Accuretic (quinapril and hydrochlorothiazide) tablets: Supply issue
People using Accuretic must get a new prescription to change to an alternative high blood pressure medicine.
On this page
2 December 2022:
We plan to delist Accuretic early in 2023.
What happened to Accuretic?
Recent batches of Accuretic, quinapril with hydrochlorothiazide, were found to have small amounts of two impurities, called N-nitroso-quinapril and N-nitroso-hydrochlorothiazide. Medicine safety regulators have determined that exposure to these types of substances over a long time may increase a person’s risk of getting cancer.
The risks of nitrosamines are low, it is a greater risk if people stop taking this medicine. People should keep taking Accuretic until they have spoken to a medical professional.
This is a global issue. Pfizer, the supplier of Accuretic, has been undertaking voluntary recalls of the medicine around the world, including in Australia, Europe, the United States of America, and Canada.
Accuretic stock situation
Pfizer withdrew remaining stock from distribution on 31 October 2022.
Pharmac plans to delist Accuretic early in 2023.
Pfizer has not advised when they will be able to supply quinapril with hydrochlorothiazide without impurities to the New Zealand market. They have indicated that it is unlikely to happen before late 2023.
The impurity issue does not affect other quinapril products. Arrow-Quinapril is the funded brand of quinapril (without hydrochlorothiazide). There is ample stock of Arrow-Quinapril.
Unused stock of Accuretic
Pfizer has advised that pharmacies and wholesalers will be able to return any unused stock of Accuretic at the end of the transition period.
Pharmacies should discuss the returns process with their wholesaler.
Alternative treatment options
People taking Accuretic must talk to their prescriber about alternative treatment options. We know that the health sector is stretched, and we apologise for the added the pressure this situation creates.
We have received clinical advice that losartan with hydrochlorothiazide is a suitable funded alternative treatment. Teva, the supplier of this product, has assured us that there is ample stock of this product for everyone who needs it.
Schedule listing for losartan with hydrochlorothiazide(external link)
NZ Formulary monograph for losartan with hydrochlorothiazide(external link)
Losartan with hydrochlorothiazide information for patients – Health Navigator(external link)
We are also advised that any of the other funded ACEi and ARBs medicines (such as, candesartan) can be used with another funded thiazide or thiazide-like diuretic if required. This option would require patients to take two separate medicines rather than one combination medicine.
He Ako Hiringa has created a resource to support clinicians(external link), including a dose conversion chart.
Thank you for your assistance with the management of this issue.
Additional costs to be covered
To support the required change, Pharmac is funding primary care for the initial consultation for patients transitioning from Accuretic to an alternative treatment.
Funding for the initial consultation fee is available for any patient who:
- is currently using the Accuretic brand of medication
- is transitioning to a suitable alternative treatment
- requires an additional appointment with a prescriber in primary care to support a change from Accuretic to an alternative medicine(s).
No follow-up consultations will be funded.
Primary care providers should talk to their PHO about how to claim the reimbursement. We have provided bulk funding to PHOs to cover these costs. If you are not a member of a PHO, email email@example.com
Patients should not be charged the usual prescription co-payment for the first dispensing of their new medicine or medicines.
A one-off payment has been made to community pharmacies to reimburse them for their dispensing work and associated costs.
What to do if you take Accuretic
As soon as possible, talk to your healthcare professional to get a prescription for a new high blood pressure medicine.
You should keep taking Accuretic as prescribed until you have your new treatment. Nitrosamines pose a low risk, there are greater risks to your health if you stop taking Accuretic.
We are covering the cost of the change including a free initial consultation with your primary care prescriber.
General practices should not charge you for this appointment. They will be reimbursed through their primary health organisation (PHO).
We acknowledge that changing medicines can be disruptive. We appreciate your patience.
Who to contact?
If you have questions about the funding of alternative treatments, or the funding of Accuretic, email firstname.lastname@example.org
If you have questions or concerns about the safety of Accuretic, you should talk to your healthcare professional. You can also email Medsafe at email@example.com
If you have questions about Accuretic or the recall, email firstname.lastname@example.org
If you are a medical centre seeking reimbursement, talk to your PHO.