Quinapril

Quinapril, sold under the brand name Accupril among others, is a medication used to treat high blood pressure (hypertension), heart failure, and diabetic kidney disease.[1][2] It is a reasonable initial treatment for high blood pressure.[2] It is taken by mouth.[1][2]

Quinapril
Clinical data
Trade namesAccupril, others
Other namesQuinapril hydrochloride (USAN US)
AHFS/Drugs.comMonograph
MedlinePlusa692026
License data
Routes of
administration		By mouth
ATC code
Legal status
Legal status
Pharmacokinetic data
Protein binding97%
Elimination half-life2 hours
Identifiers
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
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (EPA)
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 Y
  • Key:JSDRRTOADPPCHY-HSQYWUDLSA-N Y
  (verify)

Common side effects include headaches, dizziness, feeling tired, and cough.[2] Serious side effects may include liver problems, low blood pressure, angioedema, kidney problems, and high blood potassium.[2] Use in pregnancy and breastfeeding is not recommended.[3] It is an ACE inhibitor and works by decreasing renin-angiotensin-aldosterone system activity.[2]

Quinapril was patented in 1980 and came into medical use in 1989.[4] It is available as a generic medication.[5] In 2019, it was the 294th most commonly prescribed medication in the United States, with more than 1 million prescriptions.[6][7]

Medical uses

Quinapril is indicated for the treatment of high blood pressure (hypertension) and as adjunctive therapy in the management of heart failure.[1] It may be used for the treatment of hypertension by itself or in combination with thiazide diuretics, and with diuretics and digoxin for heart failure.[1]

Contraindications
  • Pregnancy
  • Impaired renal and liver function
  • Patients with a history of angioedema related to previous treatment with an ACE inhibitor
  • Hypersensitivity to quinapril

Side effects

Side effects of quinapril include dizziness, cough, vomiting, upset stomach, angioedema, and fatigue.

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.

Partial Recall

In April of 2022, Pfizer voluntarily recalled five batches of the drug because of the presence of a nitrosamine, NNitroso-quinapril. Testing found that the amount of nitrosamines was above the acceptable daily intake level (all humans are exposed to nitrosamines up to a certain daily level by cured and grilled meats, water, dairy products, and vegetables) set by the U.S.'s Food and Drug Administration (FDA). Though long-term ingestion of NNitroso-quinapril potentially might cause cancer in some individuals, there is not believed to be an imminent risk of harm.[8][9]

References
  1. "Accupril- quinapril hydrochloride tablet, film coated Accupril- quinapril tablet, film coated". DailyMed. 26 August 2021. Retrieved 25 March 2022.
  2. "Quinapril Hydrochloride Monograph for Professionals". Drugs.com. American Society of Health-System Pharmacists. Retrieved 3 March 2019.
  3. "Quinapril Pregnancy and Breastfeeding Warnings". Drugs.com. Retrieved 3 March 2019.
  4. Fischer J, Ganellin CR (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 468. ISBN 9783527607495.
  5. British national formulary : BNF 76 (76 ed.). Pharmaceutical Press. 2018. p. 172. ISBN 9780857113382.
  6. "The Top 300 of 2019". ClinCalc. Retrieved 16 October 2021.
  7. "Quinapril - Drug Usage Statistics". ClinCalc. Retrieved 16 October 2021.
  8. "Pfizer recalls blood pressure tablets due to increased cancer risk". MSN.
  9. "Pfizer Voluntary Nationwide Recall of Lots of ACCUPRIL® (Quinapril HCL) Due to N-Nitroso-Quinapril Content". Food and Drug Administration. 22 April 2022.
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