Quinapril
Regulatory sources consulted
- openfda-label-b27e3d0c-4d85-44fa-bd4e-6210e8b5dcab
- ansm-rcp-69777040
- Clinical Practice Guideline (UpToDate)
- OpenFDA · C09AA08
- AEMPS CIMA · nº registro 59330 ↗
- RxNorm rxcui 35208 ↗
Approved indications
- Treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions.
Contraindications
Absolute
- Hypersensitivity to quinapril or any other ACE inhibitor.
- History of angioedema related to previous treatment with an ACE inhibitor.
- Concomitant use with sacubitril/valsartan. Do not administer within 36 hours of switching to or from sacubitril/valsartan.
- Do not co-administer with aliskiren in patients with diabetes.
- Second and third trimesters of pregnancy.
Clinical warnings
- Boxed warning · Fetal Toxicity: When pregnancy is detected, discontinue quinapril as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus. — FDA
- Major warning · Angioedema: Head and neck, and intestinal angioedema has been reported. Patients taking concomitant mTOR inhibitor (e.g., temsirolimus) or neprilysin inhibitor therapy may be at increased risk for angioedema. — FDA
Drug interactions
- HighSacubitril/ValsartanC09DX04
Mechanism: Concomitant use increases the risk of angioedema due to inhibition of neprilysin by sacubitril and inhibition of ACE by quinapril.
Recommendation: Contraindicated. Do not start quinapril until 36 hours after the last dose of sacubitril/valsartan.
FDA labelANSM RCP
- HighPotassium-sparing diureticsC03D
Mechanism: Additive effect on serum potassium, increasing the risk of hyperkalemia, especially in patients with renal impairment.
Recommendation: The combination is not recommended. If necessary, use with caution and monitor serum potassium frequently.
ANSM RCP
- HighLithiumN05AN01
Mechanism: ACE inhibitors reduce the renal clearance of lithium, increasing the risk of lithium toxicity.
Recommendation: Administer with caution and frequent monitoring of serum lithium levels is recommended.
ANSM RCP
- ModerateTetracyclineJ01AA
Mechanism: Magnesium carbonate in the quinapril formulation reduces tetracycline absorption by 28-37% due to chelation.
Recommendation: Concomitant administration of quinapril and tetracycline is recommended to be avoided.
ANSM RCP
Adverse events
Common (≥1%)
headache · dizziness · fatigue · coughing · nausea/vomiting · abdominal pain
Rare but serious
angioedema · hypotension · acute renal failure · hyperkalemia · hepatotoxicity · agranulocytosis
Pregnancy and lactation
FDA category: X
Contraindicated in the second and third trimesters of pregnancy due to risk of fetal (renal injury, oligohydramnios, cranial hypoplasia) and neonatal toxicity. Discontinue as soon as pregnancy is detected.