Quinapril

Quinapril
Names
Trade namesAccupril, others
IUPAC name
  • (3S)-2-[(2S)-2-[[(2S)-1-ethoxy-1-oxo-4-phenylbutan-2-yl]amino]propanoyl]-3,4-dihydro-1H-isoquinoline-3-carboxylic acid
Clinical data
Drug classACE inhibitor[1]
Main usesHigh blood pressure, heart failure, diabetic kidney disease[1]
Side effectsHeadaches, dizziness, feeling tired, cough, low blood pressure, angioedema, kidney problems, high blood potassium[1]
Pregnancy
category
  • D
Routes of
use		By mouth
Defined daily dose15 mg[2]
External links
AHFS/Drugs.comMonograph
US NLMQuinapril
MedlinePlusa692026
Legal
Legal status
  • In general: ℞ (Prescription only)
Pharmacokinetics
Protein binding97%
Elimination half-life2 hours
Chemical and physical data
FormulaC25H30N2O5
Molar mass438.524 g·mol−1
3D model (JSmol)
Melting point120 to 130 °C (248 to 266 °F)
SMILES
  • O=C(OCC)[C@@H](N[C@H](C(=O)N2[C@H](C(=O)O)Cc1c(cccc1)C2)C)CCc3ccccc3
InChI
  • InChI=1S/C25H30N2O5/c1-3-32-25(31)21(14-13-18-9-5-4-6-10-18)26-17(2)23(28)27-16-20-12-8-7-11-19(20)15-22(27)24(29)30/h4-12,17,21-22,26H,3,13-16H2,1-2H3,(H,29,30)/t17-,21-,22-/m0/s1 checkY
  • Key:JSDRRTOADPPCHY-HSQYWUDLSA-N checkY

Quinapril, sold under the brand name Accupril among others, is a medication used to treat high blood pressure, heart failure, and diabetic kidney disease.[1] It is a reasonable initial treatment for high blood pressure.[1] It is taken by mouth.[1]

Common side effects include headaches, dizziness, feeling tired, and cough.[1] Serious side effects may include liver problems, low blood pressure, angioedema, kidney problems, and high blood potassium.[1] Use in pregnancy and breastfeeding is not recommended.[3] It is an ACE inhibitor and works by decreasing renin-angiotensin-aldosterone system activity.[1]

Quinapril was patented in 1980 and came into medical use in 1989.[4] It is available as a generic medication.[5] A month supply of the defined daily dose of 15mg in the United Kingdom costs the NHS less than £20 as of 2020.[5] In the United States a month supply of this dose costs about US$7.[6] In 2017, it was the 269th most commonly prescribed medication in the United States, with more than one million prescriptions.[7][8]

Medical uses

Quinapril is indicated for the treatment of high blood pressure (hypertension) and as adjunctive therapy in the management of heart failure.[5] It may be used for the treatment of hypertension by itself or in combination with thiazide diuretics,[5] and with diuretics and digoxin for heart failure.

Dosage

The defined daily dose (DDD) is 15 mg by mouth or by injection.[2]

Side effects

Side effects of quinapril include back pain, increased risk of infection,difficulty sleeping, upset stomach,[5] dizziness, cough, vomiting, angioedema and fatigue.[1][5] A swollen and inflamed tongue is a rare side effect.[5]

Contraindications

  • Pregnancy[3] and first few weeks after delivery if breastfeeding.[5]
  • If used when there is impaired kidney function then the dose of quinapril may need to be less.[5]
  • If used when there is impaired liver function, caution needs to be taken if the person is also taking a diuretic.[5]
  • People with a history of angioedema related to previous treatment with an ACE inhibitor.[5]
  • Hypersensitivity to quinapril

Mechanism of action

Quinapril inhibits angiotensin converting enzyme, an enzyme which catalyses the formation of angiotensin II from its precursor, angiotensin I. Angiotensin II is a powerful vasoconstrictor and increases blood pressure through a variety of mechanisms. Due to reduced angiotensin production, plasma concentrations of aldosterone are also reduced, resulting in increased excretion of sodium in the urine and increased concentrations of potassium in the blood.

Society and culture

Cost

A month supply of the DDD of 15mg/day in the United Kingdom costs the NHS around £17 as of 2020.[5] In the United States a month supply of this dose costs about US$7.[6] In 2017, it was the 269th most commonly prescribed medication in the United States, with more than one million prescriptions.[7][8]

  • Quinapril costs (US)
  • Quinapril prescriptions (US)

References

  1. 1 2 3 4 5 6 7 8 9 10 "Quinapril Hydrochloride Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Archived from the original on 21 February 2019. Retrieved 3 March 2019.
  2. 1 2 "WHOCC - ATC/DDD Index". www.whocc.no. Archived from the original on 26 February 2021. Retrieved 7 September 2020.
  3. 1 2 "Quinapril Pregnancy and Breastfeeding Warnings". Drugs.com. Archived from the original on 3 April 2016. Retrieved 3 March 2019.
  4. ↑ Fischer, Jnos; Ganellin, C. Robin (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 468. ISBN 9783527607495. Archived from the original on 2019-03-01. Retrieved 2019-03-01.
  5. 1 2 3 4 5 6 7 8 9 10 11 12 BNF (80 ed.). London: BMJ Group and the Pharmaceutical Press. September 2020 – March 2021. pp. 183–184. ISBN 978-0-85711-369-6.{{cite book}}: CS1 maint: date format (link)
  6. 1 2 "Quinapril Prices, Coupons & Savings Tips". GoodRx. Retrieved 18 March 2021.
  7. 1 2 "The Top 300 of 2020". ClinCalc. Archived from the original on 18 March 2020. Retrieved 11 April 2020.
  8. 1 2 "Quinapril - Drug Usage Statistics". ClinCalc. Archived from the original on 8 October 2020. Retrieved 11 April 2020.
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