Drug: Accuretic

Accuretic

Generic Name: hydrochlorothiazide and quinapril (HYE droe KLOR oh THY a zide and KWIN a pril)
Brand Name: Accuretic

What is Accuretic (hydrochlorothiazide and quinapril)?

Hydrochlorothiazide is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention.

Quinapril is in a group of drugs called ACE inhibitors. ACE stands for angiotensin converting enzyme. Quinapril lowers blood pressure and also relieves symptoms of fluid retention.

Hydrochlorothiazide and quinapril is a combination medicine used to treat hypertension (high blood pressure).

Hydrochlorothiazide and quinapril may also be used for purposes not listed in this medication guide.

What is the most important information I should know about Accuretic (hydrochlorothiazide and quinapril)?

If you have diabetes, do not use hydrochlorothiazide and quinapril together with any medication that contains aliskiren (Amturnide, Tekturna, Tekamlo, Valturna).

Do not use if you are pregnant. Stop using and tell your doctor right away if you become pregnant.

What should I discuss with my healthcare provider before taking Accuretic (hydrochlorothiazide and quinapril)?

You should not use this medication if you are allergic to hydrochlorothiazide or quinapril, or if:

  • you are unable to urinate; or

  • you are allergic to any other ACE inhibitor, such as benazepril, captopril, enalapril, fosinopril, lisinopril, ramipril, trandolapril, and others.

If you have diabetes, do not use hydrochlorothiazide and quinapril together with any medication that contains aliskiren (Amturnide, Tekturna, Tekamlo, Valturna).

You may also need to avoid taking hydrochlorothiazide and quinapril with aliskiren if you have kidney disease.

To make sure hydrochlorothiazide and quinapril is safe for you, tell your doctor if you have:

  • kidney disease (or if you are on dialysis);

  • liver disease;

  • glaucoma;

  • congestive heart failure;

  • gout;

  • lupus;

  • diabetes; or

  • an allergy to sulfa drugs or penicillin.

FDA pregnancy category D. Do not use if you are pregnant. Stop using and tell your doctor right away if you become pregnant. Hydrochlorothiazide and quinapril can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. Use effective birth control.

Hydrochlorothiazide and quinapril can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.

How should I take Accuretic (hydrochlorothiazide and quinapril)?

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Conditions that may cause very low blood pressure include: vomiting, diarrhea, heavy sweating, heart disease, dialysis, a low-salt diet, or taking diuretics (water pills). Follow your doctor's instructions about the type and amount of liquids you should drink while taking hydrochlorothiazide and quinapril. Tell your doctor if you have a prolonged illness that causes diarrhea or vomiting.

Your blood pressure will need to be checked often. Your blood and urine may also be tested if you have been vomiting or are dehydrated. Visit your doctor regularly.

Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

If you need surgery, tell the surgeon ahead of time that you are using hydrochlorothiazide and quinapril. You may need to stop using the medicine for a short time.

Store at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking Accuretic (hydrochlorothiazide and quinapril)?

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Drinking alcohol can further lower your blood pressure and may increase certain side effects of hydrochlorothiazide and quinapril.

Do not use potassium supplements or salt substitutes while you are taking hydrochlorothiazide and quinapril, unless your doctor has told you to.

Accuretic (hydrochlorothiazide and quinapril) side effects

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

Call your doctor at once if you have:

  • a light-headed feeling, like you might pass out;

  • eye pain, vision problems;

  • swelling, weight gain, shortness of breath;

  • sudden weakness or ill feeling, fever, chills, sore throat, mouth sores, trouble swallowing;

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

  • low potassium--confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling;

  • low levels of sodium--headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady; or

  • severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects may include:

  • cough;

  • headache, dizziness;

  • tired feeling;

  • muscle pain.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

What other drugs will affect Accuretic (hydrochlorothiazide and quinapril)?

Other drugs may interact with hydrochlorothiazide and quinapril, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Source: http://www.drugs.com/

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

Not all side effects for Accuretic 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 hydrochlorothiazide / quinapril: oral tablet

In addition to its needed effects, some unwanted effects may be caused by hydrochlorothiazide / quinapril. 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 hydrochlorothiazide / quinapril:

Less common
  • Cough producing mucus
  • diarrhea
  • difficulty breathing
  • tightness in the chest
Rare
  • Blurred vision
  • confusion
  • decreased urination
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • dry mouth
  • increase in heart rate
  • irregular heartbeat
  • muscle cramps or pain
  • numbness, tingling, pain, or weakness in the hands or feet
  • rapid breathing
  • seizures
  • sunken eyes
  • sweating
  • thirst
  • trembling
  • unusual tiredness or weakness
  • weakness and heaviness of the legs
  • wrinkled skin

Some of the side effects that can occur with hydrochlorothiazide / 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:

Less common
  • Coughing
  • lack or loss of strength
  • sleepiness or unusual drowsiness
Rare
  • Back pain
  • change in vision
  • difficulty having a bowel movement (stool)
  • discouragement
  • feeling sad or empty
  • impaired vision
  • irritability
  • lack of appetite
  • loss of interest or pleasure
  • trouble concentrating
  • trouble sleeping

For Healthcare Professionals

Applies to hydrochlorothiazide / quinapril: oral tablet

Respiratory

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

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]

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]

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

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]

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]

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

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]

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]

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[Ref]

Endocrine

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]

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]

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]

Source: http://www.drugs.com/

Hydrochlorothiazide / quinapril Pregnancy Warnings

-Use is contraindicated. (AU, UK) -This drug should not be used in pregnancy unless the benefit outweighs the risk to the fetus. (US) AU TGA pregnancy category: D US FDA pregnancy category: D Comments: -Adequate methods of contraception should be encouraged. -If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential harm to the fetus.

-Data have shown an association between major congenital malformations and the use of ACE inhibitors during the first trimester. The use of drugs that act directly on the renin-angiotensin system during the second and third trimesters of pregnancy has been associated with fetal and neonatal injury, including hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death. Oligohydramnios has also been reported, presumably resulting from decreased fetal limb contractures, craniofacial deformation, and hypoplastic lung development. Prematurity, intrauterine growth retardation, and patent ductus arteriosus have also been reported, although it is not clear whether these occurrences were due to exposure to the drug. -Mothers whose embryos and fetuses are exposed to an ACE inhibitor during the first trimester should be informed of the risks. When pregnancy is detected or expected, this should be discontinued as soon as possible. -Cases of neonatal thrombocytopenia associated with antepartum administration of thiazide diuretics have been reported. AU TGA pregnancy category D: Drugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects. Accompanying texts should be consulted for further details. US FDA pregnancy category D: There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Hydrochlorothiazide / quinapril Breastfeeding Warnings

A decision should be made to discontinue breastfeeding or discontinue the drug, taking into account the importance of the drug to the mother. Excreted into human milk: Yes (hydrochlorothiazide, quinapril) The effects in the nursing infant are unknown.

Source: http://www.drugs.com/

Health Services in Toronto

Drug Database Online

Welcome to WebHealthNetwork an online drug guide and dictionary, here you can get drug information and definitaions for most popular pharmaceutical and medicinal drugs, and specifically Accuretic. Find what medications you are taking today.