Home Drug Guide Spirapril Hydrochloride

Drug Guide

Generic Name

Spirapril Hydrochloride

Brand Names Renormax

Classification

Therapeutic: Antihypertensive

Pharmacological: ACE inhibitor (Angiotensin-Converting Enzyme inhibitor)

FDA Approved Indications

Hypertension
Heart failure (off-label)

Mechanism of Action

Spirapril inhibits the angiotensin-converting enzyme, reducing the conversion of angiotensin I to angiotensin II, leading to vasodilation, decreased blood volume, and reduced blood pressure.

Dosage and Administration

Adult: Typically 2.5 to 5 mg once daily, titrated based on response. Maximum dose usually 20 mg daily.

Pediatric: Data limited; use in children not well established.

Geriatric: Start at lower doses due to increased sensitivity; monitor closely.

Renal Impairment: Dose adjustment may be necessary; start at lower doses and titrate gradually.

Hepatic Impairment: No specific adjustment recommended, but caution advised.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed; crosses the placenta.

Metabolism: Hydrolyzed to active metabolite spiraprilat.

Excretion: Primarily via renal route.

Half Life: Approximately 2-4 hours for spirapril, active metabolite has a longer half-life.

Contraindications

History of angioedema related to previous ACE inhibitor use
Concurrent use with aliskiren in patients with diabetes or renal impairment
Pregnancy (especially second and third trimesters)

Precautions

Renal impairment
Hyperkalemia
Aortic stenosis
Caution in patients with bilateral renal artery stenosis

Adverse Reactions - Common

Cough (Common)
Hyperkalemia (Uncommon)
Dizziness (Common)
Headache (Common)

Adverse Reactions - Serious

Angioedema (Rare)
Neutropenia or agranulocytosis (Rare)
Renal impairment or failure (Rare)

Drug-Drug Interactions

Use with other antihypertensives or diuretics may enhance hypotensive effects.
Potassium-sparing diuretics or potassium supplements can increase hyperkalemia risk.
Use with NSAIDs may reduce antihypertensive efficacy and impair renal function.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, renal function (BUN, serum creatinine), and serum electrolytes regularly.

Diagnoses:

Risk for decreased cardiac output
Risk for electrolyte imbalance

Implementation: Administer as prescribed, typically once daily. Educate patients on symptoms of hypotension, cough, and angioedema.

Evaluation: Assess blood pressure response and renal function periodically.

Patient/Family Teaching

Take medication exactly as prescribed.
Report signs of swelling, difficulty breathing, or rash immediately.
Avoid potassium supplements and potassium-rich foods unless advised by healthcare provider.
Warn about possible dizziness or lightheadedness, especially when standing up quickly.

Special Considerations

Black Box Warnings:

Pregnancy: can cause injury or death to the fetus; discontinue as soon as pregnancy is detected.

Genetic Factors: Genetic predisposition to angioedema may increase risk.

Lab Test Interference: May alter serum potassium and renal function tests.

Overdose Management

Signs/Symptoms: Severe hypotension, dizziness, dehydration.

Treatment: Discontinue medication, provide supportive care, and administer IV fluids as needed. Use vasopressors if necessary.

Storage and Handling

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

Stability: Stable for 24 months when stored properly.