Accupril: Effective Blood Pressure Control for Cardiovascular Health
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Accupril (quinapril hydrochloride) is an angiotensin-converting enzyme (ACE) inhibitor prescription medication specifically formulated for the management of hypertension and as adjunctive therapy in heart failure. This pharmaceutical agent works by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in decreased vascular resistance and blood pressure. Clinical evidence supports its role in reducing cardiovascular morbidity and mortality when used as part of a comprehensive treatment plan under appropriate medical supervision.
Features
- Active pharmaceutical ingredient: Quinapril hydrochloride
- Available in tablet formulations: 5 mg, 10 mg, 20 mg, and 40 mg strengths
- Standardized manufacturing process ensuring consistent bioavailability
- Demonstrated 24-hour hemodynamic effect with once or twice daily dosing
- Favorable pharmacokinetic profile with approximately 60% oral bioavailability
- Established therapeutic window with predictable dose-response relationship
Benefits
- Achieves significant reduction in both systolic and diastolic blood pressure measurements
- Decreases afterload on the heart, improving cardiac output in heart failure patients
- Reduces proteinuria and slows progression of diabetic nephropathy in hypertensive patients with type 1 diabetes
- Demonstrates cardioprotective effects by preventing left ventricular hypertrophy
- Provides endothelial protection through modulation of vascular tone and inflammation
- Offers flexible dosing regimen that can be tailored to individual patient needs
Common use
Accupril is primarily indicated for the treatment of hypertension, either as monotherapy or in combination with thiazide diuretics. It is also approved for use in the management of heart failure as adjunctive therapy when added to conventional regimens including diuretics and digitalis. Off-label uses include renal protection in diabetic nephropathy and management of left ventricular dysfunction following myocardial infarction. The medication is typically prescribed as part of a comprehensive cardiovascular risk reduction strategy that may include lifestyle modifications and other antihypertensive agents.
Dosage and direction
Initial dosing for hypertension in patients not on diuretics is 10-20 mg once daily, with subsequent adjustment based on therapeutic response. Maintenance doses typically range from 20-80 mg daily, administered as a single dose or in two divided doses. For heart failure, initial dosing begins at 5 mg twice daily, with gradual titration to a target maintenance dose of 20-40 mg daily in two divided doses. Dosage adjustment is necessary in renal impairment: for creatinine clearance 30-60 mL/min, initial dose is 5 mg daily; for clearance 10-30 mL/min, 2.5 mg daily. Administration should occur at approximately the same time each day, with or without food, though consistent administration relative to meals is recommended.
Precautions
Patients should be monitored for hypotension, especially during initial dosing and titration periods. Renal function should be assessed prior to initiation and periodically during therapy, particularly in patients with renal artery stenosis, heart failure, or volume depletion. Serum potassium levels require monitoring, especially in patients receiving potassium supplements, potassium-sparing diuretics, or with renal impairment. Angioedema may occur at any time during treatment, requiring immediate discontinuation and appropriate medical intervention. Use with caution in patients with collagen vascular disease or those receiving immunosuppressive therapy due to increased risk of neutropenia/agranulocytosis.
Contraindications
Accupril is contraindicated in patients with known hypersensitivity to quinapril or any other ACE inhibitor. History of angioedema related to previous ACE inhibitor therapy represents an absolute contraindication. Concomitant use with aliskiren-containing products in patients with diabetes is contraindicated. The medication is contraindicated during the second and third trimesters of pregnancy due to risk of fetal injury and death. Do not use in patients with hereditary or idiopathic angioedema.
Possible side effect
Common adverse reactions (≥1%) include headache (5.8%), dizziness (4.3%), fatigue (2.6%), cough (2.5%), and nausea/vomiting (1.9%). Less frequent side effects include orthostatic hypotension (1.5%), hyperkalemia (1.4%), and renal impairment (1.2%). Serious but rare adverse events include angioedema (0.1%), neutropenia/agranulocytosis, hepatic failure, and symptomatic hypotension. The characteristic dry, persistent cough associated with ACE inhibitors may develop in 5-20% of patients, often necessitating discontinuation.
Drug interaction
Significant interactions occur with potassium supplements and potassium-sparing diuretics, increasing hyperkalemia risk. Nonsteroidal anti-inflammatory drugs may diminish the antihypertensive effect and increase renal impairment risk. Dual blockade of the renin-angiotensin system with ARBs or aliskiren increases adverse event risk. Lithium excretion may be reduced, potentially leading to lithium toxicity. Tetracycline absorption may be reduced due to magnesium carbonate in some formulations. Antidiabetic agents may see enhanced hypoglycemic effects requiring dosage adjustment.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed administration. Consistent daily adherence is important for maintaining stable blood pressure control, and patients should be educated on the importance of regular dosing without interruption.
Overdose
Symptoms of overdose include pronounced hypotension, which may manifest as dizziness, lightheadedness, or syncope. Bradycardia, electrolyte disturbances, and renal failure may occur. Management involves supportive care with volume expansion with normal saline to maintain blood pressure. Hemodialysis may be effective in removing quinapril and its active metabolite. Patients should be monitored in a critical care setting with continuous blood pressure and ECG monitoring until stabilized.
Storage
Store at controlled room temperature 20°-25°C (68°-77°F) with excursions permitted between 15°-30°C (59°-86°F). Keep container tightly closed and protect from moisture. Dispense in original container with child-resistant closure. Keep out of reach of children and pets. Do not use if tablets show evidence of moisture damage or discoloration. Properly discard any unused medication after the expiration date printed on the packaging.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Accupril is available by prescription only and should be used under appropriate medical supervision. Individual response to therapy may vary, and healthcare providers should consider the complete clinical picture when prescribing this medication. Patients should not initiate, adjust, or discontinue therapy without consulting their healthcare provider. Full prescribing information including boxed warnings should be reviewed before administration.
Reviews
Clinical trials demonstrate Accupril’s efficacy with 65-70% of hypertensive patients achieving blood pressure control (<140/90 mmHg) at recommended doses. In heart failure studies, patients showed significant improvement in exercise tolerance and reduction in hospitalizations. The medication generally receives positive evaluations from prescribing physicians for its efficacy profile and tolerability compared to other ACE inhibitors. Patient satisfaction surveys indicate good adherence rates due to once-daily dosing convenience, though the characteristic ACE inhibitor cough remains a common reason for discontinuation in susceptible individuals. Long-term follow-up studies confirm maintained efficacy and safety profile over extended treatment periods.