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Product info: Blood Pressure
Accupril is in a group of drugs called ACE inhibitors. ACE stands for angiotensin converting enzyme.
Accupril is used to treat high blood pressure (hypertension) and heart failure.
Accupril may also be used for purposes other than those listed in this medication guide.

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What other drugs will affect Accupril?

Before taking Accupril, tell your doctor if you are taking any of the following drugs:

gold injections to treat arthritis;

lithium (Lithobid, Eskalith);

tetracycline (Brodspec, Panamycin, Sumycin, Tetracap);

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

salt substitutes that contain potassium; or

a diuretic (water pill).

This list is not complete and there may be other drugs that can interact with Accupril. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.
Where can I get more information?
Your pharmacist can provide more information about Accupril.
What does my medication look like?

Quinapril is available with a prescription under the brand name Accupril. 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.

Accupril 5 mg - elliptical, brown, film-coated, scored tablet

Accupril 10 mg - triangular, brown, film-coated tablet

Accupril 20 mg - round, brown, film-coated tablet

Accupril 40 mg - elliptical, brown, film-coated tablet
Remember, keep this and all other medicines out of the reach of children. Never share your medicines with others and use this medication only for the condition prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

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Accutane (ISOTRETINOIN) is a drug used for the treatment of severe, disfiguring cystic acne that has not cleared up in response to milder medications such as antibiotics.
It works on the oil glands within the skin, shrinking them and diminishing their output. Accutane derives from vitamin A and is found in small quantities naturally in the body.

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Why should Accutane not be prescribed?

If Accutane gives you an allergic reaction, you will not be able to use it.

If you are a woman of childbearing age, you should not take Accutane if you are pregnant, if you think there is a possibility you might get pregnant during the treatment, or if you are unable to keep coming back to the doctor for monthly checkups, including pregnancy testing.


Special warnings about Accutane

Stop taking Accutane and notify your doctor immediately at the first sign of a skin rash or any other allergic reaction. Although they are rare, serious and even fatal allergic reactions have been known to occur.

When you first start taking Accutane, it is possible that your acne will get worse before it starts to get better.

Accutane may cause depression or other mental problems such as: mood swings, aggression, sadness, hopelessness, loss of pleasure, fatigue, difficulty concentrating, change in sleep patterns, restlessness, and irritability. In rare cases, it has prompted thoughts of suicide. If you begin to feel depressed or become troubled by suicidal thoughts, contact your doctor immediately.

Before starting Accutane therapy, all patients must sign a consent form noting that they are aware of the possibility of mental side effects, the danger of birth defects, and the need for certain other precautions.

If you are a woman of childbearing age and you are considering taking Accutane, you will be given both spoken and written warnings (the iPLEDGE program) about the importance of avoiding pregnancy during the treatment. You will also be asked to sign a second consent form noting that:
You must not take Accutane if you are pregnant, may become pregnant during treatment, or are breastfeeding;
If you get pregnant while taking Accutane, your baby will be at high risk for birth defects;
If you take Accutane, you must use 2 effective forms of birth control from 1 month before the start of treatment through 1 month after the end of treatment;
You must have 2 negative pregnancy tests (one just before starting Accutane therapy), and must be tested every month during therapy;
You may participate in a program that includes an initial free pregnancy test and birth control counseling session;
If you become pregnant, you must immediately stop taking Accutane and see your doctor;
You have read and understood the Accutane patient brochure and asked your doctor any questions you had;
You have been invited to participate in a survey of women being treated with Accutane.

Some people taking Accutane, including some who simultaneously took tetracycline, have experienced headache, nausea, and visual disturbances caused by increased pressure within the skull. Avoid taking tetracycline while using Accutane. See a doctor immediately if you have these symptoms; if the doctor finds swelling of the optic nerve at the back of your eye, you must stop taking Accutane at once and see a neurologist for further care.

Be careful driving at night. Some people have experienced a sudden decrease in night vision.

Accutane affects the body's processing of fats and sugars. It should be used cautiously by people with diabetes, excess weight, high triglyceride or cholesterol levels, or a tendency to drink too much alcohol. If you have any of these conditions, your doctor will monitor you closely during Accutane therapy.

You may not be able to tolerate your contact lenses during and after your therapy with Accutane.

You should stop taking Accutane immediately if you have abdominal pain, bleeding from the rectum, or severe diarrhea. You may have an inflammatory disease of the bowel.

You should not donate blood during your therapy with Accutane and for a month after you stop taking it.

You may become more sensitive to light while taking Accutane. Try to stay out of the sun as much as possible.

You should not use wax hair removal treatments or skin resurfacing procedures (dermabrasion, laser treatments) while taking Accutane or for 6 months after completing therapy.

Some people taking Accutane develop vision or hearing problems. If you notice changes in your vision or hearing, stop taking Accutane and contact your doctor.

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Product info: Blood Pressure
Aceon (PERINDOPRIL) is in a group of drugs called ACE inhibitors. ACE stands for angiotensin converting enzyme.
Aceon is used to treat high blood pressure (hypertension) and to prevent heart attack in people with coronary artery disease.
Aceon may also be used for purposes other than those listed in this medication guide.

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Aceon

Generic Name: perindopril erbumine
Dosage Form: tablets

Rx Only

500063/500064 Rev Mar 2008
Use in Pregnancy


When used in pregnancy, ACE inhibitors can cause injury and even death to the developing fetus. When pregnancy is detected, Aceon® Tablets should be discontinued as soon as possible. See WARNINGS: Fetal/Neonatal Morbidity and Mortality.
Aceon Description

Aceon® (perindopril erbumine) Tablets is the tert-butylamine salt of perindopril, the ethyl ester of a non-sulfhydryl angiotensin-converting enzyme (ACE) inhibitor. Perindopril erbumine is chemically described as (2S,3?S,7?S)-1-[(S)-N-[(S)-1-Carboxy-butyl]alanyl]hexahydro-2-indolinecarboxylic acid, 1-ethyl ester, compound with tert-butylamine (1:1). Its molecular formula is C19H32N2O5C4H11N. Its structural formula is:


Perindopril erbumine is a white, crystalline powder with a molecular weight of 368.47 (free acid) or 441.61 (salt form). It is freely soluble in water (60% w/w), alcohol and chloroform.

Perindopril is the free acid form of perindopril erbumine, is a pro-drug and metabolized in vivo by hydrolysis of the ester group to form perindoprilat, the biologically active metabolite.

Aceon® Tablets is available in 2 mg, 4 mg and 8 mg strengths for oral administration. In addition to perindopril erbumine, each tablet contains the following inactive ingredients: colloidal silica (hydrophobic), lactose, magnesium stearate and microcrystalline cellulose. The 4 and 8 mg tablets also contain iron oxide.
Aceon - Clinical Pharmacology

Mechanism of Action: Aceon® (perindopril erbumine) Tablets is a pro-drug for perindoprilat, which inhibits ACE in human subjects and animals. The mechanism through which perindoprilat lowers blood pressure is believed to be primarily inhibition of ACE activity. ACE is a peptidyl dipeptidase that catalyzes conversion of the inactive decapeptide, angiotensin I, to the vasoconstrictor, angiotensin II. Angiotensin II is a potent peripheral vasoconstrictor, which stimulates aldosterone secretion by the adrenal cortex, and provides negative feedback on renin secretion. Inhibition of ACE results in decreased plasma angiotensin II, leading to decreased vasoconstriction, increased plasma renin activity and decreased aldosterone secretion. The latter results in diuresis and natriuresis and may be associated with a small increase of serum potassium.

ACE is identical to kininase II, an enzyme that degrades bradykinin. Whether increased levels of bradykinin, a potent vasodepressor peptide, play a role in the therapeutic effects of Aceon® Tablets remains to be elucidated.

While the principal mechanism of perindopril in blood pressure reduction is believed to be through the renin-angiotensin-aldosterone system, ACE inhibitors have some effect even in apparent low-renin hypertension. Perindopril has been studied in relatively few black patients, usually a low-renin population, and the average response of diastolic blood pressure to perindopril was about half the response seen in nonblacks, a finding consistent with previous experience of other ACE inhibitors.

After administration of perindopril, ACE is inhibited in a dose and blood concentration-related fashion, with the maximal inhibition of 80 to 90% attained by 8 mg persisting for 10 to 12 hours. Twenty-four hour ACE inhibition is about 60% after these doses. The degree of ACE inhibition achieved by a given dose appears to diminish over time (the ID50 increases). The pressor response to an angiotensin I infusion is reduced by perindopril, but this effect is not as persistent as the effect on ACE; there is about 35% inhibition at 24 hours after a 12 mg dose.

Pharmacokinetics: Oral administration of Aceon® (perindopril erbumine) Tablets results in its rapid absorption with peak plasma concentrations occurring at approximately 1 hour. The absolute oral bioavailability of perindopril is about 75%. Following absorption, approximately 30 to 50% of systemically available perindopril is hydrolyzed to its active metabolite, perindoprilat, which has a mean bioavailability of about 25%. Peak plasma concentrations of perindoprilat are attained 3 to 7 hours after perindopril administration. The presence of food in the gastrointestinal tract does not affect the rate or extent of absorption of perindopril but reduces bioavailability of perindoprilat by about 35%. (See PRECAUTIONS: Food Interaction.)

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