Quinapril Hydrochloride

Increased serum lithium levels and symptoms of lithium toxicity reported. Risk increases if diuretic also used. Requires frequent monitoring.

In elderly, volume-depleted, or renal-compromised patients, NSAIDs with ACE inhibitors may cause renal function deterioration including acute renal failure. Antihypertensive effect may be attenuated.

Nitritoid reactions (facial flushing, nausea, vomiting, hypotension) reported rarely with injectable gold and concomitant ACE inhibitor therapy.

Concomitant diuretic therapy, especially recently instituted, may cause excessive reduction of blood pressure after quinapril initiation. Risk can be minimized by discontinuing diuretic or cautiously increasing salt intake.

Concomitant neprilysin inhibitor therapy may increase risk for angioedema.

Concomitant mTOR inhibitor therapy may increase risk of angioedema in patients taking quinapril.

Simultaneous administration reduces tetracycline absorption by approximately 28-37%, possibly due to high magnesium content in quinapril tablets.

Multiple dose therapy with cimetidine has no effect on the pharmacokinetics of single doses of quinapril.

Multiple dose therapy with propranolol has no effect on the pharmacokinetics of single doses of quinapril.

Single dose anticoagulant effect of warfarin (measured by prothrombin time) was not significantly affected by quinapril.

• Co-administration of multiple 10 mg doses of atorvastatin with 80 mg of quinapril hydrochloride resulted in no significant change in the steady-state pharmacokinetic parameters of atorvastatin.

• No pharmacokinetic interaction was observed when single doses of quinapril hydrochloride and hydrochlorothiazide were administered concomitantly.

Drug Interactions Concomitant Diuretic Therapy As with other ACE inhibitors, patients on diuretics, especially those on recently instituted diuretic therapy, may occasionally experience an excessive reduction of blood pressure after initiation of therapy with quinapril hydrochloride. The possibility of hypotensive effects with quinapril hydrochloride may be minimized by either discontinuing the diuretic or cautiously increasing salt intake prior to initiation of treatment with quinapril hydrochloride. If it is not possible to discontinue the diuretic, the starting dose of quinapril should be reduced (see DOSAGE AND ADMINISTRATION ).