No Iron) |
Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Multivitamins/Minerals (with AE, No Iron). Specifically, thiazide diuretics may decrease the excretion of calcium, and continued concomitant use can also result in metabolic alkalosis. |
|
Naftopidil |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Neuromuscular-Blocking Agents (Nondepolarizing) |
Thiazide and Thiazide-Like Diuretics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing). |
|
Nicergoline |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Nicorandil |
May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Nicorandil |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Nitroprusside |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. |
|
Nonsteroidal Anti-Inflammatory Agents |
Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Nonsteroidal Anti-Inflammatory Agents |
Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Thiazide and Thiazide-Like Diuretics. |
|
Opioid Agonists |
May enhance the adverse/toxic effect of Diuretics. Opioid Agonists may diminish the therapeutic effect of Diuretics. |
|
Oxcarbazepine |
Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of OXcarbazepine. Specifically, there may be an increased risk for hyponatremia. |
|
Pentoxifylline |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Pholcodine |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. |
|
Phosphodiesterase 5 Inhibitors |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Porfimer |
Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. |
|
Potassium Salts |
May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Potassium-Sparing Diuretics |
May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Pregabalin |
Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Pregabalin. Specifically, the risk of angioedema may be increased. |
|
Prostacyclin Analogues |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Quinagolide |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. |
|
Racecadotril |
May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. Specifically, the risk for angioedema may be increased with this combination. |
|
Ranolazine |
May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Reboxetine |
May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. |
|
Salicylates |
May enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. Salicylates may diminish the therapeutic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Selective Serotonin Reuptake Inhibitors |
May enhance the hyponatremic effect of Thiazide and Thiazide-Like Diuretics. |
|
Sirolimus |
May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Tacrolimus (Systemic) |
Angiotensin-Converting Enzyme Inhibitors may enhance the hyperkalemic effect of Tacrolimus (Systemic). |
|
Temsirolimus |
May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Thiazide and Thiazide-Like Diuretics |
May enhance the hypotensive effect of AngiotensinConverting Enzyme Inhibitors. Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
TiZANidine |
May enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Tolvaptan |
May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Toremifene |
Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Toremifene. |
|
Trimethoprim |
May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. |
|
Verteporfin |
Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. |
|
Vitamin D Analogs |
Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Vitamin D Analogs. |
|
Yohimbine |
May diminish the antihypertensive effect of Antihypertensive Agents. |
|
Risk Factor D (Consider therapy modification) |
|
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Aliskiren |
May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Aliskiren may enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Aliskiren may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. Management: Aliskiren use with ACEIs or ARBs in patients with diabetes is contraindicated. Combined use in other patients should be avoided, particularly when CrCl is less than 60 mL/min. If combined, monitor potassium, creatinine, and blood pressure closely. |
|
Allopurinol |
Angiotensin-Converting Enzyme Inhibitors may enhance the potential for allergic or hypersensitivity reactions to Allopurinol. |
|
Amifostine |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered. |
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Angiotensin II Receptor Blockers |
|
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Bile Acid Sequestrants |
May decrease the absorption of Thiazide and Thiazide-Like Diuretics. The diuretic response is likewise decreased. |
|
Grass Pollen Allergen Extract (5 Grass Extract) |
Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Grass Pollen Allergen Extract (5 Grass Extract). Specifically, ACE inhibitors may increase the risk of severe allergic reaction to Grass Pollen Allergen Extract (5 Grass Extract). |
|
Iron Dextran Complex |
Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Iron Dextran Complex. Specifically, patients receiving an ACE inhibitor may be at an increased risk for anaphylactic-type reactions. Management: Follow iron dextran recommendations closely regarding both having resuscitation equipment and trained personnel on-hand prior to iron dextran administration and the use of a test dose prior to the first therapeutic dose. |
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Lanthanum |
May decrease the serum concentration of Angiotensin-Converting Enzyme Inhibitors. Management: Administer angiotensin-converting enzyme inhibitors at least two hours before or after lanthanum. |
|
Lithium |
Thiazide and Thiazide-Like Diuretics may decrease the excretion of Lithium. |
|
Lithium |
Angiotensin-Converting Enzyme Inhibitors may increase the serum concentration of Lithium. Management: Lithium dosage reductions will likely be needed following the addition of an ACE inhibitor. Monitor patient response to lithium closely following addition or discontinuation of concurrent ACE inhibitor treatment. |
|
Obinutuzumab |
May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. |
|
Quinolones |
Quinapril may decrease the serum concentration of Quinolones. Management: Separate doses of quinapril and oral quinolones by at least 2 hours in order to reduce the risk of interaction. Monitor for reduced efficacy of the quinolone if these products are used concomitantly. Exceptions: LevoFLOXacin (Oral Inhalation). |
|
Sodium Phosphates |
Angiotensin-Converting Enzyme Inhibitors may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with ACEIs, or seeking alternatives to oral sodium phosphate bowel preparation. If the combination cannot be avoided, maintain adequate hydration and monitor renal function closely. |
|
Sodium Phosphates |
Diuretics may enhance the nephrotoxic effect of Sodium Phosphates. Specifically, the risk of acute phosphate nephropathy may be enhanced. Management: Consider avoiding this combination by temporarily suspending treatment with diuretics, or seeking alternatives to oral sodium phosphate bowel preparation. If the combination cannot be avoided, hydrate adequately and monitor fluid and renal status. |
|
Tetracyclines |
Quinapril may decrease the serum concentration of Tetracyclines. Management: Separate doses of quinapril and oral tetracycline derivatives by at least 2 hours in order to reduce the risk of interaction. Monitor for reduced efficacy of the tetracycline if these products are used concomitantly. Exceptions: Eravacycline. |
|
Topiramate |
Thiazide and Thiazide-Like Diuretics may enhance the hypokalemic effect of Topiramate. Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Topiramate. Management: Monitor for increased topiramate levels/adverse effects (e.g., hypokalemia) with initiation/dose increase of a thiazide diuretic. Closely monitor serum potassium concentrations with concomitant therapy. Topiramate dose reductions may be necessary. |
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Urapidil |
May interact via an unknown mechanism with Angiotensin-Converting Enzyme Inhibitors. Management: Avoid concomitant use of urapidil and angiotensin-converting enzyme (ACE) inhibitors. |
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Risk Factor X (Avoid combination) |
|
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Aminolevulinic Acid (Systemic) |
Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic). |
|
Bromperidol |
Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents. |
|
Dofetilide |
HydroCHLOROthiazide may enhance the QTc-prolonging effect of Dofetilide. HydroCHLOROthiazide may increase the serum concentration of Dofetilide. |
|
Levosulpiride |
Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Levosulpiride. |
|
Mecamylamine |
Sulfonamides may enhance the adverse/toxic effect of Mecamylamine. |
|
Promazine |
Thiazide and Thiazide-Like Diuretics may enhance the QTc-prolonging effect of Promazine. |
|
Sacubitril |
Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Sacubitril. Specifically, the risk of angioedema may be increased with this combination. |
Monitoring parameters:
- Blood pressure
- BUN, serum creatinine, and electrolytes
- CBC with differential periodically (requires more frequent monitoring if the patient has collagen vascular disease and/or renal impairment)
How to administer Quinapril and Hydrochlorothiazide (Accuretic)?
- Administer without relation to a meal.
Mechanism of action of Quinapril and Hydrochlorothiazide (Accuretic):
Quinapril:
- It acts as a competitive inhibitor of the angiotensin-converting enzyme (ACE).
- This causes a decrease in angiotensin 2, which leads to increased plasma renin activity, and a reduction of aldosterone production.
- It also prevents angiotensin I from angiotensin III (a powerful vasoconstrictor).
- Angiotensin II may increase adrenergic output from the CNS. This could explain why there is a hypotensive effect.
- The vasoactive kallikreins in active hormone conversion by ACE inhibitors are reduced, resulting in lower blood pressure.
Hydrochlorothiazide:
- Inhibits sodium reabsorption in distal tubules, increasing excretion of water and sodium as well as potassium ions.
See individual agents.
International Brand Names of Quinapril and hydrochlorothiazide:
- Accuretic
- Accumax-Co
- Accupro Comp
- Accuzide
- Acuilix
- Acuretic
- Koretic
Quinapril and hydrochlorothiazide Brand Names in Pakistan:
No Brands Available in Pakistan.
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