Accuzid, 25 mg+20 mg 30 pcs

Accuzid is a combination antihypertensive drug consisting of the ACE inhibitor quinapril and the thiazide diuretic hydrochlorothiazide in three different ratios. Quinapril is an ACE inhibitor. ACE catalyzes the formation of angiotensin II, which has a vasoconstrictor effect and controls vascular tone, including through stimulation of aldosterone secretion by the adrenal cortex. Quinapril inhibits circulating and tissue ACE and causes reduction of vasopressor activity and aldosterone secretion. Elimination of the negative effect of angiotensin II on renin secretion by a feedback mechanism leads to an increase in plasma renin activity.

At the same time, the decrease of BP is accompanied by a decrease of RAS and renal vascular resistance, while changes of HR, cardiac output, renal blood flow, glomerular filtration rate and filtration fraction are insignificant or absent. In addition, quinapril slightly reduces potassium loss caused by hydrochlorothiazide, which due to its diuretic action also increases plasma renin activity, aldosterone secretion, decreases serum potassium levels and increases its excretion with urine.

Hydrochlorothiazide is a diuretic that has a direct effect on the kidneys, increasing the excretion of sodium, chloride, water, and potassium and bicarbonate ions, and decreasing the excretion of calcium ions. Although the mechanism of antihypertensive action of diuretics is not fully understood, with their long-term use there is a decrease in ROS, probably associated with changes in sodium ion metabolism. Thus, the combination of quinapril and hydrochlorothiazide leads to a more pronounced BP reduction than therapy with each drug alone.

Pharmacological action

Accuzide has an antihypertensive effect.

Indications

The indications for the use of Accuzid are arterial hypertension in patients requiring combination therapy with quinapril and a diuretic.

Active ingredient

Composition

1 tablet contains quinapril (in hydrochloride form) 20 mg,

hydrochlorothiazide 25 mg.

How to take, the dosage

Intentionally once daily, regardless of meals.

For patients not receiving diuretics (whether or not quinapril monotherapy has previously been used), the recommended starting dose is 1 tablet of Accuzid (20 mg +12.5 mg) once daily.

Thereafter, if necessary, the dose may be increased to 2 tablets of Accuzid (20 mg + 12.5 mg) once daily or to the maximum recommended daily dose of Accuzid – (20 mg + 25 mg) once daily.

Interaction

The use of tetracycline together with quinapril reduces the absorption of tetracycline by approximately 28-37%. This is due to the presence of magnesium carbonate as a filler in the drug. It should be borne in mind the possibility of this interaction when prescribing quinapril/hydrochlorothiazide simultaneously with tetracycline or with other drugs that react with magnesium.
Lithium is usually not prescribed together with diuretics. Diuretics decrease its renal clearance and increase the risk of toxic effects. Increased serum lithium concentrations and symptoms of lithium poisoning due to sodium loss caused by quinapril/hydrochlorothiazide have been found in patients taking lithium and ACE inhibitors simultaneously. When using quinapril/hydrochlorothiazide, the risk of lithium intoxication may increase. Concomitant use of these drugs should be used with caution; frequent monitoring of serum lithium levels is recommended. Concomitant use of a diuretic may increase the risk of lithium toxicity.

When using quinapril with propranololol, hydrochlorothiazide, digoxin or cimetidine, no clinically important pharmacokinetic interactions have been observed. The anticoagulant effect of a single dose of warfarin (assessed by prothrombin time) was not significantly altered by concomitant administration of quinapril twice daily.

Alcohol, barbiturates or drugs – orthostatic hypotension may occur; antidiabetic agents (oral hypoglycemic agents and insulin) – it may be necessary to increase the dose of antidiabetic agents; other antihypertensive agents – additive effect or potentiation of effect; GCS, adrenocorticotropic hormone – increased electrolyte loss, especially hypokalemia; Pressor amines (e.g., norepinephrine) – some decrease in response to these drugs may occur; nondepolarizing myorelaxants (e.g., tubocurarine) – increased response to myorelaxants may occur; NSAIDs – in some patients, NSAID use may decrease the diuretic, natriuretic and antihypertensive effects of loop, potassium-saving and thiazide diuretics.

Therefore, when using quinapril/hydrochlorothiazide and NSAIDs concomitantly, patients need careful monitoring to obtain the desired effect of Accuzide; drugs that increase serum potassium levels – quinapril may decrease aldosterone levels, which in turn may cause potassium retention.

Therefore, concomitant use of quinapril and potassium preparations or preparations containing potassium salts should be careful, with appropriate monitoring of serum potassium concentration; anion exchange resins – absorption of hydrochlorothiazide is impaired by anion exchange resins such as colestyramine and colestipol. Simultaneous use of anion exchange resins binds hydrochlorothiazide and reduces its absorption from the digestive tract by up to 85% and 43%, respectively.

Special Instructions

Accuzid may cause symptomatic arterial hypotension, but not more frequently than with monotherapy with both components of the drug. Symptomatic hypotension is rare when treating patients with uncomplicated arterial hypertension with quinapril, but it may develop as a result of ACE inhibitor therapy in patients with decreased blood pressure, for example, after treatment with diuretics, when maintaining a sodium restricted diet or when performing hemodialysis.

In case of symptomatic hypotension, the patient should be placed horizontally and, if necessary, should be given an IV infusion of 0.9% sodium chloride solution. Transient arterial hypotension is not a contraindication for further use of the drug, but in such cases it is advisable to reduce the dose. In patients with chronic heart failure in combination with or without renal insufficiency, ACE inhibitor therapy for arterial hypertension may lead to excessive BP decrease, which may be accompanied with oliguria, azotemia and, in rare cases, acute renal failure and even lethal outcome.

The treatment of such patients with Accuside should be started under close medical control and monitoring during the first 2 weeks and with increasing of the drug dose. In rare cases ACE inhibitor therapy may be accompanied with agranulocytosis and bone marrow suppression in patients with uncomplicated arterial hypertension but more frequently in patients with impaired renal function, especially with connective tissue diseases. In these cases, the number of leukocytes in the blood should be monitored.Thiazide diuretics sometimes cause exacerbation of SLE.

Contraindications

Side effects

The most common side effects (>1%) with any combination of quinapril and hydrochlorothiazide were headache (6.7%), dizziness (4.8%), cough (3.2%), which was usually nonproductive and persistent and resolved after stopping therapy, and increased fatigue (2.9%).

In general, side effects were mild and transient, independent of age, sex, race, and duration of therapy.

Overdose

There is no information on Accuside overdose during treatment of humans.

The main clinical manifestations of hydrochlorothiazide mototherapy are symptoms associated with electrolyte loss (hypokalemia, hypochloremia, hyponatremia) and dehydration due to diuresis stimulation. With concomitant use of foxglove drugs hypokalemia may increase cardiac arrhythmia.

There is no information about specific therapy of quinapril/hydrochlorothiazide overdose. The effectiveness of hemodialysis and peritoneal dialysis is negligible.

The treatment is symptomatic.

Pregnancy use

It is contraindicated in pregnancy and children under 18 years of age.