Quinapril

ACCUPRIL

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Pronunciation: KWIN-a-pril

Quinapril ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Quinapril ballicule

Quinapril ACCUPRIL mascot mnemonic cartoon — Visual mnemonic: Quinapril mascot
**“Queen April’s Acumen”**
Easter/April theme → ACE inhibitor = -pril (aPril)
Bananas in bunches → ↑ serum potassium

What it isACE inhibitor; hypertension and heart failure.

Why this oneLong-acting once-daily prodrug with the class renal benefit.

What limits itCough, hyperkalemia and the hemodynamic creatinine rise. Contraindicated in pregnancy; tetracycline absorption is reduced by its magnesium content.

Quinapril molecular structure (skeletal formula) — Molecular structure: Quinapril

FDA-approved for

hypertension (1991)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Fetal toxicity — discontinue as soon as pregnancy is detected.

FDA dosing	Population	Start	Target	Max
Hypertension	Adults	10 or 20 mg QD (5 mg if on a diuretic)	20-80 mg/day QD or divided BID	80 mg/day
Hypertension	Elderly (>=65 y)	10 mg QD	titrate to response	80 mg/day
Heart failure (adjunct to diuretics/digitalis)	Adults	5 mg BID	20-40 mg/day divided BID

Titration Hypertension: adjust at intervals of at least 2 weeks. Heart failure: titrate at weekly intervals.

Renal Reduce initial dose by CrCl: >60 mL/min 10 mg; 30-60 mL/min 5 mg; 10-30 mL/min 2.5 mg; <10 mL/min insufficient data

Hepatic Undefined

Instructions

If on a diuretic, discontinue it 2-3 days before starting if possible; otherwise start 5 mg with close monitoring until BP stabilizes

Available strengths

tab 5, 10, 20, 40 mg

Contraindications

History of angioedema related to previous ACE inhibitor therapy
Combination with a neprilysin inhibitor (e.g., sacubitril); do not give within 36 h of switching to/from sacubitril/valsartan
Co-administration with aliskiren in patients with diabetes

Cautions

Fetal toxicity — discontinue when pregnancy detected
Angioedema
Symptomatic hypotension, especially with concomitant diuretics
Hyperkalemia
Impaired renal function

Adverse reactions

Headache, dizziness, fatigue, cough, nausea/vomiting, abdominal pain

Pregnancy Fetal toxicity — drugs acting on the renin-angiotensin system can cause injury/death to the developing fetus; discontinue as soon as pregnancy is detected (boxed warning).

Lactation Undefined

Cost

Quinapril (ACCUPRIL)

Strength		#/mo	CostPlus
5 mg	tab	30 qd	not offered
10 mg	tab	30 qd	not offered
20 mg	tab	30 qd	not offered
40 mg	tab	30 qd	not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Quinapril is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Generic entry2004

⚠ BOXED WARNING

Fetal toxicity

Principal riskAngioedema and hyperkalemia

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk4 / 4

Legacy pregnancy categoryD

Defining liabilityHyperkalemia, kidney injury, angioedema, fetal toxicity and increased lithium exposure.

Active metabolites

Quinaprilat

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Memory aids: interaction avatars

Box: minimal PK interactions

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