Moexipril

Indications

Moexipril is used for: Hypertension

Adult Dose

Hypertension Initial: 7.5mg PO qDay 1 hour prior to meal, OR 3.75mg PO qDay if on thiazide diuretc Maintenance: 7.5-30 mg/day PO qDay or divided q12hr Administer 1 hr before meals

Child Dose

Renal Dose

Renal Impairment CrCl <40 mL/min: Initial 3.75 mg PO qDay, no more than 15 mg/day

Administration

Contra Indications

Hypersensitivity to moexipril/other ACE inhibitors History of hereditary or angioedema associated with previous ACE inhibitor treatment Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan Bilateral renal artery stenosis Do not coadminister with aliskiren in patients with diabetes mellitus or with renal impairment (ie, GFR <60 mL/min/1.73 m²)

Precautions

Apheresis (LDL) with dextran sulfate, hypertrophic cardiomyopathy, collagen vascular dz, hemodialysis with high flux membrane, arotic stenosis Less effective in African-Americans Excessive hypotension if concomitant diuretics, hypovolemia, hyponatremia Risk of hyperkalemia, especially with renal impairment, DM, or those taking concomitant K+-elevating drugs Dual blockade of the renin angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for hypotension, hyperkalemia, and renal function changes (including acute renal failure) compared to monotherapy ACE inhibition also causes increased bradykinin levels which putatively mediates angioedema Coadministration with mTOR inhibitors (eg, temsirolimus) may increased risk for angioedema Renal impairment may occur Neutropenia/agranulocytosis reported Cough may occur within the first few months Cholestatic jaundice may occur Use caution in severe aortic stenosis Discontinue immediately if pregnant (see Contraindications and Black Box Warnings) Renal impairment

Pregnancy-Lactation

Pregnancy & Lactation Pregnancy Category: C (1st trimester); D (2nd & 3rd trimesters) Discontinue as soon as pregnancy detected; during the second and third trimesters of pregnancy, drugs that act directly on the renin-angiotensin have been associated with fetal injury that includes hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death Lactation: not known if excreted into breast milk; use caution

Interactions

Adverse Effects

Side effects of Moexipril : 1-10% Dizziness Hypotension Peripheral edema Cough Headache Myalgia Polyuria Hyponatremia Pharyngitis Sinusitis Rash Nausea/vomiting Hyperkalemia Hyponatremia Frequency Not Defined Angioedema Arrhythmia Chest pain Pneumonitis Syncope Proteinuria Agranulocytosis (esp. if pt has CVD with or without renal impairment) Hepatic failure (rare) Renal failure

Mechanism of Action

Angiotensin converting enzyme (ACE) inhibitors dilate arteries and veins by competively inhibiting the conversion of angiotensin I to angiotensin II (a potent endogenous vasoconstrictor) and by inhibiting bradykinin metabolism; these actions result in preload and afterload reductions on the heart ACE inhibitors also promote sodium and water excretion by inhibiting angiotensin-II induced aldosterone secretion; elevation in potassium may also be observed ACE inhibitors also elicit renoprotective effects through vasodilation of renal arterioles ACE inhibitors reduce cardiac and vascular remodeling associated with chronic hypertension, heart failure, and myocardial infarction