Home Drug Guide Moexipril Hydrochloride

Drug Guide

Generic Name

Moexipril Hydrochloride

Brand Names Univasc

Classification

Therapeutic: Antihypertensive

Pharmacological: ACE inhibitor

FDA Approved Indications

Management of hypertension to lower blood pressure and reduce the risk of cardiovascular events.

Mechanism of Action

Moexipril inhibits angiotensin-converting enzyme (ACE), preventing the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This results in vasodilation and decreased blood pressure.

Dosage and Administration

Adult: Initial dose: 7.5 mg once daily. Titrate as needed up to 30 mg daily in 1 or 2 doses based on response.

Pediatric: Not indicated for pediatric use.

Geriatric: Start at lower doses due to increased sensitivity and renal function considerations. Monitor renal function and potassium levels regularly.

Renal Impairment: Reduce dose; initial dose may be 2.5 to 5 mg once daily. Adjust based on blood pressure response and renal function.

Hepatic Impairment: Use with caution; no specific dose adjustment provided, but hepatic impairment may alter drug metabolism.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed; volume of distribution approximately 16 L.

Metabolism: Metabolized in the liver via hydrolysis to active metabolites.

Excretion: Excreted primarily by the kidneys; about 60-70% unchanged in urine.

Half Life: Approximately 2 hours.

Contraindications

History of angioedema related to previous ACE inhibitor therapy.
Bilateral renal artery stenosis.
Pregnancy (see pregnancy section).

Precautions

Monitor blood pressure, renal function, and serum potassium regularly.
Use with caution in patients with renal impairment, heart failure, or volume depletion.

Adverse Reactions - Common

Cough (Occasional)
Dizziness (Common)
Fatigue (Common)
Headache (Common)

Adverse Reactions - Serious

Angioedema (Rare)
Hyperkalemia (Less common)
Hypotension (Less common)
Renal impairment (Less common)

Drug-Drug Interactions

Diuretics, especially potassium-sparing types; other antihypertensives; NSAIDs; potasssium supplements; lithium.

Drug-Food Interactions

Avoid salt substitutes containing potassium.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, signs of dehydration or volume depletion, renal function, and serum potassium levels.

Diagnoses:

Risk for decreased cardiac perfusion related to hypotension.
Risk for electrolyte imbalance.

Implementation: Administer as directed, usually once daily, with or without food. Caution about orthostatic hypotension, especially after first dose.

Evaluation: Assess for reduction in blood pressure, monitor for side effects, and ensure no signs of angioedema or hyperkalemia.

Patient/Family Teaching

Instruct to report symptoms of angioedema (swelling of face, lips, tongue, throat).
Advised to avoid potassium-rich foods and salt substitutes.
Warn about dizziness or lightheadedness upon standing.
Importance of regular monitoring of blood pressure and labs.

Special Considerations

Black Box Warnings:

Fetal toxicity: can cause injury or death to the fetus when used during pregnancy.

Genetic Factors: Some populations may have altered responses due to genetic polymorphisms affecting the RAS pathway.

Lab Test Interference: May increase serum potassium and BUN/creatinine levels.

Overdose Management

Signs/Symptoms: Hypotension, hyperkalemia, renal impairment.

Treatment: Discontinue drug, administer IV fluids for hypotension, and monitor electrolytes and renal function. Consider vasopressors if needed.

Storage and Handling

Storage: Store at room temperature away from moisture and heat.

Stability: Stable under recommended conditions.