Index of drugs

Arterial hypertension of all stages - in monotherapy or in combination with diuretics. Congestive heart failure - in combination with diuretic and / or digitalis glycosides.

1 tabl powl. contains 5 mg, 10 mg, 20 mg or 40 mg quinapril.

Chinapril is a prodrug that is hydrolysed to the active metabolite - quinaprilat - an ACE-converting enzyme inhibitor that works in plasma and tissues. ACE catalyses the conversion of angiotensin I to angiotensin II, which is a potent vasodilator. ACE inhibition results in a decrease in angiotensin II and a reduction in aldosterone release; the bradykinin metabolism is also likely to be inhibited. Quinapril has no effect on the lipid profile and has no negative effect on Glucose metabolism. Chinapril reduces peripheral and renal resistance. There are no clinically significant changes in renal blood flow and glomerular filtration rate. Chinaprilate causes lowering of blood pressure in a sitting and standing position. At the recommended doses, the maximum effect is obtained after 2-4 h. In some patients, achieving the maximum antihypertensive effect may take 2-4 weeks. The bioavailability of the active metabolite - quinaprilat is 30-40% of the administered quinapril oral dose. The maximum concentration in the blood is obtained after about 2 hours after administration. About 97% of the active substance binds to plasma proteins. When using multiple doses of T_0,5 is 3 hours. The stationary state is reached within 2-3 days. Quinaprilate is mainly excreted unchanged in the urine.

Hypersensitivity to quinapril, to other ACE inhibitors or other components of the preparation. History of angioedema associated with prior use of ACE inhibitors. Hereditary or idiopathic angioneurotic edema. Pregnancy and breastfeeding.

Caution should be exercised in the case of dehydration (eg as a result of diuretics, salt restrictions in the diet, dialysis, diarrhea or vomiting), in patients with impaired renal function, heart failure, high doses of loop diuretics, hyponatraemia - risk of symptomatic hypotension (these patients should be closely monitored at the beginning of therapy and when adjusting the dose of diuretic and / or quinapril, this also applies to patients with ischemic heart disease or cerebrovascular disease, in which a significant reduction in blood pressure may cause a heart attack or cerebrovascular episode) . Patients who are at higher risk and whose treatment should be started in a hospital include: patients treated with high doses of loop diuretics (eg> 80 mg furosemide) or several diuretics, patients with hypovolaemia, hyponatremia (<130 mEq / l ) or systolic blood pressure <90 mmHg, patients treated with high doses of vasodilators, with creatinine in the blood> 150 μmol / l or patients> 70 years. Carefully use in patients with hypertrophic cardiomyopathy and left ventricular outflow disorders due to, for example, aortic valve stenosis or subvalvular stenosis. In severe cases justified by the results of hemodynamic tests, quinapril should not be used. Caution should be used in patients with bilateral renal artery stenosis or renal artery stenosis of the only active kidney, especially in patients with renal insufficiency. The risk of severe hypotension and renal failure is greater in the case of concomitant renal arterial hypertension. In these patients, small doses of the product should be used at the beginning of the treatment and the dose should be carefully increased; therapy with diuretics should be discontinued and renal function should be monitored during the first weeks of treatment with quinapril. Experience with the use of quinapril in patients with severe renal impairment (creatinine clearance <10 ml / min) and dialysis patients is insufficient - use is not recommended.There is no experience with the use of quinapril in patients after a recent kidney transplant surgery - the drug is not recommended in this group of patients. In patients receiving ACE inhibitors treated with hemodialysis using dialysis membranes with high permeability, anaphylactoid reactions have been observed - consideration should be given to using a different type of dialysis membrane or other group of antihypertensive agents. For patients requiring desensitisation (eg Hymenoptera venom) or for LDL-apheresis treatment with dextran sulphate, it is recommended to temporarily discontinue ACE inhibitors due to the risk of life-threatening anaphylactoid reactions. Caution should be used in patients with impaired liver function, undergoing major surgery or during anesthesia with hypotensive agents, and in patients with a history of angioneurotic edema, not associated with administration of ACE inhibitors, in patients with diabetes. Particular caution should be exercised when using quinapril in patients with vascular collagen, treated with immunosuppressive drugs, Allopurinol or procainamide, and in patients in whom these factors coexist, especially if there have been renal dysfunctions (the number of leukocytes should be monitored). ACE inhibitors are more likely to cause angioneurotic edema in black patients than in other human races. Chinapril may be less effective in lowering blood pressure in black patients. Due to the risk of hyperkalemia, caution should be used in patients with renal failure, diabetes, treated with potassium-sparing diuretics, taking potassium supplements or potassium chloride substitutes, and in patients taking other medicines that may cause an increase in potassium in the blood (eg heparin). Patients with primary hyperaldosteronism do not respond to treatment with antihypertensive drugs acting through the renin-angiotensin system - ACE inhibitors are not recommended in these patients. The efficacy and safety of the drug in children and adolescents has not been confirmed - the preparation is not recommended in this group of patients.

The preparation is contraindicated in pregnancy and breast-feeding. The use of ACE inhibitors in the first trimester of pregnancy potentially is associated with an increased risk of congenital malformations. Prolonged exposure to ACE inhibitors in the second and third trimester of pregnancy causes toxic effects on the fetus (renal dysfunction, oligohydramnios, delayed ossification of the skull) and toxic to the newborn (renal failure, hypotension, hyperkalemia). ACE inhibitors given to pregnant women can cause death of the fetus and newborn baby. In women planning pregnancy, ACE inhibitors should not be used. Women of childbearing potential should be warned of potential risks, and ACE inhibitors in these patients should be used after careful consideration of the benefit to risk. Chinapril is excreted in human milk.

Common (≥1 / 100, <1/10): pain and dizziness, fatigue, hypotension, cough, nausea, vomiting, diarrhea. Uncommon (≥1 / 1000, <1/100): insomnia, nervousness; paresthesia, drowsiness; palpitations, cardiac arrest, chest pain, angina pectoris; orthostatic hypotension; neutropenia; sinusitis, pharyngitis, upper respiratory tract infection; indigestion, abdominal pain, dry mouth, bloating; rash, pruritus, urticaria, exfoliative dermatitis, increased sweating, rash; proteinuria (sometimes with worsening of renal function); impotence; weakness, angioneurotic edema (face, extremities, lips, mucous membranes, tongue, glottis and / or larynx). Rare (≥1 / 10,000, <1/1000): depression, confusion; balance disorders, neuropathy; blurred vision, amblyopia; Tinnitus; tachycardia, syncope, myocardial infarction, transient ischemic attacks, cerebral haemorrhage; agranulocytosis; bronchospasm, dyspnea, bronchitis, rhinitis, worsening of asthma symptoms, eosinophilic pneumonia, viral infections; taste disorders, constipation, pancreatitis, inflammation of the tongue, intestinal obstruction; liver dysfunction; erythema multiforme, Stevens-Johnson syndrome, epidermal necrolysis, psoriasis-like rash, alopecia, pemphigus, hypersensitivity to light; arthralgia, muscle pain, backache; kidney problems.Very rare (<1 / 10,000): allergic alveolitis, anaphylactoid reactions; cholestatic jaundice, hepatitis; kidney failure. Other gynaecomastia, vasculitis have been reported with other ACE inhibitors; it can not be ruled out that these side effects are specific to the whole group of drugs. There was an increase in blood creatinine and urea nitrogen, angioedema of the intestine, and individual cases of haemolytic anemia were reported in patients with congenital G-6-PD deficiency. There have been rare cases of agranulocytosis and a combination of fever, polyserositis, vasculitis, myalgia, arthralgia and arthritis, increased serum antinuclear antibodies, accelerated ESR, eosinophilia and leukocytosis. Reductions in hematocrit, platelets and leukocytes as well as increased liver enzymes and bilirubin in the blood were also observed. Rarely, during the treatment with angiotensin converting enzyme inhibitors, a syndrome that started with cholestasis jaundice and progressed to fulminant hepatic necrosis, sometimes leading to death, has been reported.

Orally. Adults.Arterial hypertension. monotherapyThe recommended initial dose in uncomplicated hypertension is 10 mg per day. Depending on the clinical response, the dose may be gradually increased (doubling the dose) to a maintenance dose of 20-40 mg per day administered in 1-2 doses. In the majority of patients, a single dose of quinapril given once a day is used for chronic treatment. Doses up to 80 mg / day were used in some patients.Concomitant use of diureticsThe recommended starting dose of quinapril is 2.5 mg / day. The dose should then be gradually increased until the optimal therapeutic response is achieved.Congestive heart failure: the recommended starting dose is 2.5 mg per day. The dose should then be gradually increased to 40 mg daily, administered in 1-2 doses, simultaneously with a diuretic and / or cardiac glycoside. The maintenance dose is usually 10-20 mg per day in combination with other medicines. In the treatment of severe or unstable congestive heart failure and in patients who are at higher risk, the use of quinapril should always be started in a hospital under close medical supervision.
In the elderly, the recommended starting dose for the treatment of primary hypertension is 2.5 mg; then the dose is gradually increased until an optimal therapeutic response is obtained. In patients with impaired renal function with a creatinine clearance of 30-60 ml / min, the maximum recommended starting dose is 5 mg; at a clearance of 10-30 ml / min - 2.5 mg.
The preparation can be taken regardless of the meal; the preparation should be taken regularly at the same time.