Accupro
Akcupro: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Use in the elderly
- 14. Drug interactions
- 15. Analogs
- 16. Terms and conditions of storage
- 17. Terms of dispensing from pharmacies
- 18. Reviews
- 19. Price in pharmacies
Latin name: Accupro
ATX code: C09AA06
Active ingredient: quinapril (quinapril)
Producer: Pfizer Manufacturing Deutschland, GmbH (Germany)
Description and photo update: 2019-26-08
Prices in pharmacies: from 502 rubles.
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Accupro is an antihypertensive drug for the treatment of hypertension and chronic heart failure.
Release form and composition
Dosage form - film-coated tablets, dosage:
- 5 mg: oval, biconvex, white, with a line and the number "5" on both sides (10 pcs. In blisters, in a cardboard box 3 blisters);
- 10 mg: triangular, biconvex, white, with the number "10" on one side, with a line on both sides (10 pcs. In blisters, 3 blisters in a cardboard box);
- 20 mg: round, biconvex, white, with the number "20" on one side, with a line on both sides (10 pcs. In blisters, in a cardboard box 3 blisters);
- 40 mg: oval, biconvex, red-brown, engraved with "PD 535" on one side and the number "40" on the other (6 pcs. In blisters, 5 blisters in a cardboard box).
Each pack also contains instructions for using Accupro.
Composition of 1 tablet:
- active substance: quinapril (in the form of hydrochloride) - 5, 10, 20 or 40 mg;
- auxiliary components: gelatin, crospovidone, lactose monohydrate, magnesium stearate, magnesium carbonate;
- the composition of the film shell: tablets 5, 10 and 20 mg - white opadry OY-S-7331 (hyprolosis, hypromellose, macrogol 400, titanium dioxide) and herbal wax; 40 mg tablets - brown opadry Y-5-9020G (hyprolose, hypromellose, macrogol 400, titanium dioxide, iron oxide red dye) and herbal wax.
Pharmacological properties
Pharmacodynamics
The active ingredient of Akcupro is quinapril, an angiotensin-converting enzyme (ACE) inhibitor, an antihypertensive agent.
ACE accelerates the conversion of angiotensin I into angiotensin II, which has a vasoconstrictor effect and increases vascular tone, including due to stimulation of the adrenal cortex to produce aldosterone. Quinapril competitively inhibits the activity of this enzyme, reduces aldosterone production and vasopressor activity. By eliminating the negative effect of angiotensin II on renin secretion by the feedback mechanism, plasma renin activity is increased. A decrease in blood pressure (BP) is accompanied by a decrease in total peripheral vascular resistance (OPSS) and blood flow resistance. At the same time, the rates of filtration fraction and glomerular filtration are insignificant or completely absent.
The drug increases exercise tolerance. With prolonged use, it improves the blood supply to the ischemic myocardium, promotes the reverse development of myocardial hypertrophy in patients with arterial hypertension.
Accupro also reduces platelet aggregation, increases renal and coronary blood flow.
After a single dose of the drug, the hypotensive effect develops within 1 hour, reaching a maximum in 2-4 hours. The duration of action of Akcupro is up to 24 hours and depends on the size of the dose taken. A clinically pronounced effect develops within several weeks of treatment.
Pharmacokinetics
After oral administration, the maximum concentration (C max) in the blood plasma of quinapril reaches within one hour, its metabolite quinaprilat - within two hours. Simultaneous food intake does not affect the degree of absorption of the drug, but can increase the time to reach C max (fatty foods can reduce the absorption of the substance). Considering the excretion of quinapril and its metabolites by the kidneys, the degree of absorption of Akcupro is about 60%.
Quinapril is rapidly metabolized by cleavage of the ester group under the action of liver enzymes to quinaprilat (the main metabolite is quinapril dibasic acid), a substance that is a potent ACE inhibitor. Approximately 38% of the received dose of the drug circulates in the blood plasma in the form of quinaprilat.
About 97% of quinapril or quinaprilat circulates in the blood plasma in a protein bound form.
The drug does not penetrate the blood-brain barrier.
It is excreted: by the kidneys in the urine - 61% (of which in the form of quinapril and quinaprilat - 56%), through the intestines - 37%.
The half-life (T ½) from plasma: quinapril - 1-2 hours, quinaprilat - 3 hours.
Pharmacokinetic parameters of the drug in special clinical cases:
- renal failure: T ½ increases in proportion to the decrease in creatinine clearance;
- alcoholic cirrhosis: concentration decreases (due to impaired deesterification of quinapril);
- elderly age (over 65 years): excretion decreases, which is usually associated with age-related impairment of renal function, however, significant differences in the safety and efficacy of quinaprilat do not differ from those in younger patients.
Indications for use
Accupro is used for:
- Arterial hypertension in the form of monotherapy or simultaneously with thiazide diuretics and beta-blockers;
- Chronic heart failure, concurrently with diuretics and cardiac glycosides.
Accupro has a hypotensive effect. The drug is effective for mild to moderate arterial hypertension. Reduces blood pressure both while sitting and standing. Begins to act within an hour after ingestion, minimally affecting the heart rate.
Contraindications
- lactose intolerance, lactase deficiency, glucose-galactose malabsorption syndrome;
- period of pregnancy and lactation;
- age up to 18 years;
- the simultaneous use of aliskiren, aliskiren-containing drugs, angiotensin II receptor antagonists or other drugs that inhibit the RAAS in patients with diabetes mellitus, including diabetic nephropathy, in patients with impaired renal function (glomerular filtration rate <60 ml / min / 1, 73 m 2), with chronic heart failure and arterial hypertension, hyperkalemia (> 5 mmol / l);
- hereditary and / or idiopathic angioedema;
- anamnestic data on the development of angioedema associated with ACE inhibitors;
- hypersensitivity to any component in the composition of the tablets.
Accupro tablets should be used with caution in the following cases: hyperkalemia, mitral / aortic stenosis, hypertrophic obstructive cardiomyopathy, coronary heart disease, coronary insufficiency, severe heart failure in patients at high risk of severe arterial hypotension, symptomatic arterial hypotension in patients who have previously taken diuretics and adhering to a diet with limited salt intake, cerebrovascular insufficiency, inhibition of bone marrow hematopoiesis, a decrease in the volume of BCC (including diarrhea / vomiting), diabetes mellitus, liver dysfunction (especially with concomitant diuretic administration), renal dysfunction, bilateral renal artery stenosis or stenosis of an artery of a solitary kidney, a condition after kidney transplantation,being on hemodialysis (creatinine clearance <10 ml / min), severe autoimmune systemic diseases of the connective tissue, the simultaneous use of a potassium-sparing diuretic, extensive surgical interventions and general anesthesia, the combined appointment of other antihypertensive drugs, inhibitors of mTOR and DPP-4 enzymes.
Akcupro, instructions for use: method and dosage
When treating arterial hypertension simultaneously with diuretics, the initial dose of Accupro is 5 mg per day. For monotherapy, administration can be started at 10 or 20 mg. Depending on the tolerance of the drug and the therapeutic effect, the dose can be gradually increased to the optimal one, not exceeding 80 mg per day.
In the treatment of chronic heart failure, Akcupro is used in combination with diuretics and cardiac glycosides. The starting dose is usually 5 mg up to twice a day. It is not recommended to change the dose more often than once a month.
In case of impaired renal function, 5 mg per day is prescribed; for elderly people, treatment can be started with 10 mg.
Side effects
Gradation of side effects according to the classification of the World Health Organization: very often -> 1/10, often - from> 1/100 to 1/1000 to 1/10 000 to <1/1000, very rarely - <1/10 000, including individual messages.
Possible adverse reactions from various organs and body systems:
- cardiovascular system: often - a marked decrease in blood pressure; infrequently - symptoms of vasodilation, increased blood pressure, palpitations, angina pectoris, postural hypotension, tachycardia, fainting, heart failure, cardiogenic shock, stroke, myocardial infarction;
- nervous system: often - paresthesia, insomnia, dizziness, headache, increased fatigue; infrequently - drowsiness, irritability, depression, vertigo;
- respiratory system: often - cough, chest pain, pharyngitis, dyspnea;
- urinary system: infrequently - urinary tract infections, acute renal failure;
- hematopoietic system: infrequently - hemolytic anemia, thrombocytopenia;
- digestive system: often - abdominal pain, diarrhea, nausea, vomiting, dyspepsia; infrequently - flatulence, dryness of the mucous membrane of the mouth or throat, gastrointestinal bleeding, angioedema of the intestine, pancreatitis; rarely - hepatitis;
- musculoskeletal system: often - back pain; infrequently - arthralgia;
- reproductive system: infrequently - decreased potency;
- organ of vision: infrequently - visual impairment;
- skin and subcutaneous tissues: infrequently - increased sweating, pruritus, rash, exfoliative dermatitis, alopecia, pemphigus, photosensitivity reactions;
- allergic reactions: infrequently - anaphylactic reactions; rarely - angioedema;
- laboratory parameters: very rarely - agranulocytosis, neutropenia (the cause-and-effect relationship of these disorders with the use of Akcupro has not yet been established); an increase in the concentration of creatinine and urea nitrogen in the blood serum (especially with the simultaneous use of diuretics);
- others: infrequently - viral infections, malaise, peripheral or generalized edema; rarely, eosinophilic pneumonitis.
With the simultaneous use of gold preparations (sodium aurothiomalate), the development of a symptom complex has been described, including a decrease in blood pressure, nausea, vomiting, and facial flushing.
Overdose
In case of an overdose, there is a pronounced decrease in blood pressure, weakness, dizziness, visual impairment.
The patient needs to take a horizontal position. Peritoneal dialysis and hemodialysis are ineffective. Treatment is aimed at eliminating the developed symptoms. To increase the volume of circulating blood, intravenous administration of a 0.9% sodium chloride solution is considered appropriate.
special instructions
Like other ACE inhibitors, Accupro can cause a side effect in the form of angioedema. In this regard, patients should be warned about the need to immediately discontinue the drug if the following signs appear: swelling of the face, tongue and / or vocal folds, laryngeal whistle. Antihistamines may be prescribed to relieve symptoms. Before stopping the edema, the patient should be under close medical supervision. Angioneurotic edema with involvement of the larynx can lead to death, therefore, in case of edema threatening the development of airway obstruction, urgent therapy is required, including subcutaneous administration of a solution of epinephrine / adrenaline 1: 1000 (0.3–0.5 ml).
With the use of ACE inhibitors, cases of the development of angioedema of the intestine have also been described. The patients complained of abdominal pain, sometimes with nausea and vomiting. Some patients had no previous angioedema of the face, the level of C1-esterase was normal. The diagnosis was established by means of ultrasound examination, computed tomography of the abdominal cavity, or at the time of surgery. In this regard, in patients receiving Accupro and presenting with pain in the abdominal region, the probability of the presence of angioedema of the intestine should be taken into account when conducting a differential diagnosis.
The risk of developing angioedema due to taking Accupro is increased in patients with a history of edema not associated with the use of ACE inhibitors.
Life-threatening anaphylactic reactions can develop in patients taking Accupro during hymenoptera venom desensitization therapy.
Anaphylactic reactions to the drug are possible in patients undergoing LDL (low density lipoprotein) apheresis with dextran sulfate, and in patients on hemodialysis, which uses high-flow membranes (for example, polyacrylonitrile). It is recommended to avoid such combinations, or use alternative membranes, or prescribe other antihypertensive drugs.
In patients with uncomplicated arterial hypertension receiving Accupro, symptomatic arterial hypotension rarely occurs. It develops, probably due to a concomitant decrease in the volume of circulating blood, for example, due to hemodialysis or adherence to a diet with limited consumption of table salt. In this case, the patient should be given a horizontal position and an intravenous infusion of 0.9% sodium chloride solution should be performed. Transient arterial hypotension is not a contraindication to continuing therapy, however, it is recommended to evaluate the feasibility of the simultaneous use of a diuretic, or to reduce the dose of Accupro. Other causes of decreased blood volume, such as diarrhea and vomiting, can also lead to a pronounced decrease in blood pressure. In such cases, a doctor's consultation is required.
In patients who are already receiving diuretics, the addition of Accupro to therapy can lead to the development of symptomatic arterial hypotension. In this regard, it is recommended to temporarily stop taking the diuretic 2–3 days before the start of quinapril, with the exception of patients with difficult to treat or malignant arterial hypertension. If monotherapy with an ACE inhibitor fails to achieve the required antihypertensive effect, the diuretic should be resumed. In cases where it is not possible to temporarily cancel the diuretic, you need to prescribe Akcupro in the minimum initial dose.
Due to the risk of agranulocytosis in patients with kidney disease and / or connective tissue diseases, the number of leukocytes in the blood should be monitored during the period of use of Accupro.
One of the side effects of quinapril is a cough, which is usually unproductive, persistent, and resolves after discontinuation of the drug. When conducting a differential diagnosis of cough, it is necessary to take into account its possible connection with Accupro.
Patients should be warned to seek immediate medical attention if any signs of infection (such as fever or acute tonsillitis) appear, as these symptoms may indicate the development of neutropenia.
In chronic heart failure and there is a risk of severe arterial hypotension, treatment with quinapril should be started with the dose recommended by the doctor, under his close supervision. Special supervision is required in the first two weeks of therapy and with each increase in the dose of Accupro.
The patient should warn the doctor / anesthetist about taking an ACE inhibitor if surgery, including dental, is necessary.
Influence on the ability to drive vehicles and complex mechanisms
Patients receiving Accupro need to be careful when driving a car, working with complex mechanisms and performing other activities that require increased attention, especially at the beginning of therapy.
Application during pregnancy and lactation
Akcupro is contraindicated in pregnant women and women who are planning a pregnancy. Also, the drug is prohibited for patients of reproductive age if they do not use reliable methods of contraception.
When used during pregnancy, ACE inhibitors increase the risk of developing abnormalities in the nervous and cardiovascular systems of the fetus. Cases of the development of oligohydramnios in a pregnant woman and preterm labor are described. Children whose mothers received an ACE inhibitor during pregnancy may experience the following disorders: intrauterine growth retardation, renal pathology (including acute renal failure), arterial hypotension, lung hypoplasia, contractures of the extremities, hypoplasia of the skull bones, deformation of the facial part of the skull, patent ductus arteriosus. Cases of intrauterine fetal death and death of a newborn are known.
Women should use reliable contraceptive methods during therapy. If pregnancy occurs during the treatment period, Accupro should be canceled immediately.
Newborns exposed to quinapril in utero should be closely monitored for arterial hypotension, hyperkalemia and oliguria. With the development of oliguria, maintenance of blood pressure and renal perfusion are indicated.
Akcupro is contraindicated during lactation.
Pediatric use
Accupro is not intended for use in pediatric practice.
With impaired renal function
The half-life of the drug increases as renal function decreases, so the dose of Accupro must be adjusted.
Maximum initial doses depending on creatinine clearance (CC):
- CC> 60 ml / min - 10 mg;
- CC 30-60 ml / min - 5 mg;
- CC 10-30 ml / min - 2.5 mg (½ tablet with a dosage of 5 mg).
The dose of the drug should be increased under close monitoring of renal function, taking into account the therapeutic effect.
Due to the fact that there are insufficient data on the safety of taking quinapril, Accupro should be used with caution in patients on hemodialysis (CC <10 ml / min), with impaired renal function, bilateral renal artery stenosis or stenosis of a solitary kidney artery, conditions after transplantation kidneys.
For violations of liver function
In patients with progressive disease or impaired liver function, Akcupro should be used with caution in combination with a diuretic, since even small changes in water and electrolyte balance can cause hepatic coma.
Use in the elderly
At the beginning of therapy, elderly patients are advised to prescribe Akcupro in a daily dose of 10 mg. In the future, it can be increased until the desired therapeutic effect is achieved.
Drug interactions
- estrogens: the hypotensive effect of quinapril decreases (due to fluid retention);
- diuretics: increased antihypertensive effect;
- lithium preparations: the concentration of lithium in the blood serum increases, which can lead to the development of intoxication (the combination should be used with caution, under constant monitoring of the lithium level in the blood serum; diuretics should not be added to this combination of drugs, since they increase the risk of lithium intoxication);
- hypoglycemic oral drugs, insulin: their effect is enhanced, there is a risk of hypoglycemia;
- drugs that increase the content of potassium in the blood serum (potassium preparations, potassium-sparing diuretics, salt substitutes containing potassium): an increase in the level of potassium in the blood is possible (care should be taken when using such combinations);
- procainamide, allopurinol, cytostatic agents, immunosuppressants: leukopenia may develop;
- narcotic analgesics, antihypertensive drugs, drugs for general anesthesia: the hypotensive effect of quinapril is enhanced;
- tetracycline and other drugs that interact with magnesium: absorption of these drugs is reduced due to the presence of magnesium carbonate in Accupro;
- non-steroidal anti-inflammatory drugs (including selective COX-2 inhibitors): the antihypertensive effect of quinapril is weakened; in patients with impaired renal function, patients with reduced BCC (including as a result of the use of diuretics) and the elderly, the development / deterioration of renal function up to acute renal failure is possible (careful monitoring of renal function is required when using such a combination);
- drugs that suppress bone marrow function: the risk of developing agranulocytosis and / or neutropenia increases;
- gold preparations: the development of a symptom complex is possible, including a decrease in blood pressure, facial flushing, nausea and vomiting;
- angiotensin II receptor antagonists, aliskiren and drugs that inhibit the RAAS: a double blockade of the RAAS activity may develop, which can manifest itself as a decrease in blood pressure, impaired renal function up to acute renal failure and hyperkalemia (blood pressure, renal function and blood electrolyte levels should be carefully monitored);
- inhibitors of mTOR enzymes (for example, temsirolimus), DPP-4 inhibitors (gliptins), estramustine: there is a significant risk of developing angioedema (special care is required);
- ethanol: the antihypertensive effect of quinapril is enhanced.
No drug interactions have been identified with the simultaneous use of Akcupro and the following drugs: propranolol, cimetidine, digoxin, hydrochlorothiazide, warfarin, atorvastatin.
Analogs
The analogues of Accupro are: Amprilan, Angiopril-25, Arentopres, Berlipril, Vasolong, Vero-Captopril, Hypernik, Gopten, Dapril, Dilaprel, Diroton, Zokardis, Invoril, Irumed, Capoten, Captopril, Quadropril, Lizamopril, Lizamopril, Lizamopril Parnavel, Perindopril, Perineva, Pyramil, Pyristar, Ramepress, Ramipril, Renitek, Tritace, Fozikard, Fosinopril, Hartil, Enalapril, Enap, Enapharm.
Terms and conditions of storage
Store at a temperature not exceeding 25 ° C. Keep out of the reach of children.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Akcupro
Reviews about Akcupro, left on specialized medical sites by doctors, are mostly positive. According to research data, in addition to lowering blood pressure, this drug improves heart function, strengthens the walls of the vascular system and makes them more elastic. First of all, quinapril is recommended for patients with hypertension and signs of circulatory disorders. It is also used for heart failure.
Most patients confirm the high antihypertensive efficacy of Accupro, both when used as a single drug and in combination with other drugs. However, there are reports describing serious side effects (including angioedema), due to which therapy had to be interrupted. Also, some users complain about the high cost of the drug compared to many analogues.
The price of Akcupro in pharmacies
Approximate prices for Akcupro (30 tablets per pack): 10 mg - 412-635 rubles, 20 mg - 478-569 rubles, 40 mg - 523-683 rubles.
Akcupro: prices in online pharmacies
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Drug name Price Pharmacy |
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Akcupro 10 mg film-coated tablets 30 pcs. 502 RUB Buy |
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Akcupro 20 mg film-coated tablets 30 pcs. 575 RUB Buy |
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Akcupro tablets p.p. 20mg 30 pcs. 578 r Buy |
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Akcupro tablets p.p. 10mg 30 pcs. RUB 605 Buy |
Maria Kulkes Medical journalist About the author
Education: First Moscow State Medical University named after I. M. Sechenov, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
