fosinopril

Absorption: 36% absorbed following oral administration.

Distribution: Minimally distributed to tissues.

Protein Binding: 99.4%.

Metabolism/Excretion: Converted by the liver and GI mucosa to fosinoprilat, the active metabolite: 50% excreted in urine, 50% in feces.

Half-Life: 12 hr.

Time/Action Profile ⬆ ⬇

(effect on BP—single dose‡)

ROUTE	ONSET	PEAK	DURATION
PO	Within 1 hr	2–6 hr	24 hr

‡Full effects may not be noted for several wk.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Bilateral renal artery stenosis;
History of angioedema with previous use of ACE inhibitors;
Concurrent use with aliskiren in patients with diabetes or moderate to severe renal impairment (CCr <60 mL/min);
OB: Pregnancy;
Lactation: Lactation.

Use Cautiously in:

Renal impairment, hypovolemia, hyponatremia, or concurrent diuretic therapy;
Black patients (monotherapy for hypertension less effective, may require additional therapy; higher risk of angioedema);
Surgery/anesthesia (hypotension may be exaggerated);
Rep: Women of reproductive potential;
Pedi: Children 6 yr (safety and effectiveness not established);
Geri: Initial dose recommended in older adults.

Family history of angioedema.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypotension, chest pain, edema

Derm: rash

GI: abdominal pain, diarrhea, nausea, vomiting

GU: erectile dysfunction, impaired renal function

F and E: hyperkalemia

MS: muscle cramps

Neuro: dizziness, fatigue, headache, insomnia, weakness

Resp: cough, dyspnea

Misc: ANGIOEDEMA

Interactions ⬆ ⬇

Drug-drug:

Excessive hypotension may occur with concurrent use of diuretics.
Additive hypotension with other antihypertensive agents.
↑risk of hyperkalemia with concurrent use of potassium supplements, potassium-sparing diuretics, or potassium-containing salt substitutes.
↑risk of hyperkalemia, renal impairment, hypotension, and syncope with concurrent use of angiotensin II receptor antagonists or aliskiren; avoid concurrent use with aliskiren in patients with diabetes or CCr <60 mL/min.
NSAIDs and selective COX-2 inhibitors may blunt the antihypertensive effect and ↑ the risk of renal impairment.
Absorption may be ↓ by antacids; separate administration by 1–2 hr.
↑levels and the risk of toxicity of lithium.
↑risk of angioedema with temsirolimus, sirolimus, or everolimus.

Route/Dosage ⬆ ⬇

Hypertension

PO (Adults ): 10 mg once daily; may be ↑ as required up to 80 mg/day.
PO (Children ≥6 yr and >50 kg): 5–10 mg once daily.

Heart Failure

PO (Adults ): 10 mg once daily (5 mg once daily in patients who have been vigorously diuresed); may be ↑ over several wk up to 40 mg/day.

Availability ⬆ ⬇

(Generic available)

Tablets: 10 mg ; 20 mg; 40 mg
In combination with: hydrochlorothiazide.

Assessment ⬆ ⬇

Hypertension: Monitor BP and pulse frequently during initial dose adjustment and periodically during therapy. Notify health care professional of significant changes.
Assess patient for signs of angioedema (swelling of face, extremities, eyes, lips, tongue, difficulty in swallowing or breathing); may occur at any time during therapy. Discontinue medication and provide supportive care.
HF: Monitor weight and assess patient routinely for resolution of fluid overload (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous distention).

Lab Test Considerations:

Monitor renal function. May cause ↑ in BUN and serum creatinine.
- May cause hyperkalemia.
- Monitor CBC periodically during therapy in patients with collagen vascular disease and/or renal disease. May rarely cause slight ↓ in hemoglobin and hematocrit as well as neutropenia and eosinophilia.
- May cause ↑ AST, ALT, alkaline phosphatase, and serum bilirubin.

Implementation ⬆ ⬇

Correct volume depletion, if possible, before initiation of therapy due to possible precipitous drop in BP during first 1–3 hr following first dose. Risk of hypotension may be ↓ by discontinuing diuretics or cautiously increasing salt intake 2–3 days prior to beginning fosinopril. Monitor BP closely. Resume diuretics if BP is not controlled.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed at the same time each day, even if feeling well. Take missed doses as soon as remembered but not if almost time for next dose. Do not double dose. Warn patient not to discontinue ACE inhibitor therapy unless directed by health care professional.Rep: May cause fetal harm. Advise females of reproductive potential to use effective contraception and notify health care professional if pregnancy is planned or suspected or if breastfeeding. If pregnancy is detected, discontinue fosinopril as soon as possible.
- Caution patient to avoid salt substitutes containing potassium or foods containing high levels of potassium or sodium unless directed by health care professional (see Food Sources for Specific Nutrients).
- Caution patient to change positions slowly to minimize orthostatic hypotension. Use of alcohol, standing for long periods, exercising, and hot weather may ↑ risk of orthostatic hypotension.
- Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications, especially NSAIDs and cough, cold, or allergy remedies.
- May cause dizziness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
- Advise patient to inform health care professional of medication regimen before treatment or surgery.
- Instruct patient to notify health care professional immediately if rash; mouth sores; sore throat; fever; swelling of hands or feet; irregular heartbeat; chest pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; or difficulty swallowing or breathing occurs. Persistent dry cough may occur and may not subside until medication is discontinued. Consult health care professional if cough becomes bothersome. Also notify health care professional if nausea, vomiting, or diarrhea occurs and continues.
- Emphasize the importance of follow-up examinations to evaluate effectiveness of medication.
Hypertension: Encourage patient to comply with additional interventions for hypertension (weight reduction, low sodium diet, discontinuation of smoking, moderation of alcohol consumption, regular exercise, and stress management). Medication controls but does not cure hypertension.
- Instruct patient and family on correct technique for monitoring BP. Advise them to check BP at least weekly and to report significant changes to health care professional.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇