Accupril

Buy Accupril

Accupril Information

Brand Name: Accupril

Generic Name: Quanipril

Other Common Names: Acupril

Accupril (Quinapril HCl) is used to treat high blood pressure and some forms of heart failure alone or in combination with other medications.

Accupril indications:

Hypertension

Quinapril HCl, the active ingredient in Accupril, is indicated for the treatment of hypertension. It may be used alone or in combination with thiazide diuretics.

Heart Failure

Quinapril HCl, the active ingredient in Accupril, is indicated in the management of heart failure as adjunctive therapy when added to conventional therapy including diuretics and/or digitalis.

In using Accupril, consideration should be given to the fact that another angiotensin- converting enzyme inhibitor, captopril, has caused agranulocytosis, particularly in patients with renal impairment or collagen vascular disease. Available data are insufficient to wshow that quinapril HCl does not have a similar risk.

Angioedema in black patients

Black patients receiving ACE inhibitor monotherapy have been reported to have a higher incidence of angioedema compared to non-blacks. It should also be noted that in controlled clinical trials ACE inhibitors have an effect on blood pressure that is less in black patients than in non-blacks.

Accupril Ingredients and Composition

How Does Accupril Work?

Mechanism of Action

Quinapril, the active ingredient in Accupril, is deesterified to the principal metabolite, quinaprilat, which is an inhibitor of ACE activity in human subjects and animals. ACE is a peptidyl dipeptidase that catalyzes the conversion of angiotensin I to the vasoconstrictor, angiotensin II. The effect of quinapril in hypertension and in congestive heart failure (CHF) appears to result primarily from the inhibition of circulating and tissue ACE activity, thereby reducing angiotensin II formation. Quinapril inhibits the elevation in blood pressure caused by intravenously administered angiotensin I, but has no effect on the pressor response to angiotensin II, norepinephrine or epinephrine. Angiotensin II also stimulates the secretion of aldosterone from the adrenal cortex, thereby facilitating renal sodium and fluid reabsorption. Reduced aldosterone secretion by quinapril may result in a small increase in serum potassium. In controlled hypertension trials, treatment with quinapril HCl alone resulted in mean increases in potassium of 0.07 mmol/L Removal of angiotensin II negative feedback on renin secretion leads to increased plasma renin activity (PRA).

While the principal mechanism of antihypertensive effect of Accupril is thought to be through the renin-angiotensin-aldosterone system, quinapril exerts antihypertensive actions even in patients with low renin hypertension. Quinapril HCl was an effective antihypertensive in all races studied, although it was somewhat less effective in blacks (usually a predominantly low renin group) than in nonblacks. ACE is identical to kininase II, an enzyme that degrades bradykinin, a potent peptide vasodilator; whether increased levels of bradykinin play a role in the therapeutic effect of quinapril remains to be elucidated.

How To Take Accupril and Accupril Dosage and Administration

Hypertension

Monotherapy

The recommended initial dosage of Accupril in patients not on diuretics is 10 or 20 mg once daily. Dosage should be adjusted according to blood pressure response measured at peak (2-6 hours after dosing) and trough (predosing). Generally, dosage adjustments should be made at intervals of at least 2 weeks. Most patients have required Accupril dosages of 20, 40, or 80 mg/day, given as a single dose or in 2 equally divided doses. In some patients treated once daily, the antihypertensive effect may diminish toward the end of the dosing interval. In such patients an increase in dosage or twice daily administration may be warranted. In general, doses of 40-80 mg and divided doses give a somewhat greater effect at the end of the dosing interval.

Concomitant Diuretics

If blood pressure is not adequately controlled with Accupril monotherapy, a diuretic may be added. In patients who are currently being treated with a diuretic, symptomatic hypotension occasionally can occur following the initial dose of quinapril HCl. To reduce the likelihood of hypotension, the diuretic should, if possible, be discontinued 2 to 3 days prior to beginning therapy with Accupril. Then, if blood pressure is not controlled with Accupril alone, diuretic therapy should be resumed.

If the diuretic cannot be discontinued, an initial dose of 5 mg Accupril should be used with careful medical supervision for several hours and until blood pressure has stabilized.

Heart Failure

Accupril is indicated as adjunctive therapy when added to conventional therapy including diuretics and/or digitalis. The recommended starting Accupril dose is 5 mg twice daily. This dose may improve symptoms of heart failure, but increases in exercise duration have generally required higher doses. Therefore, if the initial dosage of quinapril HCl is well tolerated, patients should then be titrated at weekly intervals until an effective dose, usually 20 to 40 mg daily given in two equally divided doses, is reached or undesirable hypotension, orthostatis, or azotemia prohibit reaching thisq dose.

Following the initial dose of Accupril, the patient should be observed under medical supervision for at least two hours for the presence of hypotension or orthostatis and, if present, until blood pressure stabilizes. The appearance of hypotension or orthostatis, or azotemia early in dose titration should not preclude further careful dose titration. Consideration should be given to reducing the dose of concomitant diuretics.

Dose Adjustments in Patients with Heart Failure and Renal Impairment or Hyponatremia

Pharmacokinetic data indicate that quinapril elimination is dependent on level of renal function. In patients with heart failure and renal impairment, the recommended initial dose of quinapril HCl is 5 mg in patients with a creatinine clearance above 30 ml/min and 2.5 mg in patients with a creatinine clearance of 10 to 30 ml/min. There is insufficient data for dosage recommendation in patients with a creatinine clearance less than 10 ml/min.

If the initial dose is well tolerated, Accupril may be administered the following day as a twice daily regimen. In the absence of excessive hypotension or significant deterioration of renal function, the dose may be increased at weekly intervals based on clinical and hemodynamic response.

If you suspect a Accupril Overdose

No data are available with respect to Accupril overdosage in humans. Doses of 1440 to 4280 mg/kg of quinapril cause significant lethality in mice and rats.

The most likely clinical manifestation of Accupril overdose would be symptoms attributable to severe hypotension.

Laboratory determinations of serum levels of quinapril and its metabolites are not widely available, and such determinations have, in any event, no established role in the management of quinapril overdose.

No data are available to suggest physiological maneuvers (e.g., maneuvers to change pH of the urine) that might accelerate elimination of quinapril and its metabolites.

Hemodialysis and peritoneal dialysis have little effect on the elimination of quinapril and quinaprilat. Angiotensin II could presumably serve as a specific antagonist-antidote in the setting of quinapril overdose, but angiotensin II is essentially unavailable outside of scattered research facilities. Because the hypotensive effect of quinapril is achieved through vasodilation and effective hypovolemia, it is reasonable to treat quinapril overdose by infusion of normal saline solution.

Accupril Side Effects

Accupril Warnings

Accupril Precautions and Contraindications

General

Impaired Renal Function

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 Accupril, may be associated with oliguria and/or progressive azotemia and rarely acute renal failure and/or death.

In Accupril 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.

Some patients with hypertension or heart failure with no apparent preexisting renal vascular disease have developed increases in blood urea and serum creatinine, usually minor and transient, especially when quinapril HCl has been given concomitantly with a diuretic. This is more likely to occur in patients with preexisting renal impairment. Dosage reduction and/or discontinuation of any diuretic and/or Accupril may be required.

Evaluation of Patients with Hypertension or Heart Failure Should Always Include Assessment of Renal Function

Hyperkalemia and Potassium-Sparing Diuretics:

In clinical trials, hyperkalemia (serum potassium <5.8 mmol/L) occurred in approximately 2% of patients receiving Accupril. In most cases, elevated serum potassium levels were isolated values which resolved despite continued therapy. Less than 0.1% of patients discontinued therapy due to hyperkalemia. Risk factors for the development of hyperkalemia include renal insufficiency, diabetes mellitus, and the concomitant use of potassium-sparing diuretics, potassium supplements, and/or potassium-containing salt substitutes, which should be used cautiously, if at all, with Accupril.

Cough

Presumably due to the inhibition of the degradation of endogenous bradykinin, persistant non-productive cough has been reported with all ACE inhibitors, always resolving after disconinuation of therapy. ACE inhibitor-induced cough should be considered in the differential diagnosis of cough.

Surgery/Anesthesia

In patients undergoing major surgery or during anesthesia with agents that produce hypotension, quinapril HCl will block angiotensin II formation secondary to compensatory renin release. If hypotension occurs and is considered to be due to this mechanism, it can be corrected by volume expansion.

Contraindications to Accupril

Accupril is contraindicated in patients who are hypersensitive to this product and in patients with a history of angioedema related to previous treatment with an ACE inhibitor.

Accupril Clinical Trials and Studies

Taking Accupril during Pregnancy or Breast-feeding

When used in pregnancy during the second and third trimesters, ACE inhibitors such as Accupril can cause injury and even death to the developing fetus. When pregnancy is detected, Accupril should be discontinued as soon as possible.

Accupril Pill Identification / ID and Appearance

Accupril tablets are supplied as follows:

Accupril 5-mg tablets: brown, film-coated, elliptical scored tablets, coded "PD 527" on one side and "5" on the other.

Accupril 10-mg tablets: brown, film-coated, triangular tablets, coded "PD 530" on one side and "10" on the other.

Accupril 20-mg tablets: brown, film-coated, round tablets, coded "PD 532" on one side and "20" on the other. (Order 20mg Accupril Dose)

Accupril 40-mg tablets: brown, film coated, elliptical tablets, coated "PD 535" on one side and "40" on the other. (Order 40mg Accupril Dose)

Articles and information related to Accupril

• Blood Pressure

Buy Accupril