Accupril Side Effects

Generic Name: quinapril

Note: This page contains information about the side effects of quinapril. Some of the dosage forms included on this document may not apply to the brand name Accupril.

Not all side effects for Accupril may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to quinapril: oral tablet

In addition to its needed effects, some unwanted effects may be caused by quinapril (the active ingredient contained in Accupril). In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking quinapril:

Less common
  • Abdominal or stomach pain
  • blurred vision
  • chest pain
  • confusion
  • diarrhea
  • difficult or labored breathing
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • nausea
  • sweating
  • tightness in the chest
  • unusual tiredness or weakness
  • vomiting

Some of the side effects that can occur with quinapril may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common
  • Headache
Less common
  • Back pain
  • coughing
  • difficulty with moving
  • joint pain
  • muscle aching or cramping
  • muscle pains or stiffness
  • rash
  • swollen joints

For Healthcare Professionals

Applies to quinapril: oral tablet

General

Quinapril is generally well-tolerated. Overall, 12% to 37% of patients experience an adverse drug event associated with quinapril (the active ingredient contained in Accupril) but less than 6% of patients discontinue therapy due to an adverse drug event. Side effects are not more common in the elderly.[Ref]

Nervous system

Nervous system side effects are the most common. Dizziness, headache, and fatigue occur in 2% to 7% of patients. Somnolence, paresthesias, or asthenia are reported in less than 1% of patients.[Ref]

Cardiovascular

Exacerbation of congestive heart failure (CHF) and of angina pectoris are each reported in one patient with preexisting NYHA class II to III CHF.[Ref]

Cardiovascular side effects include orthostatic hypotension in 6% of patients and angioedema in 0.1% of patients. First-dose orthostatic hypotension is less common than with other ACE inhibitors, occurring in only 0.4% to 2.5% of patients. Less than 1% of patients report chest pain during quinapril therapy.[Ref]

Gastrointestinal

Gastrointestinal side effects are uncommon, and limited mainly to general abdominal pain in up to 6% of patients. Dysgeusia, nausea, vomiting, dyspepsia, or diarrhea is reported in 0.5% to 2.0% of patients. Several reports of pancreatitis have been associated with ACE inhibitor therapy.[Ref]

An 83-year-old female developed signs of pancreatitis after eleven days of quinapril therapy. Upon admission to the hospital, the patient complained of epigastric and left upper-quadrant abdominal tenderness. Laboratory values revealed elevated serum amylase, serum lipase, and white blood cell count. Quinapril was discontinued on admission in the view of possible ACE inhibitor-associated pancreatitis. Three days after discontinuation of quinapril, the patient's abdominal pain resolved and laboratory values were normal.[Ref]

Respiratory

Respiratory system complaints are limited to an idiosyncratic cough in 1% to 8% of patients. Bronchitis or rhinitis occurs in approximately 2% of patients.[Ref]

A retrospective study has revealed a significantly higher incidence of discontinuation of angiotensin converting enzyme inhibitor therapy due to cough among black patients compared with non-black patients (9.6% vs. 2.4%).

Several agents have been studied for treating cough with ACE inhibitors. No long term trials exist to allow a definitive treatment option. Cromolyn has the most data showing some benefit. Other agents studied include baclofen, theophylline, sulindac, and benzonatate.[Ref]

Hematologic

Hematologic side effects are extremely uncommon. No cases of agranulocytosis have been reported. Decreased white blood cell counts in 0.4% and reductions in neutrophil counts in 2.0% of patients are reported.[Ref]

Musculoskeletal

Musculoskeletal pain is reported in 2% to 5% of patients.[Ref]

Renal

Renal insufficiency is rare. Data from a study of 37 patients with renal insufficiency reveal no significant adverse effect of quinapril (the active ingredient contained in Accupril) on renal function. Elevated serum creatinine and BUN is reported in 1.0% and 0.1% of patients, respectively.[Ref]

Genitourinary

Genitourinary problems are limited to complaints of impotence in less than 0.5% of men.[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.[Ref]

Hypersensitivity reactions to angiotensin converting enzyme (ACE) inhibitors may be life threatening. Angioedema of the face, extremities, lips, tongue, glottis and/or pharynx have been reported rarely in patients receiving ACE inhibitors. In addition, intestinal angioedema has been reported in patients treated with ACE inhibitors. It is recommended that any patient with dyspnea, dysphagia, or significant facial angioedema stop therapy immediately and avoid ACE inhibitor therapy in general.

Rash and photosensitivity are each reported in small studies of patients with NYHA class II to III congestive heart failure and in approximately 0.2% of 1417 patients in a large study. Anaphylactoid reaction has also been reported.[Ref]

Psychiatric

A 90-year-old white male developed symptoms of depression including lessened appetite, insomnia, anhedonia, lessened energy and suicidal ideation soon after initiating quinapril (the active ingredient contained in Accupril) therapy. The patient had no prior psychiatric history or history of drug abuse. The decision was made to discontinue quinapril therapy and the patient was subsequently given diltiazem treatment. The patient reported improvement in mood within the first 48 hours of discontinuing quinapril.[Ref]

Psychiatric side effects including symptoms of major depression have been associated with quinapril therapy in at least one documented case report.[Ref]

References

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4. Rosenthal J, Bahrmann H, Benkert K, Baumgart P, Bonner G, Klein G, Neiss A, Schnelle K, Frohlich ED "Analysis of adverse effects among patients with essential hypertension receiving an ACE inhibitor or a beta-blocker." Cardiology 87 (1996): 409-14

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7. Wadworth AN, Brogden RN "Quinapril: a review of its pharmacological properties, and therapeutic efficacy in cardiovascular disorders." Drugs 41 (1991): 378-99

8. Larochelle P, Haynes B, Maron N, Dugas S "A postmarketing surveillance evaluation of quinapril in 3742 canadian hypertensive patients - the ACCEPT study." Clin Ther 16 (1994): 838-53

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10. Antonios TFT, Macgregor GA "Angiotensin converting enzyme inhibitors in hypertension: potential problems." J Hypertens 13 Suppl (1995): s11-6

11. Schnaper HW "Comparison of the efficacy and safety of quinapril vs. captopril in treatment of moderate to severe hypertension." Angiology 40 (1989): 389-95

12. Alderman CP "Adverse effects of the angiotensin-converting enzyme inhibitors." Ann Pharmacother 30 (1996): 55-61

13. Frishman WH "The efficacy and safety of quinapril in the treatment of moderate to severe and severe hypertension: comparison to captopril." Clin Cardiol 13 (1990): vii26-31

14. Pflugfelder PW, Baird MG, Tonkon MJ, Dibianco R, Pitt B "Clinical consequences of angiotensin-converting enzyme inhibitor withdrawal in chronic heart failure - a double-blind, placebo-controlled study of quinapril." J Am Coll Cardiol 22 (1993): 1557-63

15. Lenz T, Schulte KL, Wagner B, Lilienthal J, Gotzen R "Quinapril, hydrochlorothiazide, and combination in patients with moderate to severe hypertension." Eur Heart J 15 (1994): 940-6

16. Romero R, Castellote E, Ocon J, Wagner B "Controlled multicenter study with quinapril, hydrochlorothiazide, and combination in patients with moderate to severe hypertension." J Cardiovasc Pharmacol 26 (1995): 114-8

17. Taylor SH "A comparison of the efficacy and safety of quinapril with that of enalapril in the treatment of mild to moderate essential hypertension." Angiology 40 (1989): 382-8

18. Maclean D "Quinapril: a double-blind, placebo-controlled trial in essential hypertension." Angiology 40 (1989): 370-81

19. Materson BJ "Adverse effects of angiotensin-converting enzyme inhibitors in antihypertensive therapy with focus on quinapril." Am J Cardiol 69 (1992): c46-53

20. Northridge DB, Rose E, Raftery ED, Lahiri A, Elder AT, Shaw TR, Henderson E, Dargie HJ "A multicentre, double-blind, placebo-controlled trial of quinapril in mild, chronic heart failure." Eur Heart J 14 (1993): 403-9

21. Frishman WH "The safety and efficacy of quinapril in the treatment of mild to moderate essential hypertension." Clin Cardiol 13 (1990): vii19-25

22. Sedman AJ, Posvar E "Clinical pharmacology of quinapril in healthy volunteers and in patients with hypertension and congestive heart failure." Angiology 40 (1989): 360-9

23. Frank GJ, Knapp LE, Olson SC, Phelps MC, Quade MM, Rieger MM, Sedman AJ "Overview of quinapril, a new ACE inhibitor." J Cardiovasc Pharmacol 15 (1990): s14-23

24. Forette B, Koen R, Vivaut E "Efficacy and safety of quinapril in the elderly hypertensive patient." Am Heart J 123 (1992): 1426-32

25. Banas JS, Jr "Preliminary hemodynamic report of the efficacy and safety of quinapril in acute and chronic treatment of patients with congestive heart failure." Angiology 40 (1989): 396-404

26. Gavazzi A, Marioni R, Campana C, Montemartini C "Comparative trial of quinapril versus captopril in mild to moderate congestive heart failure." J Hypertens 12 Suppl (1994): s89-93

27. Singh S "Angiotensin-converting enzyme (ACE) inhibitor-induced acute pancreatitis: in search of the evidence." South Med J 99 (2006): 1327-8

28. Semple PF "Putative mechanisms of cough after treatment with angiotensin converting enzyme inhibitors." J Hypertens 13 Suppl (1995): s17-21

29. Sharif MN, Evans BL, Pylypchuk GB "Cough induced by quinapril with resolution after changeing to fosinopril." Ann Pharmacother 28 (1994): 720-2

30. Luque CA, Ortiz MV "Treatment of ACE inhibitor-induced cough." Pharmacotherapy 19 (1999): 804-10

31. Elliott WJ "Higher incidence of discontinuation of angiotensin converting enzyme inhibitors due to cough in black subjects." Clin Pharmacol Ther 60 (1996): 582-8

32. Wynckel A, Ebikili B, Melin JP, Randoux C, Lavaud S, Chanard J "Long-term follow-up of acute renal failure caused by angiotensin converting enzyme inhibitors." Am J Hypertens 11 (1998): 1080-6

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