Acapril Tablet

 

**Important Disclaimer:** This summary is for educational and informational purposes only and should not, under any circumstances, replace direct consultation with a qualified physician or pharmacist. Always refer to the product's internal leaflet or consult a healthcare professional before use.

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**Acapril Tablet**

**Manufacturer:** (Specific manufacturer may vary by region/generic producer, but Quinapril is often associated with Pfizer's Accupril brand, and generic versions are widely available from various manufacturers like Aurobindo Pharma Ltd.)

Acapril Tablet, containing the active ingredient Quinapril, is an Angiotensin-Converting Enzyme (ACE) inhibitor. It is primarily used to treat high blood pressure (hypertension) and heart failure. By blocking the formation of a substance that narrows blood vessels, Quinapril helps to relax blood vessels, lower blood pressure, and reduce the workload on the heart.

**Indications and Usage**

Acapril (Quinapril) is indicated for:

* **Hypertension:** Treatment of high blood pressure, either alone or in combination with other antihypertensive agents.

* **Heart Failure:** Management of heart failure, typically in combination with diuretics and/or digitalis.

**Characteristics**

Quinapril is a prodrug that is rapidly converted to its active metabolite, quinaprilat, in the liver. Quinaprilat is a potent, long-acting ACE inhibitor. ACE inhibitors work by blocking the enzyme responsible for converting angiotensin I to angiotensin II, a powerful vasoconstrictor. This action leads to vasodilation (widening of blood vessels), reduced peripheral vascular resistance, and decreased aldosterone secretion, resulting in lower blood pressure and reduced cardiac preload and afterload. This mechanism makes it effective in managing both hypertension and heart failure.

**Dosage and Administration**

* **Form:** Oral Tablets.

* **Recommended Use:** Taken by mouth, with or without food, as directed by a healthcare professional.

* **Initial Dose (Hypertension):** Typically 10 mg or 20 mg once daily for patients not on diuretics. For patients on diuretics, a lower initial dose (e.g., 5 mg) may be considered.

* **Maintenance Dose (Hypertension):** Usually 20 mg to 80 mg per day, administered as a single dose or in two divided doses.

* **Initial Dose (Heart Failure):** Typically 5 mg once or twice daily.

* **Maintenance Dose (Heart Failure):** Usually 20 mg to 40 mg per day, in two divided doses.

* **Frequency:** Once or twice daily, depending on the indication and individual response. Dosage should be adjusted based on blood pressure response and patient tolerance.

**Contraindications**

Acapril (Quinapril) is contraindicated in:

* Patients with a history of angioedema (severe allergic reaction with swelling) related to previous ACE inhibitor treatment.

* Patients with hereditary or idiopathic angioedema.

* Pregnant women (can cause fetal harm or death).

* Concomitant use with aliskiren in patients with diabetes or renal impairment (GFR < 60 mL/min/1.73 m²).

* Hypersensitivity to quinapril or any other ACE inhibitor.

**Warnings and Precautions**

* **Angioedema:** Can occur at any time during treatment, potentially life-threatening. If it occurs, discontinue immediately and seek emergency medical attention.

* **Hypotension:** Symptomatic hypotension may occur, especially after the first dose, in patients who are volume-depleted (e.g., due to diuretic therapy, dialysis, vomiting, diarrhea). Monitor blood pressure closely.

* **Renal Impairment:** May cause acute renal failure or worsen existing renal impairment, especially in patients with severe congestive heart failure or renal artery stenosis. Monitor kidney function regularly.

* **Hyperkalemia:** May increase serum potassium levels, especially in patients with renal impairment, diabetes mellitus, or those taking potassium-sparing diuretics or potassium supplements. Monitor serum potassium levels.

* **Cough:** A persistent, non-productive cough is a common side effect of ACE inhibitors and usually resolves after discontinuation.

* **Hepatic Failure:** Rarely, ACE inhibitors have been associated with a syndrome that starts with cholestatic jaundice and progresses to fulminant hepatic necrosis. Discontinue if jaundice or marked elevations of hepatic enzymes develop.

* **Pregnancy:** Use during pregnancy is contraindicated due to risks of fetal injury and death.

* **Lactation:** Not recommended during breastfeeding.

* **Surgery/Anesthesia:** Caution should be exercised in patients undergoing major surgery or during anesthesia with agents that produce hypotension, as ACE inhibitors may block angiotensin II formation secondary to compensatory renin release.

**Pharmacokinetics**

* **Absorption:** Quinapril is rapidly absorbed from the gastrointestinal tract and extensively metabolized to quinaprilat (the active metabolite) in the liver. Peak plasma concentrations of quinaprilat are typically reached within 1 hour after an oral dose.

* **Distribution:** Quinaprilat is widely distributed throughout the body.

* **Metabolism:** Quinapril is primarily metabolized by esterase hydrolysis to quinaprilat. Quinaprilat itself undergoes further metabolism to inactive metabolites.

* **Elimination:** Quinaprilat is primarily eliminated by renal excretion. The elimination half-life of quinaprilat is approximately 2-3 hours, but its effective half-life (due to tight binding to ACE) is longer, allowing for once-daily or twice-daily dosing.

**Side Effects**

* **Common (≥ 1%):**

    * Dizziness, lightheadedness (especially upon standing)

    * Headache

    * Cough (dry, persistent)

    * Fatigue

    * Nausea, vomiting, abdominal pain

* **Less Common/Serious:**

    * Angioedema (swelling of face, lips, tongue, throat, extremities)

    * Hypotension (low blood pressure)

    * Renal dysfunction or failure

    * Hyperkalemia (high potassium levels)

    * Liver enzyme elevations, jaundice

    * Neutropenia/Agranulocytosis (rare, severe decrease in white blood cells)

**Drug Interactions**

* **Diuretics:** Increased risk of symptomatic hypotension, especially with initial doses. Diuretic dose reduction or temporary discontinuation may be necessary.

* **Potassium-Sparing Diuretics, Potassium Supplements, or Potassium-Containing Salt Substitutes:** Increased risk of hyperkalemia. Concurrent use is generally not recommended.

* **Lithium:** Increased serum lithium levels and symptoms of lithium toxicity. Monitor lithium levels closely.

* **Non-Steroidal Anti-inflammatory Drugs (NSAIDs):** May reduce the antihypertensive effect of ACE inhibitors and increase the risk of renal impairment.

* **Dual Blockade of the Renin-Angiotensin System (RAS):** Concomitant use of ACE inhibitors with Angiotensin Receptor Blockers (ARBs) or aliskiren is generally not recommended, especially in patients with diabetes or renal impairment, due to increased risk of hypotension, hyperkalemia, and renal impairment.

* **mTOR Inhibitors (e.g., sirolimus, everolimus, temsirolimus):** Increased risk of angioedema.

* **Gold Injections:** Nitritoid reactions (flushing, nausea, vomiting, hypotension) have been reported rarely in patients on concomitant gold therapy and ACE inhibitors.

**Patient Counseling**

* **Dosage and Administration:** Instruct patients to take the medication as prescribed, usually once or twice daily. It can be taken with or without food.

* **Hypotension:** Advise patients about the possibility of dizziness or lightheadedness, especially with the first dose or when standing up quickly. Avoid driving or operating machinery until effects are known.

* **Cough:** Inform patients about the possibility of a dry, persistent cough and to report it to their healthcare provider.

* **Angioedema:** Educate patients on the signs and symptoms of angioedema (swelling of face, lips, tongue, throat) and to seek immediate medical attention if these occur.

* **Pregnancy:** Emphasize that Acapril is contraindicated in pregnancy and to notify their doctor immediately if they become pregnant.

* **Dietary Considerations:** Advise against using potassium supplements or salt substitutes containing potassium without consulting a healthcare professional.

* **Monitoring:** Stress the importance of regular follow-up appointments for blood pressure, kidney function, and potassium level monitoring.

* **Storage:** Store at room temperature, away from moisture and heat.

* **Keep out of reach of children.**

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**Sources:**

* [https://bit.ly/DrugsComAccupril](https://www.drugs.com/accupril.html)

* [https://bit.ly/RxListAccupril](https://www.rxlist.com/accupril-drug.htm)

* [https://bit.ly/MayoClinicQuinapril](https://www.mayoclinic.org/drugs-supplements/quinapril-oral-route/description/drg-20069256)