====== Moexipril ======

Moexipril is an ACE inhibitor used primarily for hypertension.

It is less commonly prescribed compared to lisinopril or enalapril.

Class:
→ [[cardio:raas:acei|ACE Inhibitors]]

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===== Mechanism of Action =====

• Inhibits Angiotensin-Converting Enzyme (ACE)
• ↓ Angiotensin II
• ↓ Aldosterone
• ↑ Bradykinin

Net Effects:
• ↓ Systemic vascular resistance
• ↓ Blood pressure
• ↓ Sodium retention

Mechanism identical to other ACE inhibitors.

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===== Unique Features =====

• Prodrug (converted to active moexiprilat)
• Shorter duration compared to lisinopril
• Absorption reduced by food (take 1 hour before meals)

Because of food effect and less convenient dosing, rarely first-line in modern practice.

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===== Indications =====

==== Hypertension ====
• Approved for treatment of hypertension
• Not commonly used for heart failure compared to other ACE inhibitors

→ [[cardio:hypertension:start|Hypertension Module]]

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===== Dosing =====

Hypertension:
• Start: 7.5 mg once daily (1 hour before meals)
• Typical range: 7.5–30 mg daily (once or divided)

May require twice-daily dosing.

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===== Pharmacokinetics =====

• Prodrug → activated in liver
• Renally cleared
• Reduced bioavailability with food
• Half-life ~2–9 hours (active metabolite)

Dose adjustment required in renal impairment.

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===== Adverse Effects =====

Class Effects:
• Dry cough
• Hyperkalemia
• Hypotension
• Angioedema (rare)

No major differences from other ACE inhibitors.

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===== Monitoring =====

Monitor:
• Serum creatinine
• Potassium

Check labs within 1–2 weeks of initiation or dose changes.

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===== Contraindications =====

• Pregnancy
• History of ACE inhibitor–induced angioedema
• Bilateral renal artery stenosis

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===== Clinical Pearls =====

✔ Less commonly used ACE inhibitor  
✔ Must be taken before meals  
✔ Similar efficacy to other ACE inhibitors  
✔ No clear advantage over more commonly used agents  

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Related:

→ [[cardio:raas:acei|ACE Inhibitors]]
→ [[cardio:raas:lisinopril|Lisinopril]]
→ [[cardio:raas:enalapril|Enalapril]]
→ [[cardio:start|Return to CV Modules]]