Indications for ACCURETIC:
Not for initial therapy. Previously titrated: use same doses as individual components. Switching from quinapril monotherapy: initially one Accuretic 10/12.5 tab or one Accuretic 20/12.5 tab once daily; allow 2–3 weeks before increasing hydrochlorothiazide component. Switching from hydrochlorothiazide 25mg/day monotherapy: initially one Accuretic 10/12.5 tab daily or one Accuretic 20/12.5 tab once daily. Adjust based on response and serum potassium. Renal impairment (CrCl ≤30mL/min): not recommended.
Anuria. Sulfonamide allergy. History of ACEI-associated angioedema. Concomitant aliskiren in patients with diabetes. Concomitant neprilysin inhibitor (eg, sacubitril): avoid within 36hrs of switching to or from sacubitril/valsartan.
Fetal toxicity may develop; discontinue if pregnancy is detected. Correct salt/volume depletion prior to initiation. Ischemic heart disease. Cerebrovascular disease. Reduce dose or discontinue if symptomatic hypotension develops. Renal or hepatic impairment. Dialysis (esp. high-flux membrane). Postsympathectomy. Surgery. SLE. Acute myopia and secondary angle-closure glaucoma; discontinue immediately if develop. History of angioedema. Severe CHF. Cirrhosis. Diabetes. Gout. Black patients may have a higher risk of angioedema than non-Blacks. Monitor for hyperkalemia in diabetes or renal insufficiency. Monitor renal function in severe CHF, hypertension, or renal artery stenosis. Monitor WBCs in renal or collagen vascular disease. Monitor calcium levels in hypercalcemia. Discontinue if angioedema, laryngeal edema or stridor, jaundice or marked elevation in liver enzymes occurs. Give SC epinephrine for airway obstruction if indicated. Elderly. Neonates. Pregnancy (esp. 2nd & 3rd trimester). Nursing mothers: not recommended.
ACE inhibitor + diuretic (thiazide).
See Contraindications. Orthostatic hypotension potentiated by alcohol, barbiturates, narcotics. Concomitant K+ supplements, K+-sparing diuretics, K+-containing salt substitutes may cause hyperkalemia; monitor serum levels. Hypokalemia more likely with corticosteroids, ACTH. Potentiates nondepolarizing muscle relaxants. Reduces tetracycline absorption. May increase lithium levels; monitor frequently. May potentiate other antihypertensives (eg, ganglionic or peripheral adrenergic-blocking drugs). May antagonize pressor amines. May be antagonized by, and renal toxicity potentiated by NSAIDs, including selective COX-2 inhibitors; monitor renal function periodically in elderly and/or volume-depleted. May be antagonized by cholestyramine, colestipol resins. Monitor antidiabetic agents. May interfere with parathyroid tests; interrupt for few days before testing. Nitritoid reactions with concomitant injectable gold (eg, sodium aurothiomalate); rare. Dual inhibition of the renin-angiotensin system with ARBs, ACEIs, or aliskiren may increase risk of hypotension, hyperkalemia, renal function changes; monitor closely. Concomitant aliskiren in renal impairment (CrCl <60mL/min): not recommended. Monitor for digoxin toxicity.
Cough, somnolence, orthostatic hypotension; rare: angioedema, anaphylactoid reactions, electrolyte disturbances, excessive hypotension, hepatic failure, neutropenia, agranulocytosis; HCTZ: increased risk for non-melanoma skin cancer.