Cilazapril with hydrochlorothiazide: Discontinued

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 informed Pharmac it could no longer supply this medicine in New Zealand. The medicine is now delisted.

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

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

When will cilazapril with hydrochlorothiazide be unavailable?

From 1 March 2020, cilazapril with hydrochlorothiazide were no longer be funded for new patients.
From end of 2020, stocks of cilazapril with hydrochlorothiazide ran out.

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

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

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

Information for health care professionals

Prescribers had to:

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

What are the funded treatment options?

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

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

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 did this happen

Stocks ran out at the end of 2020.

From 1 March 2020, new patients were not able to start on funded cilazapril with hydrochlorothiazide.

What were the funded treatment options?

There are a number of fully funded treatment options. Patients needed to talk to their health care professional to find out which is best for them.

Who to contact

If you have any questions, contact PHARMAC on: