Quinapril Side Effects

Some side effects of quinapril may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

For the Consumer

Applies to quinapril: oral tablet

Get emergency medical help if you have any of these signs of an allergic reaction while taking quinapril: hives; severe stomach pain; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

• feeling like you might pass out;

• fever, chills, body aches, flu symptoms;

• pale or yellowed skin, dark colored urine, fever, confusion or weakness;

• high potassium (slow heart rate, weak pulse, muscle weakness, tingly feeling);

• chest pain;

• urinating more or less than usual, or not at all;

• swelling, rapid weight gain; or

• jaundice (yellowing of the skin or eyes).

Less serious side effects of quinapril may include:

• headache;

• cough;

• muscle pain, back pain;

• dizziness, tired feeling;

• nausea, vomiting, diarrhea, stomach discomfort; or

• mild skin itching or rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

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, 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

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.

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

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 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

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.

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.

Psychiatric

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

A 90-year-old white male developed symptoms of depression including lessened appetite, insomnia, anhedonia, lessened energy and suicidal ideation soon after initiating quinapril 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.

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