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APO-QUINAPRIL/HCTZ is a brand name for Quinapril, supplied as a tablet. The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: APO-QUINAPRIL/HCTZ (quinapril hydrochloride and hydrochlorothiazide) is indicated for the treatment of essential hypertension in patients for whom combination therapy is appropriate. APO-QUINAPRIL/HCTZ is not indicated for initial therapy. Patients in whom quinapril and hydrochlorothiazide are initiated simultaneously…
Verbatim from this product's HC label. Tap a section to expand.
1 Dosing Considerations Dosage of APO-QUINAPRIL/HCTZ must be individualized. The fixed combination is not for initial therapy. The dose of APO-QUINAPRIL/HCTZ (quinapril hydrochloride and hydrochlorothiazide) should be determined by titration of the individual components.
Once the patient has been successfully titrated with the individual components as described below, APO-QUINAPRIL/HCTZ may be substituted if the titrated doses and dosing schedule can be achieved by the fixed combination (see 1 INDICATIONS and 7 WARNINGS AND PRECAUTIONS).
In some patients, a twice daily administration may be required. Patients do not generally require hydrochlorothiazide (HCTZ) in excess of 50 mg daily, particularly when combined with other antihypertensive agents. 2 Recommended Dose and Dosage Adjustment Quinapril Monotherapy: The recommended initial dose of quinapril in patients not on diuretics is 10 mg once daily.
An initial dose of 20 mg once daily can be considered for patients without advanced age, renal impairment, or concomitant heart failure and who are not volume depleted (see 7 WARNINGS AND PRECAUTIONS, Cardiovascular, Hypotension). Dosage should be adjusted according to blood pressure (BP) response, generally at intervals of 2 to 4 weeks.
A dose of 40 mg daily should not be exceeded. In some patients treated once daily, the antihypertensive effect may diminish towards the end of the dosing interval. This can be evaluated by measuring BP just prior to dosing to determine whether satisfactory control is being maintained for 24 hours.
If it is not, either 2x daily administration with the same total daily dose, or an increase in dose should be considered. If BP is not controlled with quinapril alone, a diuretic may be added. After the addition of a diuretic, it may be possible to reduce the dose of quinapril.
Concomitant Diuretic Therapy:
Symptomatic hypotension occasionally may occur following the initial dose of quinapril and is more likely in patients who are currently being treated with a diuretic. The diuretic should, if possible, be discontinued for 2 to 3 days before beginning therapy with quinapril to reduce the likelihood of hypotension (see 7 WARNINGS AND PRECAUTIONS, Cardiovascular, Hypotension).
If the diuretic cannot be discontinued, an initial dose of 5 mg of quinapril should be used with careful medical supervision for several hours and until BP has stabilized. The dosage of quinapril should subsequently be titrated (as described above) to the optimal response.
). 2 Breast-feeding). 73 m2), o hyperkalemia (> 5 mMol/L) or o congestive heart failure who are hypotensive (see 7 WARNINGS AND PRECAUTIONS, Cardiovascular, Dual blockade of the Renin-Angiotensin System (RAS) and Renal, Renal Impairment, and
, Cardiovascular, - Hypotension and 9 DRUG INTERACTIONS). Patients should be titrated on the individual drugs. If the fixed combination represents the dosage determined by this titration, the use of APO-QUINAPRIL/HCTZ may be more convenient in the management of patients.
If during maintenance therapy dosage adjustment is necessary, it is advisable to use individual drugs. 1 Pediatrics (<18 years of age) Pediatrics (<18 years of age): No data are available to Health Canada; therefore, Health Canada has not authorized an indication for pediatric use.
2 Geriatrics (> 65 years of age) Therapeutic effects appear to be the same for elderly (>65 years of age) and younger adult patients given the same daily dosages, with no increase in adverse events in elderly patients. 2 CONTRAINDICATIONS APO-QUINAPRIL/HCTZ is contraindicated in: • Patients who are hypersensitive to this drug or to any ingredient in the formulation, including any non-medicinal ingredient, or component of the container.
For a complete listing, see 6 DOSAGE FORMS, STRENGTHS, COMPOSITION AND PACKAGING. • Patients with a history of angioedema related to previous treatment with an angiotensin converting enzyme (ACE) inhibitor (see 7 WARNINGS AND PRECAUTIONS, General, Angioedema).
• Combination with sacubitril/valsartan due to increased risk of angioedema. APO- QUINAPRIL/HCTZ must not be initiated until at least 36 hours have elapsed following discontinuation of sacubitril/valsartan therapy. If treatment with APO-QUINAPRIL/HCTZ is stopped, sacubitril/valsartan therapy must not be initiated until 36 hours after the last APO-QUINAPRIL/HCTZ (Quinapril and Hydrochlorothiazide Tablets) PRODUCT MONOGRAPH Page 5 of 61 dose of APO-QUINAPRIL/HCTZ.
• Patients hypersensitive to other sulfonamide-derived drugs because of the hydrochlorothiazide component. • Patients with anuria. 1 Pregnant Women and
APO-QUINAPRIL/HCTZ is contraindicated in: • Patients who are hypersensitive to this drug or to any ingredient in the formulation, including any non-medicinal ingredient, or component of the container. For a complete listing, see 6 DOSAGE FORMS, STRENGTHS, COMPOSITION AND PACKAGING.
• Patients with a history of angioedema related to previous treatment with an angiotensin converting enzyme (ACE) inhibitor (see 7 WARNINGS AND PRECAUTIONS, General, Angioedema). • Combination with sacubitril/valsartan due to increased risk of angioedema.
APO- QUINAPRIL/HCTZ must not be initiated until at least 36 hours have elapsed following discontinuation of sacubitril/valsartan therapy. If treatment with APO-QUINAPRIL/HCTZ is stopped, sacubitril/valsartan therapy must not be initiated until 36 hours after the last APO-QUINAPRIL/HCTZ (Quinapril and Hydrochlorothiazide Tablets) PRODUCT MONOGRAPH Page 5 of 61 dose of APO-QUINAPRIL/HCTZ.
• Patients hypersensitive to other sulfonamide-derived drugs because of the hydrochlorothiazide component. • Patients with anuria. 1 Pregnant Women and 8 ADVERSE REACTIONS). 2 Breast-feeding). 73 m2), o hyperkalemia (> 5 mMol/L) or o congestive heart failure who are hypotensive (see 7 WARNINGS AND PRECAUTIONS, Cardiovascular, Dual blockade of the Renin-Angiotensin System (RAS) and Renal, Renal Impairment, and 9 DRUG INTERACTIONS, Aliskiren-containing medicines and Angiotensin receptor blockers (ARBs)).
73m2), o hyperkalemia (> 5mMol/L) o congestive heart failure who are hypotensive (see 9 DRUG INTERACTIONS, Angiotensin receptor blockers (ARBs)). • Patients with the rare hereditary condition of galactose intolerance, glucose-galactose malabsorption or Lapp lactase deficiency as APO-QUINAPRIL/HCTZ contains lactose (see 7 WARNINGS AND PRECAUTIONS, Sensitivity/Resistance).
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
Other brands of Quinapril in Canada.
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Brand names are compiled from public regulatory records for active-ingredient mapping only. Drugvu is not affiliated with any manufacturer. This is not medical advice.
If a diagnosis of acute respiratory distress syndrome (ARDS) is suspected, APO-QUINAPRIL/HCTZ should be withdrawn and appropriate treatment given.
Dosage Adjustment in Renal Impairment:
For use in hemodialysis patients, see 7 WARNINGS APO-QUINAPRIL/HCTZ (Quinapril and Hydrochlorothiazide Tablets) PRODUCT MONOGRAPH Page 7 of 61 AND PRECAUTIONS and 8 ADVERSE REACTIONS, Anaphylactoid Reactions during Membrane Exposure.
Quinapril should be administered on days when dialysis is not performed. 5 <10 Insufficient data for dosage recommendation Patients should subsequently have dosage titrated (as described above) to the optimal response as described under Monotherapy.
When concomitant diuretic therapy is required in patients with severe renal impairment, a loop diuretic rather than a thiazide is preferred for use with quinapril. Therefore, for patients with severe renal dysfunction, APO-QUINAPRIL/HCTZ is not recommended.
Dosage in the Elderly:
The recommended initial dosage of quinapril is 10 mg once daily (depending on renal function), followed by titration to the optimal response as described above under Monotherapy. 4 Missed Dose If a dose of this medication has been missed, it should be taken as soon as possible.
However, if it is almost time for the next dose, the missed dose should be skipped. The patient should be cautioned against taking two doses concomitantly to “make up” for the missed dose.