Quinapril
ACCUPRIL
What it isACE inhibitor; hypertension and heart failure.
Why this oneLong-acting once-daily prodrug with the class renal benefit.
What limits itCough, hyperkalemia and the hemodynamic creatinine rise. Contraindicated in pregnancy; tetracycline absorption is reduced by its magnesium content.
FDA-approved for
- hypertension (1991)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypertension | Adults | 10 or 20 mg QD (5 mg if on a diuretic) | 20-80 mg/day QD or divided BID | 80 mg/day |
| Hypertension | Elderly (>=65 y) | 10 mg QD | titrate to response | 80 mg/day |
| Heart failure (adjunct to diuretics/digitalis) | Adults | 5 mg BID | 20-40 mg/day divided BID |
Titration Hypertension: adjust at intervals of at least 2 weeks. Heart failure: titrate at weekly intervals.
Renal Reduce initial dose by CrCl: >60 mL/min 10 mg; 30-60 mL/min 5 mg; 10-30 mL/min 2.5 mg; <10 mL/min insufficient data
Hepatic Undefined
Instructions
- If on a diuretic, discontinue it 2-3 days before starting if possible; otherwise start 5 mg with close monitoring until BP stabilizes
Contraindications
- History of angioedema related to previous ACE inhibitor therapy
- Combination with a neprilysin inhibitor (e.g., sacubitril); do not give within 36 h of switching to/from sacubitril/valsartan
- Co-administration with aliskiren in patients with diabetes
Cautions
- Fetal toxicity — discontinue when pregnancy detected
- Angioedema
- Symptomatic hypotension, especially with concomitant diuretics
- Hyperkalemia
- Impaired renal function
Adverse reactions
- Headache, dizziness, fatigue, cough, nausea/vomiting, abdominal pain
Pregnancy Fetal toxicity — drugs acting on the renin-angiotensin system can cause injury/death to the developing fetus; discontinue as soon as pregnancy is detected (boxed warning).
Lactation Undefined
⚠ BOXED WARNING
- Fetal toxicity
Principal riskAngioedema and hyperkalemia
Cost, est. cash$10–$300/month
Generic entry2004
Classes and tags
Clinical profile
Legacy pregnancy categoryD
Defining liabilityHyperkalemia, kidney injury, angioedema, fetal toxicity and increased lithium exposure.
Active metabolites
Mechanism of action: Quinapril ballicule
Open Quinapril in the interactive console ↗
Memory aids: mascots and interaction avatars
Easter/April theme → ACE inhibitor = -pril (aPril)
Bananas in bunches → ↑ serum potassium
