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► Accupro 40 (quinapril) - Practical Medicine

Accupro 40 (quinapril) - coated tablets

The name of the preparation Character; dose; package Manufacturer Price 100% Price after refund In which pharmacy?
Accupro 40 coated tablets; 40 mg; 28 tabl. Pfizer Europe 31.18 0.00
24.73
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Note: reimbursed drug prices are in line with the regulations in force from July 1, 2018.

The preparation contains the substance:quinapril

The drug is available on prescription

What is Accupro?

A drug from the group of angiotensin-converting enzyme inhibitors, which, like all preparations in this group, inhibits the formation of angiotensin II, a substance that causes vasoconstriction and stimulates the release of aldosterone.

What does Accupro contain and how does it work?

The active substance is quinapril belonging to a group of medicines called angiotensin converting enzyme inhibitors. The common mechanism of action of drugs in this group consists in inhibiting the activity of the enzyme responsible for the formation of angiotensin II (this enzyme is an angiotensin convertase, often abbreviated as ACE, which is derived from the English nameAngiotensin Converting Enzyme). Inhibition of this enzyme results in limiting the conversion (conversion) of inactive angiotensin I to active angiotensin II. Angiotensin II plays an important role in the pathophysiology of hypertension. The effect of angiotensin II is vasoconstriction and the increase in the release of aldosterone, which leads to increased blood pressure. The effect of drugs from the angiotensin-converting enzyme group leads to a decrease in the angiotensin II concentration, and thus to a decrease in blood pressure. In addition, ACE inhibitors exacerbate the effects of bradykinin (a substance that relaxes on blood vessels), exert a protective effect on vessels and have antiatherosclerotic activity. They are used as blood pressure lowering drugs and in the treatment and prophylaxis of cardiovascular diseases as well as in the treatment of kidney diseases (diabetic nephropathy and non-diabetic nephropathy). In clinical trials, many of them have been proven effective in reducing cardiovascular mortality. In patients with heart failure , ACE inhibitors reduce vascular resistance, which improves hemodynamic conditions and increases exercise capacity, positively affecting the quality of life.
Quinapril is well absorbed and quickly converted to the active form - quinaprilat in the liver. The antihypertensive effect starts within 1 hour after taking the drug and is the strongest after about 2 hours. Full antihypertensive effect is achieved after about 2 weeks of use.

When should I use Accupro?

The preparation is indicated for the treatment of:
· Essential hypertension (monotherapy or combination treatment)
· Congestive heart failure (combination therapy with diuretic and / or digitalis glycosides).

When not to use this preparation?

Unfortunately, even if there are indications to use the preparation, it can not always be used. You can not use the product if you are allergic (you are hypersensitive) to any of the ingredients of the preparation or to another ACE inhibitor. You can not use the preparation if:
· You have ever had angioneurotic edema or there is congenital (hereditary) angioneurotic edema
· Impaired blood drainage from the left ventricle.
Do not use the preparation in patients with aortic valve stenosis.
Do not use in parallel with aliskiren in patients with diabetes or with renal impairment (glomerular filtration rate GFR less than 60 ml / min / 1.73 m2).
The preparation is contraindicated in the second and third trimester of pregnancy and during breastfeeding. It is not recommended during the first trimester of pregnancy.

Take special care with Accupro?

Certain diseases and other circumstances may constitute a contraindication to use or indication to change the dosage of the preparation. In some situations it may be necessary to carry out specific check-ups.
Hypersensitivity reactions, including Anaphylactic reactions and related severe reactions, may be observed during the period of the use of the preparation and are life-threatening.
Special care should be taken because the preparation may cause a sudden and significant reduction in blood pressure, especially after the first dose. The increased risk of hypotension after taking the preparation concerns especially people:
· With a reduced volume of circulating, dehydrated or electrolyte-depleted (eg taking diuretics, low-salt diets, sodium deficient, dialysed, diarrhea or vomiting)
· With increased activation of the renin-angiotensin-aldosterone system (RAA), which may be suspected in the case of severe hypertension, congestive heart failure, hemodynamically significant impairment of the inflow or outflow of blood from the left ventricle (eg aortic stenosis or mitral [bipolar]) , unilateral renal artery stenosis with a second active kidney), people with liver cirrhosis and / or ascites, people undergoing surgery or anaesthetized
· With severe congestive heart failure (also possible with oliguria, progressive azotemia and acute renal failure )
· With an increased risk of myocardial ischemia or the brain in severe hypotension (eg people with ischemic heart disease or cerebrovascular narrowing, in whom hypotension could cause a heart attack, stroke).
In the above cases, treatment can only be started under close medical supervision. Because of the increased risk of hypotension, special medical supervision and careful monitoring are required, especially during the first 2 weeks of treatment and each time during dose escalation. Before starting treatment, electrolyte deficits should be leveled and adequate hydration should be provided (if possible, the doctor will recommend discontinuation of diuretics).
In the case of symptomatic hypotension, the patient should be placed on the back and called for medical help. The occurrence of hypotension after the first dose of the preparation is not a contraindication for further use of the preparation, however, it is necessary to achieve stabilization of blood pressure and fluid volume.
Renal monitoring may be necessary in patients with renal impairment, but in most cases renal function does not change.
In patients with impaired renal function (creatinine clearance less than 60 ml / min) dosage adjustment may be necessary (dose reduction, prolongation of intervals between doses). An individualized dose is determined by a doctor. Regular monitoring of renal function is necessary.
The use of ACE inhibitors can cause kidney problems in sensitive people. The risk of renal dysfunction, including acute renal failure, especially occurs in patients with severe heart failure. There may also be oliguria, progressive azotemia and, rarely, acute renal failure and death.
In patients with bilateral renal artery stenosis or arterial stenosis of the sole active kidney, the preparation may increase the risk of renal failure, especially when using diuretics in parallel. In these patients, treatment can be started only under strict medical supervision (preferably in a hospital) from small doses, gradually increased according to the doctor's instructions. If possible, your doctor will advise you to stop using diuretics. It is necessary to monitor kidney function for the first few weeks of treatment.
After administration of the preparation in patients with hypertension or heart failure, without previous renal impairment, elevation of urea and creatinine in the blood may occur, especially if the preparation is used in parallel with the diuretic. If necessary, your doctor will recommend a dose reduction or discontinuation of the diuretic and / or quinapril. The probability of occurrence of these disorders is greater in people with pre-existing renal impairment. Renal function should be carefully monitored, especially during the first few weeks after starting treatment.
It is not recommended for patients with severe renal impairment (creatinine clearance less than 10 ml / min).
The preparation may cause angioneurotic edema (swelling of the face, lips, tongue, throat, larynx that may impede breathing and may be life-threatening). In the event of the first symptoms of edema, stop using the preparation and seek medical help immediately. It is necessary to hospitalize, monitor the patient and sometimes take appropriate treatment. After the occurrence of angioneurotic edema, the preparation or other ACE inhibitors may not be used again. The risk of angioneurotic edema is increased in people who have had angioedema in the past and in black people.
An increased risk of angioneurotic edema also occurs in patients using temsirolimus (or other mTOR inhibitors) or vildagliptin (or other DPP IV inhibitors). Use caution if your doctor advises you to start treatment with these medicines in people using ACE inhibitors.
The preparation may cause intestinal angioedema (abdominal pain, sometimes nausea and vomiting) which should be taken into account in case of abdominal pain.
The preparation may cause hematological disorders (decreased neutrophil count [neutropenia], significant reduction in the number of all granulocytes [agranulocytosis], thrombocytopenia, anemia, bone marrow suppression). Your doctor will advise you to regularly check your blood counts, especially at the beginning of your treatment, and if you have kidney problems, people with connective tissue disease (such as lupus erythematosus or scleroderma) and those who are using other medicines that can cause changes in blood counts (allopurinol, immunosuppressants, corticosteroid s, procainamide, cytostatics). In case of any symptoms of infection (eg fever, enlargement of the lymph nodes, sore throat) it is necessary to consult a doctor and make sure that the body's immunity has not decreased.
The use of the preparation is associated with an increased risk of anaphylactic reaction to insect venom and other allergens, also during desensitization (if desensitization is planned, a doctor should be consulted who, if possible, will recommend temporary discontinuation of the preparation).
Procedures for extracorporeal circulation (hemodialysis, hemofiltration, apheresis of low-density lipoproteins), during which blood is exposed to electrically negatively charged surfaces, may lead to severe anaphylactoid reactions, manifested by facial edema, hypotension, dyspnea, sudden feeling hot.
In patients with impaired liver function, caution should be exercised, especially if diuretics are used in parallel. Even small disturbances of fluid and electrolyte balance can lead to hepatic coma. Rare cholestatic jaundice may occur, which can lead to fulminant hepatic necrosis, sometimes fatal. If you have cholestatic jaundice or increase in liver enzymes, you should immediately consult a doctor because it may be necessary to discontinue use and initiate appropriate treatment.
ACE inhibitors may cause a dry, persistent cough (due to the severity of bradykinin), without coughing, which disappears after discontinuation of the preparation.
Inform the doctor about the use of the preparation if you are planning an operation or other procedure requiring anesthesia. Using the product in parallel with medicines used for anesthesia can lead to significant hypotension and even shock.
The preparation may cause hyperkalaemia (increase in potassium in the blood).Hyperkalaemia may cause serious arrhythmias. Your doctor will monitor the level of potassium in your blood, especially if you are at increased risk for hyperkalemia, including kidney problems, people with diabetes, medicines that increase the amount of potassium in your blood (potassium, potassium-retaining diuretics or Heparin ).
In diabetic patients taking oral antidiabetic agents or insulin , your doctor will prescribe blood Glucose monitoring, especially during the initial period of use. There is a risk of hypoglycaemia, an excessive reduction in blood glucose.
Additional information about the other ingredients of the preparation:
· The product contains lactose; people with galactose intolerance, lactase deficiency or malabsorption of glucose-galactose should not use this preparation.

Does this preparation affect the ability to drive vehicles?
The preparation may impair your ability to drive and use machines / machines, especially during the initial treatment period.

Dosage of Accupro

The preparation is in the form of coated tablets. It is intended for oral use. Do not exceed the recommended doses because it will not increase the effectiveness of the drug and may harm your health and life. If you have any doubts regarding the use of the preparation, consult a physician.
Adults:
Arterial hypertension (monotherapy): in patients not taking diuretics initially 10-20 mg per day. Depending on the effectiveness of the treatment, your doctor may increase the dose (usually at 4-week intervals) to a maintenance dose of 20-40 mg per day, taken as a single dose or in two divided doses. The maximum dose is 40 mg / day, although in clinical trials, up to 80 mg / day has been used in some patients.
Arterial hypertension (combination therapy with diuretics): the initial dose is 5 mg per day. The doctor will then gradually increase the dose until the desired clinical effect is achieved.
Congestive heart failure (in combination with diuretic and / or digitalis glycosides): the starting dose is 5 mg 1-2 times a day. After taking the dose, the patient should remain under close medical supervision due to the risk of hypotension. The doctor will adjust the dose based on the patient's individual response to treatment. The effective dose is usually 10-40 mg / day in 2 equal divided doses.
In patients with impaired renal function, an individual dose adjustment is necessary. If the creatinine clearance is less than 60 ml / min but greater than 30 ml / min, the starting dose is usually 5 mg per day. If the creatinine clearance is less than 30 ml / min but greater than 10 ml / min, the starting dose is 2.5 mg per day. In individual cases, a suitably adjusted dose is determined by the doctor. In these people, treatment can only be carried out under strict medical supervision
In the elderly, the recommended starting dose will be determined by a doctor (usually 10 mg once daily). The doctor will then increase the dose until the desired clinical response is obtained.
Children:
There are no recommendations for use in children.

Can I use Accupro during pregnancy and breastfeeding?

During pregnancy, do not use any medicine without consulting your doctor!
It is very important that before using any medicine during pregnancy or breastfeeding, consult a physician and explain beyond any doubt the potential risks and benefits associated with the use of the drug. If you are pregnant or plan to become pregnant, please inform the doctor prescribing the prescription for this medicine.
The preparation should not be used during the first trimester of pregnancy. The use of the preparation in the second and third trimester of pregnancy is contraindicated. If a woman plans to become pregnant she should consult a doctor because it is recommended to change the way of antihypertensive treatment. If you suspect or confirm pregnancy during the period of taking the preparation, you should consult a doctor as soon as possible because immediate discontinuation of the preparation is required. Your doctor may prescribe other antihypertensive agents.
The use of the preparation is contraindicated during breast-feeding.

Can I use other preparations in parallel?

Tell your doctor about all medicines you have recently taken, including those that are over the counter.
Since the preparation contains Magnesium carbonate, in the case of parallel use with Tetracycline s, the absorption of tetracycline may be reduced by approximately 30%.
For people taking diuretics in parallel, there is an increased risk of complications resulting from sudden hypotension. If possible, your doctor will advise you to stop using diuretics. If diuretic therapy can not be discontinued, treatment should be started with a lower initial dose and the patient should remain under strict medical supervision for not less than 2 hours after taking the initial dose.
Parallel use of drugs that affect the level of potassium in the blood (potassium salts, some diuretics and antihypertensives, eg spironolactone, triamterene, amiloride, eplerenone, potassium supplements, trimethoprim, tacrolimus, cyclosporine, heparin) and potassium-containing salt substitutes can lead to increased levels of potassium in the blood (hyperkalemia). The simultaneous use of quinapril with the preparations mentioned above is not recommended. If it is necessary to use them, the doctor will recommend regular monitoring of potassium in the blood.
Inform the doctor about the use of the preparation if you are planning an operation or other procedure requiring anesthesia. Using the product in parallel with medicines used for anesthesia can lead to significant hypotension and even shock.
The preparation may increase the toxic effects of lithium salts. Parallel administration of lithium is not recommended, and if necessary, combination of lithium should be monitored. Parallel use of diuretics increases the risk of lithium toxicity.
Non-steroidal anti-inflammatory drugs (eg Acetylsalicylic acid , Ibuprofen , COX-2 inhibitors) may reduce the antihypertensive effects of the preparation and may cause renal dysfunction, including acute renal failure. The kidneys should be monitored regularly. Caution should be exercised, especially in the elderly, with reduced volume of fluid, dehydrated, diuretic and renal dysfunction.
Rarely, people who use gold preparations (eg aurotionate) and quinapril may experience symptoms like nitrates (including redness of the face, nausea, vomiting, hypotension).
An increased risk of angioneurotic edema also occurs in patients using temsirolimus (or other mTOR inhibitors) or vildagliptin (or other DPP IV inhibitors). Use caution if your doctor advises you to start treatment with these medicines in people using ACE inhibitors.
Drugs that can affect blood counts (allopurinol, immunosuppressive drugs, corticosteroids, procainamide, cytostatics) increase the risk of hematological disorders, especially leukopenia.
If the preparation is used in conjunction with antihypertensive drugs or other medicines that can lower blood pressure (eg Nitroglycerin e and other nitrates, tricyclic antidepressants, anesthetics, antipsychotics, barbiturates, opioid medicines), there may be an increase in antihypertensive effect and hypotension.
There were no clinically relevant interactions between quinapril and Atorvastatin .
Antacids may reduce the bioavailability of quinapril.
Taking the product in parallel with antidiabetic medicines (oral preparations, insulin) may increase blood glucose levels and increase the risk of hypoglycaemia. Blood glucose should be carefully monitored, especially during the first month of treatment.
Due to the risk of hypotension, hyperkalemia and / or renal dysfunction, including acute renal failure, parallel use of the preparation and medicines from the group of sartans (angiotensin antagonists) or aliskiren requires caution. Blood pressure, renal function and electrolyte concentration should be carefully monitored.
The use of the parallel formulation with aliskiren in patients with diabetes mellitus or with renal impairment (glomerular filtration rate GFR less than 60 ml / min / 1.73 m2) is contraindicated.

What side effects can occur?

Like all medicines, Accupro can also cause side effects, although it will not occur in all patients who use this medicine. Remember that the expected benefits of using the drug are usually greater than the damage resulting from the occurrence of side effects.
Common side effects include: headache and dizziness, exhaustion, insomnia, fatigue, tingling and numbness (paresthesia), hypotension, dry persistent cough, shortness of breath, diarrhea, nausea, vomiting, indigestion, abdominal pain, rash, pruritus, kidney problems, back pain, chest pain, sore throat, rhinitis, increased creatinine and urea in the blood, increase in potassium in the blood (hyperkalemia). Uncommon: depression, nervousness, confusion, transient ischemic attack, drowsiness, visual disturbances, tinnitus, palpitations, increased heart rate (tachycardia), angina pectoris, myocardial infarction, vasodilation, dryness of the oral mucosa, bloating, excessive sweating, pruritus, rash, angioneurotic edema (swelling of the face, lips, tongue, throat, larynx in sporadic cases that may cause narrowing of the airways, impede breathing and life-threatening), renal dysfunction, proteinuria, sexual dysfunction (impotence ), peripheral edema and generalized edema, fever. Rarely or very rarely: balance disorders, fainting, blurred vision, eosinophilic pneumonia, inflammation of the tongue, taste disturbance, constipation, intestinal obstruction , angioedema of the intestines, urticaria, erythema multiforme, pemphigus, psoriasis-like bloom. Incidence unknown: hematological disorders (anemia, decreased white blood cell count [leukopenia], thrombocytopenia, agranulosis), symptoms caused by orthostatic hypotension (eg dizziness, syncope, balance disorders), cerebrovascular events, hematological disorders (decrease in hemoglobin, hematocrit reduction, reduction of white blood cells), pancreatitis, increased liver enzymes and increased bilirubin in the blood, jaundice, hepatitis, bronchitis, inflammation of the upper respiratory tract, sinusitis, urinary tract inflammation, anaphylactic reactions, bronchospasm , severe skin reactions (Stevens and Johnson syndrome, exfoliative dermatitis, toxic epidermal necrolysis), hypersensitivity to light, alopecia. Dermatological manifestations may be accompanied by: fever, muscle and joint pain, vasculitis, polyserositis, abnormalities in the results of laboratory tests.

Other preparations on the Polish market containing quinapril

Accupro 5 (coated tablets)
Accupro 10 (coated tablets)
Accupro 20 (coated tablets)
Acurenal (coated tablets)
Pulsaren 20 (coated tablets)