Hydrochlorothiazide is a thiazide diuretic (water pill). It increases the amount of salt and water you lose in your urine. Hydrochlorothiazide is used to lower blood pressure and to decrease edema (swelling).

Quinapril is in a class of drugs called angiotensin-converting-enzyme inhibitors (ACE inhibitors). Quinapril is used to lower blood pressure and to relieve the symptoms of congestive heart failure, including shortness of breath and swelling of the legs.

Hydrochlorothiazide and quinapril is used to treat hypertension (high blood pressure).

Hydrochlorothiazide and quinapril may also be used for purposes other than those listed in this medication guide.

Take hydrochlorothiazide and quinapril exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

Take each dose with a full glass of water.

Do not stop taking this medication without first talking to your doctor. If you stop taking your medication, your condition could become worse.

Store hydrochlorothiazide and quinapril at room temperature away from moisture and heat.

Before taking hydrochlorothiazide and quinapril, tell your doctor if you are taking any of the following drugs:

• a potassium supplement such as K-Dur, Klor-Con, and others;

• a salt substitute that contains potassium;

• another diuretic (water pill) especially triamterene (Dyrenium, Maxzide, Dyazide), spironolactone (Aldactone), or amiloride (Midamor);

• cholestyramine (Questran) or colestipol (Colestid);

• a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Motrin, Advil), ketoprofen (Orudis, Orudis KT, Oruvail), naproxen (Naprosyn, Anaprox, Aleve), diclofenac (Cataflam, Voltaren), etodolac (Lodine), fenoprofen (Nalfon), flurbiprofen (Ansaid), indomethacin (Indocin), ketorolac (Toradol), mefenamic acid (Ponstel), nabumetone (Relafen), oxaprozin (Daypro), piroxicam (Feldene), sulindac (Clinoril), or tolmetin (Tolectin);

• an oral diabetes medication such as glipizide (Glucotrol), glyburide (Micronase, Glynase, Diabeta), chlorpropamide (Diabinese), tolazamide (Tolinase), tolbutamide (Orinase), and others;

• tetracycline (Sumycin, others);

• lithium (Lithane, Lithobid, Eskalith, others);

• a calcium channel blocker such as amlodipine (Norvasc), diltiazem (Cardizem, Dilacor XR, Tiazac), nifedipine (Adalat, Procardia), verapamil (Calan, Verelan, Isoptin), and others;

• doxazosin (Cardura), prazosin (Minipress), or terazosin (Hytrin);

• reserpine, guanadrel (Hylorel), or guanethidine (Ismelin);

• a nitrate such as nitroglycerin (Nitrostat, Transderm-Nitro, Nitro-Dur, Nitro-Bid, Minitran, others), isosorbide mononitrate (Imdur, ISMO), or isosorbide dinitrate (Isordil, Sorbitrate);

• a pain reliever such as codeine, morphine (MS Contin, MSIR, Roxanol, others), propoxyphene (Darvocet, Darvon, Wygesic), oxycodone (Percocet, Percodan), meperidine (Demerol), and others;

• a barbiturate such as phenobarbital (Luminal, Solfoton), amobarbital (Amytal), secobarbital (Seconal), and butabarbital (Butisol); or

• a steroid medicine such as cortisone (Cortone), dexamethasone (Decadron, Hexadrol), betamethasone (Celestone), hydrocortisone (Cortef, Hydrocortone), prednisone (Orasone, Deltasone), prednisolone (Delta Cortef, Prelone), methylprednisolone (Medrol), and others.

You may not be able to take hydrochlorothiazide and quinapril, or you may require a dosage adjustment or special monitoring during your treatment if you are taking any of the medicines listed above.

Drugs other than those listed here may also interact with hydrochlorothiazide and quinapril or affect your condition. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

Use caution when driving, operating machinery, or performing other hazardous activities. Hydrochlorothiazide and quinapril may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities. Also use caution when rising from a sitting or lying position.

Use alcohol cautiously. Alcohol may further lower blood pressure, causing increased drowsiness and dizziness while you are taking hydrochlorothiazide and quinapril.

Avoid a diet high in salt. Too much salt may cause your body to retain water and may decrease the effects of hydrochlorothiazide. Ask your doctor or nurse about low-salt diet alternatives.

Do not use salt substitutes or potassium supplements without first talking to your doctor while taking quinapril and hydrochlorothiazide. These products could cause potassium levels in your blood to become dangerously high.

Avoid prolonged exposure to sunlight. Hydrochlorothiazide may increase the sensitivity of your skin to sunlight. Use a sunscreen and wear protective clothing when exposure to the sun is unavoidable.

Heavy sweating, vomiting, diarrhea, or other causes of fluid loss may lead to very low blood pressure, dizziness, and fainting during therapy with hydrochlorothiazide and quinapril. Maintain proper fluid intake to prevent dehydration and related adverse effects.

Seek emergency medical attention.

Symptoms of a hydrochlorothiazide and quinapril overdose might include increased urination, nausea, vomiting, diarrhea, dizziness, fainting, weakness, fatigue, and unconsciousness.

Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take only your next regularly scheduled dose. Do not take a double dose of this medication.

Quinapril is in the FDA pregnancy category D. This means that quinapril is known to harm an unborn baby. When used during the second and third trimesters of pregnancy, quinapril can cause injury and even death to the developing fetus. Do not take hydrochlorothiazide and quinapril if you are pregnant.

Quinapril may increase the risk of dangerous allergic reactions. Before taking hydrochlorothiazide and quinapril, tell your doctor if you have ever had an allergic reaction that involved swelling of your lips, face, tongue, or throat or difficulty breathing. Seek emergency medical attention if you develop any of these symptoms while taking hydrochlorothiazide and quinapril.

Use caution when driving, operating machinery, or performing other hazardous activities. Hydrochlorothiazide and quinapril may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities. Also use caution when rising from a sitting or lying position.

Do not take hydrochlorothiazide and quinapril if you have an allergy to sulfa-based drugs such as sulfa antibiotics. You may have an allergic reaction to hydrochlorothiazide.

Quinapril may increase the risk of dangerous allergic reactions. Before taking hydrochlorothiazide and quinapril, tell your doctor if you have ever had an allergic reaction that involved swelling of your lips, face, tongue, or throat or difficulty breathing. Seek emergency medical attention if you develop any of these symptoms while taking hydrochlorothiazide and quinapril.

Before taking hydrochlorothiazide and quinapril, tell your doctor if you

• have diabetes,

• have gout,

• have a collagen vascular disease such as systemic lupus erythematosus or scleroderma,

• have pancreatitis;

• have kidney disease,

• have liver disease,

• have a blood or bone marrow disease,

• are taking salt substitutes, potassium supplements (e.g., K-Dur, Klor-Con), or potassium-sparing diuretics such as amiloride (Midamor), triamterene (Dyrenium, Dyazide, Maxzide), or spironolactone (Aldactone); or

• are on a salt-restricted diet or have high levels of potassium in your blood.

You may not be able to take hydrochlorothiazide and quinapril, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

Quinapril is in the FDA pregnancy category D. This means that quinapril is known to harm an unborn baby. When used during the second and third trimesters of pregnancy, quinapril can cause injury and even death to the developing fetus. Do not take hydrochlorothiazide and quinapril if you are pregnant.

Hydrochlorothiazide and quinapril pass into breast milk and may harm a nursing infant. Do not take this medication without first talking to your doctor if you are breast-feeding a baby.

If you are over 60 years of age, you may be more likely to experience side effects from hydrochlorothiazide and quinapril. Your doctor may prescribe a lower dose of this medication.

Hydrochlorothiazide and quinapril is not approved for use by children.

Your pharmacist has additional information about hydrochlorothiazide and quinapril written for health professionals that you may read.

Hydrochlorothiazide and quinapril is available with a prescription under the brand name Accuretic. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.

Quinapril/hydrochlorothiazide strengths are as follows:

• Accuretic 10/12.5 (10 mg/12.5 mg)—pink, almond-shaped tablets

• Accuretic 20/12.5 (20 mg/12.5 mg)—pink, triangular-shaped tablets

• Accuretic 20/25 (20 mg/25 mg)—pink, round tablets