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Uses

Hypertension

Management of hypertension (alone or in combination with other classes of antihypertensive agents).

One of several preferred initial therapies in hypertensive patients with heart failure, postmyocardial infarction, high coronary disease risk, diabetes mellitus, chronic renal failure, and/or cerebrovascular disease.

Can be used as monotherapy for initial management of uncomplicated hypertension; however, thiazide diuretics are preferred by JNC 7.

CHF

Management of symptomatic CHF, usually in conjunction with cardiac glycosides, diuretics, and β-adrenergic blocking agents.

Diabetic Nephropathy

A first-line agent in the treatment of diabetic nephropathy† in hypertensive patients with type 2 diabetes mellitus.

Dosage and Administration

General

Hypertension

• Quinapril/hydrochlorothiazide fixed combinations should not be used for initial treatment of hypertension.

Administration

Oral Administration

Administer orally once or twice daily.

Manufacturer makes no specific recommendation regarding administration of quinapril with meals; administer quinapril/hydrochlorothiazide fixed combinations without regard to meals. (See Food under Pharmacokinetics.)

Dosage

Available as quinapril hydrochloride; dosage expressed in terms of quinapril.

Pediatric Patients

Hypertension

Oral

Some experts recommend an initial dosage of 5–10 mg once daily. Increase dosage as necessary to a maximum dosage of 80 mg once daily.†

Adults

Hypertension

Oral

Initially, 10 or 20 mg once daily as monotherapy. Adjust dosage at ≥2-week intervals to achieve BP control.

In patients currently receiving diuretic therapy, discontinue diuretic, if possible, 2–3 days before initiating quinapril. May cautiously resume diuretic therapy if BP not controlled adequately with quinapril alone. If diuretic cannot be discontinued, increase sodium intake and initiate quinapril at 5 mg daily under close medical supervision for several hours and until BP has stabilized.

Usual dosage: 20–80 mg daily, given in 1 dose or 2 divided doses.

If effectiveness diminishes toward end of dosing interval in patients treated once daily, consider increasing dosage or administering drug in 2 divided doses.

Quinapril/Hydrochlorothiazide Combination Therapy

Oral

If BP is not adequately controlled by monotherapy with quinapril or hydrochlorothiazide, can switch to the fixed-combination preparation containing quinapril 10 mg and hydrochlorothiazide 12.5 mg or, alternatively, quinapril 20 mg and hydrochlorothiazide 12.5 mg. Adjust dosage of either or both drugs according to patient’s response.

If BP is controlled by monotherapy with hydrochlorothiazide 25 mg daily but potassium loss is problematic, can switch to fixed-combination preparation containing quinapril 10 mg and hydrochlorothiazide 12.5 mg or, alternatively, quinapril 20 mg and hydrochlorothiazide 12.5 mg.

If BP is controlled with quinapril 20 mg and hydrochlorothiazide 25 mg (administered separately) and if no clinically important electrolyte disturbance is observed, can switch to the fixed-combination preparation containing these corresponding doses for convenience.

CHF

Oral

Initially, 5 mg twice daily. Monitor closely for ≥2 hours until BP has stabilized. To minimize risk of hypotension, reduce diuretic dosage, if possible.

Adjust dosage at weekly intervals to reach usual dosage.

Usual dosage: 20–40 mg daily, given in 2 equally divided doses.

Prescribing Limits

Pediatric Patients

Hypertension

Oral

Maximum 80 mg daily.†

Special Populations

Dosage in Renal Impairment

Hypertension

Oral

Initially, 10 mg once daily in adults with Cl_cr >60 mL/minute; 5 mg once daily in those with Cl_cr 30–60 mL/minute; or 2.5 mg once daily in those with Cl_cr 10–30 mL/minute. Titrate at 2-week intervals until BP is controlled. (See Renal Impairment under Cautions.)

Quinapril/hydrochlorothiazide fixed combinations are not recommended in patients with severe renal impairment (Cl_cr ≤30 mL/minute or S_cr >3 mg/dL).

CHF

Oral

Initially (first day), 5 mg in patients with moderate renal impairment (Cl_cr >30 mL/minute) or 2.5 mg in patients with severe renal impairment (Cl_cr 10–30 mL/minute) under close medical supervision. If well tolerated, administer as twice-daily regimen on subsequent days. Titrate at weekly intervals based on clinical and hemodynamic response.

Geriatric Patients

Hypertension

Oral

Initially, 10 mg once daily as monotherapy. Adjust dosage at ≥2-week intervals to achieve BP control.