Nurses Compass
Drug Guide
Moexipril Hydrochloride and Hydrochlorothiazide
Classification
Therapeutic: Antihypertensive
Pharmacological: ACE inhibitor and thiazide diuretic combination
FDA Approved Indications
- Hypertension
Mechanism of Action
Moexipril is an angiotensin-converting enzyme (ACE) inhibitor that decreases angiotensin II, leading to vasodilation and decreased aldosterone secretion. Hydrochlorothiazide is a thiazide diuretic that inhibits sodium and chloride reabsorption in the distal convoluted tubule, increasing the excretion of sodium, chloride, and water.
Dosage and Administration
Adult: Typically one tablet once daily, titrated as needed based on blood pressure response.
Pediatric: Not approved for pediatric use.
Geriatric: Start at lower doses due to potential for increased sensitivity and risk of hypotension.
Renal Impairment: Use caution; dosage adjustments may be necessary.
Hepatic Impairment: Use with caution; monitor closely.
Pharmacokinetics
Absorption: Well absorbed from the gastrointestinal tract.
Distribution: Widely distributed; crosses the placenta but not significantly into breast milk.
Metabolism: Moexipril is a prodrug converted in the liver; hydrochlorothiazide is minimally metabolized.
Excretion: Excreted primarily via the kidneys.
Half Life: Moexipril approximately 2 hours; active metabolite approximately 3-6 hours; hydrochlorothiazide approximately 6-15 hours.
Contraindications
- History of angioedema related to previous ACE inhibitor therapy.
- Concomitant use with aliskiren in patients with diabetes or renal impairment.
- Allergy to sulfonamides (hydrochlorothiazide).
Precautions
- Pregnancy (category D), lactation, bilateral renal artery stenosis, electrolyte disturbances, history of hypersensitivity to sulfonamides.
Adverse Reactions - Common
- Dizziness (Common)
- Hypotension (Common)
- Hypokalemia or Hyperkalemia (Common)
- Headache (Common)
Adverse Reactions - Serious
- Angioedema (Rare)
- Hepatic failure (Rare)
- Electrolyte disturbances leading to arrhythmias (Rare)
- Neutropenia or agranulocytosis (Rare)
Drug-Drug Interactions
- Other antihypertensives, potassium-sparing diuretics, lithium, nonsteroidal anti-inflammatory drugs (NSAIDs).
Drug-Food Interactions
- Excessive potassium intake may increase risk of hyperkalemia.
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood pressure, renal function, serum electrolytes.
Diagnoses:
- Risk for hypotension
- Electrolyte imbalance
Implementation: Administer as prescribed, monitor BP and labs regularly, educate patient about symptoms of hypotension and electrolyte disturbances.
Evaluation: Assess for desired blood pressure reduction and absence of adverse effects.
Patient/Family Teaching
- Take medication consistently, even if feeling well.
- Report signs of angioedema, persistent cough, hyperkalemia.
- Avoid potassium supplements and salt substitutes containing potassium.
- Notify provider if pregnant or planning to become pregnant.
Special Considerations
Black Box Warnings:
- Pregnancy: can cause injury and death to the developing fetus (discontinue as soon as pregnancy is detected).
Genetic Factors: Sensitivity varies based on genetic background affecting drug metabolism and response.
Lab Test Interference: Hydrochlorothiazide may interfere with glucose and uric acid measurements.
Overdose Management
Signs/Symptoms: Severe hypotension, electrolyte disturbances.
Treatment: Discontinue medication, supportively manage hypotension with IV fluids or vasopressors as needed, monitor electrolytes closely.
Storage and Handling
Storage: Store at room temperature away from moisture, heat, and light.
Stability: Stable in original container for at least 24 months.