Quinapril

Quinapril is an ACE inhibitor previously used for hypertension and heart failure.

It has largely been discontinued in the United States due to nitrosamine impurity concerns (2022 recall), but remains pharmacologically representative of the ACE inhibitor class.

Class: → ACE Inhibitors

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

Net Effects: • ↓ Systemic vascular resistance • ↓ Blood pressure • ↓ Ventricular remodeling (in HF)

Mechanistically identical to other ACE inhibitors.

• Prodrug (converted to quinaprilat) • Historically used in hypertension and heart failure • Withdrawn in the U.S. market (2022) due to nitrosamine contamination risk

Clinical relevance now primarily academic/reference.

• Effective blood pressure reduction

→ Hypertension Module

• Used similarly to other ACE inhibitors • Not commonly used in modern GDMT

→ Heart Failure Module

Hypertension: • Start: 10–20 mg once daily • Typical range: 20–80 mg daily (once or divided)

Heart Failure: • Often started at lower doses (5–10 mg daily) • Titrated as tolerated

• Prodrug → activated in liver • Renally cleared • Half-life of active metabolite ~2 hours • Duration supports once- or twice-daily dosing

Dose adjustment required in renal impairment.

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

No significant pharmacologic differences from other ACE inhibitors.

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

✔ Pharmacologically similar to other ACE inhibitors ✔ Prodrug ✔ Withdrawn from U.S. market (2022 recall) ✔ Primarily of historical/reference value

Related:

→ ACE Inhibitors → Lisinopril → Return to CV Modules