Quinapril/ Hydrochlorothiazide

Registered South African indications:

• Hypertension

Should a woman become pregnant while receiving quinapril/ hydrochlorothiazide, the treatment should be stopped promptly and switched to a different class of medicine. (See “Contraindications” and “Special Populations - Pregnancy and Breastfeeding”). Should a woman contemplate pregnancy, the doctor should consider alternative medication

Contraindications

• Hypersensitivity to the active ingredients or any of the excipients in this combination product
• Hypersensitivity to other sulphonamide-derived medicines due to the hydrochlorothiazide component
• History of angioedema related to previous therapy with ACE inhibitors or angiotensin receptor blockers (ARBs); such patients must never again be given these medicines
• Hereditary or idiopathic angioedema
• Hypertrophic obstructive cardiomyopathy (HOCM)
• Anuria or severe renal function impairment (creatinine clearance <30ml/min), as hydrochlorothiazide may produce cumulative effects or precipitate azotaemia
• Bilateral renal artery stenosis
• Renal artery stenosis in patients with a single kidney
• Aortic stenosis
• Concomitant therapy with potassium-sparing diuretics such as spironolactone, triamterene, or amiloride
• Porphyria
• Addison’s disease, as this is a fixed-dose combination tablet containing a thiazide diuretic and ACE inhibitor
• Lithium therapy, as concomitant administration with quinapril/ hydrochlorothiazide may lead to toxic blood concentrations of lithium
• Pregnancy
• Breastfeeding

Cautions

• Mild to moderate renal impairment
• Hepatic impairment
• Elderly
• Aortic stenosis
• Asthma
• Volume depletion
• Severe renin-dependent hypertension
• Congestive cardiac failure
• Renal artery stenosis
• Systemic lupus erythematosus
• Black patients
• Haemodialysis
• Low density lipoprotein aphoresis
• Gout
• Diabetes mellitus
• Hyperkalaemia
• Major surgery
• Anaesthesia
• Risk factors for acute angle closure glaucoma
• Galactose intolerance
• Lapp-lactase deficiency
• Glucose-galactose malabsorption

Forms avail. in SA and covered in this monograph: tab

Hypertension - mild to moderate

Quinapril/ Hydrochlorothiazide
10/ 12.5 (mg)

• Oral (tab): 1 tab, dly; Max: 2 tab/24hrs

20/ 12.5 (mg)

• Oral (tab): 1 tab, dly

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Do not cut/crush/chew/dissolve

Not established for use in children

Recommendations for this combination product as per highest risk category when comparing individual active ingredients

Pregnancy

• Contraindicated

Breastfeeding

• Contraindicated

Renal Impairment

• Mild to moderate: Caution; no dose adjustment recommended
• Severe: Contraindicated
• Anuria: Contraindicated

Hepatic Impairment

• Caution; no dose adjustment recommended 

Elderly

• Caution; no dose adjustment recommended

Porphyria Information

South African recommendations

• Contraindicated

Central Nervous System Disorders

• Insomnia
• Confusion
• Depression
• Anxiety
• Dizziness
• Headache
• Somnolence
• Paraesthesia
• Unsteadiness
• Stroke
• Fatigue

Cardiovascular Disorders

• Transient ischaemic attack
• Syncope
• Chest pain
• Tachycardia
• Palpitations
• Myocardial infarction
• Arrhythmia
• Vasodilation
• Hypotension
• Vasculitis
• Oedema

Respiratory Disorders

• Bronchitis
• Upper respiratory tract infection
• Pharyngitis
• Rhinitis
• Viral infection
• Sinusitis 
• Cough
• Dyspnoea
• Dry throat
• Bronchospasm

Gastrointestinal Disorders

• Dysgeusia
• Nausea and vomiting
• Diarrhoea
• Dyspepsia
• Abdominal pain
• Flatulence
• Dry mouth
• Constipation
• Glossitis
• Ileus
• Small bowel angioedema

Hepatobiliary Disorders

• Pancreatitis
• Hepatitis
• Cholestatic jaundice
• Increased hepatic enzymes
• Increased serum bilirubin

Genitourinary Disorders

• Urinary tract infection
• Renal impairment
• Proteinuria
• Tubulointerstitial nephritis
• Erectile dysfunction

Endocrine and Metabolic Disorders

• Hyperkalaemia
• Gout 
• Hyperuricaemia
• Impaired glucose tolerance
• Increased serum creatinine
• Increased serum urea
• Increased serum cholesterol
• Increased serum triglycerides

Musculoskeletal Disorders

• Myalgia
• Arthralgia
• Back pain

Skin and Subcutaneous Tissue Disorders

• Alopecia
• Photosensitivity
• Pruritis
• Rash
• Hyperhidrosis
• Dermatitis psoriasiforms
• Urticaria
• Toxic epidermal necrolysis
• Erythema multiforme
• Exfoliative dermatitis 
• Pemphigus
• Purpura
• Stevens Johnson syndrome
• Systemic lupus erythematosus

Immune, Blood and Lymphatic System Disorders

• Agranulocytosis
• Haemolytic anaemia
• Neutropenia
• Thrombocytopenia
• Eosinophilia
• Anaphylactoid reactions
• Angioedema
• Fever
• Decreased haematocrit
• Increased antinuclear antibody 
• Increased erythrocyte sedimentation rate

Sensory Disorders

• Amblyopia
• Blurred vision
• Acute myopia
• Acute angle closure glaucoma
• Vertigo 
• Tinnitus

• Potassium-sparing diuretics
• Spironolactone
• Triamterene
• Amiloride
• Tetracyclines
• Agents that increase serum potassium
• Diuretics
• Antihypertensives
• Noradrenaline
• Lithium
• Corticosteroids
• Adrenocorticotropic hormone
• Non-steroidal anti-inflammatory drugs
• Allopurinol
• Cytostatic agents
• Immunosuppressive agents
• Procainamide
• Central nervous system depressants
• Digoxin
• Antacids
• Antidiabetic agents
• Cholestyramine
• Colestipol
• Angiotensin II receptor blockers
• Uricosuric agents

• Renal function
• Electrolytes

Specific cases may require

• Serum potassium
• Full blood count

Quinapril
Quinapril is a potent angiotensin-converting enzyme (ACE) inhibitor. This enzyme functions to convert angiotensin I to angiotensin II which is involved in vascular control and functions through many different mechanisms, including stimulation of aldosterone secretion. By inhibiting the ACE, quinapril prevents the downstream vasopressor activity and aldosterone secretion effected by angiotensin II. 

Hydrochlorothiazide
Hydrochlorothiazide acts primarily in the distal convoluted tubule where it inhibits sodium chloride transport. It competes for the chloride site and affects the electrolyte reabsorption by increasing sodium and chloride excretion. This reduces plasma volume indirectly and increases plasma renin activity, aldosterone secretion and urinary potassium loss. 

COMBINATION PREPARATIONS

Quinapril/ Hydrochlorothiazide

Tablet 10mg/12.5mg

• Accumax Co (Pfizer) (Discontinued: 22/03/2022)
• Accuretic (Pfizer) originator
• Adco-Quinaretic (Adcock)
• Auro Quinapril Co (Aurobindo)
• Kwinco (Aurobindo)

Tablet  20mg/12.5mg

• Accumax Co (Pfizer) (Discontinued: 22/03/2022)
• Accuretic (Pfizer) originator
• Adco-Quinaretic (Adcock)
• Auro Quinapril Co (Aurobindo)
• Kwinco (Aurobindo)