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Treatment of hypertension;and Heart failure


Aortic stenosis or outflow tract obstruction; renovascular disease. Pregnancy.

Adverse reactions:

Dizziness, headache, fatigue, GI disturbances, taste disturbances, persistent dry cough and other upper resp tract symptoms, skin rashes, angioedema, hypersensitivity reactions, renal impairment, hyperkalaemia, hyponatraemia, blood disorders, proteinuria, chest pain, palpitations, tachycardia, stomatitis, pancreatitis, cholestatic jaundice; alopoecia; muscle cramps; paraesthesias, mood and sleep disturbances, impotence. Potentially Fatal: Pronounced hypotension which could result in MI or stroke in patients with ischaemic heart disease or cerebrovascular disease. Anaphylactic reactions including angioedema of the face, extremities, lips, tongue, glottis and larynx.


Antacids Quinapril bioavailability may be decreased. Separate administration times by 1 to 2 h. Capsaicin Cough may be exacerbated. Digoxin May cause increased or decreased digoxin levels. Diuretics Increased risk of hypotension. Food Food (especially fat) reduces bioavailability of quinapril. Indomethacin, salicylates (eg, aspirin) May reduce hypotensive effects, especially in low renin or volume-dependent hypertensive patients. Lithium May cause increased lithium levels and symptoms of lithium toxicity. Loop diuretics Effects of loop diuretics may be decreased. Phenothiazines Enhanced hypotensive effect. Potassium supplements and potassium-sparing diuretics Hyperkalemia. Tetracycline Decreased tetracycline absorption.


Warnings Pregnancy When used in pregnancy during the second and third trimesters, ACE inhibitors can cause injury and even death to the developing fetus. When pregnancy is detected, discontinue therapy as soon as possible. Pregnancy Category D (second, third trimester); Category C (first trimester). Avoid use in pregnant patients and discontinue drug as soon as pregnancy is detected; closely observe infants with histories of in utero exposure. Lactation Undetermined. Children Safety and efficacy not established. Elderly May show higher peak blood levels of metabolite. Renal Function May further decrease renal function with elevations in BUN and serum creatinine because of decreased renal perfusion. Furthermore, dosage should be reduced to compensate for reduced drug elimination. Hepatic Function Use drug with caution; dosage reduction may be necessary because of impaired metabolism. Angioedema May occur and is potentially fatal if laryngeal edema occurs. Intestinal angioedema has occurred. Use drug with extreme caution in patients with hereditary angioedema. Cough Chronic cough may occur during treatment; more common in women. Hepatic failure Rarely, ACE inhibitors have been associated with a syndrome that starts with cholestatic jaundice and progresses to fulminant hepatic necrosis and sometimes death. Hypotension/first-dose effect Significant decreases in BP may occur after first dose, especially in severely salt- or volume-depleted patients (eg, patients on aggressive diuretic therapy) or in those with heart failure. Neutropenia and agranulocytosis Have occurred rarely; risk appears greater with renal function impairment, heart failure, or immunosuppression. Proteinuria Has occurred with similar agents, especially with high doses or prior renal disease.



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