Cilazapril with hydrochlorothiazide: Discontinuation

Cilazapril with hydrochlorothiazide is a medicine used for the treatment of patients with hypertension who are not adequately controlled on monotherapy. This medicine may also be used for other indications.

What's changing?

Apotex, the supplier of cilazapril with hydrochlorothiazide has informed PHARMAC it will no longer be able to supply this medicine in New Zealand. The supply is depleted.

Apo-Cilazapril/Hydrochlorothiazide is the only Medsafe registered brand of cilazapril with hydrochlorothiazide tablets in New Zealand. This means cilazapril with hydrochlorothiazide is no longer be available to patients. From 1 March 2020 no new patients were able to start on this medicine.

While this discontinuation does not apply to cilazapril tablets without hydrochlorothiazide, no new patients can start on cilazapril monotherapy. 

Read more about changes to cilazapril

When will cilazapril with hydrochlorothiazide be unavailable?

  • From 1 March 2020, cilazapril with hydrochlorothiazide was no longer be funded for new patients.
  • From end of 2020, current cilazapril with hydrochlorothiazide stocks run out.

From 1 March 2020, prescribers must endorse any prescriptions for cilazapril with hydrochlorothiazide for patients who were taking this medicine prior to 1 March 2020.

Pharmacists may annotate the prescription as endorsed where there exists a record of prior dispensing of cilazapril with hydrochlorothiazide.

People taking cilazapril with hydrochlorothiazide will need to talk to their health care professional about alternative treatments.

Information for health care professionals

Prescribers will need to:

  • ensure no new patients are started on cilazapril with hydrochlorothiazide from 1 March 2020.
  • transition patients currently on cilazapril with hydrochlorothiazide to alternative treatments.

What are the funded treatment options?

Based on advice we have received from our expert clinical advisors, alternative treatment options for cilazapril with hydrochlorothiazide include:

  • A suitable fully funded alternative angiotensin II antagonist with diuretic would be losartan with hydrochlorothiazide
  • A suitable fully funded alternative ACE inhibitor with diuretic would be quinapril with hydrochlorothiazide

Agent

Cilazapril with hydrochlorothiazide

(Apo-Cilazapril/ Hydrochlorothiazide)

Quinapril with hydrochlorothiazide

(Accuretic)

Losartan with hydrochlorothiazide

(Arrow-Losartan & Hydrochlorothiazide)

Approximate Equivalent Strength

5 mg cilazapril with

12.5 mg hydrochlorothiazide

20 mg* quinapril with

12.5 mg hydrochlorothiazide1

50 mg losartan with

12.5 mg hydrochlorothiazide1

Indication

For the treatment of hypertension not adequately controlled with monotherapy

Dosing Regimen  

5 mg/12.5 mg once daily2

Initially one 10/12.5 mg tablet daily, increased to 20/12.5 mg daily if necessary3

Initially one 50/12.5 mg tablet once daily to a maximum 2 tablets (i.e. 100 /25 mg) once daily4

* Quinapril with hydrochlorothiazide is also available in a 10 mg with 12.5 mg preparation

When changing patients to another fixed dose combination it is recommended to monitor blood pressure and renal function (creatinine and electrolytes).

A fixed dose combination would be the preferred alternative to cilazapril with hydrochlorothiazide, although some people may prefer to change to two separate medicines (i.e. an ACE inhibitor and a separate diuretic). Currently cilazapril is used infrequently or not at all in other countries and we are aware of only one manufacturer of the active ingredient internationally. For this reason, alternative treatment agents should be considered. There are a number of different funded ACE inhibitors and one of these could be prescribed together with a funded thiazide or thiazide-like diuretic.

1. Table of subsidised ACE inhibitors, available tablet strength and recommended doses – BPAC NZ Website(external link) 

2. NZ Formulary listing for cilazapril + hydrochlorothiazide(external link)

3. NZ Formulary listing for quinapril + hydrochlorothiazide(external link)

4. NZ Formulary listing for losartan + hydrochlorothiazide(external link)

Information for people taking cilazapril with hydrochlorothiazide 

Cilazapril with hydrochlorothiazide is used to treat people with high blood pressure and may also be used for other conditions.

What's changing

The supplier of cilazapril with hydrochlorothiazide (Apotex) informed PHARMAC it will no longer be able to supply this medicine in New Zealand. The current supply is likely to run out by the end of 2020.

No other brands of this medication are available, you will need to change to a different ACE inhibitor when the current supply runs out.

If you take cilazapril with hydrochlorothiazide, talk to your health care professional about alternative treatments.

When will this happen

We expect stocks to run out by the end of 2020. We recommend you talk to your health care professional before this to manage your move to a different medicine. 

From 1 March 2020, new patients will not be funded for cilazapril with hydrochlorothiazide. 

What are the funded treatment options?

There are a number of fully funded treatment options. You will need to talk to your health care professional to find out which is best for you.

Who to contact

If you have any questions, contact PHARMAC on: