fosinopril

foe-SIN-oh-pril

Therapeutic Classification: antihypertensives

Pharmacologic Classification: ace inhibitors

REMS

Hypertension (as monotherapy or in combination with other antihypertensive agents).
HF.

Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins. ACE inhibitors also ↑ plasma renin levels and ↓ aldosterone levels. Net result is systemic vasodilation.

Therapeutic effects:

Lowering of BP in patients with hypertension.
Decreased afterload and symptoms in patients with HF.

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.

(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.

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;
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.

Exercise Extreme Caution in:

Family history of angioedema.

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

Drug-drug:

Excessive hypotension may occur with concurrent use of diuretics.
Additive hypotension with other antihypertensive agents.
↑risk of hyperkalemia with potassium supplements, potassium-sparing diuretics, or potassium-containing salt substitutes.
↑risk of hyperkalemia, renal impairment, hypotension, and syncope with 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 ↑ risk of renal impairment.
Absorption may be ↓ by antacids; separate administration by 1–2 hr.
May ↑ levels and risk of toxicity of lithium.
↑risk of angioedema with temsirolimus, sirolimus, or everolimus.

Hypertension

PO (Adults ): 10 mg once daily; may ↑ as needed 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 ↑ over several wk up to 40 mg/day.

(Generic available)

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

Hypertension: Monitor BP and HR frequently during initial dose adjustment and periodically during therapy. Notify health care provider of significant changes.
Assess patient for signs of angioedema (swelling of face, extremities, eyes, lips, or 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 ↑ 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 ↑ AST, ALT, alkaline phosphatase, and serum bilirubin.

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

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 provider.
- Caution patient to avoid salt substitutes containing potassium or foods containing high levels of potassium or sodium unless directed by health care provider (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 provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider 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 provider of medication regimen before treatment or surgery.
- Instruct patient to notify health care provider 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 provider if cough becomes bothersome. Also notify health care provider if nausea, vomiting, or diarrhea occurs and continues.
- May cause fetal harm. Advise women of reproductive potential to use effective contraception and notify health care provider immediately if pregnancy is planned or suspected and to avoid breastfeeding. Fosinopril should be discontinued as soon as possible when pregnancy is detected. Conduct serial ultrasound exams in pregnant patients exposed to fosinopril; may cause oligohydramnios. Monitor infants exposed to fosinopril in utero for hypotension, oliguria, and hyperkalemia. If oliguria or hypotension occurs, support BP and renal perfusion. Exchange transfusions or dialysis may be required as a means of reversing hypotension and/or substituting for disordered renal function.
- 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, 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 provider.

Decrease in BP without appearance of excessive side effects.
Decrease in signs and symptoms of HF.

~~Monopril~~

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆