Quinapril

CLINICAL USE

Angiotensin converting enzyme inhibitor:Hypertension Heart failure

DOSE IN NORMAL RENAL FUNCTION

2.5–80 mg daily in 1–2 divided doses In heart failure 40 mg is normal maximum dose

PHARMACOKINETICS

Molecular weight :475 (as hydrochloride)

%Protein binding :97

%Excreted unchanged in urine : 30

Volume of distribution (L/kg) :1.5

half-life – normal/ESRD (hrs) :1/12–14

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Start with low dose, adjust according to response

10 to 20 : Start with low dose, adjust according to response

<10 : Start with low dose, adjust according to response

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in GFR <10 mL/min

HD :25% dialysed. Dose as in GFR <10 mL/min

HDF/high flux :Dialysed. 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

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Renal failure has been reported with ACE inhibitors: mainly in patients with renal artery stenosis, post renal transplant and those with severe congestive heart failureA high 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 be avoidedHyperkalaemia and other side effects more common in patients with renal impairmentClose monitoring of renal function during therapy is necessary in those patients with known renal insufficiency.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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