| QUINAPRIL HYDROCHLORIDe
Classifications: angiotensin-converting enzyme (ace) inhibitor; antihypertensive; Therapeutic: antihypertensive; ace inhibitor
Pregnancy Category: C first trimester; D second and third trimester
5 mg, 10 mg, 20 mg, 40 mg tablets
Potent, long-acting second-generation ACE inhibitor that lowers BP by interrupting the conversion sequences initiated by
renin to form angiotensin II, a vasoconstrictor. Inhibition of ACE also decreases circulating aldosterone, a secretory response
to angiotensin II stimulation. Reduces pulmonary capillary wedge pressure, systemic vascular resistance, and mean arterial
pressure, with concurrent increases in cardiac output, cardiac index, and stroke volume.
Lowers BP by producing vasodilation. Effective in the treatment of CHF because it improves cardiac indicators.
Mild to moderate hypertension, CHF.
Hypersensitivity to quinapril or other ACE inhibitors; children; pregnancy (category C first trimester, category D second
and third trimester), lactation.
Renal insufficiency, severe CHF; autoimmune disease, volume-depleted patients, renal artery stenosis, neutropenia.
Route & Dosage
Adult: PO 1020 mg q.d., may increase up to 80 mg/d in 12 divided doses
Geriatric: PO Start with 2.55 mg q.d.
Clcr 3060 mL/min: 5 mg/q.d. initially; <1030 mL/min: 2.5 mg/d initially
- Discontinue diuretics 23 d before initiation of quinapril. Do NOT exceed initial dose of 5 mg if diuretics cannot be
- Store at 15°30° C (59°86° F) and protect from moisture.
Adverse Effects (≥1%)CV:
Edema, hypotension. CNS:
, headache. GI:
Nausea, vomiting, diarrhea. Hematologic:
Hyperkalemia, proteinuria. Respiratory:
Cough. Body as a Whole: Angioedema,
Diagnostic Test Interference
May increase BUN or serum creatinine.
Interactions Drug: potassium-sparing diuretics
may increase risk of hyperkalemia. May elevate serum lithium
levels, resulting in lithium
Rapidly from GI tract. Onset:
1 h. Peak:
24 h. Duration:
Up to 24 h. Distribution:
97% bound to plasma proteins; crosses placenta; not known if distributed into breast milk. Metabolism:
Extensively metabolized in liver to its active metabolite, quinaprilat. Elimination:
5060% in urine, primarily as quinaprilat; 30% in feces. Half-Life:
Assessment & Drug Effects
- Monitor BP at time of peak effectiveness, 24 h after dosing, and at end of dosing interval just before next dose.
- Report diminished antihypertensive effect toward end of dosing interval. Inadequate trough response may indicate need to
divide daily dose.
- Monitor for first-dose hypotension, especially in salt- or volume-depleted clients.
- Lab tests: Monitor BUN and serum creatinine periodically. Increases may necessitate dose reduction or discontinuation of
drug. Monitor serum potassium values.
- Observe for S&S of hyperkalemia (see Appendix F).
Patient & Family Education
- Discontinue quinapril and report S&S of angioedema (e.g., swelling of face or extremities, difficulty breathing or swallowing)
- Maintain adequate fluid intake and avoid potassium supplements or salt substitutes unless specifically prescribed by physician.
- Note: A high-fat meal may lessen drug's absorption.