Accupro (quinapril)

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.

Quinapril has an additive effect with other medicines that decrease blood pressure, particularly other medicines used to treat high blood pressure (antihypertensives). In people taking antihypertensive medicines it may cause a large drop in blood pressure with the first dose, particularly in people taking diuretic medicines such as furosemide. This may cause dizziness, which can usually be relieved by lying down until the symptoms pass. If you are taking a diuretic medicine, your doctor may reduce your dose or ask you to stop taking it for a few days before starting quinapril. This is to prevent your blood pressure from dropping too low. Other medicines that decrease blood pressure include the following:

alpha-blockers such as prazosin (these are also used to treat an enlarged prostate gland)

beta-blockers such as propranolol

calcium-channel blockers such as verapamil, nifedipine

clonidine

diuretics, eg furosemide, bendroflumethiazide

nitrates, eg glyceryl trinitrate

certain antidepressants

certain antipsychotics

alprostadil

baclofen

benzodiazepines, eg temazepam.

Non-steroidal anti-inflammatory drugs (NSAIDs, eg indometacin, aspirin, ibuprofen) may reduce the blood pressure lowering effect of quinapril, and may increase the risk of a decline in kidney function.

There may be a risk of raised potassium levels in the blood (hyperkalaemia) if any of the following medicines are taken with quinapril, hence these are not normally recommended for use in combination with quinapril. If you are taking any of the following with this medicine you should have regular blood tests to monitor the amount of potassium in your blood:

potassium-sparing diuretics (eg spironolactone, triamterene, amiloride)

potassium supplements

potassium-containing salt substitutes (eg Lo-Salt)

ciclosporin

heparin.

Quinapril may increase the blood level of the medicine lithium and for this reason, it is not normally recommended for people taking lithium. People taking this medicine in combination with lithium should have the level of lithium in their blood closely monitored.

Quinapril may possibly enhance the blood sugar lowering effect of insulin and oral antidiabetic medicines, and so could increase the risk of low blood sugar (hypoglycaemia). People with diabetes should therefore carefully monitor their blood sugar while taking this medicine, particularly in the first few weeks of treatment.

There may be an increased risk of a drop in the normal numbers of white blood cells in the blood if this medicine is taken in combination with any of the following medicines:

allopurinol

azathioprine

immunosuppressant therapy

procainamide.

Accupro tablets should not be taken at the same time as tetracyline antibiotics. This is because Accupro tablets contain magnesium carbonate, which may reduce the absorption of tetracycline-type antibiotics from the gut and could make them less effective. Separating the doses of these two medicines by two to three hours should avoid the interaction.

Other medicines containing the same active ingredient

Quinil

Quinapril tablets are also available without a brand name, ie as the generic medicine.

Accuretic contains quinapril in combination with the diuretic medicine hydrochlorothiazide.

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