Accuzide® [Hydrochlorothiazide, Quinapril]
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Accuzide is a combined antihypertensive drug that contains the ACE inhibitor quinapril and thiazide diuretic hydrochlorothiazide in three different ratios. Quinapril - an ACE inhibitor. ACE catalyzes the formation of angiotensin II, which has a vasoconstrictor effect and controls vascular tone, including by stimulating the secretion of aldosterone by the adrenal cortex. Quinapril inhibits circulating and tissue ACE and causes a decrease in vasopressor activity and aldosterone secretion. The elimination of the negative effect of angiotensin II on renin secretion by the feedback mechanism leads to an increase in plasma renin activity. At the same time, a decrease in blood pressure is accompanied by a decrease in OPSS and resistance of renal vessels, while changes in heart rate, cardiac output, renal blood flow, glomerular filtration rate and filtration fraction are insignificant or absent. In addition, quinapril somewhat reduces the loss of potassium caused by hydrochlorothiazide, which due to its diuretic effect also increases plasma renin activity, secretion of aldosterone, decreases serum potassium levels and increases its excretion with urine.
Hydrochlorothiazide is a diuretic that has a direct effect on the kidneys, increasing the excretion of sodium ions, chlorides, water, as well as potassium and bicarbonate ions, and reducing the excretion of calcium ions. Although the mechanism of the antihypertensive effect of diuretics has not been fully studied, with their long-term use, there is a decrease in OPSS, probably due to a change in the exchange of sodium ions. Thus, the use of a combination of quinapril and hydrochlorothiazide leads to a more pronounced decrease in blood pressure than therapy with each drug separately.
Arterial hypertension (in patients for whom combination therapy with quinapril and diuretic is indicated).
1 tablet contains quinapril (in the form of hydrochloride) 20 mg, hydrochlorothiazide 25 mg.
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Dosage and Administration
For oral use 1 time per day, regardless of the meal. For patients who do not receive diuretics (regardless of whether Quinapril was given monotherapy before or not), the recommended initial dose is 1 table. Accuzide (20 mg +12.5 mg) once a day. Subsequently, if necessary, the dose can be increased to 2 table. Accuzide (20 mg + 12.5 mg) 1 time per day or up to the maximum recommended daily dose of Accuzide - (20 mg + 25 mg) 1 time per day.
The most frequent side effects (> 1%) when taking any combination of quinapril and hydrochlorothiazide were headache (6.7%), dizziness (4.8%), cough (3.2%), which was usually unproductive, persistent and disappeared after stopping therapy, increased fatigue (2.9%).
In general, side effects were mild and transient, not dependent on age, gender, race, and duration of therapy.
- angioedema in history as a result of prior therapy with ACE inhibitors;
- childhood and adolescence under 18 years of age (efficacy and safety of the drug have not been established)
- hypersensitivity to the drug;
- Hypersensitivity to sulfanilamide derivatives.
- pregnancy and lactation.
The use of tetracycline with quinapril reduces the absorption of tetracycline by approximately 28–37%. This is due to the presence in the preparation of magnesium carbonate as a filler. It should be borne in mind the possibility of such an interaction with the simultaneous appointment of quinapril / hydrochlorothiazide with tetracycline or with other drugs that react with magnesium.
Lithium is not usually prescribed with diuretics. Diuretic drugs reduce its renal clearance and increase the risk of toxic effects. An increase in serum lithium concentration and symptoms of lithium poisoning as a result of sodium loss under the action of quinapril / hydrochlorothiazide were detected in patients who simultaneously took lithium and ACE inhibitors. With quinapril / hydrochlorothiazide, the risk of lithium intoxication may increase. The simultaneous use of these drugs should be carried out with caution; recommended frequent monitoring of lithium levels in serum. Concomitant use of a diuretic may increase the risk of lithium toxicity.
When quinapril was administered with propranolol, hydrochlorothiazide, digoxin, or cimetidine, no clinically important pharmacokinetic interactions were observed. The anticoagulant effect of a single dose of warfarin (estimated by prothrombin time) did not change significantly with simultaneous administration of quinapril 2 times a day.
Alcohol, barbiturates or drugs — orthostatic hypotension may occur; antidiabetic agents (oral hypoglycemic agents and insulin) - it may be necessary to increase the dose of antidiabetic agents; other antihypertensive agents - additive effect or potentiation effect; GCS, adrenocorticotropic hormone - an increase in electrolyte loss, especially hypokalemia; Pressor amines (for example, norepinephrine) - perhaps a slight decrease in the response to the use of these drugs; non-depolarizing muscle relaxants (for example, tubocurarine) - it is possible to increase the response to the use of muscle relaxants; NSAIDs - in some patients, the use of NSAIDs can reduce the diuretic, natriuretic and antihypertensive effects of loop, potassium-sparing and thiazide diuretics. Therefore, with simultaneous use of quinapril / hydrochlorothiazide and NSAIDs, patients need careful monitoring to get the desired effect from Accuzide; drugs that increase the level of potassium in the blood serum - quinapril can reduce the level of aldosterone, which in turn may cause potassium retention.Therefore, the simultaneous use of quinapril and potassium preparations or preparations containing potassium salts, must be careful, with appropriate control of the concentration of potassium in the blood serum; anion exchange resins - the absorption of hydrochlorothiazide is impaired under the influence of such anion exchange resins as colestiramine and colestipol. The simultaneous use of anion-exchange resin binds hydrochlorothiazide and reduces its absorption from the digestive tract to 85 and 43%, respectively.
Accuzide®e can cause symptomatic hypotension, however, no more often than with monotherapy with both components of the drug. Symptomatic hypotension is rarely seen in the treatment of quinapril in patients with uncomplicated arterial hypertension, but it can develop as a result of therapy with ACE inhibitors in patients with reduced BCC, for example, after diuretic therapy, with a diet limited in sodium or during hemodialysis. If symptomatic hypotension appears, the patient should be given a horizontal position and, if necessary, should be given a IV infusion using a 0.9% sodium chloride solution. Transient arterial hypotension is not a contraindication to the further use of the drug, but in such cases it is advisable to reduce its dose. In patients with chronic heart failure, with or without renal insufficiency, therapy with an ACE inhibitor for hypertension may lead to an excessive decrease in blood pressure, which may be accompanied by oliguria, azotemia and, in rare cases, acute renal failure and even death. Treatment of such patients with Akkuzidom should begin under close medical supervision and supervision during the first 2 weeks and with an increase in the dose of the drug. In rare cases, therapy with ACE inhibitors may be accompanied by the development of agranulocytosis and suppression of bone marrow hematopoiesis in patients with uncomplicated arterial hypertension, but more often in patients with impaired renal function, especially with connective tissue diseases. In these cases, the number of leukocytes in the blood should be monitored. Thiazide diuretics sometimes cause exacerbation of SLE.
There is no information about Accuzide overdose in the process of treating people. The main clinical manifestations of hydrochlorothiazide mototherapy are symptoms associated with electrolyte loss (hypokalemia, hypochloremia, hyponatremia), and dehydration due to diuresis. With the concomitant use of drugs digitalis hypokalemia may increase heart arrhythmia.
Information about the specific treatment of quinapril / hydrochlorothiazide overdose is not available. The effectiveness of hemodialysis and peritoneal dialysis is negligible. Symptomatic treatment.
- Brand name: Accuzide®
- Active ingredient: Hydrochlorothiazide, Quinapril
- Dosage form: pills, coated.
- Manufacturer: Pfizer
- Country of Origin: USA
- Simultaneous determination of hydrochlorothiazide, quinapril and quinaprilat in human plasma by liquid chromatography-tandem mass spectrometry
- Effect of quinapril, quinapril-hydrochlorothiazide, and enalapril on the bone mass of hypertensive subjects: relationship with angiotensin converting enzyme polymorphisms
- Efficacy and safety of the quinapril-hydrochlorothiazide combination on ambulatory blood pressure profiles
- Comparison of quinapril and atenolol as single drugs or in combination with hydrochlorothiazide in moderate to severe hypertensives, using automated ambulatory monitoring.
- A validated stability-indicating LC method for simultaneous determination of quinapril and hydrochlorothiazide in pharmaceutical samples
- Influence of the Renin Profile on the Blood Pressure Response to Different Doses of Hydrochlorothiazide plus either Quinapril or Captopril
- Quinapril + hydrochlorothiazide attenuates hypokalaemia
- Beneficial effects of add-on hydrochlorothiazide in rats with myocardial infarction optimally treated with quinapril
- Comparison of Stability-Indicating LC Methods Using Light Scattering and Photodiode Array Detection with Monolithic Column for Determination of Quinapril and Hydrochlorothiazide
- Controlled Multicenter Study with Quinapril, Hydrochlorothiazide, and Combination in Patients with Moderate to Severe Hypertension
- Antihypertensive Effect of Low-Dose Hydrochlorothiazide Alone or in Combination with Quinapril in Black Patients with Mild to Moderate Hypertension
- Quinapril, hydrochlorothiazide, and combination in patients with moderate to severe hypertension
- Simultaneous densitometric determination of quinapril and hydrochlorothiazide in the combination tablets
- Continuous wavelet transform and chemometric methods for quantitative resolution of a binary mixture of quinapril and hydrochlorothiazide in tablets