What to Know About Accupril

The drug Accupril (quinapril) is typically prescribed to adults to treat three things—high blood pressure, heart failure, and kidney problems. It helps lower blood pressure, so it is a good option to treat arterial hypertension, congestive heart failure, and kidney failure in people with diabetes.

Accupril is an angiotensin-converting enzyme (ACE) inhibitor, a class of drugs that stop the body from producing a protein called angiotensin II. Angiotensin II narrows blood vessels, making it harder for blood to pass through. By blocking this enzyme, blood vessels stay open, blood flows more freely, and the vessels are under less pressure.

Several other ACE inhibitors treat high blood pressure, so you may be wondering if Accupril is right for you. It’s usually taken as a tablet once or twice a day and generally has mild side effects that dissipate with time. More severe side effects include swelling of the face or limbs (angioedema), so read on to learn more about this drug and what to watch for while taking it.

Uses

The FDA approved Accupril in 1991 for the treatment of:

• Arterial hypertension (high blood pressure)
• Congestive heart failure (in combination with a diuretic and digitalis)

Off-Label Uses

Doctors may prescribe Accupril and other ACE inhibitors if they find protein in your urine (proteinuria)—which is evidence that your kidneys may be damaged (diabetic nephropathy). ACE inhibitors can reduce proteinuria and prevent kidney injury in people with type 1 diabetes (only one, captopril, is formally approved for such use).

Accupril and other ACE Inhibitors can also help manage chronic kidney disease and slow disease progression.

Before Taking

According to the American College of Cardiology, almost half of adults have hypertension, also known as high blood pressure. Doctors diagnose hypertension with a blood pressure cuff, which detects the pressure against which the heart has to pump to eject blood out to the body.

The cuff puts pressure on your vessels, so your blood can only pass through when your heart is pushing the blood through harder than the cuff is. A healthcare provider pressurizes the cuff by inflating it around your arm and listens with a stethoscope for your blood passing through the vessels. The cuff’s pressure reading when your blood starts to flow through is equal to your blood pressure. 

The blood pressure reading is a combination of two numbers, the systolic number over the diastolic number. The systolic blood pressure is how much pressure your heart puts on your vessels during a beat—when it squeezes blood into your arteries. Diastolic blood pressure is the pressure in your blood vessels when your heart is between beats. 

The doctor will first listen for the higher systolic number during the heartbeat, lower the cuff’s pressure, and listen for the lower diastolic number. These days these steps are usually done automatically by an electronic blood pressure cuff. Normal or healthy blood pressure is under 120 over 80.

The American College of Cardiology defines several stages of high blood pressure above normal:

• Elevated blood pressure is when systolic is between 120-129, and the diastolic is under 80.
• Stage 1 high blood pressure is when systolic is between 130-139 or the diastolic is between 80-89.
• Stage 2 high blood pressure is when systolic at least 140 or diastolic is at least 90.
• A hypertensive crisis is when either the systolic reading is over 180 or the diastolic is over 120.

Getting a high blood pressure diagnosis may stress you out, but there are things you can do to feel better. Your doctor will likely suggest changes to your diet, increased activity, and stress reduction. If you have no history of cardiovascular disease, your doctor will probably start medication at stage 2. If you have a history of cardiovascular disease, they may prescribe ACE inhibitors at Stage 1.

The National Institutes of Health define heart failure as the weakening of the heart muscle to the point that it is no longer pumping enough blood to keep the body healthy. Your doctor may make this diagnosis after reviewing your health history, performing a physical exam, and doing several diagnostic tests, including blood tests and scans of your heart and lungs.

Knowing your heart isn’t working as well as it should is scary. The American Heart Association defines the four heart failure classes based on worsening fatigue symptoms, heart palpitation, and shortness of breath. Doctors will start treatment early on, in class I or II, to prevent as much damage as possible:

• Class I: Symptoms are mild and don’t impact physical activity. 
• Class II: Symptoms mildly impact physical activity, but resting is still comfortable.
• Class III: Symptoms significantly limit physical activity.
• Class IV: Symptoms make any physical activity uncomfortable and show up while resting.

Precautions and Contraindications

If you have a personal or family history of angioedema (swelling of the face and limbs) or overreaction to Accupril or any ingredient in the drug, let your doctor know, as these conditions would likely disqualify you from taking the medication.

There are a few conditions in which Accupril is avoided or used with extreme caution:

• Impaired kidney function due to an increased risk of hyperkalemia and kidney failure.
• Hypotension (low blood pressure) due to a potentially life-threatening drop in blood pressure
• Acute or advanced liver disease due to an increased risk of liver failure
• Pregnancy due to a risk of fetal toxicity and death

If you have any of these conditions, your doctor will use their clinical judgment to weigh the benefits and risks. If they decide to prescribe Accupril or another ACE inhibitor, they will closely monitor your blood pressure, kidney function, liver enzymes, and fetal development to avoid complications.

Other ACE Inhibitors

Nine other ACE inhibitors have similar mechanisms of action and many of the same indications for use:

• Benazepril
• Captopril
• Enalapril
• Fosinopril
• Lisinopril
• Moexipril
• Perindopril
• Ramipril
• Trandolapril

Doctors choose which ACE inhibitor to prescribe based on age, race, side effects, dosing schedules, and their own experiences with the drug. 

Among Black people with hypertension, for example, ACE inhibitors tend to work less well when used on their own. According to a review in the Annals of Pharmacotherapy, treatment may require additional medications, such as calcium channel blockers or thiazide diuretics, to provide adequate control.

Dosage

Accupril is available as a tablet in 5-milligram (mg), 10-mg, 20-mg, and 40-mg formulations. These drugs are typically started on a lower dose and increased over time to let your body adjust to the medication. Doses are increased every two weeks for hypertension, and every week for heart failure until your symptoms go away.

Modifications

Your doctor will measure your kidney function by testing your creatinine clearance and might reduce your dose if your clearance is too low.

Potassium levels also will be monitored as ACE inhibitors may cause a rise in potassium.

How to Take and Store

Accupril can be taken with or without food, although high-fat meals may decrease absorption. Accupril can be stored safely at room temperature (up to 77 F) but shouldn’t be frozen. 

If you miss a dose, take it as soon as you remember, unless it’s already time for your next pill. In that case, skip the missed dose and continue your medicine regimen as prescribed. Don’t double dose.

Side Effects

Side effects can occur with all ACE inhibitors, but thankfully, the side effects of Accupril are mild and tend to resolve as your body adapts to treatment. 

Common

Accupril has fewer adverse reactions than ACE inhibitors like Vasotec (enalapril) but may still cause side effects, including:

• Headache
• Dizziness
• Dry cough
• Chest pain
• Sore throat
• Metallic taste
• Itchiness
• Nausea

If side effects persist or worsen, let your doctor know.

Severe

The most severe complication of ACE inhibitors like Accupril is angioedema, a swelling of the face, limbs, or throat. This swelling, on rare occasions, can become severe and even life-threatening. It can also happen in the small intestine (called intestinal angioedema), which may cause abdominal pain, cramping, nausea, and vomiting.

Another rare side effect, typically found in people with preexisting liver disease, is liver failure. It can rapidly progress in users of ACE inhibitors, leading to massive liver necrosis and death, so call your doctor immediately if jaundice or other hepatitis symptoms develop.

Warnings and Interactions

Significant drug interactions include:

• Lithium
• Nonsteroid anti-inflammatory drugs
• Potassium-sparing diuretics
• Potassium supplements
• Potassium salts
• Rapamycin and rapamycin derivatives (like the cancer drugs temsirolimus and everolimus)
• Tetracycline antibiotics

To avoid interactions, advise your doctor about any medications you take, including prescription, over-the-counter, nutritional, herbal, or recreational drugs.