Quinapril/Hydrochlorothiazide

DEA Class; Rx

Common Brand Names; Accuretic

• ACEI/Diuretic Combos; 
• ACEI/HCTZ Combos

ACE inhibitor and thiazide diuretic
Used for hypertension
Counteracts the potassium loss from hydrochlorothiazide; more effective than ACE monotherapy in Black patients

Indicated for the treatment of hypertension.

Anuria

Hypersensitivity to either component or sulfonamides

History of angioedema

Hereditary or idiopathic angioedema

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

No adverse effects specific to the combination have been observed; adverse effects limited to those previously reported with quinapril and hydrochlorothiazide

Quinapril

• Dizziness (4-8%)

• Headache (2-6%)

• Cough (2-4%)

• Hyoptension (3%)

• Fatigue (3%)

• Hyperkalemia (2%)

• Chest pain (2%)

• Nausea/vomiting (1-2%)

• Rash (1%)

• Hyperkalemia (2%)

• Myalagia (2-5%)

• Back pain (1%)

• Angioedema

• Acute renal failure

• Alopecia

• Angina

• Pancreatitis

• Hyperkalemia

Hydrochlorothiazide

• Anorexia

• Epigastric distress

• Hypotension

• Orthostatic hypotension

• Photosensitivity

• Anaphylaxis

• Anemia

• Confusion

• Erythema multiforme

• Stevens-Johnson syndrome

• Exfoliative dermatitis including toxic epidermal necrolysis

• Hypomagnesemia

• Dizziness

• Headache

• Hyperuricemia

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

May aggravate digitalis toxicity

Sensitivity reactions may occur with or without history of allergy or asthma

Risk of male sexual dysfunction

Renal impairment may occur

Acute transient myopia and acute angle-closure glaucoma has been reported, particularly with history of sulfonamide or penicillin allergy (hydrochlorothiazide is a sulfonamide)

Angioedema of the face, extremities, lips, tongue, glottis, and larynx has been reported in patients treated with angiotensin-converting enzyme inhibitors

If laryngeal stridor or angioedema of the face, tongue, or glottis occurs discontinue therapy and institute appropriate therapy immediately

Patients receiving coadministration of ACE inhibitor and mTOR (mammalian target of rapamycin) inhibitor (eg, temsirolimus, sirolimus, everolimus) therapy or a neprilysin inhibitor may be at increased risk for angioedema

Intestinal angioedema has been reported in patients treated with ACE inhibitors

Cholestatic jaundice may occur, which may progress to fulminant hepatic necrosis; discontinue

Dry hacking nonproductive cough may occur within few months of treatment; consider other causes of cough prior to discontinuation

Hyperkalemia may occur with ACE inhibitors; risk factors include renal dysfunction, diabetes mellitus, and concomitant use of potassium sparing diuretics and potassium supplements; use cautiously if at all with these agents

Thiazide diuretics may cause hypokalemia, hypochloremic alkalosis, hypomagnesemia, and hyponatremia

Hydrochlorothiazide may precipitate gout in patients with familial predisposition to gout or chronic renal failure

Symptomatic hypotension with or without syncope can occur with ACE inhibitors; mostly observed in volume depleted patients, correct volume depletion prior to initiation; monitor closely when initiating and increasing dosing

Agranulocytosis, neutropenia, or leukopenia with myeloid hypoplasia reported with other ACE inhibitor; patients with renal impairment are at high risk; monitor CBC with differential in these patients

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

Lactation: Excreted in breast milk, use caution