Moexipril

DEA Class; Rx

Common Brand Names; Univasc

• ACE Inhibitors

Angiotensin converting enzyme (ACE) inhibitors dilate arteries and veins by competitively inhibiting the conversion of angiotensin I to angiotensin II (a potent endogenous vasoconstrictor) and by inhibiting bradykinin metabolism; these actions result in preload and afterload reductions on the heart

ACE inhibitors also promote sodium and water excretion by inhibiting angiotensin-II induced aldosterone secretion; elevation in potassium may also be observed

ACE inhibitors also elicit renoprotective effects through vasodilation of renal arterioles

ACE inhibitors reduce cardiac and vascular remodeling associated with chronic hypertension, heart failure, and myocardial infarction

Indicated for the treatment of hypertension

Hypersensitivity to moexipril/other ACE inhibitors

History of hereditary or angioedema associated with previous ACE inhibitor treatment

Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan

Bilateral renal artery stenosis

Do not coadminister with aliskiren in patients with diabetes mellitus or with renal impairment (ie, GFR <60 mL/min/1.73 m²)

• Dizziness
• Hypotension
• Peripheral edema
• Cough
• Headache
• Myalgia
• Polyuria
• Hyponatremia
• Pharyngitis
• Sinusitis
• Rash
• Nausea/vomiting
• Hyperkalemia
• Hyponatremia
• Angioedema
• Arrhythmia
• Chest pain
• Pneumonitis
• Syncope
• Proteinuria
• Agranulocytosis (esp. if pt has CVD with or without renal impairment)
• Hepatic failure (rare)
• Renal failure

Apheresis (LDL) with dextran sulfate, hypertrophic cardiomyopathy, collagen vascular disease, hemodialysis with high flux membrane, aortic stenosis

Less effective in African-Americans

Excessive hypotension if concomitant diuretics, hypovolemia, hyponatremia

Risk of hyperkalemia, especially with renal impairment, DM, or those taking concomitant K+-elevating drugs

Dual blockade of the renin angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for hypotension, hyperkalemia, and renal function changes (including acute renal failure) compared to monotherapy

ACE inhibition also causes increased bradykinin levels which putatively mediates angioedema

Coadministration with mTOR inhibitors (eg, temsirolimus) may increase risk for angioedema

Renal impairment may occur

Neutropenia/agranulocytosis reported

Cough may occur within the first few months

Cholestatic jaundice may occur

Use caution in severe aortic stenosis

Discontinue immediately if pregnant (see Contraindications and Black Box Warnings)

Renal impairment

Pregnancy Category: C (1st trimester); D (2nd & 3rd trimesters)

Discontinue as soon as pregnancy detected; during the second and third trimesters of pregnancy, drugs that act directly on the renin-angiotensin have been associated with fetal injury that includes hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death

Lactation: not known if excreted into breast milk; use caution