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QUINAPRIL is a brand name for Quinapril. The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: Hypertension For the treatment of all grades of essential hypertension. Quinapril film coated tablets is effective as monotherapy or concomitantly with diuretics in patients with hypertension. Congestive Heart Failure For the treatment of congestive heart failure when given concomitantly with a diuretic and/or cardiac…
Verbatim from this product's MHRA label. Tap a section to expand.
For oral use.
Adults Hypertension Monotherapy:
The recommended initial dosage is 10 mg once daily in uncomplicated hypertension. Depending upon clinical response, patient's dosage may be titrated (by doubling the dose allowing adequate time for dosage adjustment) to a maintenance dosage of 20 to 40 mg/day given as a single dose or divided into 2 doses.
Long-term control is maintained in most patients with a single daily dosage regimen. Patients have been treated with dosages up to and including 80 mg/day. 5 mg of Quinapril film coated tablets is recommended in patients who are being treated with a diuretic.
After this the dosage of Quinapril film coated tablets should be titrated (as described above) to the optimal response. 5 mg initial dosage is recommended. After this, patients should be titrated to an effective dose: (up to 40 mg/day) given in 1 or 2 doses with concomitant diuretic and/or cardiac glycoside therapy.
Patients are often maintained effectively on doses of 10-20 mg/day given with concomitant therapy. Severe Heart Failure In the treatment of severe or unstable congestive heart failure, Quinapril film coated tablets should always be initiated in hospital under close medical supervision.
> 80 mg frusemide) or on multiple diuretic therapy, have hypovolaemia, hyponatraemia (serum sodium < 130 mgEq/l) or systolic blood pressure < 90 mm Hg, are on high dose vasodilator therapy, have a serum creatinine> 150 μmol/l or are aged 70 years or over.
5 mg is recommended followed by titration to the optimal response. Children (6 - 12 years) Not recommended. Safety and efficacy in children have not been established.
The most frequent clinical adverse reactions in hypertension and congestive heart failure are headache, dizziness, rhinitis, coughing, upper respiratory tract infection, fatigue, and nausea and vomiting. Other less frequent side effects are dyspepsia, myalgia, chest pain, abdominal pain, diarrhoea, back pain, sinusitis, insomnia, paraesthesia, nervousness, asthenia, pharyngitis, hypotension, palpitations, flatulence, depression, pruritus, rash, impotence, oedema, arthralgia, amblyopia.
Renal dysfunction, angioedema, hypotension, hyperkalaemia, neutropenia, agranulocytosis - see warnings and precautions. The following side effects have been observed associated with ACE inhibitor therapy: Cardiovascular: Tachycardia, syncope, myocardial infarction, transient ischaemic attacks, cerebral haemorrhage.
Respiratory:
Dyspnoea, glossitis, bronchitis and bronchospasm. In individual cases angioneurotic oedema involving the upper airways has caused fatal airway obstruction.
Gastro-intestinal:
Constipation, dry mouth, cholestatic icterus, hepatitis and ileus. Pancreatitis has been reported rarely in patients treated with ACE inhibitors; in some cases this has proved fatal.
Skin, vessels:
Urticaria, erythema multiforme, Stevens Johnson syndrome, epidermic necrolysis, psoriasis-like efflorescences, alopecia. May be accompanied by fever, eosinophilia and/or increased ANA-titers.
Nervous:
Rarely disorders of balance, confusion, tinnitus, blurred vision and taste disturbances.
Drug/Laboratory:
Increases in blood urea and plasma creatinine may occur. Decreases in haematocrit, platelets and white cell count as well as elevation of liver enzymes and serum bilirubin. In patients with a congenital deficiency concerning G-6-PDH individual cases of haemolytic anaemia have been reported.
Quinapril film coated tablets should not be used in patients with aortic stenosis or outflow obstruction. Patients haemodialysed using high-flux polyacrylonitrile ('AN69') membranes are very likely to experience anaphylactoid reactions if they are treated with ACE inhibitors.
It is best therefore, that this combination be avoided, either by use of alternative antihypertensive drugs or alternative membranes for haemodialysis. Similar reactions have been observed during low density lipoprotein apheresis with dextran-sulphate.
Therefore, this method should not be used in patients treated with ACE inhibitors.
Anaphylactoid reactions:
Patients receiving ACE inhibitors during desensitising treatment with hymenoptera venom have experienced life threatening anaphylactoid reactions. These reactions were avoided by temporarily withholding ACE inhibitor therapy prior to each desensitisation.
In patients with renal insufficiency, monitoring of renal function during therapy should be performed as deemed appropriate; although in the majority renal function will not alter or may improve. As a consequence of inhibiting the renin-angiotensin-aldosterone system, changes in renal function may be anticipated in susceptible individuals.
In patients with severe heart failure whose renal function may depend on the activity of the renin-angiotensin-aldosterone system, treatment with ACE inhibitors including quinapril, may be associated with oliguria and/or progressive azotemia and rarely acute renal failure and/or death.
The half-life of quinaprilat is prolonged as creatinine clearance falls. Patients with a creatinine clearance of <40 ml/min require a lower initial dosage of quinapril. These patients' dosage should be titrated upwards based upon therapeutic response, and renal function should be closely monitored although initial studies do not indicate that quinapril produces further deterioration in renal function.
Quinapril Film Coated Tablets are contraindicated in the following circumstances: -In patients with hypersensitivity to any of the ingredients. 6) -In patients with a history of angioedema related to previous treatment with ACE inhibitors.
-In patients with hereditary/idiopathic angioneurotic oedema.
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
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In clinical studies in hypertensive patients with unilateral or bilateral renal artery stenosis, increases in blood urea nitrogen and serum creatinine have been observed in some patients following ACE inhibitor therapy. These increases were almost always reversible upon discontinuation of the ACE inhibitor and/or diuretic therapy.
In such patients, renal function should be monitored during the first few weeks of therapy. 25 times the upper limit of normal) in blood urea and serum creatinine, usually minor and short-lived, especially when quinapril has been given concomitantly with a diuretic and has been observed in 4% and 3% respectively of patients on monotherapy.
This is more likely to occur in patients with pre-existing renal impairment. Dosage reduction and/or discontinuation of a diuretic and/or quinapril may be required.
Angioedema:
Angioedema has been reported in patients treated with angiotensin-converting enzyme inhibitors. If laryngeal stridor or angioedema of the face, tongue, or glottis occur, treatment should be discontinued immediately, the patient treated appropriately in accordance with accepted medical care, and carefully observed until the swelling disappears.
In instances where swelling is confined to the face and lips, the condition generally resolves without treatment; antihistamines may be useful in relieving symptoms. Angioedema associated with laryngeal involvement may be fatal. 5 ml) should be promptly administered.
Black patients receiving ACE inhibitor therapy generally have a higher incidence of angioedema than non-black patients and a lesser reduction in blood pressure.
Hypotension:
Symptomatic hypotension was rarely seen in hypertensive patients treated with Quinapril film coated tablets, but it is a possible consequence of ACE inhibition therapy particularly in salt/volume depleted patients such as those previously treated with diuretics, who have a dietary salt reduction, or who are on dialysis.
If symptomatic hypotension occurs, the patient should be placed in the supine position and, if necessary, receive an intravenous infusion of normal saline. A transient hypotensive response is not a contraindication to further doses; however, lower doses of quinapril or any concomitant diuretic therapy should be considered if this event occurs.
Neutropenia/agranulocytosis:
ACE inhibitors have been rarely associated with agranulocytosis and bone marrow depression in patients with uncomplicated hypertension, but more frequently in patients with renal impairment, especially if they also have collagen vascular disease.
As with other ACE inhibitors, monitoring of white blood cell counts in patients with collagen vascular disease and/or renal diseases should be considered.