No

Angiotensin-Converting Enzyme (ACE) Inhibitors

Treatment of hypertension, alone or in combination with thiazide diuretics; treatment of left ventricular dysfunction after myocardial infarction

C/D (2nd and 3rd trimesters)

Hypersensitivity to moexipril, moexiprilat, or any component; hypersensitivity or allergic reactions or angioedema related to previous treatment with an ACE inhibitor; pregnancy (2nd or 3rd trimester)

Anaphylactic reactions can occur. Angioedema can occur at any time during treatment (especially following first dose). Careful blood pressure monitoring with first dose (hypotension can occur especially in volume depleted patients). Dosage adjustment needed in renal impairment. Use with caution in hypovolemia; collagen vascular diseases; valvular stenosis (particularly aortic stenosis); hyperkalemia; or before, during, or immediately after anesthesia. Avoid rapid dosage escalation which may lead to renal insufficiency. Neutropenia/agranulocytosis with myeloid hyperplasia can rarely occur. If patient has renal impairment then a baseline WBC with differential and serum creatinine should be evaluated and monitored closely during the first 3 months of therapy. Hypersensitivity reactions may be seen during hemodialysis with high-flux dialysis membranes (eg, AN69). Deterioration in renal function can occur with initiation. Use with caution in unilateral renal artery stenosis and pre-existing renal insufficiency.

1% to 10%:

Cardiovascular: Hypotension, peripheral edema

Central nervous system: Headache, dizziness, fatigue

Dermatologic: Rash, alopecia, flushing, rash

Endocrine & metabolic: Hyperkalemia

Gastrointestinal: Diarrhea, nausea, heartburn

Genitourinary: Polyuria

Neuromuscular & skeletal: Myalgia

Renal: Reversible increases in creatinine or BUN

Respiratory: Cough, pharyngitis, upper respiratory infection, sinusitis

<1% (Limited to important or life-threatening symptoms): Chest pain, myocardial infarction, palpitations, arrhythmias, syncope, cerebrovascular accident, orthostatic hypotension, hypercholesterolemia, anemia, elevated LFTs, hepatitis, oliguria, proteinuria, bronchospasm, dyspnea, eosinophilic pneumonitis

Mild hypotension has been the only toxic effect seen with acute overdose; bradycardia may also occur; hyperkalemia occurs even with therapeutic doses, especially in patients with renal insufficiency and those taking NSAIDs

Following initiation of essential overdose management, toxic symptom treatment and supportive treatment should be initiated; hypotension usually responds to I.V. fluids or Trendelenburg positioning.

Allopurinol: Potential for allergic reactions increased with moexipril.

Alpha₁ blockers: Hypotensive effect increased.

Aspirin and NSAIDs may decrease ACE inhibitor efficacy and/or increase potential to alter renal function.

Diuretics: Hypovolemia due to diuretics may precipitate acute hypotensive events or acute renal failure.

Insulin: Risk of hypoglycemia may be increased.

Lithium: Risk of lithium toxicity may be increased; monitor lithium levels, especially the first 4 weeks of therapy.

Mercaptopurine: Risk of neutropenia may be increased.

Potassium-sparing diuretics (amiloride, potassium, spironolactone, triamterene): Increased risk of hyperkalemia.

Potassium supplements may increase the risk of hyperkalemia.

Probenecid: Blood levels of moexipril are increased (may occur with other ACE inhibitors).

Trimethoprim (high dose) may increase the risk of hyperkalemia.

Competitive inhibitor of angiotensin-converting enzyme (ACE); prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor; results in lower levels of angiotensin II which causes an increase in plasma renin activity and a reduction in aldosterone secretion

Peak concentrations: 1-2 hours

Duration: >24 hours

Absorption: Food decreases bioavailability (AUC decreased by ~40%)

Distribution: V_d (moexiprilat): 180 L

Protein binding (plasma): Moexipril: 90%; Moexiprilat: 50% to 70%

Metabolism: Parent drug is metabolized in liver and small intestine to moexiprilat, the 1000 times more potent diacid metabolite; both parent

Bioavailability (moexiprilat): 13%

Half-life: Moexipril: 1 hour; Moexiprilat: 2-10 hours

Time to peak: 1.5 hours

Elimination: 50% appears in the feces

Adults: Oral: Initial: 7.5 mg once daily (in patients not receiving diuretics), 1 hour prior to a meal or 3.75 mg once daily (when combined with thiazide diuretics); maintenance dose: 7.5-30 mg/day in 1 or 2 divided doses 1 hour before meals

Administer on an empty stomach

Blood pressure, heart rate, electrolytes, CBC, symptoms of hypotension

Increases BUN, creatinine, potassium, positive Coombs' [direct]; decreases cholesterol (S); may cause false-positive results in urine acetone determinations using sodium nitroprusside reagent

ACE inhibitors decrease morbidity and mortality in patients with asymptomatic and symptomatic left ventricular dysfunction. In this situation, they decrease hospitalizations for, and retard progression to, congestive heart failure. ACE inhibitors are also indicated in patients postmyocardial infarction in whom left ventricular ejection fraction is <40%. When used in patients with heart failure, the target dose should be achieved, if possible. Lower daily doses of ACE inhibitors have not demonstrated the same cardioprotective effects. Moexipril has not been as extensively studied in this setting as other ACE inhibitors and therefore should be titrated to the maximum or maximum tolerated dose. ACE inhibitors have renal protective effects in patients with proteinuria and possibly cardioprotective effects in high-risk patients.

May cause drowsiness or dizziness; may rarely cause anxiety or mood changes

May cause neutropenia; use caution with clozapine and carbamazepine; may decrease lithium clearance resulting in an increase in serum lithium levels and potential lithium toxicity; monitor serum lithium levels

No information available to require special precautions

No effects or complications reported

Take exactly as directed; do not discontinue without consulting prescriber. Take first dose at bedtime. This drug does not eliminate need for diet or exercise regimen as recommended by prescriber. Do not take potassium supplements or salt substitutes containing potassium without consulting prescriber. May cause dizziness, fainting, lightheadedness (use caution when driving or engaging in tasks that require alertness until response to drug is known); postural hypotension (use caution when rising from lying or sitting position or climbing stairs); nausea, vomiting, abdominal pain, dry mouth, or transient loss of appetite (small frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help) - report if these persist. Report chest pain or palpitations; difficulty in breathing or unusual cough; or other persistent adverse reactions. Pregnancy/breast-feeding precautions: Do not get pregnant while taking this medication; use appropriate barrier contraceptive measures. If you are, or plan to be pregnant, notify your prescriber at once. Consult prescriber if breast-feeding.

Observe for symptoms of severe hypotension, especially within the first 2 hours following the initial dose or subsequent increases in dose as well as for signs of hyperkalemia or cough; administer on an empty stomach

Tablet, as hydrochloride: 7.5 mg, 15 mg

Konstam MA, Drakup K, Baker DW, et al, "Heart Failure: Evaluation and Care of Patients With Left Ventricular Systolic Dysfunction," Clinical Practice Guideline No 11, Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services, 1994.

Lewis EJ, Hunsicker LG, Bain RP, et al, "The Effect of Angiotensin-Converting Enzyme Inhibition on Diabetic Nephropathy," N Engl J Med, 1993, 329(20):1456-62.

McAreavey D and Robertson JIS, "Angiotensin Converting Enzyme Inhibitors and Moderate Hypertension," Drugs, 1990, 40(3):326-45.

Williams JF, Bristow MR, Fowler MB, et al, "Guidelines for the Evaluation and Management of Heart Failure: Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Evaluation and Management of Heart Failure)," J Am Coll Cardiol, 1995, 26:1376-8.

Woo OF, "Captopril and Related Drugs," Poisoning and Drug Overdose, 2nd ed, Olson KR, ed, East Norwalk, CT: Appleton and Lange, 1994, 117-8.