In the treatment of ACE inhibitors, cases of angioedema in the head and neck, including 0.1% of patients who received quinapril. When a laryngeal whistle or angioedema of the face, tongue, or vocal cords quinapril should be immediately canceled. The patient should be given adequate treatment and observed before the regression of the symptoms of edema. To reduce the symptoms can be used antihistamines. Angioedema with involvement of the larynx can lead to death. If edema of the tongue, vocal cords or larynx threatens with the development of airway obstruction, adequate emergency therapy, including subcutaneous injection of an epinephrine (adrenaline) solution 1: 1000 (0.3-0.5 ml), is necessary. In the treatment of ACE inhibitors, cases of angioedema of the intestine are also described. Patients noted abdominal pain (with / without nausea or vomiting); in some cases without a previous angioedema and a normal activity of C1-esterase. The diagnosis was established using computed tomography of the abdominal region, ultrasound examination or at the time of surgery. Symptoms disappeared after discontinuation of ACE inhibitors. Therefore, in patients with abdominal pain taking ACE inhibitors,When establishing a differential diagnosis, it is necessary to take into account the possibility of developing angioedema edema of the intestine.
Patients who have a history of angioedema, not associated with an ACE inhibitor, may be at increased risk of developing it when treated with drugs of this group.
Patients receiving ACE inhibitors during desensitizing therapy with Hepaticoptera venom can develop life-threatening anaphylactoid reactions. By temporarily stopping the use of ACE inhibitors, these reactions could be avoided, but they arose again with the occasional administration of these drugs.
Anaphylactoid reactions can also develop with the use of ACE inhibitors in patients who have undergone apheresis of low-density lipoproteins by absorption with dextran sulfate or in patients on hemodialysis using high-flow membranes, such as polyacrylonitrile (for example, AN69). Therefore, similar combinations should be avoided, using either other antihypertensive drugs, or alternative membranes for hemodialysis.Symptomatic arterial hypotension is rare in the treatment of quinapril in patients with uncomplicated arterial hypertension, but it can develop as a result of therapy with ACE inhibitors in patients with reduced BCC, for example, with a diet with limited intake of salt, hemodialysis. In case of symptomatic arterial hypotension, it is necessary to conduct symptomatic therapy (the patient should take a horizontal position and, if necessary, administer an intravenous infusion with 0.9 % solution of sodium chloride). Transient arterial hypotension is not a contraindication to the further use of the drug, however in such cases it is necessary to reduce its dose or assess the advisability of simultaneous therapy with diuretics.
Other causes of BCC reduction, such as vomiting or diarrhea, can also lead to a marked decrease in blood pressure. In such cases, patients should consult a doctor.
In patients receiving diuretics, the use of quinapril may also lead to the development of symptomatic arterial hypotension.It is advisable for such patients to temporarily stop taking a diuretic 2-3 days before the start of treatment with quinapril, except for patients with malignant or difficult to treat hypertension. If monotherapy with quinapril does not provide the necessary therapeutic effect, diuretic treatment should be resumed. If you can not cancel a diuretic, then quinapril used in a low initial dose.
In patients with chronic heart failure, who are at increased risk of severe arterial hypotension, treatment with quinapril should be started with the recommended dose under the close supervision of the doctor; patients should be observed during the first two weeks of treatment, as well as in all cases when the dose of quinapril is increased.
When therapy with ACE inhibitors in patients with uncomplicated hypertension patients in rare cases develop agranulocytosis, which is more common in patients with impaired renal function and connective tissue diseases. In the treatment of quinapril, agranulocytosis rarely developed. When using quinapril (as well as other ACE inhibitors) in patients with connective tissue diseases and / or kidney disease, the number of leukocytes in the blood should be monitored.
In susceptible patients, suppression of RAAS activity can lead to impaired renal function.
In patients with severe chronic heart failure, whose renal function may be affected by RAAS activity, treatment with ACE inhibitors, including quinapril, may be accompanied by oliguria and / or progressive azotemia, and in rare cases, with acute renal failure and / or death. The use of ARA II, ACE inhibitors or aliskiren can lead to a "double" blockade of RAAS activity. This effect can be manifested by lowering blood pressure, hyperkalemia and changes in kidney function (including acute renal failure) compared with monotherapy. Care should be taken to monitor blood pressure, kidney function and electrolyte content in blood plasma in patients taking quinapril and other drugs that affect RAAS. It is necessary to avoid simultaneous use of RAAS-active agents and quinapril. If this combination is necessary, it is necessary to evaluate the ratio of the expected benefit to the possible risk of the combination and regularly monitor the function of the kidneys and potassium content in each individual case.
In patients with chronic heart failure or hypertension with unilateral or bilateral stenosis of the renal artery, in the treatment of ACE inhibitors in some cases, an increase in the concentration of urea nitrogen in the blood and serum creatinine was observed. These changes were almost always reversible and disappeared after the withdrawal of the ACE inhibitor and / or diuretic. In such cases, during the first few weeks of treatment, kidney function should be monitored.
The half-life of quinaprilate increases with decreasing CC. In patients with SC less than 60 ml / min quinapril should be used at a lower initial dose. In such patients, the dose of the drug should be increased taking into account the therapeutic effect, with regular monitoring of kidney function, although in clinical studies there was no further deterioration in renal function in drug treatment.
Hinapril in combination with diuretics should be used with caution in patients with impaired function or progressive liver disease, since small changes in the water-electrolyte balance can cause the development of hepatic coma.
ACE inhibitors, including quinapril, can increase the potassium content in the blood serum.
Hinapril can reduce hypokalemia caused by thiazide diuretics with simultaneous application. The use of quinapril in combination therapy with potassium-sparing diuretics has not been studied. Given the risk of further increase in serum potassium, combined therapy with potassium-sparing diuretics should be carried out with caution, under the control of potassium in the blood serum.
Patients with diabetes may need more careful observation and correction of a dose of hypoglycemic agents for ingestion and insulin, and control of glycemia, especially during the first month of therapy with an ACE inhibitor, including quinapril.
In the treatment of ACE inhibitors, including quinapril, noted the development of cough. In a typical case, it is unproductive, persistent and passes after discontinuation of therapy. In the differential diagnosis of cough, its possible association with ACE inhibitors should be considered.
Before surgery (including dentistry), it is necessary to alert the surgeon / anesthesiologist about the use of ACE inhibitors.
If any symptoms of infection (eg acute tonsillitis, fever) appear, the patient should consult a doctor immediately, as they may be a manifestation of neutropenia.