Quinapril
Mechanism :
Competitive inhibitor of angiotensin-converting enzyme (ACE).
Indication :
- Off-label: Pediatric hypertension
Contraindications :
Hypersensitivity to quinapril or any component of the formulation; angioedema related to previous treatment with an ACE inhibitor; concomitant use with aliskiren in patients with diabetes mellitus; concomitant use with neprilysin inhibitor (e.g., sacubitril) or within 36 hours of switching to or from neprilysin inhibitor.
Dosing :
Off-label:
5-10 mg PO daily.
Adverse Effect :
Dizziness, coughing, fatigue, nausea, vomiting, hypotension, dyspnea, diarrhea, headache, rash, myalgia, angioedema, palpitation, vasodilation, tachycardia, heart failure, hyperkalemia, myocardial infarction, cerebrovascular accident, hypertensive crisis.
Interaction :
Angiotensin II Receptor Blockers: May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors.
Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents.
Loop Diuretics: May enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors.
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.
Potassium-Sparing Diuretics: May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Start with low dose, adjust according to response |
| 10-20 | Start with low dose, adjust according to response |
| <10 | Start with low dose, adjust according to response |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in GFR<10 mL/min |
| HD | 25% dialysed. Dose as in GFR<10 mL/min |
| HDF/High flux | Dialysed. Dose as in GFR<10 mL/ min |
| CAV/VVHD | Unknown dialysability. Dose as in GFR=10–20 mL/min |
Hepatic Dose :
Quinaprilat serum concentrations are reduced in patients with alcoholic cirrhosis due to impaired de-esterification of quinapril. In hepatic impairment even though drug metabolism is impaired, the excretion of metabolite is unaltered and hence dose adjustment may not be required.