Moexipril + Hydrochlorothiazide

Indications

Moexipril + Hydrochlorothiazide is used for: Hypertension

Adult Dose

Hypertension Not for initial therapy If blood pressure not controlled with moexipril or hydrochlorothiazide monotherapy: 7.5 mg/12.5 mg, 15 mg/12.5 mg OR 15 mg/ 25 mg PO qDay Increase either or both components based on clinical response Do not increase hydrochlorothiazide component more often than q2-3Weeks Doses above moexipril 30 mg/hydrochlorothiazide 50 mg qDay have not been studied

Child Dose

<18 years: Safety and efficacy not established

Renal Dose

Administration

Contra Indications

Anuria Hypersensitivity to either component or sulfonamides History of angioedema Hereditary or idiopathic angioedema 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

Precautions

Excessive hypotension if concomitant diuretics, hypovolemia, hyponatremia Risk of hyperkalemia, especially in patients 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 DM, fluid or electrolyte imbalance, hyperuricemia or gout, SLE, liver disease, renal disease May aggravate digitalis toxicity Sensitivity reactions may occur with or without history of allergy or asthma Biliary cirrhosis or biliary obstruction Apheresis (LDL) with dextran sulfate, hypertrophic cardiomyopathy, collagen vascular disease, hemodialysis with high flux membrane, aortic stenosis Myelosuppression Renal impairment may occur Neutropenia/agranulocytosis reported Cough may occur within the first few months Cholestatic jaundice may occur Risk of male sexual dysfunction Acute transient myopia and acute angle-closure glaucoma has been reported, particularly with history of sulfonamide or penicillin allergy (hydrochlorothiazide is a sulfonamide) Avoid concomitant use with lithium

Pregnancy-Lactation

Pregnancy Category: C (1st trimester); D (2nd & 3rd trimester) Lactation: inconclusive evidence exists, use caution

Interactions

Adverse Effects

Side effects of Moexipril + Hydrochlorothiazide : Moexipril 1-10% Dizziness Hypotension Peripheral edema Cough Headache Myalgia Hyponatremia Pharyngitis Sinusitis Rash Nausea/vomiting Hyperkalemia Hyponatremia Polyuria Frequency Not Defined Angioedema Arrhythmia Chest pain Pneumonitis Syncope Proteinuria Agranulocytosis (especially if patient has CVD with or without renal impairment) Hepatic failure (rare) Renal failure Hydrochlorothiazide Frequency Not Defined Anorexia Epigastric distress Hypotension Orthostatic hypotension Photosensitivity <1% Anaphylaxis, anemia, confusion, erythema multiforme skin reactions including Stevens-Johnson syndrome, exfoliative dermatitis including toxic epidermal necrolysis, hypomagnesemia, hyponatremia, hypochloremia, dizziness, fatigue, headache, hypercalcemia, hyperuricemia, hyperglycemia, hyperlipidemia, hypercholesterolemia, muscle weakness or cramps, nausea, purpura, rash, vertigo, vomiting

Mechanism of Action

Moexipril/hydrochlorothiazide is a fixed-combination tablet that combines an angiotensin-converting enzyme (ACE) inhibitor, moexipril, and a thiazide diuretic, hydrochlorothiazide Moexipril prevents the conversion of angiotensin I to angiotensin II (a potent vasoconstrictor) through inhibition of ACE by competing with physiologic substrate (angiotensin I) for active site of ACE; inhibition of ACE initially results in decreased plasma angiotensin II concentrations & consequently, blood pressure may be reduced in part through decreased vasoconstriction, increased renin activity, and decreased aldosterone secretion Hydrochlorothiazide is a thiazide diuretic that inhibits Na reabsorption in distal renal tubules resulting in increased excretion of Na+ and water, also K+ and H+ ions