Note: This document contains side effect information about hydrochlorothiazide / quinapril. Some dosage forms listed on this page may not apply to the brand name Accuretic.

Applies to hydrochlorothiazide / quinapril: oral tablet.

Serious side effects of Accuretic

Along with its needed effects, hydrochlorothiazide / quinapril may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking hydrochlorothiazide / quinapril:

Less common

• Cough producing mucus
• diarrhea
• difficulty breathing
• large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
• tightness in the chest

Rare

• Black, tarry stools
• bleeding gums
• blistering, peeling, loosening of skin
• blood in the urine or stools
• blurred vision
• confusion
• decreased urination
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• dry mouth
• fast or irregular heartbeat
• increased sensitivity of skin to sunlight
• muscle cramps or pain
• numbness, tingling, pain, or weakness in the hands or feet
• pinpoint red spots on the skin
• rapid breathing
• seizures
• sunken eyes
• sweating
• thirst
• trembling
• unusual tiredness or weakness
• weakness and heaviness of the legs
• wrinkled skin

Incidence not known

• Persistent non-healing sore
• pink growth
• reddish patch or irritated area
• shiny bump
• shock
• speech problems
• swelling of the hands, ankles, or feet
• unusual bleeding or bruising
• white, yellow or waxy scar-like area

Other side effects of Accuretic

Some side effects of hydrochlorothiazide / quinapril may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Headache

Less common

• Back pain
• coughing
• lack or loss of strength
• sleepiness or unusual drowsiness
• trouble sleeping

Rare

• Change in vision
• constipation
• discouragement
• feeling sad or empty
• general feeling of discomfort or illness
• impaired vision
• irritability
• lack of appetite
• loss of interest or pleasure
• trouble concentrating

For Healthcare Professionals

Applies to hydrochlorothiazide / quinapril: oral tablet.

Respiratory

Common (1% to 10%): Dry cough, rhinitis, upper respiratory infection, bronchitis, pharyngitis

Uncommon (0.1% to 1%):

Rare (less than 0.1%): Pneumonia, asthma, respiratory infiltration, lung disorder, acute noncardiogenic pulmonary edema

Frequency not reported: Rash, acute pulmonary edema, interstitial cystitis^[Ref]

Renal

Patients with renal artery stenosis maintain glomerular filtration rate (GFR) by efferent arteriolar vasoconstriction, which is blocked by quinapril.

Although quinapril may be associated with a rise in serum creatinine and BUN, GFR has been shown to remain unchanged or improve in most patients.

HCTZ has been used to treat nephrogenic diabetes insipidus. However, a case in which the drug was believed to have caused this condition has been reported.^[Ref]

Frequency not reported: New or worsened renal insufficiency (especially in patients with preexisting renal insufficiency or who are angiotensin-dependent, such as those with CHF)

Quinapril:

Frequency not reported: Acute renal failure, new onset proteinuria

Hydrochlorothiazide:

Rare (less than 0.1%): Interstitial nephritis^[Ref]

Cardiovascular

Hypotension is most likely in patients who are sodium and intravascular volume depleted.^[Ref]

Common (1% to 10%): Vasodilation, vertigo, chest pain

Uncommon (0.1% to 1%): Palpitations, tachycardia

Rare (less than 0.1%): Heart failure, myocardial infarction, cerebrovascular accident, hypertensive crisis, orthostatic hypotension, cardiac rhythm disturbance

Frequency not reported: Hydrochlorothiazide-induced hypokalemia can predispose some patients to various cardiac arrhythmias, such as ventricular ectopy and complete AV heart block

Postmarketing reports: Bradycardia, cor pulmonale, vasculitis, deep thrombosis^[Ref]

Hypersensitivity

Patients with intestinal angioedema generally present with abdominal pain (with or without nausea or vomiting) and in some cases there was no prior history of facial angioedema, and C-1 esterase levels were normal. These symptoms resolve after stopping the ACE inhibitor..

There have been approximately 34 known cases of thiazide-induced pulmonary edema, encompassing 52 episodes of pulmonary edema, as of 1991 (per a 1996 review). In some cases, doses as small as 12.5 mg were associated with the development of pulmonary edema. The average time to onset of this adverse reaction was 44 minutes, women have a relative risk of 9:1, and the average age was 56 years. The mortality rate was 6%. Some experts consider this side effect grossly underreported.^[Ref]

Quinapril:

Rare (less than 0.1%): Angioedema of the face, extremities, lips, tongue, glottis and/or pharynx, intestinal angioedema

Hydrochlorothiazide:

Uncommon (0.1% to 1%): Rash, anaphylaxis^[Ref]

Nervous system

Common (1% to 10%): Headache, dizziness, fatigue, insomnia, somnolence, asthenia

Postmarketing reports: Speech disorder, meningism, amnesia^[Ref]

Metabolic

Quinapril:

Rare (less than 0.1%): Angioedema of the face, extremities, lips, tongue, glottis and/or pharynx, intestinal angioedema

Hydrochlorothiazide:

Frequency not reported: Metabolic alkalosis, hyponatremia, hypomagnesemia, hypercalcemia, hyperglycemia, elevated serum uric acid levels, increased serum cholesterol^[Ref]

HCTZ may increase total serum cholesterol by 11%, LDL lipoprotein cholesterol by 12%, and VLDL lipoprotein cholesterol levels by 50%, as well as reduce insulin secretion. It should be used with caution in patients with diabetes or hypercholesterolemia.

Hyperuricemia may be an important consideration in patients with a history of gout. Hypophosphatemia and low serum magnesium concentrations may also occur, but are usually clinically insignificant except in malnourished patients.^[Ref]

Hematologic

Quinapril:

Rare (less than 0.1%): Neutropenia, bone marrow depression

Hydrochlorothiazide:

Very rare (less than 0.01%): Immune complex hemolytic anemia, aplastic anemia, thrombocytopenia^[Ref]

Gastrointestinal

Thiazide diuretics may increase serum cholesterol and triglycerides, resulting in an increased risk of cholesterol gallstone formation. Reports of bowel strictures associated with thiazide ingestion were reported in the 1960's (although patients in these reports were on a combination HCTZ-potassium product).^[Ref]

Common (1% to 10%): Nausea, vomiting, abdominal pain, diarrhea, dyspepsia

Uncommon (0.1% to 1%): Dry mouth, gastrointestinal hemorrhage

Hydrochlorothiazide:

Rare (less than 0.1%): Pancreatitis, acute cholecystitis^[Ref]

Dermatologic

Hydrochlorothiazide:

Rare (less than 0.1%): A distinct entity with clinical and laboratory features indistinguishable from those of subacute cutaneous lupus erythematosus, pruritus, increased sweating, erythema, alopecia, pemphigus

Frequency not reported: Erythema annular centrifugum, acute eczematous dermatitis, morbilliform or leukocytoclastic vasculitis, phototoxic dermatitis

Postmarketing reports: Urticaria, maculopapular rash, petechiae, non-melanoma skin cancer^[Ref]

Endocrine

A prospective study of 34 patients who received oral thiazide diuretics for 14 years without interruption revealed an increased mean fasting blood glucose level after treatment. Withdrawal of thiazide therapy for seven months in 10 of the patients resulted in mean reductions of 10% in fasting blood glucose and 25% in the 2-hour glucose tolerance test value. A control group was not reported.^[Ref]

Hydrochlorothiazide:

Frequency not reported: Glucose intolerance and a potentially deleterious effect on the lipid profile (either of which may be important in some patients with or at risk for diabetes or coronary artery disease)^[Ref]

Musculoskeletal

Rare (less than 0.1%): Myalgias, chills, myopathy, myositis, muscle spasm, back pain, arthritis

Postmarketing reports: Paralysis, hemiplegia, abnormal gait^[Ref]

Genitourinary

Rare (less than 0.1%): Impotence in male patients, interstitial cystitis^[Ref]

Ocular

Hydrochlorothiazide:

Rare (less than 0.1%): Acute transient myopia, acute angle-closure glaucoma^[Ref]

Hepatic

Hydrochlorothiazide:

Frequency not reported: Interstitial nephritis^[Ref]