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Quinapril and Hydrochlorothiazide (Accuretic) - Uses, Dose, MOA

Angiotensin converting enzyme inhibitors and thiazide diuretics are combined in the medication quinapril and hydrochlorothiazide (Accuretic). It is applied in the treatment of hypertensive patients.

Quinapril and hydrochlorothiazide Uses:

Hypertension:
- Used in management of hypertension but not as initial therapy

Quinapril and Hydrochlorothiazide (Accuretic) Dose in Adults

Quinapril and Hydrochlorothiazide (Accuretic) Dose in the treatment of Hypertension:

Oral: Note: Not for initial therapy. Volume and/or salt depletion states should be corrected before starting therapy.
Replacement therapy:
- For individually titrated drugs, a combination product may be used in their place.
Initiation of combination therapy when monotherapy has failed to achieve desired effects:
- Patients who do not respond sufficiently to quinapril monotherapy or who do so adequately but experience considerable potassium loss while taking hydrochlorothiazide 25 mg daily
- Initial: Quinapril 10 mg/hydrochlorothiazide 12.5 mg or quinapril 20 mg/hydrochlorothiazide 12.5 mg in an OD dose; the dosage may be changed after 2 to 3 weeks of starting the therapy dependent on blood pressure response.
- Quinapril 5 to 40 mg/hydrochlorothiazide 6.25 to 25 mg OD for maintenance.

Dose in Children:

Not indicated.

Pregnancy Risk Factor D

[US Boxed Warning]Drugs that affect the renin angiotensin system may cause fetal injury or death.
Use should be stopped immediately after a female becomes pregnant.
You can also contact individual agents.

Use during breastfeeding:

Breast milk contains thiazide and quinapril diuretics.
The manufacturer recommends that the mother decide whether to breastfeed or discontinue the drug.
This is in consideration of the potential for serious adverse reactions.

Dose in Kidney Disease:

CrCl >30 mL/minute/1.73 m2 or serum creatinine ≤3 mg/dL: Dosage adjustment not necessary.
CrCl ≤30 mL/minute/1.73 m2 or serum creatinine >3 mg/dL: Not recommended for use.

Dose in Liver disease:

No dosage adjustments provided in the manufacturer's labeling (has not been studied); use cautiously.

Side Effects of Quinapril and Hydrochlorothiazide (Accuretic):

Central Nervous System:
- Dizziness
- Drowsiness
Neuromuscular & Skeletal:
- Weakness
Renal:
- Increased Blood Urea Nitrogen
- Increased Serum Creatinine
Respiratory:
- Cough
- Bronchitis

Contraindications to Quinapril and Hydrochlorothiazide (Accuretic):

Hypersensitivity to any ingredient in the formulation, including quinapril, hydrochlorothiazide, medications derived from sulfonamides, or both
Angioedema brought on by ACE inhibitor medication in the past
use of aliskiren concurrently in diabetic individuals
Using a neprilysin inhibitor concurrently or within 36 hours of moving to or from one (such as sacubitril)
Anuria.

There is little information on the interactions of ACE inhibitors, thiazides, and similar diuretics with allergens.

Cross-sensitivity is possible, however, as the chemical structure and/or the pharmacologic effects are similar.

Canadian labeling: Additional contraindications not in US labeling

Pediatric patients under 6 years
Children aged 6-16 years old with severe renal impairment (GFR 60mL/minute/1.73m).
Planning for conception or pregnancy
Women who are pregnant or have not used adequate contraception in the past three years.
Breastfeeding
In patients with moderate or severe renal impairment (GFR 60 mL/minute/1.73 m), hyperkalemia (5 mmol/L), hypotensive heart failure, or hypotension, use aliskiren, angiotensin-receptor blockers (ARBs), and other ACE inhibitors together.
concomitant use of ARBs and other ACE inhibitors in diabetic individuals with end-organ damage
Galactose intolerance patients
Lapp lactase deficiency
Glucose-galactose malabsorption syndromes

Warnings and precautions

Angioedema
- At any point of the therapeutic process, ACE inhibitors can result in angioedema. It may impact the intestine, head and neck, which could compromise your airway (presenting as abdominal pain).
- Long-term monitoring is necessary for any obstructions in the tongue, glottis or larynx.
- Previous airway surgery increases the obstruction risk.
- Angioedema risk is higher in black patients, patients suffering from idiopathic angioedema or hereditary angioedema and patients who have received ACE inhibitor therapy, combination therapy with m-tor inhibitor (eg everolimus), dipeptidyl peptidase-4 inhibitors (eg sitagliptin) or a neprilysin inhibit (eg sacubitril).
- It is crucial to manage the situation in a responsible manner.
- It is not recommended for usage in those with genetic angioedema, idiopathic angioedema, or a history of angioedema brought on by ACE inhibitors.
Cholestatic jaundice
- ACE inhibitors may cause hepatic fulminant neoplasm, which can lead to cholestatic jaundice. If there is an increase in hepatic transaminases and jaundice, therapy should be stopped.
Cough:
- Initial treatment with ACE inhibitors results in a dry, persistent cough that usually disappears within a month.
- Before stopping the drug, it is important to rule out other conditions like pulmonary congestion in patients suffering from heart failure.
Electrolyte disturbances:
- ACE inhibitors can cause hyperkalemia. Renal impairment, diabetes mellitus, renal impairment, and concomitant potassium-sparing diuretics and potassium supplements may also increase the risk.
- Use caution and strict supervision if you have to.
- Hypokalemia, hypochloremic acidosis, hypomagnesemia, and hyponatremia can all be brought on by thiazide diuretics.
- Hypokalemia can be caused by cirrhosis, brisk urisis, and concomitant potassium-lowering medications.
Gout
- Hydrochlorothiazide may cause gout in some patients who have a history of gout or are at risk of developing it.
- Doses greater than 25 mg pose an increased risk
Hematologic effects
- Agranulocytosis, anaemia, thrombocytopenia, neutropenia, and myeloid hypoplasia have all been linked to captopril, another ACE inhibitor.
- Patients with renal impairment or collagen vascular disease, eg systemic lupus-erythematosus, are at significantly higher risk for neutropenia.
- These patients require regular CBC monitoring.
Hypersensitivity reactions
- ACE inhibitors can result in anaphylactic/anaphylactoid reactions.
- Anaphylactic reactions can occur during hemodialysis using high-flux dialysis membranes (eg polyacrylonitrile) and, rarely, during low density lipoprotein apheresis using dextran sulfatecellulose.
- Anaphylactoid reactions have been rare in patients who are subject to sensitization with Hymenoptera (bee or wasp) venom and receive ACE inhibitors.
Hypotension/syncope
- Hypotension and syncope can be caused by ACE inhibitors.
- Hypovolemia can increase the risk, so volume correction before beginning treatment is recommended.
- BP monitoring is important throughout therapy, particularly when dose escalation is involved.
- Hypotension should not be considered a reason to discontinue future ACE inhibitor treatment, especially for patients with heart disease. However, a reduction of systolic pressure might be desirable.
- It should not be used in patients with hemodynamic instability after acute MI.
Ocular effects
- Acute angle-closure glaucoma or acute transitory myopia can both be brought on by hydrochlorothiazide. Within hours to weeks of the start, it can happen. Patients with significant discomfort or vision problems need to cease using it right away.
- A history of penicillin or sulfonamide allergies is one of the risk factors.
- Additional treatment may be required if the intraocular pressure is not controlled.
Photosensitivity
- There may be photosensitization.
Renal function deterioration:
- This can cause an increase in serum creatinine.
- Patients with low renal blood flow, such as those suffering from oliguria or acute renal failure, can experience complications like progressive azotemia and renal dysfunction.
- A significant impairment in renal function should not be considered a reason to stop taking the drug.
Allergy to sulfonamide ("sulfa")
- FDA-approved product labels for medications that are part of the sulfonamide chemical family include a wide contraindication for patients who have had an allergic reaction to sulfonamides.
- Members of one class may exhibit cross-reactivity with one another (eg 2 antibiotic sulfonamides).
- Crossreactivity concerns have been raised for all compounds with the sulfonamide structural.
- A deeper understanding of allergic mechanisms has shown that cross-reactivity between non-antibiotic sulfonamides and antibiotic sulfonamides is unlikely.
- Nonantibiotic sulfonamides are less likely to cause anaphylaxis (a mechanism of cross-reaction due primarily to antibody production).
- Type IV T-cell-mediated responses are less well understood. This makes it challenging to rule out the idea using our existing understanding.
- These classes are sometimes avoided by some clinicians in severe cases of reactions (Stevens Johnson syndrome/TEN).
Insufficiency of the adrenals:
- Patients with primary adrenal disease (Addison disease) should avoid diuretics for elevated blood pressure.
- To manage hypertension, it is preferable to modify glucocorticoid/mineralocorticoid therapy and/or employ alternative antihypertensive medications.
Aortic stenosis
- Patients with aortic Stenosis may experience decreased coronary perfusion, which can lead to ischemia.
Bariatric surgery
- Avoid diuretics for the first 24 hours following bariatric surgery to prevent dehydration. Dehydration and electrolyte imbalances are possible side effects.
- Once the targets for oral fluid intake have been reached, diuretics may be started again if necessary.
Cardiovascular disease
- Hypotension can occur in people with ischemic heart disease, cerebrovascular illness, or heart failure. As a result, it is crucial to be carefully watched.
- Once the fluid replacement has been completed, therapy can be resumed.
- Patients with hypotension recurrence should stop therapy.
Collagen vascular disease:
- Collagen vascular disease, especially when combined with renal impairment, can increase the risk of hematological toxicities. Therefore, caution should be taken.
Diabetes:
- Patients with diabetes mellitus or prediabetes should not use hydrochlorothiazide as it can affect their glycemic control.
Hepatic impairment
- LFTs must be examined before starting therapy.
- Patients with severe hepatic impairment shouldn't use it.
Hypercalcemia:
- Thiazide diuretics may decrease renal calcium excretion; patients with hypercalcemia should avoid their use.
Hypercholesterolemia:
- Patients with high or moderate cholesterol levels should not take hydrochlorothiazide.
Hypertrophic cardiomyopathy and outflow tract obstruction
- Reduced afterload can worsen hypertrophic cardiomyopathy symptoms and cause outflow obstruction. Therefore, it is important to use extreme caution.
Parathyroid disease
- Thiazide diuretics reduce calcium excretion; prolonged use can cause pathologic changes in parathyroid glands, including hypophosphatemia and hypercalcemia.
- Stop using thiazide before testing for parathyroid function.
Renal artery stenosis
- Patients with unstented unilateral/bilateral stenosis of the renal arteries should not take lisinopril.
- This should be avoided in the case of unstented bilateral kidney artery stenosis.
- There is a higher risk of renal dysfunction and it should not be used unless there are potential benefits.
Renal impairment
- Side effects can be more severe in those with renal impairment.
Systemic lupus, erythematosus
- Thiazides may be able to exacerbate or activate systemic lupus.

Quinapril and hydrochlorothiazide : Drug Interaction

Risk Factor C (Monitor therapy)
Ajmaline	Sulfonamides might make ajmaline more harmful or poisonous. In particular, there may be an elevated risk for cholestasis.
Alcohol (Ethyl)	Increases the effectiveness of thiazide and thiazide-like diuretics in lowering orthostatic blood pressure.
Alfuzosin	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Aminolevulinic Acid (Topical)	Aminolevulinic Acid's photosensitizing impact may be enhanced by photosensitizing agents (Topical).
Amphetamines	May lessen the effectiveness of antihypertensive agents.
Angiotensin II	The therapeutic efficacy of angiotensin II may be enhanced by angiotensin-converting enzyme inhibitors
Angiotensin-Converting Enzyme Inhibitors	Angiotensin-Converting Enzyme Inhibitors' hypotensive effects may be enhanced by thiazide and thiazide-like diuretics. Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be increased by thiazide and thiazide-like diuretics.
Anticholinergic Agents	May raise the levels of thiazide and thiazide-like diuretics in the blood.
Antidiabetic Agents	The therapeutic value of anti-diabetic agents may be diminished by thiazide and thiazide-like diuretics.
Antidiabetic Agents	The therapeutic benefit of anti-diabetic agents may be reduced by hyperglycemia-associated agents.
Antipsychotic Agents (Second Generation [Atypical])	Antipsychotic drugs' hypotensive effects may be enhanced by blood pressure-lowering medications (Second Generation [Atypical]).
Aprotinin	May lessen the effectiveness of angiotensin-converting enzyme inhibitors in treating hypertension.
AzaTHIOprine	AzaTHIOprine's myelosuppressive effects may be enhanced by angiotensin-converting enzyme inhibitors.
Barbiturates	Increases the effectiveness of thiazide and thiazide-like diuretics in lowering orthostatic blood pressure.
Barbiturates	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Benazepril	Benazepril's hypotensive impact may be strengthened by hydrochlorothiazide.
Benperidol	Benazepril may have a more nephrotoxic effect when combined with hydrochlorothiazide. Benazepril may lower the level of HydroCHLOROthiazide in the blood.
Beta2-Agonists	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Brigatinib	May lessen the effectiveness of antihypertensive agents. Antihypertensive Agents' bradycardic action may be strengthened by brutinib.
Brimonidine (Topical)	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Calcium Salts	Thiazide and Thiazide-Like Diuretics may decrease the excretion of Calcium Salts. Continued concomitant use can also result in metabolic alkalosis.
CarBAMazepine	Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of CarBAMazepine. Specifically, there may be an increased risk for hyponatremia.
Cardiac Glycosides	Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Cardiac Glycosides. Specifically, cardiac glycoside toxicity may be enhanced by the hypokalemic and hypomagnesemic effect of thiazide diuretics.
Corticosteroids (Orally Inhaled)	May enhance the hypokalemic effect of Thiazide and ThiazideLike Diuretics.
Corticosteroids (Systemic)	May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics.
Cyclophosphamide	Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Cyclophosphamide. Specifically, granulocytopenia may be enhanced.
Dapoxetine	May enhance the orthostatic hypotensive effect of Angiotensin-Converting Enzyme Inhibitors.
Dexketoprofen	May enhance the adverse/toxic effect of Sulfonamides.
Dexmethylphenidate	May diminish the therapeutic effect of Antihypertensive Agents.
Diacerein	May enhance the therapeutic effect of Diuretics. Specifically, the risk for dehydration or hypokalemia may be increased.
Diazoxide	Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of Diazoxide.
Diazoxide	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Dipeptidyl Peptidase-IV Inhibitors	May enhance the adverse/toxic effect of AngiotensinConverting Enzyme Inhibitors. Specifically, the risk of angioedema may be increased.
Drospirenone	Angiotensin-Converting Enzyme Inhibitors may enhance the hyperkalemic effect of Drospirenone.
DULoxetine	Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine.
Eplerenone	May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors.
Everolimus	May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. Specifically, the risk of angioedema may be increased.
Ferric Gluconate	Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Ferric Gluconate.
Ferric Hydroxide Polymaltose Complex	Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Ferric Hydroxide Polymaltose Complex. Specifically, the risk for angioedema or allergic reactions may be increased.
Gelatin (Succinylated)	Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Gelatin (Succinylated). Specifically, the risk of a paradoxical hypotensive reaction may be increased.
Gold Sodium Thiomalate	Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Gold Sodium Thiomalate. An increased risk of nitritoid reactions has been appreciated.
Heparin	May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors.
Heparins (Low Molecular Weight)	May enhance the hyperkalemic effect of AngiotensinConverting Enzyme Inhibitors.
Herbs (Hypertensive Properties)	May diminish the antihypertensive effect of Antihypertensive Agents.
Herbs (Hypotensive Properties)	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Hypotension-Associated Agents	Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents.
Icatibant	May diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors.
Ipragliflozin	May enhance the adverse/toxic effect of Thiazide and Thiazide-Like Diuretics. Specifically, the risk for intravascular volume depletion may be increased.
Ivabradine	Thiazide and Thiazide-Like Diuretics may enhance the arrhythmogenic effect of Ivabradine.
Levodopa-Containing Products	Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Containing Products.
Licorice	May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics.
Loop Diuretics	May enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors. Loop Diuretics may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors.
Lormetazepam	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Methylphenidate	May diminish the antihypertensive effect of Antihypertensive Agents.
Molsidomine	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Multivitamins/Fluoride (with ADE)	May enhance the hypercalcemic effect of Thiazide and Thiazide-Like Diuretics.
Multivitamins/Minerals (with ADEK, Folate, Iron)	Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Multivitamins/Minerals (with ADEK, Folate, Iron).
Multivitamins/Minerals (with AE, No Iron)	Thiazide and Thiazide-Like Diuretics may increase the serum concentration of Multivitamins/Minerals (with AE, No Iron). Specifically, thiazide diuretics may decrease the excretion of calcium, and continued concomitant use can also result in metabolic alkalosis.
Naftopidil	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Neuromuscular-Blocking Agents (Nondepolarizing)	Thiazide and Thiazide-Like Diuretics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents (Nondepolarizing).
Nicergoline	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Nicorandil	May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors.
Nicorandil	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Nitroprusside	Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside.
Nonsteroidal Anti-Inflammatory Agents	Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the combination may result in a significant decrease in renal function. Nonsteroidal Anti-Inflammatory Agents may diminish the antihypertensive effect of Angiotensin-Converting Enzyme Inhibitors.
Nonsteroidal Anti-Inflammatory Agents	Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Nonsteroidal Anti-Inflammatory Agents. Nonsteroidal Anti-Inflammatory Agents may diminish the therapeutic effect of Thiazide and Thiazide-Like Diuretics.
Opioid Agonists	May enhance the adverse/toxic effect of Diuretics. Opioid Agonists may diminish the therapeutic effect of Diuretics.
Oxcarbazepine	Thiazide and Thiazide-Like Diuretics may enhance the adverse/toxic effect of OXcarbazepine. Specifically, there may be an increased risk for hyponatremia.
Pentoxifylline	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Pholcodine	Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine.
Phosphodiesterase 5 Inhibitors	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Porfimer	Photosensitizing Agents may enhance the photosensitizing effect of Porfimer.
Potassium Salts	May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors.
Potassium-Sparing Diuretics	May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors.
Pregabalin	Angiotensin-Converting Enzyme Inhibitors may enhance the adverse/toxic effect of Pregabalin. Specifically, the risk of angioedema may be increased.
Prostacyclin Analogues	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Quinagolide	May enhance the hypotensive effect of Blood Pressure Lowering Agents.
Racecadotril	May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors. Specifically, the risk for angioedema may be increased with this combination.
Ranolazine	May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors.
Reboxetine	May enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics.
Salicylates	May enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors. Salicylates may diminish the therapeutic effect of Angiotensin-Converting Enzyme Inhibitors.
Selective Serotonin Reuptake Inhibitors	May enhance the hyponatremic effect of Thiazide and Thiazide-Like Diuretics.
Sirolimus	May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors.
Tacrolimus (Systemic)	Angiotensin-Converting Enzyme Inhibitors may enhance the hyperkalemic effect of Tacrolimus (Systemic).
Temsirolimus	May enhance the adverse/toxic effect of Angiotensin-Converting Enzyme Inhibitors.
Thiazide and Thiazide-Like Diuretics	May enhance the hypotensive effect of AngiotensinConverting Enzyme Inhibitors. Thiazide and Thiazide-Like Diuretics may enhance the nephrotoxic effect of Angiotensin-Converting Enzyme Inhibitors.
TiZANidine	May enhance the hypotensive effect of Angiotensin-Converting Enzyme Inhibitors.
Tolvaptan	May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors.
Toremifene	Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Toremifene.
Trimethoprim	May enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors.
Verteporfin	Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin.
Vitamin D Analogs	Thiazide and Thiazide-Like Diuretics may enhance the hypercalcemic effect of Vitamin D Analogs.
Yohimbine	May lessen the effectiveness of antihypertensive agents.
Risk Factor D (Consider therapy modification)
Aliskiren	Angiotensin-Converting Enzyme Inhibitors may intensify their hyperkalemic effects. Angiotensin-Converting Enzyme Inhibitors' hypotensive effects may be strengthened by aliskiren. Angiotensin-Converting Enzyme Inhibitors' nephrotoxic effects may be made worse by aliskiren. Treatment: It is not advised for diabetic patients to take aliskiren along with ACEIs or ARBs. Combination therapy should be avoided in other patients, especially when CrCl is less than 60 mL/min. If combined, keep a close eye on your blood pressure, potassium, and creatinine levels.
Allopurinol	Angiotensin-Converting Enzyme Inhibitors might make Allopurinol more likely to cause allergic or hypersensitive reactions.
Amifostine	Amifostine's hypotensive impact may be strengthened by blood pressure lowering medications. Treatment: Blood pressure-lowering drugs need to be avoided for 24 hours before amifostine is administered when used at chemotherapeutic doses.
Angiotensin II Receptor Blockers	May worsen angiotensin-converting enzyme inhibitors' toxic or severe effects. Angiotensin-Converting Enzyme Inhibitors' serum levels may rise in response to angiotensin II receptor blockers. Management: Use of telmisartan and ramipril is not advised according to US labelling. It is unclear whether another ACE inhibitor and ARB combo would be any safer. When possible, take into account alternatives to the mix.
Bile Acid Sequestrants	The absorption of thiazide and thiazide-like diuretics may be reduced. Also reduced is the diuretic reaction.
Grass Pollen Allergen Extract (5 Grass Extract)	Grass pollen allergen extract may have a more negative or toxic effect if angiotensin-converting enzyme inhibitors are used (5 Grass Extract). With regard to grass pollen allergen extract, ACE inhibitors may specifically enhance the likelihood of a severe allergic reaction (5 Grass Extract).
Iron Dextran Complex	Angiotensin-Converting Enzyme Inhibitors might make Iron Dextran Complex more harmful or poisonous. Patients taking an ACE inhibitor may be more susceptible to events of the anaphylactic variety. Management: Adhere strictly to the instructions for iron dextran administration, including the use of a test dose before the initial therapeutic dose and the availability of resuscitation tools and qualified people.
Lanthanum	May lower angiotensin-converting enzyme inhibitors' serum concentration. Angiotensin-converting enzyme inhibitors should be given at least two hours before or after lanthanum.
Lithium	The excretion of lithium may be reduced by thiazide and thiazide-like diuretics.
Lithium	The serum concentration of lithium may rise in response to angiotensin-converting enzyme inhibitors. Management: After adding an ACE inhibitor, lithium dosage decreases will probably be required. Following the addition or discontinuation of concurrent ACE inhibitor therapy, carefully monitor the patient's response to lithium.
Obinutuzumab	The hypotensive effects of blood pressure-lowering medications may be strengthened.
Quinolones	Quinolone serum levels may be reduced with quinapril. Treatment: To lessen the possibility of an interaction, provide oral quinolones and quinapril at least two hours apart. If both of these medicines are administered at the same time, keep an eye out for any quinolone efficacy reduction. Exceptions: LevoFLOXacin (Oral Inhalation) (Oral Inhalation).
Sodium Phosphates	The nephrotoxic impact of sodium phosphates may be enhanced by angiotensin-converting enzyme inhibitors. In particular, there may be an increased risk of acute phosphate nephropathy. Treatment: You might want to temporarily stop taking ACEIs or look into alternatives to the oral sodium phosphate bowel preparation in order to prevent this combo. Maintaining appropriate hydration and properly monitoring renal function should be done if the combination cannot be avoided.
Sodium Phosphates	The nephrotoxic effects of sodium phosphates may be increased by diuretics. In particular, there may be an increased risk of acute phosphate nephropathy. Treatment: You might want to temporarily stop taking diuretics or look for an alternative to the oral sodium phosphate bowel preparation in order to prevent this combo. If the combination cannot be avoided, drink well and keep an eye on your kidney and fluid levels.
Tetracyclines	Tetracyclines' serum levels may drop when using quinapril. To lessen the possibility of an interaction, quinapril and oral tetracycline derivative dosages should be separated by at least two hours. If these products are administered concurrently, keep an eye out for any tetracycline efficacy reduction. Exceptions: Eravacycline.
Topiramate	The hypokalemic impact of topiramate may be enhanced by thiazide and thiazide-like diuretics. The blood concentration of topiramate may rise in response to thiazide and thiazide-like diuretics. When using a thiazide diuretic, monitor for elevated topiramate levels and any negative consequences (such as hypokalemia). Serum potassium levels should be closely watched when receiving concurrent treatment. There may be a need to lower topiramate dosage.
Urapidil	Angiotensin-Converting Enzyme Inhibitors may interact with them through an unidentified method. Avoid taking urapidil and ACE inhibitors simultaneously as a management strategy.
Risk Factor X (Avoid combination)
Aminolevulinic Acid (Systemic)	Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic).
Bromperidol	Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents.
Dofetilide	HydroCHLOROthiazide may enhance the QTc-prolonging effect of Dofetilide. HydroCHLOROthiazide may increase the serum concentration of Dofetilide.
Levosulpiride	Thiazide and Thiazide-Like Diuretics may intensify Levosulpiride's negative/toxic effects.
Mecamylamine	Sulfonamides may intensify Mecamylamine's harmful or hazardous effects.
Promazine	Promazine's ability to prolong QTc may be enhanced by thiazide and thiazide-like diuretics.
Sacubitril	The negative or hazardous effects of sacubitril may be increased by angiotensin-converting enzyme inhibitors. In particular, this combination may raise the risk of angioedema.

Monitoring parameters:

Blood pressure
BUN, serum creatinine, and electrolytes
CBC

How to administer Quinapril and Hydrochlorothiazide (Accuretic)?

Administer without relation to a meal.

Mechanism of action of Quinapril and Hydrochlorothiazide (Accuretic):

Quinapril:

It functions as an inhibitor of the angiotensin-converting enzyme that is competitive (ACE).
This results in a drop in angiotensin II, which raises plasma renin activity and lowers the synthesis of aldosterone.
It also prevents angiotensin I from angiotensin III (a powerful vasoconstrictor).
Angiotensin II may increase adrenergic output from the CNS. This could explain why there is a hypotensive effect.
The vasoactive kallikreins in active hormone conversion by ACE inhibitors are reduced, resulting in lower blood pressure.

Hydrochlorothiazide:

increases excretion of water, sodium, and potassium ions by preventing sodium reabsorption in distal tubules.

See individual agents.

International Brand Names of Quinapril and hydrochlorothiazide:

Accuretic
Accumax-Co
Accupro Comp
Accuzide
Acuilix
Acuretic
Koretic

Quinapril and hydrochlorothiazide Brand Names in Pakistan:

No Brands Available in Pakistan.

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Quinapril and Hydrochlorothiazide (Accuretic) - Uses, Dose, MOA

Quinapril and hydrochlorothiazide Uses:

Hypertension:

Quinapril and Hydrochlorothiazide (Accuretic) Dose in Adults

Quinapril and Hydrochlorothiazide (Accuretic) Dose in the treatment of Hypertension:

Replacement therapy:

Initiation of combination therapy when monotherapy has failed to achieve desired effects:

Dose in Children:

Pregnancy Risk Factor D

Use during breastfeeding:

Dose in Kidney Disease:

Dose in Liver disease:

Side Effects of Quinapril and Hydrochlorothiazide (Accuretic):

Central Nervous System:

Neuromuscular & Skeletal:

Renal:

Respiratory:

Contraindications to Quinapril and Hydrochlorothiazide (Accuretic):

Warnings and precautions

Angioedema

Cough:

Electrolyte disturbances:

Gout

Hematologic effects

Hypersensitivity reactions

Hypotension/syncope

Ocular effects

Photosensitivity

Renal function deterioration:

Insufficiency of the adrenals:

Aortic stenosis

Bariatric surgery

Cardiovascular disease

Collagen vascular disease:

Diabetes:

Hepatic impairment

Hypercalcemia:

Hypercholesterolemia:

Hypertrophic cardiomyopathy and outflow tract obstruction

Parathyroid disease

Renal artery stenosis

Renal impairment

Systemic lupus, erythematosus

Monitoring parameters:

How to administer Quinapril and Hydrochlorothiazide (Accuretic)?

Mechanism of action of Quinapril and Hydrochlorothiazide (Accuretic):

International Brand Names of Quinapril and hydrochlorothiazide:

Quinapril and hydrochlorothiazide Brand Names in Pakistan:

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