Quinapril

US labelling (no UK SPC in bundle — verify against the UK SPC before use). Adjust dosage according to blood pressure response measured at peak (2–6 hours after dosing) and trough (predosing); dosage adjustments generally at intervals of at least 2 weeks. In some patients treated once daily the antihypertensive effect may diminish toward the end of the dosing interval — an increase in dosage or twice daily administration may be warranted; doses of 40–80 mg and divided doses give a somewhat greater effect at the end of the dosing interval. Concomitant diuretics: if possible discontinue the diuretic 2–3 days before starting quinapril; if it cannot be discontinued, use an initial dose of 5 mg with careful medical supervision for several hours until blood pressure has stabilised. Elderly (65 years and over): recommended initial dose 10 mg once daily, then titrate to optimal response. Heart failure (adjunct to conventional therapy including diuretics and/or digitalis): recommended starting dose 5 mg twice daily, titrated at weekly intervals to an effective dose, usually 20 to 40 mg daily in two equally divided doses; observe under medical supervision for at least two hours after the initial dose for hypotension or orthostasis; consider reducing the dose of concomitant diuretics. Heart failure with renal impairment or hyponatraemia: initial dose 5 mg if creatinine clearance above 30 mL/min and 2.5 mg if creatinine clearance 10 to 30 mL/min; insufficient data below 10 mL/min; if the initial dose is tolerated, a twice daily regimen may start the following day and the dose increased at weekly intervals based on clinical and haemodynamic response. No paediatric dosing is stated in the fetched label.