ACCUPRIL-20 20MG TABLET

Indications

• Essential hypertension
• Heart failure (adjunct treatment)

Dosage

Children: Refer to the BNF for Children for specific

Adults: Initially 2 mg once daily for at least 2 weeks, then increased if tolerated to 4 mg once daily. The maximum dose is 40 mg per day, adjusted according to response. For heart failure, the initial dose is 2.5 mg once daily, which can be increased if tolerated.

Mechanism of action

Quinaprilat prevents the conversion of angiotensin I to angiotensin II by inhibiting angiotensin converting enzyme. This results in decreased angiotensin II levels, leading to vasodilation, reduced vascular resistance, and decreased blood pressure. Additionally, it reduces the breakdown of bradykinin, which has vasodilatory effects. Lower levels of angiotensin II also decrease the production of plasminogen activator inhibitor-1 (PAI-1), thereby reducing the risk of thrombosis, particularly following myocardial infarction.

Pharmacodynamics

Quinapril is a prodrug that converts to Quinaprilat, an effective ACE inhibitor. It has a wide therapeutic window and long duration of action, making it suitable for once-daily administration. It effectively lowers blood pressure and provides symptomatic relief in heart failure by reducing preload and afterload on the heart.

Pharmacokinetics

Quinapril is absorbed after oral administration, with peak plasma concentrations typically occurring within 1 hour. It has a half-life of approximately 2 hours, but its active metabolite, Quinaprilat, has a longer half-life of about 9 hours. The drug is primarily excreted via the kidneys, necessitating dose adjustments in patients with renal impairment. Food does not significantly affect the absorption of Quinapril.

Adverse effects

• Muscle cramps
• Visual disturbances
• Hypoglycaemia
• Malaise
• Mood alterations
• Cholestasis

Interactions

• ACE inhibitors

Precautions

• Caution in renal impairment
• Caution in elderly patients

Pregnancy

Not recommended; caution should be exercised in women who are pregnant or planning to become pregnant.

Breast-feeding

Not recommended; alternative treatment options with better established safety during breastfeeding are available.

Storage

Store in a cool, dry place away from direct sunlight.

Formulations

• Quinapril 2.5 mg tablets
• Quinapril 5 mg tablets
• Quinapril 10 mg tablets
• Quinapril 20 mg tablets

Mechanism of action

Angiotensin II constricts coronary blood vessels and is positively inotropic, which under normal circumstances, would increase vascular resistance and oxygen consumption. This action can eventually lead to myocyte hypertrophy and vascular smooth muscle cell proliferation. Angiotensin II also stimulates production of plasminogen activator inhibitor-1 (PAI-1), increasing the risk of thrombosis. Quinaprilat prevents the conversion of angiotensin I to angiotensin II by inhibition of angiotensin converting enzyme, and also reduces the breakdown of bradykinin. Reduced levels of angiotensin II lead to lower levels of PAI-1, reducing the risk of thrombosis, especially after a myocardial infarction.

Pharmacodynamics

Quinapril is a prodrug of an angiotensin converting enzyme (ACE) inhibitor used in the treatment of hypertension or adjunct in the treatment of heart failure. Quinapril has a wide therapeutic window and a long duration of action as it is given in doses of 10-80mg once daily.