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Information on level of drugs into breastmilk
Published in Wendy Jones, Breastfeeding and Medication, 2018
Quinapril is rapidly converted to its active metabolite quinaprilat. Begg et al. (2001) studied six women taking 20 mg quinapril daily. Four hours after the dose no drug was recovered from milk. No quinaprilat was detected at any time. The authors therefore suggested that quinapril is safe in breastfeeding. The BNF recommends that it should be avoided in the first few weeks after delivery, particularly in preterm infants, due to the risk of profound neonatal hypotension; if essential, it may be used in mothers breast-feeding older infants – the infant’s blood pressure should be monitored. Hale (2017) reported the relative infant dose as 1.6.
The Treatment of Hypertension with Nutrition, Nutritional Supplements, Lifestyle and Pharmacologic Therapies
Published in Stephen T. Sinatra, Mark C. Houston, Nutritional and Integrative Strategies in Cardiovascular Medicine, 2022
ALA is effective in the treatment of hypertension, especially as part of the metabolic syndrome [2–5,259–263]. Lipoic acid reduces oxidative stress, inflammation and serum aldehydes, closing calcium channels which leads to vasodilation, improved endothelial function and lower BP [2–5,259–263]. Urinary albumin excretion is stabilized in DM subjects given 600 mg of ALA compared to placebo for 18 months (p< 0.05) [263]. In a double-blind crossover study of 36 patients with CHD given 200 mg of lipoic acid with 500 mg of acetyl-L-carnitine twice daily for 8 weeks [262], there was a 2% increase in brachial artery diameter and a decrease in SBP from 151 ± 20 to 142 ± 18 mmHg (p < 0.03) with no change in DBP [262]. However, patients with metabolic syndrome had a reduction in SBP from 139 ± 21 to 132 ± 15 mmHg (p < 0.03) and DBP from 76 ± 8 to 73 ± 8 mmHg (p < 0.06) [262]. In a 2-month double-blind crossover study of 40 patients with DM and stage I hypertension, quinapril 40 mg daily vs quinapril 40 mg with lipoic acid 600 mg daily reduced urinary albumin excretion by 30% with quinapril and 53% quinapril with lipoic acid (p < 0.005), the BP was reduced significantly by 10% in both groups, and the flow medicated dilation (FMD) increased 58% with quinapril and 116% with the combination (p < 0.005) [261]. The HOMA-IR decreased 19% with quinapril and 40% with quinapril with lipoic acid (p < 0.005). The combined administration of lipoic acid and pyridoxine improves albuminuria in patients with diabetic nephropathy [223]. The recommended dose is 100–200 mg/day of R-lipoic acid with biotin 2–4 mg/day to prevent biotin depletion with long-term use of lipoic acid. R-lipoic acid is recommended instead of the L isomer because of its preferred use by the mitochondria [2–5].
The Post-Transplant Patient with Hypertension
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Martin Hausberg, Karl Heinz Rahn
Several studies compared the effects of calcium channel blockers with those of ACE inhibitors in renal transplant patients. Mourad et al. (61), van der Schaaf et al. (62), Sennesael et al. (63), Curtis et al. (64) and Abu-Romeh et al. (65) compared the effects of an ACE inhibitor with those of a calcium antagonist in cyclosporine-treated renal transplant patients. None of these studies showed adverse effects for the ACE inhibitors. Mourad et al. showed after a treatment period of 30 months a similar degree of renal protection and reduction of arterial pressure with lisinopril and nifedipine (61). Van der Schaaf et al. found amlodipine to have a more pronounced antihypertensive effects than lisinopril in renal allograft recipients (62). Glomerular filtration rate increased with amlodipine, whereas it remained unchanged during lisinopril treatment. In this crossover study, patients were treated for 2 months with each drug. In a similar crossover design, Sennesael et al. compared perindopril and amlodipine in 10 renal allograft recipients and found no significant differences in blood pressure reduction or renal function (63). Curtis et al. (64) and Abu-Romeh et al. (65) both showed a slight decrease in glomerular filtration rate with the ACE inhibitor but not with the calcium antagonist. However, these two studies comprised only treatment periods of less than 1 month. Grekas et al. showed that combination therapy of a calcium antagonist with an ACE inhibitor in renal allograft recipients for 2 months results in superior blood pressure control, reduction in proteinuria and no significant change in glomerular filtration rate when compared to antihypertensive therapy with a calcium antagonist alone (66). Taken together, ACE inhibitors appear as effective as calcium antagonists with regard to blood pressure reduction and preservation of graft function. The effects of the ACE inhibitor quinapril and those of the beta-blocker atenolol on blood pressure and graft function were compared in cyclosporine-treated hypertensive kidney transplant recipients (67). Quinapril and atenolol were equally effective in the treatment of post-transplant hypertension in renal allograft recipients. Renal transplant function did not differ between patients treated with quinapril and with atenolol. In neither group could a significant deterioration of renal allograft function be observed at the end of the 24 months’ treatment period. However, when compared to the changes in the atenolol group, quinapril-treated renal allograft recipients showed a significant reduction of proteinuria and urinary albumin excretion at the end of the 24 months’ observation period (Figure 60.4).
Angiotensin-converting enzyme inhibitor induced angioedema: not always a class effect? A case report and short narrative review
Published in Current Medical Research and Opinion, 2021
Guillaume Becker, Fabien Rougerie, Amelia-Naomi Sabo, Marie-Caroline Dalmas, Estelle Ayme-Dietrich, Laurent Monassier
The patient was a 62-year-old Caucasian man with a longstanding history of arterial hypertension for which he was treated with spironolactone, altizide and quinapril. Spironolactone and altizide had been administered at regular daily doses of 25 mg and 15 mg, respectively, for the past 17 years. Quinapril had been administered at a regular daily dose of 20 mg for the past 18 years. The patient was not taking any self-medication or other medication when angioedema occurred. Therefore, we did not identify any other medication that could have contributed to angioedema (including antibiotics, aspirin, non-steroidal anti-inflammatory drugs, bupropion and DPP-4 inhibitors). His medical records included benign prostate enlargement (known for 19 years), internal hemorrhoids discovered during a routine colonoscopy 7 years prior, and a benign thyroid nodule (euthyroid condition) in the left lobe discovered incidentally during imaging for other reasons. His surgical history included an appendectomy 13 years earlier and hydrocele surgery performed 2 years before. The patient was thoroughly questioned about his possible personal or family history of allergy (i.e. cutaneous, mucosal, systemic). He had no familial or individual history of allergy, although he described a rash after self-medication with vitamin C 10 years earlier. No intervening factor such as insect bites or food allergy was identified in this patient.
Benefit and risk evaluation of quinapril hydrochloride
Published in Expert Opinion on Drug Safety, 2023
Maryam Barkhordarian, Jannel A. Lawrence, Sebahat Ulusan, Muhammed Ibrahim Erbay, Wilbert S. Aronow, Rahul Gupta
The effectiveness of quinapril in different medical conditions such as congestive heart failure and hypertension makes this medication a good choice in the management of these conditions. The drug positively affects left ventricular diastolic and systolic functions. In addition, quinapril is advantageous compared to other ACE inhibitors due to its less frequent daily dosing and protective effect. In addition, quinapril is advantageous compared to other ACE inhibitors due to a less frequent daily dosing and showing a protective effect.