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Quinapril
Overview
What is Quinapril?
Quinapril hydrochloride USP is the hydrochloride salt of quinapril, the ethyl ester of a non-sulfhydryl,angiotensin-converting enzyme (ACE) inhibitor, quinaprilat.
Quinapril hydrochloride USP is chemically described as [3S-[2[R*(R*)], 3R*]]-2-[2-[[1(ethoxycarbonyl)-3-phenylpropyl]amino]-1-oxopropyl]-1 ,2,3,4-tetrahydro-3-isoquinolinecarboxylicacid, monohydrochloride. Its empirical formula is CSHNs -HCI and its structural formula is:
Quinapril hydrochloride USP is a white to off-white amorphous powder that is freely soluble inaqueous solvents.
Quinapril Tablets USP contain quinapril hydrochloride equivalent to 5 mg, 10 mg, 20 mg, or 40 mgof quinapril for oral administration.
Each tablet also contains lactose monohydrate, magnesium carbonate, magnesium stearate,crospovidone, povidone and opadry brown (hypromellose, titanium dioxide, ironoxide and macrogol).
What does Quinapril look like?
What are the available doses of Quinapril?
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What should I talk to my health care provider before I take Quinapril?
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How should I use Quinapril?
What interacts with Quinapril?
Quinapril hydrochloride is contraindicated in patients who are hypersensitive to this product and inpatients with a history of angioedema related to previous treatment with an ACE inhibitor.
What are the warnings of Quinapril?
Anaphylactoid and Possibly Related Reactions
Presumably because angiotensin-converting inhibitors affect the metabolism of eicosanoids andpolypeptides, including endogenous bradykinin, patients receiving ACE inhibitors (including may be subject to a variety of adverse reactions, some of them serious.
Head and Neck Angioedema
Angioedema of the face, extremities, lips, tongue, glottis, and larynxhas been reported in patients treated with ACE inhibitors and has been seen in 0.1% of patientsreceiving quinapril hydrochloride.
In two similarly sized U.S. postmarketing trials that, combined, enrolled over 3,000 black patients andover 19,000 non-blacks, angioedema was reported in 0.30% and 0.55% of blacks (in study 1 and 2respectively) and 0.39% and 0.17% of non-blacks.
Angioedema associated with laryngeal edema can be fatal. If laryngeal stridor or angioedema of theface, tongue, or glottis occurs, treatment with quinapril hydrochloride should be discontinuedimmediately, the patient treated in accordance with accepted medical care, and carefully observeduntil the swelling disappears. In instances where swelling is confined to the face and lips, thecondition generally resolves without treatment; antihistamines may be useful in relieving symptoms. (see ).
Intestinal Angioedema
Intestinal angioedema has been reported in patients treated with ACEinhibitors. These patients presented with abdominal pain (with or without nausea or vomiting); insome cases there was no prior history of facial angioedema and C-1 esterase levels were normal.The angioedema was diagnosed by procedures including abdominal CT scan or ultrasound, or atsurgery, and symptoms resolved after stopping the ACE inhibitor. Intestinal angioedema should beincluded in the differential diagnosis of patients on ACE inhibitors presenting with abdominal pain.
Patients with a history of angioedema
Patients with a history of angioedema unrelated to ACEinhibitor therapy may be at increased risk of angioedema while receiving an ACE inhibitor (see also ).
Anaphylactoid reactions during desensitization
Two patients undergoing desensitizingtreatment with hymenoptera venom while receiving ACE inhibitors sustained life-threateninganaphylactoid reactions. In the same patients, these reactions were avoided when ACE inhibitorswere temporarily withheld, but they reappeared upon inadvertent rechallenge.
Anaphylactoid reactions during membrane exposure
Anaphylactoid reactions have beenreported in patients dialyzed with high-flux membranes and treated concomitantly with an ACEinhibitor. Anaphylactoid reactions have also been reported in patients undergoing low-densitylipoprotein apheresis with dextran sulfate absorption.
Hepatic Failure
Rarely, ACE inhibitors have been associated with a syndrome that starts withcholestatic jaundice and progresses to fulminant hepatic necrosis and (sometimes) death. Themechanism of this syndrome is not understood. Patients receiving ACE inhibitors who developjaundice or marked elevations of hepatic enzymes should discontinue the ACE inhibitor and receiveappropriate medical follow-up.
Hypotension
Excessive hypotension is rare in patients with uncomplicated hypertension treatedwith quinapril hydrochloride alone. Patients with heart failure given quinapril hydrochloride commonlyhave some reduction in blood pressure, but discontinuation of therapy because of continuingsymptomatic hypotension usually is not necessary when dosing instructions are followed. Cautionshould be observed when initiating therapy in patients with heart failure (see ). In controlled studies, syncope was observed in 0.4% of patients (N=3203); thisincidence was similar to that observed for captopril (1 %) and enalapril (0.8%).
Patients at risk of excessive hypotension, sometimes associated with oliguria and/or progressiveazotemia, and rarely with acute renal failure and/or death, include patients with the followingconditions or characteristics: heart failure, hyponatremia, high dose diuretic therapy, recent intensivediuresis or increase in diuretic dose, renal dialysis, or severe volume and/or salt depletion of anyetiology. It may be advisable to eliminate the diuretic (except in patients with heart failure), reducethe diuretic dose or cautiously increase salt intake (except in patients with heart failure) beforeinitiating therapy with quinapril hydrochloride in patients at risk for excessive hypotension who areable to tolerate such adjustments.
In patients at risk of excessive hypotension, therapy with quinapril hydrochloride should be startedunder close medical supervision. Such patients should be followed closely for the first two weeks oftreatment and whenever the dose of quinapril hydrochloride and/or diuretic is increased. Similarconsiderations may apply to patients with ischemic heart or cerebrovascular disease in whom anexcessive fall in blood pressure could result in a myocardial infarction or a cerebrovascular accident.
If excessive hypotension occurs, the patient should be placed in the supine position and, ifnecessary, receive an intravenous infusion of normal saline. A transient hypotensive response is nota contraindication to further doses of quinapril hydrochloride, which usually can be given withoutdifficulty once the blood pressure has stabilized. If symptomatic hypotension develops, a dosereduction or discontinuation of quinapril hydrochloride or concomitant diuretic may be necessary.
Neutropenia/Agranulocytosis
Another ACE inhibitor, captopril, has been shown to causeagranulocytosis and bone marrow depression rarely in patients with uncomplicated hypertension,but more frequently in patients with renal impairment, especially if they also have a collagen vasculardisease, such as systemic lupus erythematosus or scleroderma. Agranulocytosis did occur duringquinapril hydrochloride treatment in one patient with a history of neutropenia during previouscaptopril therapy. Available data from clinical trials of quinapril hydrochloride are insufficient to showthat, in patients without prior reactions to other ACE inhibitors, quinapril hydrochloride does notcause agranulocytosis at similar rates. As with other ACE inhibitors, periodic monitoring of whiteblood cell counts in patients with collagen vascular disease and/or renal disease should beconsidered.
Fetal/Neonatal Morbidity and Mortality
ACE inhibitors can cause fetal and neonatal morbidity anddeath when administered to pregnant women. Several dozen cases have been reported in the worldliterature. When pregnancy is detected, ACE inhibitors should be discontinued as soon as possible.
The use of ACE inhibitors during the second and third trimesters of pregnancy has been associatedwith fetal and neonatal injury, including hypotension, neonatal skull hypoplasia, anuria, reversible orirreversible renal failure, and death. Oligohydramnios has also been reported, presumably resultingfrom decreased fetal renal function; oligohydramnios in this setting has been associated with fetallimb contractures, craniofacial deformation, and hypoplastic lung development. Prematurity,intrauterine growth retardation, and patent ductus arteriosus have also been reported, although it isnot clear whether these occurrences were due to the ACE inhibitor exposure.
These adverse effects do not appear to have resulted from intrauterine ACE inhibitor exposure thathas been limited to the first trimester. Mothers whose embryos and fetuses are exposed to ACEinhibitors only during the first trimester should be so informed. Nonetheless, when patients becomepregnant, physicians should make every effort to discontinue the use of quinapril hydrochloride assoon as possible.
Rarely (probably less often than once in every thousand pregnancies), no alternative to ACEinhibitors will be found. In these rare cases, the mothers should be apprised of the potential hazardsto their fetuses, and serial ultrasound examinations should be performed to assess the intraamnioticenvironment.
If oligohydramnios is observed, quinapril hydrochloride should be discontinued unless it isconsidered lifesaving for the mother. Contraction stress testing (CST), a non-stress test (NST), orbiophysical profiling (BPP) may be appropriate, depending upon the week of pregnancy. Patientsand physicians should be aware, however, that oligohydramnios may not appear until after the fetushas sustained irreversible injury.
Infants with histories of in utero exposure to ACE inhibitors should be closely observed forhypotension, oliguria, and hyperkalemia. If oliguria occurs, attention should be directed towardsupport of blood pressure and renal perfusion. Exchange transfusion or dialysis may be required asa means of reversing hypotension and/or substituting for disordered renal function. Removal ofquinapril hydrochloride, which crosses the placenta, from the neonatal circulation is not significantlyaccelerated by these means.
No teratogenic effects of quinapril hydrochloride were seen in studies of pregnant rats and rabbits.On a mg/kg basis, the doses used were up to 180 times (in rats) and one time (in rabbits) themaximum recommended human dose.
What are the precautions of Quinapril?
General
As a consequence of inhibiting the renin-angiotensinaldosterone system,changes in renal function may be anticipated in susceptible individuals. In patients with severe heartfailure whose renal function may depend on the activity of the renin-angiotensinaldosterone system,treatment with ACE inhibitors, including quinapril hydrochloride, may be associated with oliguriaand/or progressive azotemia and rarely acute renal failure and/or death.
In clinical studies in hypertensive patients with unilateral or bilateral renal artery stenosis, increasesin blood urea nitrogen and serum creatinine have been observed in some patients following ACEinhibitor therapy. These increases were almost always reversible upon discontinuation of the ACEinhibitor and/or diuretic therapy. In such patients, renal function should be monitored during the firstfew weeks of therapy.
Some patients with hypertension or heart failure with no apparent preexisting renal vascular diseasehave developed increases in blood urea and serum creatinine, usually minor and transient,especially when quinapril hydrochloride has been given concomitantly with a diuretic. This is morelikely to occur in patients with preexisting renal impairment. Dosage reduction and/or discontinuationof any diuretic and/or quinapril hydrochloride may be required.
Evaluation of patients with hypertension or heart failure should always include assessmentof renal function
Hyperkalemia and potassium-sparing diuretics: In clinical trials, hyperkalemia (serum potassium≥5.8 mmol/L) occurred in approximately 2% of patients receiving quinapril hydrochloride. In mostcases, elevated serum potassium levels were isolated values which resolved despite continuedtherapy. Less than 0.1% of patients discontinued therapy due to hyperkalemia. Risk factors for thedevelopment of hyperkalemia include renal insufficiency, diabetes mellitus, and the concomitant useof potassium-sparing diuretics, potassium supplements, and/or potassium containing saltsubstitutes, which should be used cautiously, if at all, with quinapril hydrochloride (see ).
Presumably due to the inhibition of the degradation of endogenous bradykinin, persistentnon-productive cough has been reported with all ACE inhibitors, always resolving afterdiscontinuation of therapy. ACE inhibitor-induced cough should be considered in the differentialdiagnosis of cough.
In patients undergoing major surgery or during anesthesia with agents thatproduce hypotension, quinapril hydrochloride will block angiotensin II formation secondary tocompensatory renin release. If hypotension occurs and is considered to be due to this mechanism,it can be corrected by volume expansion.
Information for Patients
Female patients of childbearing age should be told about the consequences of secondandthird-trimester exposure to ACE inhibitors, and they should also be told that theseconsequences do not appear to have resulted from intrauterine ACE-inhibitor exposure that hasbeen limited to the first trimester. These patients should be asked to report pregnancies to theirphysicians as soon as possible.
Angioedema, including laryngeal edema can occur with treatment with ACEinhibitors, especially following the first dose. Patients should be so advised and told to reportimmediately any signs or symptoms suggesting angioedema (swelling of face extremities, eyes, lips,tongue, difficulty in swallowing or breathing: and to stop taking the drug until they have consultedwith their physician (see ).
Patients should be cautioned that light-headedness can occur,especially during the first few days of quinapril hydrochloride therapy, and that it should be reportedto a physician. If actual syncope occurs, patients should be told to not take the drug until they haveconsulted with their physician (see ).
All patients should be cautioned that inadequate fluid intake or excessive perspiration, diarrhea, orvomiting can lead to an excessive fall in blood pressure because of reduction in fluid volume, withthe same consequences of lightheadedness and possible syncope.
Patients planning to undergo any surgery and/or anesthesia should be told to inform their physicianthat they are taking an ACE inhibitor.
Patients should be told not to use potassium supplements or salt substitutescontaining potassium without consulting their physician (see ).
Patients should be told to report promptly any indication of infection (eg, sore throat,fever) which could be a sign of neutropenia.
NOTE: As with many other drugs, certain advice to patients being treated with quinaprilhydrochloride is warranted. This information is intended to aid in the safe and effective use of thismedication. It is not a disclosure of all possible adverse or intended effects.
Drug Interactions
As with other ACE inhibitors, patients on diuretics, especially thoseon recently instituted diuretic therapy may occasionally experience an excessive reduction of bloodpressure after initiation of therapy with quinapril hydrochloride. The possibility of hypotensive effectswith quinapril hydrochloride may be minimized by either discontinuing the diuretic or cautiouslyincreasing salt intake prior to initiation of treatment with quinapril hydrochloride. If it is not possibleto discontinue the diuretic, the starting dose of quinapril should be reduced (see .
Quinapril can attenuate potassium loss caused by thiazidediuretics and increase serum potassium when used alone. If concomitant therapy of quinaprilhydrochloride with potassium-sparing diuretics (eg, spironolactone, triamterene, or amiloride),potassium supplements, or potassium-containing salt substitutes is indicated, they should be usedwith caution along with appropriate monitoring of serum potassium (see ).
Simultaneous administration oftetracycline with quinapril hydrochloride reduced the absorption of tetracycline by approximately28% to 37%, possibly due to the high magnesium content in quinapril hydrochloride tablets. Thisinteraction should be considered if coprescribing quinapril hydrochloride and tetracycline or otherdrugs that interact with magnesium.
Increased serum lithium levels and symptoms of lithium toxicity have been reported inpatients receiving concomitant lithium and ACE inhibitor therapy. These drugs should becoadministered with caution and frequent monitoring of serum lithium levels is recommended. If adiuretic is also used, it may increase the risk of lithium toxicity.
Drug interaction studies of quinapril hydrochloride with other agents showed:
Carcinogenesis, Mutagenesis, Impairment of Fertility
Quinapril hydrochloride was not carcinogenic in mice or rats when given in doses up to 75 or100 mg/kg/day (50 to 60 times the maximum human daily dose, respectively, on an mg/kg basis and3.8 to 10 times the maximum human daily dose when based on an mg/m basis) for 104 weeks.Female rats given the highest dose level had an increased incidence of mesenteric lymph nodehemangiomas and skin/subcutaneous lipomas. Neither quinapril nor quinaprilat were mutagenic inthe Ames bacterial assay with or without metabolic activation. Quinapril was also negative in thefollowing genetic toxicology studies: in vitro mammalian cell point mutation, sister chromatidexchange in cultured mammalian cells, micronucleus test with mice, chromosome aberrationwith V79 cultured lung cells, and in an cytogenetic study with rat bone marrow. There wereno adverse effects on fertility or reproduction in rats at doses up to 100 mg/kg/day (60 and 10 timesthe maximum daily human dose when based on mg/kg and mg/m , respectively).
Pregnancy: Teratogenic Effects: Pregnancy: Category B.
Pregnancy Categories C (first trimester) and D (second and third trimesters): See WARNINGS,Fetal/Neonatal Morbidity and Mortality
Nursing Mothers
Because quinapril hydrochloride is secreted in human milk, caution should be exercised when thisdrug is administered to a nursing woman.
Pediatric Use
The safety and effectiveness of quinapril hydrochloride in pediatric patients have not beenestablished.
Geriatric Use
Clinical studies of quinapril hydrochloride did not include sufficient numbers of subjects aged 65 andover to determine whether they respond differently from younger subjects. Other reported clinicalexperience has not identified differences in responses between the elderly and younger patients.
In general, dose selection for an elderly patient should be cautious, usually starting at the low endof the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function,and of concomitant disease or other drug therapy.
This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to thisdrug may be greater in patients with impaired renal function. Because elderly patients are more likelyto have decreased renal function, care should be taken in dose selection, and it may be useful tomonitor renal function.
Elderly patients exhibited increased area under the plasma concentration time curve and peak levelsfor quinaprilat compared to values observed in younger patients; this appeared to relate todecreased renal function rather than to age itself.
What are the side effects of Quinapril?
Hypertension
Quinapril hydrochloride has been evaluated for safety in 4960 subjects and patients. Of these, 3203patients, including 655 elderly patients, participated in controlled clinical trials. Quinaprilhydrochloride has been evaluated for long-term safety in over 1400 patients treated for 1 year ormore.
Adverse experiences were usually mild and transient.
In placebo-controlled trials, discontinuation of therapy because of adverse events was required in4.7% of patients with hypertension.
Adverse experiences probably or possibly related to therapy or of unknown relationship to therapyoccurring in 1% or more of the 1563 patients in placebo-controlled hypertension trials who weretreated with quinapril hydrochloride are shown below.
Array
Hypertension
Clinical adverse experiences probably, possibly, or definitely related, or of uncertain relationship totherapy occurring in 0.5% to 1.0% (except as noted) of the patients with hypertension treated withquinapril hydrochloride (With or without concomitant diuretic) in controlled or uncontrolled trials(N=4847) and less frequent, clinically significant events seen in clinical trials or postmarketingexperience (the rarer events are in italics) include (listed by body system):
General
back pain, malaise, viral infections,
Cardiovascular
palpitation, vasodilation, tachycardia, , , , ,
Hematology
hemolytic anemia
Gastrointestinal
flatulence, dry mouth or throat, constipation,
Nervous/Psychiatric
somnolence, vertigo, syncope, nervousness, depression, insomnia,paresthesia
Integumentary
alopecia, increased sweating, pemphigus, pruritus,
Urogenital
urinary tract infection, impotence,
Respiratory
eosinophilic pneumonitis
Other
amblyopia, edema, arthralgia, pharyngitis,
Array
Fetal/Neonatal Morbidity and Mortality
See
Angioedema
Angioedema has been reported in patients receiving quinapril hydrochloride (0.1 %). Angioedemaassociated with laryngeal edema may be fatal. If angioedema of the face, extremities, lips, tongue,glottis, and/or larynx occurs, treatment with quinapril hydrochloride should be discontinued andappropriate therapy instituted immediately. (See .)
Clinical Laboratory Test Findings
(See )
(See )
Creatinine and Blood Urea Nitrogen
Increases (>1.25 times the upper limit of normal) in serumcreatinine and blood urea nitrogen were observed in 2% and 2%, respectively, of all patients treatedwith quinapril hydrochloride alone. Increases are more likely to occur in patients receivingconcomitant diuretic therapy than in those on quinapril hydrochloride alone. These increases oftenremit on continued therapy.
What should I look out for while using Quinapril?
Quinapril hydrochloride is contraindicated in patients who are hypersensitive to this product and inpatients with a history of angioedema related to previous treatment with an ACE inhibitor.
What might happen if I take too much Quinapril?
Doses of 1440 to 4280 mg/kg of quinapril cause significant lethality in mice and rats. No specificinformation is available on the treatment of overdosage with quinapril. The most likely clinicalmanifestation would be symptoms attributable to severe hypotension.
Laboratory determinations of serum levels of quinapril and its metabolites are not widely available,and such determinations have, in any event, no established role in the management of quinapriloverdose.
No data are available to suggest physiological maneuvers (eg, maneuvers to change pH of the urine)that might accelerate elimination of quinapril and its metabolites.
Hemodialysis and peritoneal dialysis have little effect on the elimination of quinapril and quinaprilat.Angiotensin II could presumably serve as a specific antagonist-antidote in the setting of quinapriloverdose, but angiotensin II is essentially unavailable outside of scattered research facilities.Because the hypotensive effect of quinapril is achieved through vasodilation and effectivehypovolemia, it is reasonable to treat quinapril overdose by infusion of normal saline solution.
How should I store and handle Quinapril?
Store at controlled room temperature 20° to 25°C (68° to 77°F) [see USP] .Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09Quinapril Tablets USP are supplied as follows:5-mg tablets:IG267 NDC 55111-621-90 bottles of 90 tabletsNDC 55111-621 -1 a bottles of 1000 tablets10-mg tablets: IG268NDC 55111-622-90 bottles of 90 tabletsNDC 55111-622-1 a bottles of 1000 tablets20-mg tablets:IG269NDC 55111-623-90 bottles of 90 tabletsNDC 55111-623-1 a bottles of 1000 tablets40-mg tablets:IG270NDC 55111-624-90 bottles of 90 tabletsNDC 55111-624-10 bottles of 1000 tabletsDispense in well-closed containers as defined in the USP.Store at controlled room temperature, 20° to 25°C (68° to 7JOF) with excursions permitted betweenPlacebo 15° to 30°C (59° to 86°F). [See USP]. Manufactured by:InvaGen Pharmaceuticals, IncHauppauge, NY 11788Distributed by:Dr. Reddy's Laboratories Inc.,Bridgewater, NJ 08807 USARev: 05/09
Clinical Information
Chemical Structure
No Image foundClinical Pharmacology
Quinapril is deesterified to the principal metabolite, quinaprilat, which is aninhibitor of ACE activity in human subjects and animals. ACE is a peptidyl dipeptidase that catalyzesthe conversion of angiotensin I to the vasoconstrictor, angiotensin II. The effect of quinapril inhypertension appears to result primarily from the inhibition of circulating and tissue ACE activity,thereby reducing angiotensin II formation. Quinapril inhibits the elevation in blood pressure causedby intravenously administered angiotensin I, but has no effect on the pressor response toangiotensin II, norepinephrine or epinephrine. Angiotensin II also stimulates the secretion ofaldosterone from the adrenal cortex, thereby facilitating renal sodium and fluid reabsorption.Reduced aldosterone secretion by quinapril may result in a small increase in serum potassium. Incontrolled hypertension trials, treatment with quinapril hydrochloride alone resulted in meanincreases in potassium of 0.07 mmol/L (see ). Removal of angiotensin II negativefeedback on renin secretion leads to increased plasma renin activity (PRA).
While the principal mechanism of antihypertensive effect is thought to be through the reninangiotensin-aldosterone system, quinapril exerts antihypertensive actions even in patients with lowrenin hypertension. Quinapril hydrochloride was an effective antihypertensive in all races studied,although it was somewhat less effective in blacks (usually a predominantly low renin group) than innonblacks. ACE is identical to kininase II, an enzyme that degrades bradykinin, a potent peptidevasodilator; whether increased levels of bradykinin playa role in the therapeutic effect of quinaprilremains to be elucidated.
Non-Clinical Toxicology
Quinapril hydrochloride is contraindicated in patients who are hypersensitive to this product and inpatients with a history of angioedema related to previous treatment with an ACE inhibitor.Reference
This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"
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Clonazepam Description Each single-scored tablet, for oral administration, contains 0.5 mg, 1 mg, or 2 mg Clonazepam, USP, a benzodiazepine. Each tablet also contains corn starch, lactose monohydrate, magnesium stearate, microcrystalline cellulose, and povidone. Clonazepam tablets USP 0.5 mg contain Yellow D&C No. 10 Aluminum Lake. Clonazepam tablets USP 1 mg contain Yellow D&C No. 10 Aluminum Lake, as well as FD&C Blue No. 1 Aluminum Lake. Chemically, Clonazepam, USP is 5-(o-chlorophenyl)-1,3-dihydro-7-nitro-2H-1,4-benzodiazepin-2-one. It is a light yellow crystalline powder. It has the following structural formula: C15H10ClN3O3 M.W. 315.72Tips
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Interactions
A total of 440 drugs (1549 brand and generic names) are known to interact with Imbruvica (ibrutinib). 228 major drug interactions (854 brand and generic names) 210 moderate drug interactions (691 brand and generic names) 2 minor drug interactions (4 brand and generic names) Show all medications in the database that may interact with Imbruvica (ibrutinib).