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.

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.

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.

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.

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.

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.

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.

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.

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.

Musculoskeletal

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

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.

Genitourinary

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

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.

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.

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.

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

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