moexipril/hydrochlorothiazide

Action and Spectrum

Mechanism of action

moexipril and hydrochlorothiazide work synergistically to lower blood pressure. moexipril blocks the production of angiotensin II, which causes blood vessels to constrict. Hydrochlorothiazide increases the excretion of fluid from the body, which helps to decrease the blood volume in the blood vessels

Spectrum

moexipril/Hydrochlorothiazide has a broad spectrum of activity and is effective in lowering blood pressure in patients with mild to moderate hypertension. However, it may not be suitable for all patients, and individuals with severe hypertension may require additional medications to achieve optimal blood pressure control

Drug Interaction

Adverse Reaction

Frequency defined:

moexipril

1-10%

Edema

Cough

Headache

Myalgia

Hyponatremia

Pharyngitis

Sinusitis

Rash

Nausea/vomiting

Hyperkalemia

Hyponatremia

Polyuria

Dizziness

Hypotension

Peripheral

Frequency undefined

Hepatic renal failure

Arrhythmia

Chest failure

Renal has pain

Pneumonitis

Syncope

Proteinuria

Agranulocytosis

hydrochlorothiazide

Hypotension

Photosensitivity Anorexia

Epigastric distress

Hypotension

Orthostatic

<1%

multiforme Anaphylaxis

anemia

confusion

erythema

skin necrolysis

hypomagnesemia

hyponatremia

epidermal dermatitis

Stevens-Johnson syndrome

Black Box Warning

Black box warning

Drugs that immediately affect the renin-angiotensin system can harm or even kill a growing baby. If pregnancy is found, stop taking the medication as soon as possible

Contraindication / Caution

Contraindications

• Hypersensitivity:moexipril/Hydrochlorothiazide is contraindicated in patients who have a history of hypersensitivity to moexipril, hydrochlorothiazide, or any other ACE inhibitors or thiazide diuretics.
• Pregnancy: moexipril/Hydrochlorothiazide should not be used during pregnancy as it may cause harm to the developing fetus.
• Breastfeeding: It is not recommended to use moexipril/hydrochlorothiazide while breastfeeding as it may be excreted into the breast milk and cause harm to the nursing infant.
• Severe renal impairment: moexipril/Hydrochlorothiazide is contraindicated in patients with severe renal impairment or end-stage renal disease.
• Severe hepatic impairment: moexipril/Hydrochlorothiazide is contraindicated in patients with severe hepatic impairment or biliary cirrhosis.
• Anuria: moexipril/Hydrochlorothiazide is contraindicated in patients with anuria (absence of urine output).
• Concomitant use with aliskiren: moexipril/Hydrochlorothiazide should not be used in combination with aliskiren in patients with diabetes or renal impairment.

Caution

• Electrolyte imbalances: moexipril/Hydrochlorothiazide can cause electrolyte imbalances and deficient potassium levels. Patients should have their electrolyte levels monitored regularly
• Hypotension: moexipril/Hydrochlorothiazide can cause hypotension (low blood pressure) particularly in patients who are volume-depleted, such as those who are taking diuretics, have recently undergone dialysis, or have severe heart failure.
• Renal impairment: moexipril/hydrochlorothiazide can impair renal function, particularly in patients with preexisting renal impairment. Dose adjustments or discontinuation may be necessary if renal function declines.
• Hyperuricemia: moexipril/Hydrochlorothiazide can cause an increase in serum uric acid levels, which may lead to gout attacks
• Surgery/anesthesia: moexipril/hydrochlorothiazide may increase the risk of hypotension during surgery and anesthesia

Pregnancy / Lactation

Pregnancy consideration: C  (1^st trimester)

D (2^nd trimester)

Lactation: Excretion of the drug in human breast milk is unknown

Pregnancy category:

Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester.

Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women.

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.

Category D: adequate data available with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.

Category N: There is no data available for the drug under this category

Pharmacology

Pharmacology

• moexipril works by inhibiting the ACE enzyme, which converts angiotensin I to angiotensin II, a potent vasoconstrictor. By inhibiting this enzyme, moexipril decreases the levels of angiotensin II and leads to vasodilation, decreasing blood pressure. moexipril also increases the levels of bradykinin, a vasodilator, which further contributes to its anti-hypertensive effects
• hydrochlorothiazide works by blocking sodium and chloride reabsorption in the kidney’s distal tubules, which leads to increased excretion of water and electrolytes, including sodium, chloride, and potassium. This results in a decrease in blood volume, which leads to a decrease in blood pressure
• The combination of moexipril and hydrochlorothiazide provides an additive anti-hypertensive effect, resulting in a more significant decrease in blood pressure than either medication alone

Pharmacodynamics

The combination of moexipril and hydrochlorothiazide provides an additive anti-hypertensive effect, resulting in a more significant decrease in blood pressure than either medication alone. The combination also has the potential to reduce some of the side effects associated with high doses of each medication alone, such as the electrolyte imbalances that can occur with high doses of thiazide diuretics

Pharmacokinetics

Absorption

moexipril is rapidly absorbed from the gastrointestinal tract after oral administration, with a low bioavailability of 13-22% due to extensive first-pass metabolism. The drug is converted to its active metabolite moexiprilat by hepatic esterases. hydrochlorothiazide is rapidly and completely absorbed from the gastrointestinal tract after oral administration, with a bioavailability of approximately 70%

Distribution

moexipril is highly protein-bound (90%) to plasma proteins, primarily to albumin. The volume of distribution is large, approximately 180 L. hydrochlorothiazide is moderately protein-bound (68%) to plasma proteins, mainly to albumin. The volume of distribution is relatively small, at about 3.6-7.8 L/kg

Metabolism

moexipril is extensively metabolized by the liver, with moexiprilat being the active metabolite. moexipril undergoes hydrolysis to form moexiprilat, which is responsible for the therapeutic effect of the drug. hydrochlorothiazide is minimally metabolized by the liver, with only about 10% of the dose undergoing hepatic metabolism.

Elimination/Excretion

moexipril and its metabolites are excreted primarily in the feces (50%), with only 13% excreted in the urine. The elimination half-life of moexipril is about 1 hour, while the half-life of moexiprilat is 2-9 hours. hydrochlorothiazide is excreted unchanged in the urine (50-70%) and faeces. The elimination half-life is about 6-15 hours

Adminstartion

Administration

Oral Administration

• In geriatrics, dosage adjustment may be necessary.
• It is typically appropriate to start combination medication only after a patient has failed to achieve the intended effect with monotherapy in order to reduce dose-independent side effects.
• Reduce the amount of hydrochlorothiazide you take to prevent electrolyte problems
• fewer benefits for African Americans
• The manufacturer advises dosing one hour before a meal because food reduces absorption

Patient Information Leaflet

Patient information leaflet

Generic Name: moexipril/hydrochlorothiazide

Why do we use moexipril/hydrochlorothiazide?

moexipril, an ACE inhibitor, and hydrochlorothiazide, a diuretic, are both components of the pharmaceutical combination known as moexipril/hydrochlorothiazide. Adult patients with hypertension (high blood pressure) are treated with this pharmaceutical combination