Accupro® [Quinapril]

Brand Pfizer

In stock 957 Items

Available since: 2019-09-19

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Clinical Pharmacology

Accupro - antihypertensive drug, ACE inhibitor.

Indications

Arterial hypertension, chronic heart failure.

Composition

1 coated tablet contains 40 mg quinapril hydrochloride.
Excipients: magnesium carbonate, magnesium stearate, lactose, gelatin, crospovidone, hydroxypropylmethylcellulose, hydroxypropylcellulose, titanium dioxide, macrogol 400, candelae wax, Opadry White OY-S-7331.

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Dosage and Administration

When conducting monotherapyhypertension The recommended initial dose of quinapril in patients not receiving diuretics is 10 mg or 20 mg 1 time / day. Depending on the clinical effect, the dose can be increased to a maintenance dose of 20 mg or 40 mg / day, which is usually prescribed in 1 dose or divided into 2 parts. As a rule, the dose should be changed at intervals of 4 weeks. In most patients, it is possible to achieve adequate blood pressure control during long-term treatment by using the drug 1 time / day. In some patients, the dose of quinapril reached 80 mg / day.

Adverse reactions

From the side of the central nervous system and peripheral nervous system: dizziness, weakness, headache; rarely, paresthesia, mood and sleep disorders.
Since the cardiovascular system: possible hypotension; rarely - tachycardia.
From the digestive system: possible dyspeptic symptoms (including dry mouth, anorexia); rarely - stomatitis, abdominal pain, pancreatitis, cholestatic jaundice.
Metabolism: possible hyperkalemia, hyponatremia; rarely, proteinuria, an increase in the level of urea and creatinine in the blood (mainly in patients with impaired renal function).
On the part of the respiratory system: possible dry cough, bronchitis, rhinitis.
From the hemopoietic system: rarely - neutropenia, agranulocytosis, thrombocytopenia, anemia.
From the urinary system: possible impaired renal function.
From the reproductive system: rarely - impotence.
Allergic reactions: skin rash, angioedema, and other hypersensitivity reactions are possible.
Dermatological reactions: rarely - alopecia.
Other: rarely muscle cramps.

Contraindications

- Hypersensitivity to any component of the drug.
- Angioedema in history as a result of prior therapy with ACE inhibitors, hereditary and / or idiopathic angioedema.
- Age up to 18 years.
- Pregnancy and lactation.
- Lactase deficiency, lactose intolerance and glucose-galactose malabsorption syndrome.
Carefully.
Symptomatic arterial hypotension in patients previously taking diuretics and following a diet with restriction of salt intake; severe heart failure in patients with a high risk of arterial hypotension; conditions accompanied by a decrease in circulating blood volume (BCC) (including vomiting and diarrhea); hyperkalemia; oppression of bone marrow hematopoiesis; aortic stenosis; cerebral circulatory failure, coronary heart disease, coronary insufficiency - a sharp decrease in blood pressure during therapy with ACE inhibitors, can worsen the course of these diseases; bilateral renal artery stenosis or arterial stenosis of a single kidney, condition after kidney transplantation; impaired renal function; in patients on hemodialysis (CC less than 10 ml / min) (there are insufficient data on the use of Accupro® in these patients); autoimmune systemic diseases of the connective tissue (including systemic lupus erythematosus, scleroderma); abnormal liver function (especially when used simultaneously with diuretics); with simultaneous use with potassium-sparing diuretics; diabetes; extensive surgical interventions and general anesthesia.

Drug interactions

Antihypertensives, diuretics, opioid analgesics, agents for general anesthesia enhance the hypotensive effect. NSAIDs, salt - weaken the effect. Potassium preparations, potassium-sparing diuretics (amiloride, spironolactone, triamterene) - increase the risk of hyperkalemia. Enhances the effect of ethanol, slows down the elimination of Li +. Enhances the hypoglycemic effect of sulfonylurea derivatives, insulin.Increases the risk of leukopenia with simultaneous use with allopurinol, cytotoxic drugs, immunosuppressants, procainamide. Estrogens weaken the hypotensive effect due to fluid retention. Drugs that cause bone marrow depression increase the risk of developing neutropenia and / or agranulocytosis or even death.

Special instructions

Care must be taken when prescribing to patients with reduced BCC (including as a result of diuretic therapy, while limiting NaCl intake, hemodialysis, diarrhea and vomiting) due to an increased risk of developing a sudden decrease in blood pressure after applying even the initial dose of ACE. Transient hypotension is not a contraindication for the continuation of drug treatment after stabilization of blood pressure (the dose should be reduced). In the event of an excessive decrease in the patient's blood pressure, the patient is transferred to a horizontal position with a low headboard, and if necessary, physiological saline is infused (to increase the volume of the BCC). Before starting treatment for 2-3 days, it is necessary to cancel the previous diuretic therapy, except for patients with malignant or difficult to treat hypertension. In these patients, the use of quinapril can be started immediately, in a reduced dose, under careful medical supervision (within 2 hours after administration and an additional 1 hour until blood pressure has stabilized) and a careful increase in dose. Patients with malignant hypertension or concomitant severe heart failure should begin treatment in a hospital. Before starting therapy with ACE inhibitors, it is necessary to count the total number of leukocytes, as well as control over the leukocyte formula 1 time per month for the first 3-6 months of treatment, and with periodic intervals of up to 1 year in patients with an increased risk of neutropenia connective tissue in high doses, at the first sign of infection). Before and during treatment, monitoring of blood pressure, kidney function, plasma K + content, control of Hb content in peripheral blood, creatinine, urea, control of electrolyte concentration and “liver” enzymes in the blood are necessary. The use of dialysis membranes AN69 in combination with ACE inhibitors is not recommended (due to the possibility of anaphylactoid reactions in patients). For newborns who have been exposed to prenatal ACE inhibitors, it is recommended to conduct careful monitoring to identify hypotension, oliguria and hyperkalemia. When oliguria, it is necessary to maintain blood pressure and renal perfusion by injecting appropriate fluids and vasoconstrictor agents. In newborns and infants, the risk of oliguria and neurological disorders is associated with a decrease in renal and cerebral blood flow, due to a decrease in blood pressure caused by ACE inhibitors; in this case, it is recommended to use in lower initial doses and careful observation. Care must be taken when driving or doing other work that requires special attention, because dizziness is possible, especially after the initial dose of an ACE inhibitor in patients taking diuretics. Care should be taken when performing physical exercises or hot weather due to the risk of dehydration and hypotension due to a decrease in fluid volume. Before surgery (including dentistry) it is necessary to warn the surgeon / anesthesiologist about the use of ACE inhibitors.

Overdosage

Symptoms: marked reduction in blood pressure, dizziness, weakness, visual disturbances.
Treatment is symptomatic. The patient should take a horizontal position, it is advisable to carry out intravenous infusion using a 0.9% solution of sodium chloride (to increase the BCC).
Hemodialysis and peritoneal dialysis are not effective.