Usual Adult Dose for Hypertension

Initial dose: 10 or 20 mg orally once a day in patients not on diuretics
Maintenance dose: 20 to 80 mg orally per day, administered as a single dose or in two equally divided doses

Use:

• Treatment of hypertension

Usual Adult Dose for Congestive Heart Failure

Initial dose: 5 mg orally twice a day
Maintenance dose: 20 to 40 mg orally per day administered in two equally divided doses

Comments:

• This dose may improve symptoms of heart failure, but increases in exercise duration have generally required higher doses.
• If the initial dosage is well tolerated, patients should then be titrated at weekly intervals until an effective dose.

• Management of heart failure as adjunctive therapy when added to conventional therapy including diuretics and/or digitalis

Usual Geriatric Dose for Congestive Heart Failure

10 mg orally once a day

Comments: Dose should be titrated the same way as for other adult patients.

Uses:

• Treatment of hypertension
• Management of heart failure as adjunctive therapy when added to conventional therapy including diuretics and/or digitalis

Usual Geriatric Dose for Hypertension

10 mg orally once a day

Comments: Dose should be titrated the same way as for other adult patients.

Uses:

• Treatment of hypertension
• Management of heart failure as adjunctive therapy when added to conventional therapy including diuretics and/or digitalis

Renal Dose Adjustments

CrCl greater than 60 mL/min: Initial dose: 10 mg orally once a day
CrCl 30 to 60 mL/min: Initial dose: 5 mg orally once a day
CrCl 10 to 30 mL/min: Initial dose: 2.5 mg orally once a day
CrCl less than 10 mL/min: Data not available

Liver Dose Adjustments

Data not available

Dose Adjustments

• Doses used for hypertension should be adjusted according to blood pressure response measured at peak (2 to 6 hours after dosing) and trough (predosing). Usually, dosage adjustments should be made at intervals of at least 2 weeks.
• In patients in whom the antihypertensive effect may diminish toward the end of the dosing interval, an increase in dosage or twice a day administration may be justified. Doses of 40 to 80 mg and divided doses give a greater effect at the end of the dosing interval.
• Doses used for heart failure should be titrated at weekly intervals until an effective dose is reached or undesirable hypotension, orthostasis, or azotemia precludes this dose titration.
• If blood pressure is not controlled, a diuretic can be added. An initial dose of 5 mg orally once a day should be administered with medical supervision and until blood pressure has stabilized.
• 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.

Precautions

US BOXED WARNING:

• FETAL TOXICITY: When pregnancy is detected, discontinue use as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.

Dialysis

Hemodialysis and peritoneal dialysis: Little effect on the elimination of quinapril

Other Comments

Administration advice:

• If blood pressure is not adequately controlled with quinapril monotherapy, a diuretic may be added.
• To reduce the likelihood of hypotension, the diuretic should, if possible, be discontinued 2 to 3 days prior to beginning therapy with quinapril.

• Protect from light

• Cardiovascular: Closely monitor blood pressure
• Renal: Closely monitor renal function
• Metabolic: Closely monitor electrolytes

Frequently asked questions

• Do ACE inhibitors make COVID-19 worse?