Adults: Take 1 hr ac. Uncontrolled BP on Moexipril/HCTZ Monotherapy: Initial: 7.5mg-12.5mg, 15mg-12.5mg, or 15mg-25mg qd. Titrate: Based on clinical response. May increase HCTZ dose after 2-3 weeks. Max: 30mg-50mg qd. Controlled BP on 25mg qd HCTZ with Hypokalemia: Switch to 3.75mg-6.25mg (1/2 of 7.5mg-12.5mg tab). Excessive BP Reduction with 7.5mg-12.5mg:
Not for initial therapy. Not recommended with severe renal impairment (CrCl 40mL/min/1.73m ). Symptomatic hypotension may occur, most likely in patients with salt and/or volume depletion; correct such conditions before therapy. May precipitate hepatic coma with hepatic impairment or progressive liver disease. Caution in elderly. HCTZ: Enhanced antihypertensive effects in postsympathectomy patients. May precipitate azotemia with severe renal disease. May cause idiosyncratic reaction, resulting in acute transient myopia and acute angle-closure glaucoma; d/c as rapidly as possible. May cause exacerbation or activation of systemic lupus erythematosus
(SLE), hyperuricemia, precipitation of frank gout or overt diabetes, hypercalcemia,
See Contraindications. Dual blockade of the RAS is associated with increased risks of hypotension, hyperkalemia, and changes in renal function (including acute renal failure); closely monitor BP, renal function, and electrolytes with concomitant agents that affect the RAS. Avoid with aliskiren in patients with renal impairment (GFR <60mL/min). NSAIDs, including selective cyclooxygenase-2 inhibitors, may attenuate diuretic, natriuretic, and antihypertensive effects.
HCTZ: Potentiation of orthostatic hypotension may occur with alcohol, barbiturates, or narcotics. Dosage adjustment of antidiabetic drugs (oral agents and insulin) may be required. Cholestyramine and colestipol resins may reduce absorption. Corticosteroids and adrenocorticotropic hormone may intensify electrolyte depletion, particularly hypokalemia. May decrease response to pressor amines (eg, norepinephrine). May increase responsiveness to nondepolarizing skeletal muscle relaxants (eg, tubocurarine). Increased absorption with guanabenz or propantheline. May potentiate action of other antihypertensives, especially ganglionic or peripheral adrenergic-blocking drugs. Moexipril: NSAIDs may deteriorate renal
function. Increased lithium levels and symptoms of toxicity reported; use with caution and monitor
+ lithium levels. Increased risk of hyperkalemia with K -sparing diuretics (spironolactone, amiloride, ++ triamterene), K supplements, or K -containing salt substitutes; use with caution and monitor
Category D, not for use in nursing.
Moexipril: ACE inhibitor; decreases angiotensin II formation, leading to decreased vasoconstriction, increased plasma renin activity, and decreased aldosterone secretion. HCTZ:
Thiazide diuretic; not established. Affects distal renal tubular mechanisms of electrolyte
(moexiprilat); C and AUC reduced by 70% and 40%, respectively, with low-fat breakfast, or max
80% and 50%, respectively, with high-fat breakfast. Distribution: Moexipril: V =2.8L/kg d
(moexiprilat); plasma protein binding (50%, moexiprilat). HCTZ: V =1.5-4.2L/kg; plasma protein d binding (21-24%); crosses placenta; found in breast milk. Metabolism: Rapid via de-esterification; moexiprilat (active metabolite). Elimination: Moexipril: Urine (1% unchanged, 7% moexiprilat, 5% other metabolites), feces (1% unchanged, 52% moexiprilat); T=1.3 hrs, 2-9 hrs (moexiprilat). 1/2
HCTZ: Kidney (>60% unchanged); T=5.6-14.8 hrs.
Assess for history of ACE inhibitor-associated angioedema, anuria, hypersensitivity to drug or sulfonamide-derived drugs, history of allergy or bronchial asthma, volume/salt depletion, CHF, collagen vascular disease, renal artery stenosis, SLE, risk factors for hyperkalemia, hepatic/renal function, pregnancy/nursing status, and possible drug interactions. Obtain baseline serum electrolytes.
Advise to take therapy 1 hr ac. Instruct to d/c use and report immediately to physician if signs/symptoms of angioedema (swelling of the face, extremities, eyes, lips, tongue, difficulty in breathing) occur. Inform that lightheadedness may occur, especially during the 1st few days of therapy; instruct to d/c use and consult physician if fainting occurs. Inform that excessive perspiration, dehydration, and other causes of volume depletion (eg, diarrhea, vomiting) may lead to excessive fall in BP; advise to consult physician if these conditions develop. Instruct not to use
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