Quinapril

General Toxicity Notes
Blood pressure is the best guide to dose and interval. Hypotensive effects magnified by natriuretic agents or sodium depletion. May cause hyperkalemia, metabolic acidosis. Acute renal dysfunction with bilateral or transplant renal artery stenosis, low renal perfusion pressure. Dry cough in 5-10% of patients.
Excreted Unchanged %
30
Half-Life (Normalesrd) Hours
1-2 (3 quinaprilat)/6-15
Plasma Protein Binding %
97
Volume Of Distribution L/Kg
1.5
Dose For Normal Renal Function
10-20 mg q24h
Second Dose
Second Dose: 20-40 mg q12-24h
Adjustment For Renal Failure Method
D
Adjustment For Renal Failure Gfr, Ml/Min >50 [Recommended Level]
100% [B]
Adjustment For Renal Failure Gfr, Ml/Min 10-50 [Recommended Level]
2.5-5 mg q24h [B]
Adjustment For Renal Failure Gfr, Ml/Min <10 [Recommended Level]
2.5 mg [B]
Supplement For Dialysis [Recommendation Level]: Ihd
IHD: Dose for GFR <10,[B]
Supplement For Dialysis [Recommendation Level]: Pd
PD: Dose for GFR <10, [A]
Supplement For Dialysis [Recommendation Level]: Crrt
CRRT: Dose for GFR 10-50, titrate, [D]
References
Halstenson CE, Opsahl JA, Rachael K, Olson SC, Horvath AM, Abraham PA, et al. The pharmacokinetics of quinapril and its active metabolite, quinaprilat, in patients with various degrees of renal function. J Clin Pharmacol. 1992; 32: 344-50. [PMID: 1569237] / Hoyer J, Schulte KL, Lenz T. Clinical pharmacokinetics of angiotensin converting enzyme (ACE) inhibitors in renal failure. Clin Pharmacokinet. 1993; 24: 230-54. [PMID: 8462229] / Plosker GL, Sorkin EM. Quinapril. A reappraisal of its pharmacology and therapeutic efficacy in cardiovascular disorders. Drugs. 1994; 48: 227-52. [PMID: 7527326] / Swartz RD, Starmann B, Horvath AM, Olson SC, Posvar EL. Pharmacokinetics of quinapril and its active metabolite quinaprilat during continuous ambulatory peritoneal dialysis. J Clin Pharmacol. 1990; 30: 1136-41. [PMID: 2273086] / Wolter K, Fritschka E. Pharmacokinetics and pharmacodynamics of quinaprilat after low dose quinapril in patients with terminal renal failure. Eur J Clin Pharmacol. 1993; 44 Suppl 1: S53-6. [PMID: 8387427]
Toxicity Notes
Active metabolite is quinaprilat, 96% of which is excreted by kidneys. Titrate based on blood pressure response.