BLACK BOX WARNING
- fetal toxicity
quinapril
Brand: Accupril
⚠ BBW Prototype: lisinopril
Drug Class: ACE inhibitor
Drug Family: antihypertensive
Subclass: prodrug ACE inhibitor
Organ Systems: cardiovascularrenal
Mechanism of Action
Prodrug converted to quinaprilat; inhibits ACE; high tissue ACE affinity.
ACE (angiotensin-converting enzyme)
Indications
- hypertension
- heart failure
Contraindications
- pregnancy
- ACE-inhibitor angioedema
Adverse Effects
Common
- cough
- hyperkalemia
- dizziness
Serious
- angioedema
- AKI
Pharmacokinetics (ADME)
| Absorption | 60% bioavailability |
| Distribution | high tissue ACE affinity |
| Metabolism | hepatic to quinaprilat |
| Excretion | renal |
| Half-life | 2 hours (parent), 25 hours (quinaprilat) |
| Onset | 1 hour |
| Peak | 2-4 hours |
| Duration | 24 hours |
| Protein Binding | 97% |
| Vd | moderate |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| tetracyclines | magnesium in quinapril tablets chelates tetracyclines, reducing absorption | moderate |
| potassium-sparing diuretics | additive hyperkalemia | major |
Nursing Considerations
- Separate from tetracycline/quinolone antibiotics
- Monitor BP and K+
- High tissue affinity may provide prolonged tissue RAAS blockade
Clinical Pearls
- Highest tissue ACE affinity among ACE inhibitors
- Tablet contains magnesium carbonate — chelates tetracyclines
Safety Profile
Pregnancy contraindicated
Lactation avoid
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
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