Quinapril instructions for administration

Instructions for administration
Monotherapy Concomitant diuretics Renal impairment Elderly (≥65 years) Heart failure/renal impairment or hyponatremia

Monotherapy
The recommended initial dosage of Quinapril tablets in patients not on diuretics is 10 or 20 mg once daily. Dosage should be adjusted according to blood pressure response measured at peak (2 to 6 hours after dosing) and trough (predosing). Generally, dosage adjustments should be made at intervals of at least 2 weeks. Most patients have required dosages of 20, 40, or 80 mg/day, given as a single dose or in two equally divided doses. In some patients treated once daily, the antihypertensive effect may diminish toward the end of the dosing interval. In such patients an increase in dosage or twice daily administration may be warranted. In general, doses of 40 to 80 mg and divided doses give a somewhat greater effect at the end of the dosing interval. Return to top

Concomitant diuretics
If blood pressure is not adequately controlled with Quinapril tablets monotherapy, a diuretic may be added. In patients who are currently being treated with a diuretic, symptomatic hypotension occasionally can occur following the initial dose of Quinapril tablets. To reduce the likelihood of hypotension, the diuretic should, if possible, be discontinued 2 to 3 days prior to beginning therapy with Quinapril tablets. Then, if blood pressure is not controlled with Quinapril tablets alone, diuretic therapy should be resumed. If the diuretic cannot be discontinued, an initial dose of 5 mg Quinapril tablets should be used with careful medical supervision for several hours and until blood pressure has stabilized. The dosage should subsequently be titrated (as described above) to the optimal response. Return to top

Renal impairment
Kinetic data indicate that the apparent elimination half-life of Quinaprilat increases as creatinine clearance decreases. Recommended starting doses, based on clinical and pharmacokinetic data from patients with renal impairment, are as follows: Patients should subsequently have their dosage titrated (as described above) to the optimal response. Return to top

Elderly (≥65 years)
The recommended initial dosage of Quinapril tablets in elderly patients is 10 mg given once daily followed by titration (as described above) to the optimal response. Following the initial dose of Quinapril tablets, the patient should be observed under medial supervision for at least two hours for the presence of hypotension or orthostatis and, if present, until blood pressure stabilizes. The appearance of hypotension, orthostatis, or azotemia early in dose titration should not preclude further careful dose titration. Consideration should be given to reducing the dose of concomitant diuretics. Return to top

Heart failure/renal impairment or hyponatremia
Pharmacokinetic data indicate that Quinapril elimination is dependent on level of renal function. In patient with heart failure and renal impairment, the recommended initial dose of Quinapril is 5 mg in patients with a creatinine clearance above 30 mL/min and 2.5 mg in patients with a creatinine clearance of 10 to 30 mL/min. There is insufficient data for dosage recommendation in patients with a creatinine clearance less than 10 mL/min. If the initial dose is well tolerated, Quinapril may be administered the following day as a twice daily regimen. In the absence of excessive hypotension or significant deterioration of renal function, the dose may be increased at weekly intervals based on clinical and hemodynamic response. Return to top