Moexipril (Monograph)

Drug class: Angiotensin-Converting Enzyme Inhibitors

Medically reviewed by Drugs.com on May 10, 2026. Written by ASHP.

Important warnings

This medicine can cause some serious health issues

• Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.¹

• When pregnancy is detected, discontinue moexipril as soon as possible.¹

Introduction

Non-sulfhydryl ACE inhibitor.¹

Uses for Moexipril

Hypertension

Management of hypertension (alone or in combination with thiazide diuretics).^{1 3 4 5 6 7 8 9 10}

Comprehensive guidelines for the management of hypertension in adults have been published by various authoritative groups.^{501 1200 1300 1301 1302 1642}

Lifestyle/behavioral modifications (e.g., weight reduction in patients who are overweight or obese, dietary changes, sodium reduction, potassium supplementation, increased physical activity, moderation of alcohol intake, smoking cessation, stress reduction) are recommended as first-line therapy to lower BP and reduce total cardiovascular risk.^{1200 1300 1302}

ACE inhibitors are recommended as one of several preferred pharmacologic agents for initial management of hypertension in adults; other preferred options include angiotensin II receptor antagonists, long-acting dihydropyridine calcium-channel blockers, and thiazide or thiazide-like diuretics.^{501 503 1200 1301 1302} While there may be individual differences with respect to recommendations for initial drug selection and use in specific patient populations, current evidence indicates that these antihypertensive drug classes all generally produce comparable cardiovascular risk reduction benefits.^{501 503 1200 1302 1642}

Individualize choice of therapy; consider patient characteristics (e.g., age, ethnicity/race, comorbidities, cardiovascular risk) as well as drug-related factors (e.g., ease of administration, availability, adverse effects, cost.^{501 503 1200 1300 1302}

Specific guidelines and recommendations for the management of hypertension in pregnancy have been published by experts such as the American College of Cardiology (ACC), American Heart Association (AHA), and the American College of Obstetricians and Gynecologists (ACOG).^{1200 1305 1306}

Current guidelines from the American Academy of Pediatrics on treatment of hypertension recommend the use of angiotensin II receptor antagonists, ACE inhibitors, long-acting calcium channel blockers, or thiazide diuretics as initial agents for treatment of hypertension in children and adolescents.¹¹⁵⁰

Moexipril Dosage and Administration

General

Pretreatment Screening

• Verify pregnancy status in females of reproductive potential.¹

• Evaluate and correct sodium or volume depletion; if this is not possible, consider initiating treatment at a lower dosage.¹

• Obtain baseline renal function.¹

• Obtain baseline BP measurements.¹²⁰⁰

Patient Monitoring

• Monitor BP.¹ In patients at risk for excessive hypotension, monitor BP and symptoms closely for at least 2 weeks after initiation of moexipril or diuretic therapy or dosage adjustment of either drug.¹

• Monitor renal function periodically, particularly during the first few weeks of therapy in patients with unilateral or bilateral renal artery stenosis.¹

• Monitor serum potassium periodically.¹

• Follow-up evaluation of adherence and response to drug treatment should occur regularly until BP control is achieved.¹²⁰⁰ Periodically reinforce adherence to lifestyle modifications (e.g., heart-healthy diet, sodium intake reduction, increased physical activity).¹²⁰⁰

Administration

Administer orally (as tablets) once or twice daily 1 hour before meals.¹ Twice daily dosing may address diminished antihypertensive effect at the end of the once daily dosing interval.¹

Dosage

Available as moexipril hydrochloride; dosage expressed in terms of the salt.¹

Adjust dosage according to patient tolerance and response.¹

Adults

Hypertension

Oral

Initial dosage in patients not receiving a diuretic: 7.5 mg once daily 1 hour before a meal.¹ Adjust dosage at ≥2-week intervals to achieve BP control.¹

In patients currently receiving a diuretic: discontinue diuretic, if possible, 2–3 days before initiating moexipril.¹ May resume diuretic therapy if BP not controlled adequately with moexipril alone.¹ If diuretic cannot be discontinued, initiate moexipril at a dosage of 3.75 mg once daily under medical supervision until BP has stabilized.¹

Usual maintenance dosage: 7.5 to 30 mg daily 1 hour before meals, given in 1 dose or 2 divided doses.¹ Total daily doses >60 mg not evaluated.¹

Antihypertensive effects may diminish towards end of dosing interval.¹ To determine an adequate response, check BP at end of dosing interval; if response is inadequate, may either increase dose or divide daily dose.¹

Special Populations

Hepatic Impairment

No specific dosage recommendations.¹

Renal Impairment

For patients with renal impairment (Cl_cr ≤40 mL/min/1.73 m²), initiate therapy with a dosage of 3.75 mg once daily with caution.¹ Titrate as tolerated, and based on response, to a maximum daily dose of 15 mg.¹

Geriatric Patients

No specific dosage recommendations.¹ Generally, caution with dosage selection is advised, usually starting at low end of dosing range.¹

Cautions for Moexipril

Contraindications

• Known hypersensitivity to moexipril.¹

• History of angioedema related to previous ACE inhibitor treatment.¹

• Concomitant therapy with aliskiren in patients with diabetes mellitus.¹

Warnings/Precautions

Warnings

Fetal/Neonatal Morbidity and Mortality

Can cause fetal harm (see Boxed Warning).¹ Use during second and third trimesters of pregnancy decreases fetal renal function and increases fetal/neonatal morbidity and mortality.¹ Resulting oligohydramnios can result in fetal lung hypoplasia and skeletal deformations.¹

Potential adverse effects in neonates include skull hypoplasia, anuria, hypotension, renal failure, and death.¹ Discontinue as soon as possible when pregnancy is detected.¹

Discontinue as soon as possible when pregnancy is detected.¹

Other Warnings/Precautions

Anaphylactoid and Possibly Related Reactions

Angioedema of the face, extremities, lips, tongue, glottis, or larynx reported in patients treated with ACE inhibitors, including moexipril.¹ When suspected, discontinue moexipril treatment immediately and determine need for observation or other appropriate therapy, including SUBQ epinephrine.¹

Intestinal angioedema reported and may present as abdominal pain.¹ Symptoms have resolved upon discontinuation of ACE inhibitor.¹

Life-threatening anaphylactoid reactions reported in at least 2 patients receiving ACE inhibitors while undergoing desensitization with hymenoptera venom.¹

Anaphylactoid reactions also reported following initiation of hemodialysis that used a high-flux membrane in patients receiving an ACE inhibitor.¹

Hypotension

Symptomatic hypotension rarely reported in patients with uncomplicated hypertension.¹ Correct volume and/or salt depletion before initiating moexipril therapy.¹

Marked hypotension, sometimes associated with oliguria and/or progressive azotemia and, rarely, acute renal failure and/or death, may occur in patients with heart failure, with or without associated renal insufficiency.¹ In patients at risk, initiate moexipril under close medical supervision, and follow patients closely for 2 weeks after starting moexipril and whenever dosage of moexipril or diuretic therapy is increased.¹ Patients with ischemic heart disease, aortic stenosis, or cerebrovascular disease may experience an excessive BP reduction resulting in MI or stroke.¹

If excessive hypotension occurs, place patient in supine position and, if necessary, administer IV infusion of 0.9% sodium chloride injection to expand fluid volume.¹ Moexipril therapy usually can be continued following restoration of volume and BP.¹

Neutropenia/Agranulocytosis

Neutropenia and agranulocytosis reported with ACE inhibitors.¹ Risk of neutropenia appears to depend principally on degree of renal impairment and presence of collagen vascular disease (e.g., systemic lupus erythematosus, scleroderma); risk with moexipril is unknown.¹

Consider periodic monitoring of leukocytes in patients with collagen vascular disease, especially if renal impairment exists.¹

Hepatic Failure

Clinical syndrome that usually is manifested initially by cholestatic jaundice and may progress to fulminant hepatic necrosis (occasionally fatal) reported rarely with ACE inhibitors.¹

If jaundice or marked elevation of liver enzymes occurs, discontinue drug and monitor patient.¹

Impaired Renal Function

Inhibition of renin-angiotensin-aldosterone (RAA) system may cause renal impairment, and, rarely, acute renal failure and/or death in susceptible patients (e.g., hypertensive patients with severe heart failure).¹

Deterioration in renal function possible in hypertensive patients with unilateral or bilateral renal artery stenosis; generally reversible following discontinuance of ACE inhibitors and/or diuretic.¹

Closely monitor renal function for first few weeks following initiation of therapy and periodically thereafter in such patients.¹ Some patients may require dosage reduction or discontinuance of ACE inhibitor and/or diuretic.¹

Hyperkalemia

Possible hyperkalemia, especially in patients with renal impairment or diabetes mellitus and those receiving drugs that can increase serum potassium concentration (e.g., potassium-sparing diuretics, potassium supplements, potassium-containing salt substitutes).¹ Use moexipril with caution in these patients.¹

Surgery/Anesthesia

Hypotension may occur during surgery or anesthesia; moexipril may block the effects on compensatory renin release in such patients.¹ May correct such hypotension by volume expansion.¹

Cough

Persistent and nonproductive cough reported; resolves after moexipril discontinuance.¹

Specific Populations

Pregnancy

Can cause fetal harm when administered to pregnant women (see Boxed Warning).¹

Use during second and third trimesters of pregnancy decreases fetal renal function and increases fetal/neonatal morbidity and mortality.¹

Discontinue moexipril as soon as possible when pregnancy detected.¹ If use of moexipril is deemed necessary, apprise mother of potential hazard to fetus.¹

Perform serial ultrasound examinations to assess intraamniotic environment.¹ If oligohydramnios is observed, discontinue moexipril unless it is considered lifesaving for the mother.¹ Fetal testing may be appropriate, based on week of pregnancy.¹ However, oligohydramnios may not appear until after the fetus has sustained irreversible injury.¹

Closely observe infants with histories of in utero exposure to moexipril for hypotension, oliguria, and hyperkalemia.¹

Lactation

Not known whether moexipril is distributed into human milk.¹ Caution advised if used in nursing women.¹

Pediatric Use

Safety and efficacy not established.¹

If oliguria or hypotension occurs in neonates with a history of in utero exposure to moexipril, support BP and renal function; exchange transfusions or dialysis may be required.¹

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.¹ Select dosage with caution because of age-related decreases in hepatic, renal, and/or cardiac function and potential for concomitant disease and drug therapy.¹

Hepatic Impairment

Hepatic failure reported rarely.¹ No available recommendations for use in patients with existing hepatic impairment.¹ Drug concentrations are altered in patients with mild to moderate cirrhosis.¹

Renal Impairment

Renal function may decrease with ACE inhibitor therapy.¹ Initial dosage adjustment recommended in patients with severe renal impairment.¹

Black Patients

Less effective in reducing BP in Black patients compared with non-Black patients.¹

Higher incidence of angioedema reported with ACE inhibitors in Black patients compared with other races.¹

Common Adverse Effects

Adverse effects (>1%): increased cough, dizziness, diarrhea, flu syndrome, fatigue, pharyngitis, flushing, rash, myalgia.¹

Drug Interactions

Specific Drugs

Moexipril Pharmacokinetics

Absorption

Bioavailability

About 13% of oral dose is absorbed.¹ Peak plasma concentration of moexiprilat is achieved within about 1.5 hours.¹

Onset

During chronic therapy, maximum antihypertensive effect with any dose is achieved after 4 weeks.¹

Duration

Antihypertensive effect of a single dose persists for about 24 hours.¹

Food

Food reduces peak plasma concentration of moexipril; administer 1 hour before meals.¹

Special Populations

In patients with cirrhosis, peak plasma concentration of moexiprilat was decreased and AUC was increased.¹

In patients with renal impairment, increased moexipril and moexiprilat concentrations.¹

Distribution

Extent

Not known whether distributed into human milk.¹

Plasma Protein Binding

Moexiprilat: 50%.¹

Elimination

Metabolism

Metabolized in the liver, principally to an active metabolite, moexiprilat.¹

Elimination Route

Following oral administration, eliminated in feces (52%), principally as moexiprilat, and to a lesser extent in urine (7%).¹

Half-life

Moexiprilat: 12 hours.¹

Stability

Storage

Oral

Tablets

Store at 20–25°C with excursions permitted to 15–30°C.¹

Protect from excessive moisture.¹

Moexipril Mechanism of Action

• Inhibits ACE (bradykinase, kininase II); inhibition of ACE results in decreased plasma angiotensin II which leads to reduced vasopressor activity and decreased aldosterone secretion.¹

• Prodrug; not pharmacologically active until hydrolyzed in the liver to moexiprilat.¹

• Principal mechanism in BP reduction is believed to be through the renin angiotensin-aldosterone system.¹

Advice to Patients

• Inform patients about the risk of angioedema, anaphylactoid reactions, and other sensitivity reactions; stress importance of discontinuing the drug and immediately reporting suggestive manifestations (e.g., edema of face, eyes, extremities, lips, or tongue; hoarseness; swallowing or breathing with difficulty) to a clinician.¹

• Inform patients of the risk of lightheadedness, syncope, especially during initial therapy or with volume depletion secondary to excessive perspiration, vomiting, or diarrhea.¹ Stress importance of adequate fluid intake; discontinue drug and contact clinician if symptoms of syncope occur.¹

• Inform patients to contact their clinician promptly if manifestations of infection or neutropenia (e.g., sore throat, fever) develop.¹

• Inform patients about the risk of hyperkalemia and the importance of avoiding the use of potassium supplements or salt substitutes containing potassium without consultation with a clinician.¹

• Inform clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.¹

• Advise patients to inform clinicians immediately if they are or plan to become pregnant or plan to breast-feed; stress importance of discussing other options for hypertension treatment if pregnancy occurs.¹ Inform patients of the risk of use during pregnancy.¹

• Inform patients of other important precautionary information.¹

Additional Information

The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer’s labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

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