Univasc

Generic name:

Moexipril hydrochloride

Drug class:

Angiotensin-converting enzyme (ACE) inhibitor

Dosage form:

Oral tablets: 7.5 mg, 15 mg

Root of administration:

Oral

Dose:

Typical dose range 7.5–30 mg once daily; initial 7.5 mg, may increase to 15–30 mg based on response; adjust in renal impairment

Mechanism of action:

Moexipril is a prodrug converted to moexiprilat, which inhibits angiotensin-converting enzyme, decreasing conversion of angiotensin I to angiotensin II, reducing vasoconstriction and aldosterone secretion, leading to lowered blood pressure.

Drug usage cases:

• Hypertension (approved)
• Heart failure (off-label)
• Post-myocardial infarction remodeling (off-label)
• Diabetic nephropathy (off-label)

Drug contra indications:

• Hypersensitivity to moexipril or other ACE inhibitors
• History of angioedema related to previous ACE inhibitor therapy
• Hereditary or idiopathic angioedema
• Pregnancy (especially 2nd and 3rd trimesters)
• Concomitant use with aliskiren in diabetic patients
• Bilateral renal artery stenosis or single kidney with stenosis

Side effects:

• Persistent dry cough
• Hypotension, dizziness, syncope
• Headache
• Hyperkalemia
• Renal impairment, elevated serum creatinine
• Fatigue
• Nausea, vomiting, diarrhea
• Rash, pruritus
• Angioedema
• Disturbances in taste (dysgeusia)
• Neutropenia, agranulocytosis (rare)

Warnings:

• Risk of angioedema; monitor and discontinue if occurs
• Risk of hypotension in volume- or salt-depleted patients; correct depletion before therapy
• Hyperkalemia risk; monitor electrolytes in renal impairment and coadministration of potassium-sparing diuretics or supplements
• Renal function deterioration; monitor serum creatinine and urea
• Aortic stenosis or outflow obstruction; use cautiously
• Dual blockade of renin-angiotensin system increases risk of hypotension, hyperkalemia, and renal impairment; avoid combination with ARBs or direct renin inhibitors in high-risk patients
• May impair renal function in renal artery stenosis; use with caution

Use during pregnancy or breastfeeding:

ACE inhibitors are contraindicated during pregnancy (Category D): associated with fetal toxicity (renal dysplasia, oligohydramnios, skull hypoplasia, neonatal renal failure). Discontinue prior to conception or as soon as pregnancy is detected. Moexipril is excreted in breast milk; discontinue drug or breastfeeding to avoid adverse effects in nursing infants.