Moexipril is an angiotensin-converting enzyme (ACE) inhibitor medication that is primarily used to treat high blood pressure (hypertension) and heart failure. ACE inhibitors like moexipril work by inhibiting the action of the angiotensin-converting enzyme, which is involved in the production of angiotensin II—a hormone that causes blood vessels to constrict and triggers the release of another hormone called aldosterone. Both of these effects contribute to increased blood pressure.

By inhibiting the production of angiotensin II, ACE inhibitors help relax and widen blood vessels, which leads to reduced blood pressure and decreased strain on the heart. This makes them useful in managing hypertension and heart failure.

Angiotensin-converting enzyme inhibitor moexipril (Cardiotensin) is used to treat adult patients with hypertension.

Moexipril (Cardiotensin) Uses:

• Hypertension:
  • Moexipril is used in the treatment of patients with hypertension

Guideline recommendations:

• In the absence of comorbidities (such as cerebrovascular disease, persistent kidney disease, diabetes, heart failure, ischemic heart disease, etc.), the 2017 Guideline for the Prevention, Detection, Evaluation, and Management of Hypertension in Adults suggests that thiazide-like diuretics or dihydropyridine calcium channel blockers may be preferable options due to improved cardiovascular endpoints (e.g., avoidance of heart failure and stroke).
• ARBs and ACE inhibitors are both appropriate for monotherapy.
• Combination therapy is usually preferred in patients at high risk (stage 2 hypertension or an atherosclerotic cardiovascular disease [ASCVD] risk of 10%) in order to achieve blood pressure targets.

Off Label Use of Moexipril in Adults:

• Non–ST-elevation acute coronary syndrome
• Stable coronary artery disease
• ST-elevation acute coronary syndrome

Read:

• Ramipril (Tritace)
• Lisinopril (Zestril)
• Enalapril (Epaned, Renitec)

Moexipril Dose in Adults:

Moexipril (Cardiotensin) Dose in the treatment of Hypertension:

• Start with: 3.75 to 7.5 mg once a day.
• Adjust the dose based on how the patient reacts.
• Maximum dose: 30 mg per day, which can be taken either once or split into two times a day. (According to ACC/AHA guidelines from 2017)

Moexipril Dose in Children:

It is not indicated in children with hypertension.

Pregnancy Risk Factor D

• Taking an ACE inhibitor like Moexipril during the first part of pregnancy can increase the chance of baby's health problems (ACOG 203 2019; ESC [RegitzZagrosek 2018]).
• Sometimes, the mom's health condition can also affect the baby (ACC/AHA [Whelton 2017]).
• Warning: These drugs can harm or even cause death to an unborn baby.
• Stop the drug if you find out you're pregnant.
• Such drugs can lead to issues like less fluid around the baby, which can harm their lungs and bones.
• It can also cause problems like low blood pressure, weak skull, and even death in babies.
• If a baby was exposed to these drugs before birth, they need to be checked for certain health issues.
• If a mom has high blood pressure for a long time, it can also harm the baby, leading to things like low weight at birth or being born too early.
• If a pregnant woman needs medicine for high blood pressure, ACE inhibitors should be the last option.
• Women who can have babies should be careful taking these drugs unless they use birth control (ADA 2019).
• If a woman is thinking about getting pregnant, these drugs should be avoided unless other treatments don't work (ACOG 203 2019).

Moexipril use during breastfeeding:

• We're not sure if moexipril gets into breast milk. If a breastfeeding mom is considering taking it, she should be careful and talk to her doctor.

Moexipril Dose in Kidney Disease:

• If your kidneys filter more than 40 mL/minute/1.73 m^2: The maker of the drug doesn't give special dose advice. So, use it carefully.
• If your kidneys filter 40 mL/minute/1.73 m^2 or less: Start with 3.75 mg per day. Don't take more than 15 mg in a day.

Moexipril Dose in Liver disease:

• The maker of the drug doesn't give special dosing advice for people with liver problems.
• But, if you have liver issues, the drug might stay in your system longer or be more potent.

Side Effects of Moexipril (Cardiotensin):

• Cardiovascular:
  • Flushing
  • Peripheral Edema
  • Hypotension
• Central Nervous System:
  • Dizziness
  • Fatigue
  • Headache
• Dermatologic:
  • Skin Rash
  • Alopecia
• Endocrine & Metabolic:
  • Hyperkalemia
  • Hyponatremia
• Gastrointestinal:
  • Heartburn
  • Nausea
  • Diarrhea
• Neuromuscular & Skeletal:
  • Myalgia
• Renal:
  • Increased Blood Urea Nitrogen (Reversible)
  • Increased Serum Creatinine (Reversible)
  • Polyuria
• Respiratory:
  • Pharyngitis
  • Sinusitis
  • Cough
  • Upper Respiratory Tract Infection

Contraindications to Moexipril (Cardiotensin):

• Don't use moexipril if:
  • You're allergic to it or any of its ingredients.
  • You've had swelling reactions (angioedema) from another ACE inhibitor.
  • You're taking aliskiren and have diabetes.
• Even though we don't have a lot of proof that people allergic to one ACE inhibitor will be allergic to others, it's possible because they're similar. So, be cautious.

Warnings and precautions

Angioedema

• There's a small chance of developing angioedema (swelling under the skin) when taking ACE inhibitors like moexipril. This can happen at any time, but it's especially important to watch out after the first dose.
• The swelling can happen in the face and neck, which can block your airway, or in the gut, causing belly pain.
• Some people, like African-Americans or those with a family history of angioedema, might have a higher chance of this.
• Taking certain other drugs, like everolimus, can also raise the risk.
• If the tongue, voice box, or windpipe are swollen, it's important to watch closely because it can block breathing.
• People who've had throat surgery before might be at a higher risk of breathing problems from this swelling.
• It's crucial to act quickly and get the right treatment if this happens.
• If someone had this swelling problem with an ACE inhibitor before, they shouldn't take moexipril.

Cholestatic jaundice

• A very rare side effect of ACE inhibitors is cholestatic jaundice, which is a type of liver problem where bile doesn't flow properly.
• This can get worse and lead to severe liver damage, and in some cases, it can be deadly.
• If there's a big increase in liver enzymes (a sign of liver damage) or if someone turns yellow (jaundice), the medication should be stopped right away.

Cough:

• A common side effect of ACE inhibitors is a dry, annoying cough. This usually starts within the first few months of taking the medicine.
• The good news is that this cough typically goes away 1 to 4 weeks after stopping the ACE inhibitor.
• But before deciding to stop the medicine because of the cough, make sure there aren’t other reasons for the cough, like lung problems, especially in people with heart issues.

Hyperkalemia:

• Taking ACE inhibitors can lead to high potassium levels in the blood, which is called hyperkalemia.
• People more at risk include those with kidney problems, diabetes, or those taking certain other medications or supplements that have potassium.
• If you're using ACE inhibitors alongside these other potassium sources, be very careful. It's a good idea to regularly check your potassium levels to stay safe.

Hypersensitivity reactions

• Taking ACE inhibitors can sometimes cause serious allergic reactions.
• People getting certain types of dialysis or blood treatments can have a strong reaction if they're also on ACE inhibitors. This is especially true for treatments using specific materials like AN69 or dextran sulfate cellulose.
• There have also been rare cases where people getting treatments for bee or wasp sting allergies had strong reactions while on ACE inhibitors.

Hypotension/syncope

• Taking ACE inhibitors can cause low blood pressure, which might make some people faint, especially after the first few doses.
• This happens more often in people who are already low on fluids in their body. So, it's good to fix that before starting the medicine.
• Patients need close watching, especially when starting the medicine or when the dose is increased.
• Even though the dose might need to be changed, low blood pressure isn't always a reason to stop the medicine completely. For people with heart failure, having a bit of a drop in blood pressure can actually be a good thing.

Neutropenia/agranulocytosis:

• An ACE inhibitor called captopril has been linked to rare cases where people have very low white blood cell counts. This condition makes it harder for the body to fight off infections.
• People with kidney problems have a higher chance of getting this side effect.
• If someone also has certain diseases like lupus on top of kidney problems, their risk is even higher.
• For these at-risk patients, doctors should regularly check their complete blood counts to keep an eye on their white blood cells.

Renal function deterioration:

• ACE inhibitors can sometimes affect kidney function, leading to increased levels of certain waste products in the blood.
• This is especially a concern for people who already have kidney issues, like narrowed kidney arteries or heart failure, which makes them rely heavily on certain mechanisms affected by the medicine.
• This kidney problem can cause reduced urine output, acute kidney failure, and buildup of waste in the blood.
• A small rise in a specific kidney marker (serum creatinine) might happen when starting the medicine. But you'd only think about stopping the medicine if there's a big and ongoing drop in kidney function.

Aortic stenosis

• Be careful when giving ACE inhibitors to people with a narrowed aorta (aortic stenosis).
• The medicine might lower blood flow to the heart, which can lead to a lack of oxygen to the heart muscle.

Ascites:

• Don't use ACE inhibitors in people with fluid buildup in their abdomen (ascites) from severe liver disease or when other treatments don't work.
• If you absolutely have to use the medicine in patients with liver-related fluid buildup, closely watch their blood pressure and kidney function to avoid quick kidney failure.

Cardiovascular disease

• Starting this medicine in people with heart or brain blood vessel problems needs close watching because a drop in blood pressure could lead to serious issues like a heart attack or stroke.
• If blood pressure drops too low, giving fluids might help. After that, the medicine might be continued.
• But if the low blood pressure happens again, the medicine should be stopped.

Collagen vascular disease:

• Be careful when giving this medicine to people with diseases that affect the body's connective tissues, especially if they also have kidney problems.
• They might have a higher risk of blood-related side effects.

Hypertrophic cardiomyopathy with outflow tract obstruction (HCM)

• Be careful when giving this medicine to people with a thickened heart muscle (HCM) that has a blockage.
• The medicine might make the symptoms of this condition worse.

Renal artery stenosis

• Be cautious when giving this medicine to people with narrowing in one or both kidney arteries.
• If both kidney arteries are narrowed and don't have stents, it's usually best to avoid this medicine. It has a high risk of hurting kidney function unless the potential benefits are really worth the risks.

Renal impairment

• Be careful when giving this medicine to people who already have kidney problems.
• They might need a different dose. Also, don't increase their dose quickly, as it might make their kidney condition worse.

Moexipril: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

• Blood Pressure: Regularly check it.
• Blood Tests: Keep an eye on BUN, serum creatinine, and potassium levels.
• Special Conditions: For those with diseases affecting connective tissues or kidney issues, also periodically check the complete blood count (CBC).

High Blood Pressure Guidelines (ACC/AHA [Whelton 2017]):

• High Risk Individuals: If you have confirmed high blood pressure with known heart diseases or a high 10-year risk:
  • Aim for a blood pressure below 130/80 mm Hg.
• Lower Risk Individuals: If you have high blood pressure without high-risk factors:
  • A target below 130/80 mm Hg might be good.

Diabetes & High Blood Pressure Guidelines (ADA 2019):

• Adults (18-65) with Low Risk: If you don't have heart diseases and have a 10-year risk below 15%:
  • Aim for a blood pressure below 140/90 mm Hg.
• Adults (18-65) with High Risk: If you have heart diseases or a high 10-year risk:
  • A target below 130/80 mm Hg might be good if it can be reached safely.
• Older Adults (Over 65) in Good or Average Health:
  • Aim for a blood pressure below 140/90 mm Hg.
• Older Adults (Over 65) in Poor Health:
  • Aim for a blood pressure below 150/90 mm Hg.

How to administer Moexipril (Cardiotensin)?

• Take it by mouth.
• Do this on an empty stomach, ideally 1 hour before eating.

Mechanism of action of Moexipril (Cardiotensin):

• It blocks the action of an enzyme called ACE.
• This stops the creation of angiotensin II, a substance that narrows blood vessels.
• With less angiotensin II, blood vessels relax, which also affects some hormones, causing less aldosterone to be released.

Starts Working:

• The effects begin within 2 hours of taking it.

Strongest Effect:

• It works its best between 3 to 6 hours after taking it.

Lasts:

• The effect remains for about 24 hours.

Getting Into the Body:

• Absorption: It's not fully absorbed after taking it.
• Distribution: In the body, there's a volume of about 183 liters where it spreads.
• Binding to Proteins: About 50% of it attaches to proteins in the blood.

Changes in the Body:

• Metabolism: It's a type of medicine that changes into another form in the body. This new form is called moexiprilat, and it's much stronger (about 1,000 times) in its effects.
• Bioavailability: When taken, only about 13% of it turns into moexiprilat that actually works. This amount is less if taken with food (about 70-80% decrease in effectiveness).

Time it Stays in the Body:

• Half-Life: The time it takes for half of the medicine to leave the body is about 1.3 hours for moexipril and 2 to 9.8 hours for moexiprilat.
• Time to Reach Highest Levels: Moexiprilat, the stronger form, reaches its peak level in the body around 1.5 hours after taking it.

Leaving the Body:

• Excretion: Moexiprilat mainly leaves the body through feces (about 52%) and to a smaller extent through urine (about 7%).

International Brand Names of Moexipril:

• Cardiotensin
• Femipres
• Fempress
• Minotensol
• Moex
• Perdix
• Renoprotect
• Univasc

Molindone Brand Names in Pakistan:

Not Available.