Hydrochlorothiazide / Quinapril Side Effects

Medically reviewed by Drugs.com. Last updated on Dec 10, 2024.

Applies to hydrochlorothiazide / quinapril: oral tablet.

Precautions

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

Using this medicine while you are pregnant can harm your unborn baby, especially in your second or third trimester. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using this medicine, tell your doctor right away. You may need to stop using this medicine.

You should not use this medicine together with sacubitril. Do not use this medicine and sacubitril/valsartan (Entresto®) within 36 hours of each other.

This medicine may cause serious types of allergic reactions, including anaphylaxis, which can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

Call your doctor right away if you have severe stomach pain (with or without nausea or vomiting). This could be a symptom of intestinal angioedema.

Dizziness, lightheadedness, or fainting may also occur, especially when you get up from a lying or sitting position or if you have been taking a diuretic (water pill). Make sure you know how you react to the medicine before you drive, use machines, or do other things that could be dangerous if you are dizzy or not alert. If you feel dizzy, lie down so you do not faint. Then sit for a few moments before standing to prevent the dizziness from returning.

Check with your doctor right away if you become sick while taking this medicine, especially with severe or continuing nausea, vomiting, or diarrhea. These conditions may cause you to lose too much water or salt and may lead to low blood pressure. You can also lose water by sweating, so drink plenty of water during exercise or in hot weather.

Check with your doctor if you have a fever, chills, or sore throat. These may be symptoms of an infection resulting from low white blood cells.

This medicine may affect blood sugar levels. If you notice a change in the results of your blood or urine sugar tests, or if you have any questions, check with your doctor.

Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Check with your doctor right away if you have lower back or side pain, decreased frequency or amount of urine, bloody urine, increased thirst, swelling of the face, fingers, or lower legs, weight gain, or increased blood pressure. These could be symptoms of a serious kidney problem.

Check with your doctor immediately if blurred vision, difficulty in reading, eye pain, or any other changes in vision occurs during or after treatment. This could be a sign of a serious eye problem. Your doctor may want your eyes to be checked by an ophthalmologist (eye doctor).

Hyperkalemia (high potassium in the blood) may occur while you are using this medicine. Check with your doctor right away if you have stomach pain, confusion, irregular heartbeat, nausea or vomiting, nervousness, numbness or tingling in the hands, feet, or lips, trouble breathing, or weakness or heaviness of the legs. Do not use supplements or salt substitutes containing potassium without first checking with your doctor.

Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery or medical tests.

This medicine may increase your risk of getting skin cancer (eg, non-melanoma skin cancer). Avoid sun exposure. Use a sunscreen when you are outdoors. Avoid sunlamps and tanning beds. Talk to your doctor if you have concerns about this risk.

This medicine may be less effective in black patients. Black patients also have an increased risk of swelling of the hands, arms, face, mouth, or throat. Talk with your doctor if you have concerns about this.

Alcohol, narcotic pain relievers, or sleeping pills may cause you to feel more lightheaded, dizzy, or faint when used with this medicine. Tell your doctor if you are drinking alcohol or using pain relievers or sleeping pills.

Do not take other medicines unless they have been discussed with your doctor. This especially includes over-the-counter (nonprescription) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may tend to increase your blood pressure.

Other side effects

Some side effects of hydrochlorothiazide / quinapril may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Serious side effects

Along with its needed effects, hydrochlorothiazide / quinapril may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking hydrochlorothiazide / quinapril:

For healthcare professionals

Applies to hydrochlorothiazide / quinapril: oral tablet.

Respiratory adverse events

• Common (1% to 10%): Dry cough, rhinitis, upper respiratory infection, bronchitis, pharyngitis

Uncommon (0.1% to 1%):

• Rare (less than 0.1%): Pneumonia, asthma, respiratory infiltration, lung disorder, acute noncardiogenic pulmonary edema
• Frequency not reported: Rash, acute pulmonary edema, interstitial cystitis^[Ref]

Renal

• Frequency not reported: New or worsened renal insufficiency (especially in patients with preexisting renal insufficiency or who are angiotensin-dependent, such as those with CHF)

Quinapril:

• Frequency not reported: Acute renal failure, new onset proteinuria

Hydrochlorothiazide:

• Rare (less than 0.1%): Interstitial nephritis^[Ref]

Patients with renal artery stenosis maintain glomerular filtration rate (GFR) by efferent arteriolar vasoconstriction, which is blocked by quinapril.

Although quinapril may be associated with a rise in serum creatinine and BUN, GFR has been shown to remain unchanged or improve in most patients.

HCTZ has been used to treat nephrogenic diabetes insipidus. However, a case in which the drug was believed to have caused this condition has been reported.^[Ref]

Cardiovascular

• Common (1% to 10%): Vasodilation, vertigo, chest pain
• Uncommon (0.1% to 1%): Palpitations, tachycardia
• Rare (less than 0.1%): Heart failure, myocardial infarction, cerebrovascular accident, hypertensive crisis, orthostatic hypotension, cardiac rhythm disturbance
• Frequency not reported: Hydrochlorothiazide-induced hypokalemia can predispose some patients to various cardiac arrhythmias, such as ventricular ectopy and complete AV heart block
• Postmarketing reports: Bradycardia, cor pulmonale, vasculitis, deep thrombosis^[Ref]

Hypotension is most likely in patients who are sodium and intravascular volume depleted.^[Ref]

Hypersensitivity

Quinapril:

• Rare (less than 0.1%): Angioedema of the face, extremities, lips, tongue, glottis and/or pharynx, intestinal angioedema

Hydrochlorothiazide:

• Uncommon (0.1% to 1%): Rash, anaphylaxis^[Ref]

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.

There have been approximately 34 known cases of thiazide-induced pulmonary edema, encompassing 52 episodes of pulmonary edema, as of 1991 (per a 1996 review). In some cases, doses as small as 12.5 mg were associated with the development of pulmonary edema. The average time to onset of this adverse reaction was 44 minutes, women have a relative risk of 9:1, and the average age was 56 years. The mortality rate was 6%. Some experts consider this side effect grossly underreported.^[Ref]

Nervous system

• Common (1% to 10%): Headache, dizziness, fatigue, insomnia, somnolence, asthenia
• Postmarketing reports: Speech disorder, meningism, amnesia^[Ref]

Metabolic

Quinapril:

• Rare (less than 0.1%): Angioedema of the face, extremities, lips, tongue, glottis and/or pharynx, intestinal angioedema

Hydrochlorothiazide:

• Frequency not reported: Metabolic alkalosis, hyponatremia, hypomagnesemia, hypercalcemia, hyperglycemia, elevated serum uric acid levels, increased serum cholesterol^[Ref]

HCTZ may increase total serum cholesterol by 11%, LDL lipoprotein cholesterol by 12%, and VLDL lipoprotein cholesterol levels by 50%, as well as reduce insulin secretion. It should be used with caution in patients with diabetes or hypercholesterolemia.

Hyperuricemia may be an important consideration in patients with a history of gout. Hypophosphatemia and low serum magnesium concentrations may also occur, but are usually clinically insignificant except in malnourished patients.^[Ref]

Hematologic

Quinapril:

• Rare (less than 0.1%): Neutropenia, bone marrow depression

Hydrochlorothiazide:

• Very rare (less than 0.01%): Immune complex hemolytic anemia, aplastic anemia, thrombocytopenia^[Ref]

Gastrointestinal

• Common (1% to 10%): Nausea, vomiting, abdominal pain, diarrhea, dyspepsia
• Uncommon (0.1% to 1%): Dry mouth, gastrointestinal hemorrhage

Hydrochlorothiazide:

• Rare (less than 0.1%): Pancreatitis, acute cholecystitis^[Ref]

Thiazide diuretics may increase serum cholesterol and triglycerides, resulting in an increased risk of cholesterol gallstone formation. Reports of bowel strictures associated with thiazide ingestion were reported in the 1960's (although patients in these reports were on a combination HCTZ-potassium product).^[Ref]

Dermatologic

Hydrochlorothiazide:

• Rare (less than 0.1%): A distinct entity with clinical and laboratory features indistinguishable from those of subacute cutaneous lupus erythematosus, pruritus, increased sweating, erythema, alopecia, pemphigus
• Frequency not reported: Erythema annular centrifugum, acute eczematous dermatitis, morbilliform or leukocytoclastic vasculitis, phototoxic dermatitis
• Postmarketing reports: Urticaria, maculopapular rash, petechiae, non-melanoma skin cancer^[Ref]

Endocrine

Hydrochlorothiazide:

• Frequency not reported: Glucose intolerance and a potentially deleterious effect on the lipid profile (either of which may be important in some patients with or at risk for diabetes or coronary artery disease)^[Ref]

A prospective study of 34 patients who received oral thiazide diuretics for 14 years without interruption revealed an increased mean fasting blood glucose level after treatment. Withdrawal of thiazide therapy for seven months in 10 of the patients resulted in mean reductions of 10% in fasting blood glucose and 25% in the 2-hour glucose tolerance test value. A control group was not reported.^[Ref]

Musculoskeletal

• Rare (less than 0.1%): Myalgias, chills, myopathy, myositis, muscle spasm, back pain, arthritis
• Postmarketing reports: Paralysis, hemiplegia, abnormal gait^[Ref]

Genitourinary

• Rare (less than 0.1%): Impotence in male patients, interstitial cystitis^[Ref]

Ocular

Hydrochlorothiazide:

• Rare (less than 0.1%): Acute transient myopia, acute angle-closure glaucoma^[Ref]

Hepatic

Hydrochlorothiazide:

• Frequency not reported: Interstitial nephritis^[Ref]

See also:

Further information

Hydrochlorothiazide/quinapril side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

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