Moexipril HCl

A to Z Drug Facts

 Action Competitively inhibits angiotensin I-converting enzyme, preventing conversion of angiotensin I to angiotensin II, which is a potent vasoconstrictor and also stimulates aldosterone secretion from the adrenal cortex. This results in a decrease in BP.

 Indications Treatment of hypertension.

 Contraindications Hypersensitivity to ACE inhibitors.

 Route/Dosage

ADULTS: Initial dose: PO 7.5 mg qd. Maintenance: 7.5–30 mg/day; may add diuretic if needed and decrease dose.

 Interactions

Diuretics: Excessive reductions in blood pressure may occur. Indomethacin: Reduced hypotensive effects, especially in low-renin or volume-dependent hypertensive patients. Lithium: Increased lithium levels and symptoms of lithium toxicity. Potassium-sparing diuretics, potassium preparations: May increase serum potassium levels.

 Lab Test Interferences False elevation of liver enzymes and uric acid may occur.

 Adverse Reactions

CV: Chest pain; peripheral edema. CNS: Dizziness; fatigue; headache. DERM: Flushing; rash. EENT: Pharyngitis. GI: Nausea; diarrhea; dyspepsia. META: Hyperkalemia. RESP: Cough. OTHER: Myalgia; flu-like syndrome; angioedema.

 Precautions

Pregnancy: Category D (second and third trimester); Category C (first trimester). Can cause injury or death to fetus if used during second or third trimester. Can cause injury or death to fetus if used during second or third trimester. Lactation: Undetermined. Children: Safety and efficacy not established. Elderly: Use reduced dosage. Angioedema: Use with extreme caution in patients with hereditary angio-edema. Hypotension/first dose effect: Significant decreases in blood pressure may occur after the first dose, especially in severely salt- or volume-depleted patients or in those with heart failure. Minimize risk by discontinuing diuretics, decreasing dose or increasing salt intake approximately 2–3 days prior to initiating drug. Neutropenia/agranulocytosis: Has been reported with other ACE inhibitors. Risk appears greater in patients with renal dysfunction, heart failure or immunosuppression. Hepatic failure: Has been associated with other ACE inhibitors. Patients who develop jaundice or marked elevations of liver enzymes should discontinue drug and receive medical follow-up. Renal impairment: In renal insufficiency, creatinine may occur due to inadequate renal perfusion; monitor renal function during first few weeks of therapy and adjust dosage carefully; for patients with CrCl < 40 ml/1.73 m², an initial dose of 3.75 mg should be given. Doses may be carefully titrated to maximum of 15 mg/day.

 Administration/Storage

• Administer 1 hour before meal.
• Store in a tightly closed container. Protect from excessive moisture.

 Assessment/Interventions

• Obtain patient history.
• Monitor patient for orthostatic hypotension and tachycardia.
• If patient is using diuretics, inform the prescriber as diuretics should be either discontinued 2 to 3 days prior to beginning therapy or the dose reduced until blood pressure is stabilized.
• Monitor blood pressure closely for at least 2 hours after initial dose during the first several days of therapy.
• Observe for sudden, exaggerated hypotension response.
• Monitor blood studies, electrolytes, and renal and hepatic functions throughout therapy.
• Report increased serum potassium and decreased sodium levels to physician.
• Report signs of hyperkalemia or hyponatremia to physician.
• Notify physician if patient develops hypotension, nausea, vomiting, headache, dizziness, fatigue, angio-edema, fever, infection or mouth sores.

 Patient/Family Education

• Instruct patient to take as prescribed.
• Advise patient that chronic, dry cough may develop and to notify healthcare provider if this occurs.
• Advise patient to consult the healthcare provider before taking any otc medications. Excessive amounts of tea, coffee, cola or other drinks that could create a diuretic effect leading to volume depletion or electrolyte imbalance should be avoided.
• Explain that this medicine controls, but does not cure, hypertension and do not discontinue drug unless directed by healthcare provider.
• Teach patient and family to monitor blood pressure, keep a written record and report abnormal readings to the healthcare provider.
• Instruct patient to change positions slowly, especially after the initial dose, to decrease hypotensive effects.
• If dizziness is present, instruct patient not to drive or operate machinery or perform any tasks that require mental alertness.
• Encourage patient to comply with additional interventions for hypertension such as regular exercise, weight control, smoking cessation, sodium and alcohol restriction, diet and stress reduction.
• Instruct patient to notify healthcare provider of persistent rash, sore throat, heart palpitations, chest pain, abdominal pain, difficulty breathing, fever, excessive fatigue or angio-edema.
• Caution female patients to inform healthcare provider immediately if she becomes pregnant or is planning to become pregnant.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts