Accupril (quinapril) is an ACE inhibitor that lowers blood pressure and reduces the heart's workload. It is predominately used to treat hypertension (high blood pressure) or heart failure, but may less commonly also be used to treat a few other conditions.

This product can be used on its own if it produces sufficient results. If it does not manage the condition on its own, it's not unusual for Accupril to be given along with another blood pressure-lowering medication, such as a diuretic. These can be purchased separately if desired, but many patients prefer to buy combination pills, such as in the product Accuretic, which contains quinapril and the diuretic hydrochlorothiazide.

In the majority of cases Accupril is administered on its own at first to evaluate results. Most patients taking a diuretic prior to starting treatment with Accupril are advised to quit taking the diuretic when Accupril treatment begins, at least for the first couple of weeks; the diuretic can be resumed if Accupril is insufficient by itself. There are exceptions, however, and doctor instructions should always be followed.

Accupril for Hypertension

Accupril ultimately relaxes and widens blood vessels, as well as promotes excretion of sodium in urine, both of which lower blood pressure and reduce strain on the heart. Again it is often effective on its own, but it's also not unusual for a patient to need to add another blood pressure-reducing medication.

If taking Accupril alone, treatment typically consists of:

• Patients are typically started on 10 to 20 mg taken once per day.
• After at least two weeks on the starter dose results should be evaluated and, if needed, dosage may be increased.
• Most patients find 20, 40, or 80 mg per day to be sufficient.
• Doses of 20 mg or higher may be taken once per day or divided into two smaller doses taken twice per day. This is largely a matter of personal response.
• If doses of 40 mg or higher are needed, adding another hypertension treatment may be more beneficial than further increasing dosage.

Much of Accupril treatment is individualized according to a particular patient's response to the medication. Patients are strongly encouraged to work closely with a doctor.

It is important to monitor blood pressure at the start of treatment or following any dosage adjustments, whether taking Accupril on its own or with other medications. If it becomes alarming low or high a doctor should be consulted right away.

Black patients should be aware that ACE inhibitors tend to not produce as potent effects as in other races; this means hypotension (low blood pressure) is less likely to occur, but it is more likely that blood pressure will remain high. Again, monitoring is important.

Accupril for Heart Failure

In treating heart failure Accupril is very rarely the only medication given. A doctor will need to consider the other medications being taken, and may adjust their dosage or modify the amount of Accupril taken. It is very important that a doctor be involved in treating heart failure.

Rough guidelines for treatment are:

• Patients are typically started on 10 mg per day, taken in two 5 mg doses.
• Provided no adverse effects develop, dosage may be increased in small quantities after at least one week until 20 to 40 mg (divided into two smaller doses taken twice per day) is reached.
• If adverse effects develop, such as hypotension or orthostatis, treatment will likely be capped for some time, possibly forever.

Patients starting Accupril for heart failure are often given the initial dosage in a medical setting and are monitored for side effects for several hours. Patients for whom this is an option are advised to take advantage of it.

Heart failure and its treatment is a complicated topic. Again it is important that a doctor be involved in prescribing medications and advising an ideal dosage.

Precautions & Side Effects

Not all patients are good candidates for Accupril; namely those who:

• Are pregnant
• Have liver or kidney impairment
• Have a history of complications from other ACE inhibitors

ACE inhibitors can cause serious birth defects and should be avoided if it all possible by pregnant women. In the other two cases, Accupril may or may not be appropriate; patients will need to discuss the issue with a doctor, and be extra-alert for developing complications.

Otherwise side effects are typically mild and stop occurring as the body adjusts to treatment, including:

• Coughing
• Mild dizziness
• Stomach upset
• Vomiting
• Mild fatigue
• Angioedema

One thing to keep in mind is that Accupril will lower blood pressure to some extent, and many side effects are related to that. These can happen when blood pressure is lowered at all, and do not necessarily mean blood pressure is too low:

• Dizziness
• Lightheadedness
• Difficulty concentrating
• Blurred vision
• Nausea
• Fainting

The above symptoms are often more pronounced when rising quickly from a laying or sitting position. If experienced, blood pressure should be checked; if it's not in low ranges, self-care should be sufficient---rise from a prone position slowly, take care to avoid exertion, and so forth. These effects should pass within a week or two of starting treatment.

If blood pressure is low or the above side effects are severe, medical attention should be sought.

Why is Accupril / quinapril prescribed?

Quinapril is used alone or in combination with other medications to treat high blood pressure. It is used in combination with other medications to treat heart failure. Quinapril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently.

How should Accupril be used?

Quinapril comes as a tablet to take by mouth. It is usually taken once or twice a day. To help you remember to take quinapril, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take quinapril exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of quinapril and gradually increase your dose, not more than once every one or two weeks.

Quinapril controls high blood pressure and heart failure but does not cure them. Continue to take quinapril even if you feel well. Do not stop taking quinapril without talking to your doctor.

Accupril Precautions

Before taking quinapril,

• tell your doctor and pharmacist if you are allergic to quinapril, benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), ramipril (Altace), trandolapril (Mavik), or any other medications.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: diuretics ('water pills'); lithium (Eskalith, Lithobid); potassium supplements; and tetracycline (Sumycin). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have or have ever had heart, liver, or kidney disease; lupus; scleroderma; diabetes; or angioedema, a condition that causes difficulty swallowing or breathing and painful swelling of the the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs.
• tell your doctor if you plan to become pregnant or are breast-feeding.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking quinapril.
• you should know that diarrhea, vomiting, not drinking enough fluids, and sweating a lot can cause a drop in blood pressure, which may cause lightheadedness and fainting.

Quinapril may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• dizziness
• excessive tiredness
• cough
• upset stomach
• vomiting

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

• swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• hoarseness
• difficulty breathing or swallowing
• yellowing of the skin or eyes
• fever, sore throat, chills, and other signs of infection
• chest pain
• lightheadedness
• fainting

Quinapril may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.