Fosinopril


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO HTN Initial: 10 mg once daily, given at bedtime. Maintenance: 10-40 mg once daily. Heart failure Initial: 10 mg once daily. Max: 40 mg once daily. Patients at high risk of hypotension: Initial: 5 mg once daily.
Dosage Details
Oral
Heart failure
Adult: Initially, 10 mg once daily, may increase to max 40 mg once daily. Patients at high risk of hypotension: Initially, 5 mg once daily.
Elderly: No dosage adjustment needed.

Oral
Hypertension
Adult: Initially, 10 mg once daily, 1st dose given at bedtime to avoid precipitous fall in BP. Maintenance: 10-40 mg once daily.
Child: >50 kg: 5-10 mg once daily.
Elderly: No dosage adjustment needed.
Renal Impairment
Hypertension:
No dosage adjustment needed.
Heart failure:
Moderate to severe: Initially, 5 mg once daily.
Administration
Should be taken on an empty stomach. Best taken 1 hr before meals. May be taken w/ meals to reduce GI discomfort.
Contraindications
History of angioedema related to previous ACE inhibitor treatment; renal artery stenosis (bilateral or unilateral in single kidney), cardiogenic shock. Pregnancy and lactation.
Special Precautions
Patients w/ collagen vascular disease, aortic or mitral valve stenosis, severe volume and/or salt depletion. Patients on dietary salt restriction and dialysis. Renal impairment.
Adverse Reactions
Persistent and non productive cough, hypotension, orthostatic hypotension, fatigue, chest pain (not cardiac), subjective cardiac rhythm disturbance, upper resp infection, intestinal angioedema, hyperkalaemia, headache, dizziness, nausea, vomiting, diarrhoea, musculoskeletal pain, weakness and sexual dysfunction.
Potentially Fatal: Anaphylactic reactions and angioedema, severe hypotension. Rarely, fulminant hepatic necrosis.
Patient Counseling Information
Patients should be informed to refrain from activities involving mental alertness and physical coordination after drug intake.
MonitoringParameters
Monitor serum electrolytes and creatinine levels frequently; BP, CBC w/ differential. Monitor renal function during the 1st few wk of treatment and periodically thereafter. Correct volume and/or salt depletion prior to treatment.
Overdosage
Symptoms: Severe hypotension, electrolyte disturbances and renal failure. Management: Admin of normal saline IV infusion, naloxone and activated charcoal. Supportive and symptomatic treatment.
Drug Interactions
Additive hyperkalaemic effect w/ K-sparing diuretics and K supplements. May increase lithium serum levels and toxicity. May decrease serum level w/ antacids. May increase risk of renal function deterioration w/ NSAIDs. May increase nitritoid reactions of gold (Na aurothiomalate).
Food Interaction
May worsen HTN w/ licorice.
Lab Interference
May cause false low serum digoxin levels w/ serological testing for digoxin.
Action
Description: Fosinopril, a prodrug of fosinoprilat competitively inhibits ACE from converting angiotensin I to angiotensin II resulting in decreased levels of angiotensin II which causes increased plasma renin activity and reduced aldosterone secretion. It also reduces Na and water retention. This promotes vasodilation and BP reduction.
Onset: 1 hr.
Duration: 24 hr.
Pharmacokinetics:
Absorption: Absorbed from the GI tract (approx 36%). Bioavailability: 36%. Time to peak plasma concentration: Approx 3 hr (fosinoprilat).
Distribution: Distributed in milk. Plasma protein binding: >95% (fosinoprilat).
Metabolism: Rapidly and completely hydrolysed to fosinoprilat (active metabolite) in GI mucosa and liver.
Excretion: Via urine and faeces. Elimination half-life: Approx 11.5 hr (hypertensive patients); approx 14 hr (patients w/ heart failure).
Storage
Store between 20-25°C. Protect from moisture.
Disclaimer: This information is independently developed by MIMS based on Fosinopril from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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