Quinapril

Pronunciation: KWIN-a-pril.

Generic name
quinapril hydrochloride
Brand names
Accupril (United States, Canada, Australia -- brand discontinued; generic quinapril remains marketed), Accupro (United Kingdom -- brand discontinued; generic quinapril remains marketed), Accuretic and equivalents (quinapril/hydrochlorothiazide combination, multiple markets)
Drug class
Angiotensin-converting enzyme (ACE) inhibitor
Form
Tablet, 5 mg, 10 mg, 20 mg, or 40 mg
Route
Oral
Legal status
Prescription-only in all markets reviewed.

Availability and supply rules vary by country

Trade names by country: United States · United Kingdom · Canada · Australia · New Zealand

Australia: Generic quinapril (Apo-Quinapril, Quinapril Generic Health, Quinapril Arrow); original Accupril brand affected by a real nitrosamine-impurity supply investigation (6) · Full directory

What quinapril hydrochloride is and how it works

Quinapril is a prescription medicine that blocks the angiotensin-converting enzyme (ACE), relaxing blood vessels and lowering blood pressure. It is used for high blood pressure and, together with a diuretic and/or digitalis, for congestive heart failure. It was originally sold as Accupril (US/Canada/Australia) or Accupro (UK), but both original brand names have been discontinued; it remains available today as generic quinapril. (1) (3)

Quinapril carries a genuine boxed warning: it must be stopped as soon as pregnancy is detected, because ACE inhibitors can seriously harm or be fatal to a developing baby, especially later in pregnancy. It also carries real risks of a serious swelling reaction (angioedema), liver problems, high blood potassium, low blood pressure, and effects on the kidneys -- always take it exactly as prescribed and tell your prescriber right away about any pregnancy, planned pregnancy, or new swelling of the face, lips, tongue, or throat.

Mechanism of action: how quinapril hydrochloride works

Quinapril is a prodrug de-esterified to its active metabolite, quinaprilat, a non-sulfhydryl angiotensin-converting enzyme (ACE) inhibitor. By inhibiting ACE, it reduces conversion of angiotensin I to angiotensin II, lowering peripheral vascular resistance and blood pressure, reducing aldosterone secretion, and may increase bradykinin (a vasodilator). (1)

What quinapril hydrochloride is used for

High blood pressure (hypertension)

Lowers high blood pressure, reducing cardiovascular risk including stroke and heart attack; can be used alone or together with a diuretic. (1)

Congestive heart failure

Used as adjunctive (add-on) therapy together with a diuretic and/or digitalis (digoxin) for congestive heart failure. (1) (7)

Before taking quinapril hydrochloride

Do not take / not appropriate for

  • Do not take quinapril if you are pregnant, especially in the second or third trimester. (all countries) (1)
  • Do not take quinapril if you have ever had angioedema (a serious swelling reaction) from an ACE inhibitor. (all countries) (1)
  • Do not take quinapril together with sacubitril or another neprilysin inhibitor. (United States) (1)
  • Do not take quinapril together with aliskiren if you have diabetes. (United States) (1)

Tell your clinician about

  • Whether you are pregnant, planning to become pregnant, or breastfeeding.
  • Any history of angioedema, kidney disease, or liver disease.
  • Any history of collagen vascular disease (such as lupus or scleroderma).
  • All other medicines you take, especially diuretics, potassium supplements, potassium-sparing diuretics, lithium, NSAIDs, tetracycline antibiotics, other blood-pressure medicines (especially aliskiren or neprilysin inhibitors), and injectable gold.
  • Whether you are of Black African or Caribbean descent, since angioedema risk has been reported to be higher in this population.
  • Whether you are dehydrated or have low blood sodium.
  • Whether you are due to have surgery or a procedure requiring anaesthesia.
(1) (3)

How to take quinapril hydrochloride

  • Take quinapril exactly as your prescriber directs, at around the same time each day, with or without food.
  • Your first dose may cause dizziness -- some product information recommends taking the first dose at bedtime.
  • Your dose is usually started low and increased gradually based on your blood pressure response.
  • Do not stop taking quinapril without talking to your prescriber, except that you should contact your prescriber immediately -- rather than stopping on your own without telling them -- if you become pregnant or think you might be pregnant, since prompt medical guidance is needed either way.
  • Tell your prescriber right away if you develop swelling of the face, lips, tongue, or throat, or difficulty breathing or swallowing -- these can be signs of a serious reaction (angioedema) requiring emergency care.
(1)

Procedures and treatment changes

Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (5) (6) (7)

Missed dose

If you miss a dose, take it as soon as you remember unless it is almost time for your next dose, in which case skip the missed dose -- do not take a double dose. If you are unsure, ask your pharmacist or prescriber.

Overdose

Seek emergency medical attention if you think too much quinapril has been taken, especially with symptoms such as severe dizziness, fainting, or a very slow heartbeat, which can indicate dangerously low blood pressure. There is no specific antidote, and dialysis does not effectively remove the drug. (1)

Side effects

Side effects and their urgency vary; report severe, persistent, or concerning symptoms.

Dizziness, especially after the first dose.

What to notice: Dizziness, especially after the first dose.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)

A dry, persistent, non-productive cough -- a well-known effect of all ACE inhibitors, which resolves after stopping the medicine.

What to notice: A dry, persistent, non-productive cough -- a well-known effect of all ACE inhibitors, which resolves after stopping the medicine.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)

Tiredness (fatigue).

What to notice: Tiredness (fatigue).

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)

Nausea or vomiting.

What to notice: Nausea or vomiting.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)

Low blood pressure, especially in people with heart failure.

What to notice: Low blood pressure, especially in people with heart failure.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)

Serious warnings

Angioedema (serious swelling reaction), including intestinal angioedema — emergency

Symptoms: Swelling of the face, lips, tongue, throat, or arms/legs, sometimes with difficulty breathing or swallowing; intestinal angioedema can instead cause abdominal pain, sometimes without visible facial swelling.

Action: Seek emergency medical help immediately -- this reaction can be fatal if it affects the throat, and your care team will decide whether quinapril can ever be restarted afterward. This risk has been reported to be higher in Black patients. (1)

Pregnancy — boxed_warning

Symptoms: Not applicable -- this is a proactive warning, not a symptom to watch for.

Action: Contact your prescriber immediately if you become pregnant or think you might be pregnant. Quinapril can cause serious injury or death to a developing baby, especially later in pregnancy, and your prescriber will need to change your treatment promptly. (1)

Liver problems — high caution

Symptoms: Yellowing of the skin or eyes (jaundice), dark urine, or unusual tiredness.

Action: Contact your prescriber promptly -- rare but serious liver injury, including progression to liver failure, has been reported with ACE inhibitors including quinapril. (1)

High blood potassium (hyperkalaemia) — high caution

Symptoms: Muscle weakness, an irregular or slow heartbeat, or tingling sensations -- high potassium often has no symptoms and is found on a blood test.

Action: Contact your prescriber promptly and have blood tests checked as recommended, especially if you have kidney problems or diabetes. (1)

Very low blood pressure — high caution

Symptoms: Severe dizziness, light-headedness, or fainting, especially after the first dose or after a dose increase.

Action: Sit or lie down and contact your prescriber promptly; seek emergency care if you faint or cannot recover quickly. This is more likely if you are dehydrated, on diuretics, or being treated for heart failure. (1)

Kidney problems — high caution

Symptoms: A significant decrease in how much urine you pass, or swelling in your legs or ankles.

Action: Contact your prescriber promptly for blood and urine tests -- quinapril can reduce kidney function, particularly during the first weeks of treatment. (1)

Low white blood cell count (neutropenia/agranulocytosis) — high caution

Symptoms: Signs of infection such as fever, sore throat, or mouth sores.

Action: Contact your prescriber promptly for a blood count check -- this is a known class effect of ACE inhibitors, with a higher risk in people with kidney impairment or collagen vascular disease. (1)

Interactions

  • Potassium supplements and potassium-sparing diuretics can raise blood potassium to dangerous levels when combined with quinapril. (1)
  • Diuretics can increase the risk of low blood pressure when starting quinapril; your prescriber may pause a diuretic for a few days beforehand. (1)
  • Tetracycline antibiotics can be absorbed less well when taken with quinapril, reducing the antibiotic's effectiveness -- your prescriber or pharmacist may advise spacing the doses apart. (1)
  • Lithium levels and toxicity risk can increase when combined with quinapril; more frequent monitoring of lithium levels is recommended. (1)
  • NSAID pain relievers can increase the risk of kidney problems when combined with quinapril, especially in older adults or those who are dehydrated. (1)
  • Sacubitril (in sacubitril/valsartan) and other neprilysin inhibitors, as well as mTOR inhibitors, can increase angioedema risk when combined with quinapril. (1)
  • Injectable gold treatments can rarely cause a nitritoid reaction (flushing, nausea, low blood pressure) when combined with ACE inhibitors like quinapril. (1)

Pregnancy, breastfeeding, kidney/liver function, age

Pregnancy

Quinapril carries a boxed warning and must be discontinued as soon as pregnancy is detected -- ACE inhibitor use, especially in the second and third trimesters, carries a genuine risk of serious injury or death to the developing baby. Contact your prescriber immediately if you become pregnant or are planning a pregnancy, so an alternative treatment can be arranged promptly. (1) (2) (3) (4) (5) (6) (7)

Breastfeeding

Quinapril is secreted in human breast milk; caution is advised, and this should be discussed individually with your prescriber. (1) (2) (3) (4) (5) (6) (7)

Children

Safety and effectiveness have not been established in children in the sources reviewed for this dossier; neonates exposed in utero should be monitored for low blood pressure, reduced urination, and high potassium. (1) (2) (3) (4) (5) (6) (7)

Elderly

Older adults are usually started on a lower dose (10 mg once daily) with careful monitoring, since decreased kidney, liver, or heart function is more common and quinaprilat levels can be higher. (1) (2) (3) (4) (5) (6) (7)

Hepatic_impairment

Specific dosing guidance for liver impairment was not detailed in the sources reviewed for this dossier; discuss with your prescriber if you have liver disease, and be aware that rare but serious liver injury has been reported. (1) (2) (3) (4) (5) (6) (7)

Renal_impairment

Requires a reduced starting dose based on kidney function: 10 mg if creatinine clearance is above 60 mL/min, 5 mg for 30-60 mL/min, 2.5 mg for 10-30 mL/min; insufficient data exist for creatinine clearance below 10 mL/min. (1) (2) (3) (4) (5) (6) (7)

Monitoring

Before starting

  • Pregnancy status in anyone who could become pregnant
  • Baseline kidney function and blood potassium
  • Baseline blood pressure
  • Review of other medicines, especially diuretics, potassium-affecting medicines, tetracycline antibiotics, and other blood-pressure medicines

During treatment

  • Kidney function and blood potassium checked periodically, especially during the first weeks of treatment or after a dose increase.
  • Blood pressure monitored, particularly after the first dose and any dose increase.
  • White blood cell counts checked periodically in patients with kidney impairment or collagen vascular disease.
  • Prompt reporting of any swelling of the face, lips, tongue, or throat, abdominal pain, or any signs of pregnancy.
(1)

Storage

Store at controlled room temperature, 20-25degC (68-77degF), and protect from light. Dispense and keep in a tight, child-resistant container, out of reach of children.

Professional information

Clinician-facing context only, sourced from the current US FDA/DailyMed generic quinapril prescribing information; verify against the current full local label before prescribing.

United States

Indication: Hypertension / heart failure (adjunctive)

Dose summary: Hypertension monotherapy: initial 10-20 mg once daily, maintenance 20-80 mg daily. With diuretic: initial 5 mg. Heart failure: initial 5 mg twice daily, target 20-40 mg daily in divided doses, titrated weekly. Elderly: initial 10 mg once daily.

Renal context: CrCl >60 mL/min: initial 10 mg. 30-60 mL/min: initial 5 mg. 10-30 mL/min: initial 2.5 mg. <10 mL/min: insufficient data. (1)

Canada / New Zealand

Indication: Essential hypertension, congestive heart failure (with diuretic and/or digoxin)

Dose summary: Initial 10 mg once daily in patients not on diuretics, titrated per response generally every 2-4 weeks to a maintenance dose of 20-40 mg/day (single or divided dose).

Renal context: Not separately detailed in the sources reviewed for this dossier; follow the current local product monograph/data sheet. (5) (7)

Mechanism of action

Hepatic guidance

Specific hepatic-impairment dosing guidance was not detailed in the sources reviewed for this dossier.

Overdose note

Hypotension is the most likely manifestation of overdose; manage with normal saline infusion and supportive care. No specific antidote exists; haemodialysis and peritoneal dialysis are ineffective at removing the drug. (1)

Frequently asked questions

Does quinapril have a boxed warning?

Yes. Quinapril's current US FDA label carries a boxed warning for fetal toxicity: ACE inhibitors like quinapril can cause serious injury or death to a developing baby, especially in the second and third trimesters, and must be stopped as soon as pregnancy is detected. Contact your prescriber immediately if you become pregnant or think you might be pregnant. (1)

Is Accupril (or Accupro) still available?

No -- the original brand names Accupril (United States, Canada, Australia) and Accupro (United Kingdom) have both been discontinued, following a 2022 recall of specific lots for a nitrosamine impurity (N-nitroso-quinapril). The active ingredient, quinapril, remains available as a generic medicine in every market reviewed for this page. (2) (3)

Why do I have a persistent dry cough on quinapril?

A persistent, non-productive dry cough is a well-known effect of all ACE inhibitors, including quinapril. It is not dangerous but can be bothersome; it resolves after stopping the medicine. Discuss with your prescriber if it troubles you. (1)

What is the mechanism of action of quinapril hydrochloride?

Quinapril is a prodrug de-esterified to its active metabolite, quinaprilat, a non-sulfhydryl angiotensin-converting enzyme (ACE) inhibitor. By inhibiting ACE, it reduces conversion of angiotensin I to angiotensin II, lowering peripheral vascular resistance and blood pressure, reducing aldosterone secretion, and may increase bradykinin (a vasodilator). (1)

What is the generic name of Quinapril?

The generic name is quinapril hydrochloride. It is sold under brand names including Accupril (United States, Canada, Australia -- brand discontinued; generic quinapril remains marketed), Accupro (United Kingdom -- brand discontinued; generic quinapril remains marketed), Accuretic and equivalents (quinapril/hydrochlorothiazide combination, multiple markets). (1) (2) (3)

What class of drug is quinapril hydrochloride?

Quinapril is classed as: Angiotensin-converting enzyme (ACE) inhibitor. (1) (2) (3)

References

  1. QUINAPRIL tablet, film coated -- full prescribing informationU.S. Food and Drug Administration / DailyMed (NIH), full prescribing information (generic quinapril hydrochloride, ANDA076803) · United States · accessed 2026-07-30 · source 1
  2. Pfizer Voluntary Nationwide Recall of Lots of ACCUPRIL (Quinapril HCl) Due to N-Nitroso-Quinapril ContentU.S. Food and Drug Administration -- Pfizer voluntary nationwide recall notice · United States · accessed 2026-07-30 · source 2
  3. Quinapril tablets (Accupro) -- patient medicine informationpatient.info (UK patient-facing medicines information, referencing the current/historical UK emc SmPC and PIL for quinapril/Accupro) · United Kingdom · accessed 2026-07-30 · source 3
  4. Quinapril and Hydrochlorothiazide/Quinapril -- lists of nationally authorised medicinal products (PSUSA/00002591 and PSUSA/00002592)European Medicines Agency (EMA) -- Periodic Safety Update Report Single Assessment (PSUSA), nationally authorised product lists · European Union · accessed 2026-07-30 · source 4
  5. ACCUPRIL (quinapril hydrochloride) -- Product Monograph, plus JAMP Quinapril generic Product MonographHealth Canada product monograph · Canada · accessed 2026-07-30 · source 5
  6. ACCUPRIL / generic quinapril ARTG registrations, and TGA safety alert on N-nitroso-quinapril nitrosamine impurityTherapeutic Goods Administration (TGA), Australia -- ARTG registrations and nitrosamine safety alert · Australia · accessed 2026-07-30 · source 6
  7. Arrow-Quinapril (quinapril hydrochloride) tablets -- New Zealand Data Sheet, plus Accuretic (quinapril/hydrochlorothiazide) data sheetMedsafe, New Zealand -- New Zealand Data Sheet · New Zealand · accessed 2026-07-30 · source 7

Brand names by country

Single-ingredient quinapril hydrochloride names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.

Priority countries

United States

  • Generic quinapril hydrochloride (brand Accupril discontinued by Pfizer following a 2022 nitrosamine-impurity recall) (1) (2)FDA approved currently labeled generic only · 5 mg, 10 mg, 20 mg, 40 mg · Chartwell RX, LLC and other generic manufacturers (e.g. Teva)

United Kingdom

  • Generic quinapril (brand Accupro discontinued) (3)generic availability reported direct current smpc not independently refetched · 5 mg, 10 mg, 20 mg, 40 mg (historical Accupro strengths) · not independently confirmed beyond patient-facing summary in this pass

Canada

  • ACCUPRIL

Australia

  • Generic quinapril (Apo-Quinapril, Quinapril Generic Health, Quinapril Arrow); original Accupril brand affected by a real nitrosamine-impurity supply investigation (6)TGA ARTG registered supply pause investigation current resumption status not fully confirmed · 5 mg, 10 mg, 20 mg · Pfizer Australia Pty Ltd (Accupril, original brand) and generic manufacturers

New Zealand

  • Arrow-Quinapril; Accuretic (quinapril/hydrochlorothiazide) (7)Medsafe data sheet confirmed · 5 mg, 10 mg, 20 mg · not independently confirmed beyond data-sheet existence in this pass
View brands in additional countries.

European Union

Quinapril and quinapril/hydrochlorothiazide (nationally authorised brands and generics) (4)

This page provides general reference information about quinapril and is not a substitute for advice from the prescriber managing your treatment. All dosing and treatment decisions, including starting, changing, or stopping this medicine, should be made with your prescriber.

Related medicines

Related conditions