MOEXIPRIL HYDROCHLORIDE

MOEXIPRIL HYDROCHLORIDE
(mo-ex'i-pril)
Univasc
Classifications: angiotensin-converting enzyme (ace) inhibitor; antihypertensive;
Therapeutic: antihypertensive, ace inhibitor
Prototype: Enalapril
Pregnancy Category: C first trimester; D second and third trimester

Availability

7.5 mg, 15 mg tablets

Action

ACE inhibitor that results in decreased conversion of angiotensin I to angiotensin II. Results in decreased vasopressor activity and aldosterone secretion. Lowering angiotensin II plasma levels results in blood pressure decreases and plasma renin activity increases.

Therapeutic Effect

ACE inhibition and decreased aldosterone secretion are responsible for its antihypertensive effect.

Uses

Hypertension.

Unlabeled Uses

CHF, left ventricular dysfunction.

Contraindications

Hypersensitivity to moexipril; history of angioedema related to an ACE inhibitor; pregnancy [(category C) first trimester; (category D) second and third trimesters], lactation.

Cautious Use

Hypersensitivity to any other ACE inhibitor; renal impairment, renal artery stenosis, volume-depleted patients; hypertensive patient with CHF; history of autoimmune disease; severe liver dysfunction; immunosuppressed patients; hyperkalemia; patients undergoing surgery/anesthesia; preexisting neutropenia; concurrent lithium therapy. Safety and efficacy in children are not established.

Route & Dosage

Hypertension
Adult: PO 7.5 mg once/d, may increase up to 30 mg/d in divided doses

Renal Impairment
Cl_cr ≤40 mL/min: start with 3.75 mg q.d. (also if patient is volume depleted or on diuretics)

Administration

Oral

Give 1 h before or 2 h after meals. Food greatly reduces absorption of moexipril.
May need to reduce starting dose 50% in patients with possible volume depletion or a history of renal insufficiency.
Store at 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

CNS: Headache, dizziness, drowsiness, sleep disturbances, nervousness, anxiety, mood changes. CV: Hypotension, chest pain, angina, peripheral edema, MI, palpitations, arrhythmias. Endocrine: Hyperkalemia. GI: Diarrhea, nausea, dyspepsia, abdominal pain, taste disturbances, constipation, vomiting, dry mouth, pancreatitis. Urogenital: Urinary frequency, increased BUN and serum creatinine. Hematologic: Neutropenia, hemolytic anemia. Respiratory: Cough, pharyngitis, rhinitis, flu-like symptoms. Skin: Angioedema (rare), rash, flushing.

Interactions

Drug: Capsaicin may exacerbate cough. nsaids may reduce antihypertensive effects. May increase lithium levels and toxicity. potassium supplements and potassium-sparing diuretics may increase risk of hyperkalemia. Food: Food greatly reduces absorption of moexipril.

Pharmacokinetics

Absorption: Readily absorbed from GI tract; approximately 13% of active metabolite reaches systemic circulation; absorption greatly reduced by food. Onset: 1 h. Duration: 24 h. Distribution: Approximately 50% protein bound. Metabolism: In liver to moexiprilat (active metabolite). Elimination: 13% in urine, 53% in feces. Half-Life: 2–9 h.

Nursing Implications

Assessment & Drug Effects

Monitor closely for systematic hypotension that may occur within 1–3 h of first dose, especially in those with high blood pressure, on a diuretic or restricted salt intake, or otherwise volume depleted.
Monitor BP and HR frequently during initiation of therapy, whenever a diuretic is added, and periodically throughout therapy.
Determine trough BP (just before next dose) before dose adjustments are made.
Lab tests: Monitor serum electrolytes, WBC with differential, Hct and Hgb, UA, and kidney and liver function tests periodically throughout therapy.
Supervise therapeutic response closely in patients with CHF.

Patient & Family Education

Report to physician immediately swelling around face or neck or in extremities.
Report S&S of hypotension (e.g., dizziness, weakness, syncope); nonproductive cough; skin rash; flu-like symptoms; jaundice; irregular heartbeat or chest pains; and dehydration from vomiting, diarrhea, or diaphoresis.
Consult physician before using potassium-containing salt substitutes.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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