Accupril: Advanced 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 heart failure. As a cornerstone therapy in cardiovascular medicine, it works by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in decreased vascular resistance and improved blood flow. Its well-established efficacy profile and dual indications make it a fundamental choice for clinicians seeking to optimize cardiovascular outcomes through targeted renin-angiotensin-aldosterone system (RAAS) inhibition.
Features
- Active pharmaceutical ingredient: Quinapril hydrochloride
- Available in tablet formulations: 5 mg, 10 mg, 20 mg, 40 mg
- Prodrug design requiring hepatic hydrolysis to active metabolite quinaprilat
- Once or twice-daily dosing regimen
- Standardized manufacturing under current Good Manufacturing Practices (cGMP)
- Bioavailability of approximately 60% unaffected by food
- Elimination half-life of active metabolite: 2-4 hours
Benefits
- Effectively lowers systolic and diastolic blood pressure through RAAS inhibition
- Reduces afterload in heart failure patients, improving cardiac output and functional capacity
- Demonstrates renal protective effects in hypertensive patients with diabetes
- Shows proven mortality reduction in post-myocardial infarction patients with left ventricular dysfunction
- Provides 24-hour blood pressure control with appropriate dosing
- Offers flexible dosing titration based on therapeutic response and tolerability
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 the management of heart failure as adjunctive therapy when standard treatments prove insufficient. In clinical practice, it may be used off-label for diabetic nephropathy and renal protection in patients with proteinuria. The medication is typically incorporated into comprehensive cardiovascular risk reduction strategies that include lifestyle modifications and concomitant lipid management.
Dosage and direction
For hypertension management, initial dosing typically begins at 10-20 mg once daily, with adjustments based on blood pressure response. Maintenance doses range from 20-80 mg daily, administered as a single dose or divided into two doses. For heart failure, therapy initiates at 5 mg twice daily, with gradual titration to target doses of 20-40 mg daily in divided doses. Dosage adjustments are necessary in renal impairment: for creatinine clearance 30-60 mL/min, initial dose is 5 mg daily; below 30 mL/min, initial dose is 2.5 mg daily. Tablets should be swallowed whole with water, with or without food.
Precautions
Patients should be monitored for hypotension, especially during initial dosing and titration periods. Renal function and serum potassium require regular assessment, particularly in patients with renal artery stenosis, diabetes, or concomitant potassium-sparing diuretics. Neutropenia/agranulocytosis has been reported with ACE inhibitors, necessitating white blood cell monitoring in patients with collagen vascular disease or immunosuppression. Angioedema may occur at any time during therapy, requiring immediate discontinuation. Use with caution in patients with aortic stenosis or hypertrophic cardiomyopathy.
Contraindications
Accupril is contraindicated in patients with known hypersensitivity to quinapril or any ACE inhibitor. It must not be used during pregnancy, particularly in the second and third trimesters, due to risk of fetal injury and death. Additional contraindications include history of angioedema related to previous ACE inhibitor therapy and concomitant use with aliskiren in patients with diabetes.
Possible side effect
Common adverse reactions include headache (6-14%), dizziness (4-8%), fatigue (2-4%), and cough (2-4%). Less frequently reported effects include gastrointestinal disturbances, rash, and orthostatic hypotension. Serious but rare side effects include angioedema (0.1%), hyperkalemia, renal impairment, neutropenia, and hepatic enzyme elevations. The characteristic dry, persistent cough typically resolves upon discontinuation of therapy.
Drug interaction
Significant interactions occur with potassium supplements, potassium-sparing diuretics, and salt substitutes, increasing hyperkalemia risk. Nonsteroidal anti-inflammatory drugs may reduce antihypertensive effects and worsen renal function. Dual blockade of RAAS with ARBs or aliskiren increases adverse event risk. Lithium levels may increase due to reduced renal clearance. Antidiabetic agents may require dosage adjustment due to improved insulin sensitivity.
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. Patients should never double the dose to make up for a missed administration. Consistent daily dosing is important for maintaining stable blood pressure control, but occasional missed doses are unlikely to cause significant hypertension rebound.
Overdose
Manifestations primarily include hypotension, which may be severe. Bradycardia, electrolyte disturbances, and renal failure may occur. Management involves supportive care with volume expansion with normal saline. Hemodialysis may be effective for removing quinaprilat. Vasopressors may be required for refractory hypotension. Patients should seek immediate medical attention for suspected overdose.
Storage
Store at controlled room temperature 20-25°C (68-77°F), with excursions permitted between 15-30°C (59-86°F). Protect from moisture and light. Keep in original container with tight closure. Do not use if tablets show signs of discoloration or deterioration. Keep out of reach of children and pets. Properly dispose of expired or unused medication through take-back programs.
Disclaimer
This information is 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. Patients should consult their healthcare provider for personalized medical advice, including potential risks and benefits specific to their clinical situation. Never initiate or discontinue medication without professional guidance.
Reviews
Clinical studies demonstrate Accupril’s efficacy in reducing blood pressure by 10-15 mmHg systolic and 5-10 mmHg diastolic in most hypertensive patients. In heart failure trials, it significantly improved exercise tolerance and reduced hospitalization rates. The medication generally receives positive expert evaluation for its predictable pharmacokinetics and well-characterized safety profile. Real-world evidence supports its position as a valuable option in cardiovascular risk management, particularly in patients requiring once-daily dosing convenience.