CLINICAL USE

Angiotensin-converting enzyme inhibitor:Hypertension

DOSE IN NORMAL RENAL FUNCTION

3.75–30 mg daily

PHARMACOKINETICS

  • Molecular weight                           :535
  • %Protein binding                           :50
  • %Excreted unchanged in urine     : 1
  • Volume of distribution (L/kg)       :183 litres
  • half-life – normal/ESRD (hrs)      :12 (of active metabolite)/Increased

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

    20–40 Start with low dose and adjust according to response

  • 10 to 20     : Start with low dose and adjust according to response
  • <10           : Start with low dose and adjust according to response

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Unknown dialysability. Dose as in GFR <10 mL/min
  • HD                     :Unknown dialysability. Dose as in GFR <10 mL/min
  • HDF/high flux   :Unknown dialysability. Dose as in GFR <10 mL/min
  • CAV/VVHD      :Unknown dialysability. Dose as in GFR 10 to 20 mL/min

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs

  • Anaesthetics: enhanced hypotensive effect
  • Analgesics: antagonism of hypotensive effect and increased risk of renal impairment with NSAIDs; hyperkalaemia with ketorolac and other NSAIDs
  • Ciclosporin: increased risk of hyperkalaemia and nephrotoxicity
  • Diuretics: enhanced hypotensive effect; hyperkalaemia with potassium-sparing diuretics
  • Epoetin: increased risk of hyperkalaemia; antagonism of hypotensive effect
  • Lithium: reduced excretion (possibility of enhanced lithium toxicity)
  • Potassium salts: increased risk of hyperkalaemia
  • Tacrolimus: increased risk of hyperkalaemia and nephrotoxicity

    ADMINISTRATION

    Reconstition

    –

    Route

    Oral

    Rate of Administration

    –

    Comments

    –

    OTHER INFORMATION

    Moexipril is a prodrug that is converted to an active metabolite, moexiprilatClose monitoring of renal function during therapy is necessary in those with renal insufficiencyRenal failure has been reported in association with ACE inhibitors, mainly in patients with severe congestive heart failure, renal artery stenosis, or post renal transplantHigh incidence of anaphylactoid reactions has been reported in patients dialysed with high-flux polyacrylonitrile membranes and treated concomitantly with an ACE inhibitor. This combination should therefore be avoidedHyperkalaemia and other side effects are more common in patients with impaired renal functionMoexipril hydrochloride.

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