Moexipril dosage and administration: Difference between revisions

Revision as of 21:05, 14 February 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2], Amr Marawan, M.D. [3]

Moexipril

Moexipril tablet

Moexipril and Hydrochlorothiazide tablet

Moexipril and Hydrochlorothiazide tablet

Overview

Moexipril tablet is an angiontensin converting enzyme inhibitor drug that is FDA approved for the treatment of hypertension, heart failure, left ventricular dysfunction after myocardial infarction, diabetic nephropathy. Adverse reactions include hypotension, rash, hyperkalemia, disorder of taste, cough. hypotension, rash, hyperkalemia, disorder of taste, cough.

Dosage and Administration

Hypertension

The recommended initial dose of moexipril hydrochloride in patients not receiving diuretics is 7.5 mg, one hour prior to meals, once daily. Dosage should be adjusted according to blood pressure response. The antihypertensive effect of moexipril hydrochloride may diminish towards the end of the dosing interval. Blood pressure should, therefore, be measured just prior to dosing to determine whether satisfactory blood pressure control is obtained. If control is not adequate, increased dose or divided dosing can be tried. The recommended dose range is 7.5 to 30 mg daily, administered in one or two divided doses one hour before meals. Total daily doses above 60 mg a day have not been studied in hypertensive patients.

In patients who are currently being treated with a diuretic, symptomatic hypotension may occasionally occur following the initial dose of moexipril hydrochloride. The diuretic should, if possible, be discontinued for 2 to 3 days before therapy with moexipril hydrochloride is begun, to reduce the likelihood of hypotension. If the patient's blood pressure is not controlled with moexipril hydrochloride alone, diuretic therapy may then be reinstituted. If diuretic therapy cannot be discontinued, an initial dose of 3.75 mg of moexipril hydrochloride should be used with medical supervision until blood pressure has stabilized.

Dosage Adjustment in Renal Impairment

For patients with a creatinine clearance ≤40 mL/min/1.73 m2, an initial dose of 3.75 mg once daily should be given cautiously. Doses may be titrated upward to a maximum daily dose of 15 mg.^[1]

References

↑ "MOEXIPRIL HYDROCHLORIDE TABLET [APOTEX CORP.]".

Adapted from the FDA Package Insert.

[dailymed.nlm.nih.gov-1] "MOEXIPRIL HYDROCHLORIDE TABLET [APOTEX CORP.]".

[1]

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 ==Dosage and Administration==
-Moexipril and [[hydrochlorothiazide]] are effective treatments for hypertension. The recommended dosage range of moexipril is 7.5 to 30 mg daily, administered in a single or two divided doses one hour before meals, while [[hydrochlorothiazide]] is effective in a dosage of 12.5 to 50 mg daily.
+====Hypertension====
-The side effects  of moexipril are generally rare and apparently independent of dose; those of [[hydrochlorothiazide]] are a mixture of dose-dependent phenomena (primarily hypokalemia) and dose-independent phenomena (e.g., [[pancreatitis]]), the former much more common than the latter. Therapy with any combination of moexipril and hydrochlorothiazide will be associated with both sets of dose-independent side effects, but regimens in which moexipril is combined with low doses of hydrochlorothiazide produce minimal effects on serum potassium. In Moexipril HCl and [[Hydrochlorothiazide]] Tablets controlled clinical trials, the average change in serum potassium was near zero in subjects who received 3.75 mg / 6.25 mg or 7.5 mg / 12.5 mg, but subjects who received 15 mg / 12.5 mg or 15 mg / 25 mg experienced a mild decrease in serum potassium, similar to that experienced by subjects who received the same dose of [[hydrochlorothiazide]] monotherapy. To minimize dose-independent side effects, it is usually appropriate to begin combination therapy only after a patient has failed to achieve the desired effect with monotherapy.
+The recommended initial dose of moexipril hydrochloride in patients not receiving diuretics is 7.5 mg, one hour prior to meals, once daily. Dosage should be adjusted according to blood pressure response. The antihypertensive effect of moexipril hydrochloride may diminish towards the end of the dosing interval. Blood pressure should, therefore, be measured just prior to dosing to determine whether satisfactory blood pressure control is obtained. If control is not adequate, increased dose or divided dosing can be tried. The recommended dose range is 7.5 to 30 mg daily, administered in one or two divided doses one hour before meals. Total daily doses above 60 mg a day have not been studied in hypertensive patients.
-====Dose Titration Guided by Clinical Effect====
+In patients who are currently being treated with a [[diuretic]], symptomatic [[hypotension]] may occasionally occur following the initial dose of moexipril hydrochloride. The diuretic should, if possible, be discontinued for 2 to 3 days before therapy with moexipril hydrochloride is begun, to reduce the likelihood of [[hypotension]]. If the patient's blood pressure is not controlled with moexipril hydrochloride alone, [[diuretic]] therapy may then be reinstituted. If diuretic therapy cannot be discontinued, an initial dose of 3.75 mg of moexipril hydrochloride should be used with medical supervision until blood pressure has stabilized.
-A patient whose blood pressure is not adequately controlled with either moexipril or [[hydrochlorothiazide]] monotherapy may be given Moexipril HCl and Hydrochlorothiazide Tablets 7.5 mg / 12.5 mg, Moexipril HCl and [[Hydrochlorothiazide]] Tablets 15 mg / 12.5 mg or Moexipril HCl and Hydrochlorothiazide Tablets 15 mg / 25 mg one hour before a meal. Further increases of moexipril, [[hydrochlorothiazide]] or both depend on clinical response. The hydrochlorothiazide dose should generally not be increased until 2-3 weeks have elapsed.
+====Dosage Adjustment in Renal Impairment====
-Total daily doses above 30 mg / 50 mg a day have not been studied in hypertensive patients. Patients whose blood pressures are adequately controlled with 25 mg of hydrochlorothiazide daily, but who experience significant potassium loss with this regimen, may achieve blood pressure control without electrolyte disturbance if they are switched to moexipril 3.75 mg/hydrochlorothiazide 6.25 mg (one-half of the Moexipril HCl and [[Hydrochlorothiazide]] Tablets 7.5 mg / 12.5 tablet). For patients who experience an excessive reduction in blood pressure with Moexipril HCl and [[Hydrochlorothiazide]] Tablets 7.5 mg / 12.5 mg, the physician may consider prescribing moexipril 3.75 mg/[[hydrochlorothiazide]] 6.25 mg.
+For patients with a [[creatinine clearance]] ≤40 mL/min/1.73 m2, an initial dose of 3.75 mg once daily should be given cautiously. Doses may be titrated upward to a maximum daily dose of 15 mg.<ref name="dailymed.nlm.nih.gov">{{Cite web  | last =  | first =  | title = MOEXIPRIL HYDROCHLORIDE TABLET [APOTEX CORP.] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=d18108f5-98ca-1220-d145-bcf4e71ceaee | publisher =  | date =  | accessdate = }}</ref>
-====Replacement Therapy====
-The combination may be substituted for the titrated individual active ingredients.
-====Use in Renal Impairment====
-The usual dosage regimen of Moexipril HCl and [[Hydrochlorothiazide]] Tablets does not need to be adjusted as long as the patient's creatinine clearance is > 40 mL/min/1.73 m2 ([[serum creatinine]] approximately < 3 mg/dL or 265 µmol/L). In patients with more severe renal impairment, loop diuretics are preferred to thiazides, so Moexipril HCl and Hydrochlorothiazide Tablets is not recommended.<ref name="dailymed.nlm.nih.gov">{{Cite web  | last =  | first =  | title = MOEXIPRIL HYDROCHLORIDE TABLET [APOTEX CORP.] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=d18108f5-98ca-1220-d145-bcf4e71ceaee | publisher =  | date =  | accessdate = }}</ref>