fosinopril sodium

fosinopril sodium

Monopril, Staril (UK)

Pharmacologic class: Angiotensin-converting enzyme (ACE) inhibitor

Therapeutic class: Antihypertensive

Pregnancy risk category C (first trimester), D (second and third trimesters)

FDA Boxed Warning

• When used during second or third trimester of pregnancy, drug may cause fetal injury or even death. Discontinue as soon as pregnancy is detected

Action

Prevents conversion of angiotensin I to the vasoconstrictor angiotensin II, thereby reducing sodium and water retention and enhancing blood flow in circulatory system

Availability

Tablets: 10 mg, 20 mg, 40 mg

⊘Indications and dosages

➣ Hypertension

Adults: 10 mg P.O. daily. May increase as required up to 80 mg/day; typical range is 20 to 40 mg P.O. daily.

➣ Heart failure

Adults: 10 mg P.O. daily. May increase over several weeks up to 40 mg/day; typical range is 20 to 40 mg/day.

Dosage adjustment

• Renal impairment

Off-label uses

• Adjunct in myocardial infarction
• Nephropathy

Contraindications

• Hypersensitivity to drug or other ACE inhibitors
• Angioedema (hereditary or idiopathic)
• Pregnancy

Precautions

Use cautiously in:
• aortic stenosis, cardiomyopathy, cerebrovascular or cardiac insufficiency, renal or hepatic impairment, hyponatremia, hypovolemia
• black patients with hypertension
• patients receiving diuretics concurrently
• elderly patients
• breastfeeding patients (safety not established)
• children (safety not established).

Administration

• Don't administer within 2 hours of antacids.
• Give with or without food, but avoid giving with high-potassium foods or potassium supplements.

Route	Onset	Peak	Duration
P.O.	Within 1 hr	2-6 hr	24 hr

Adverse reactions

CNS: dizziness, drowsiness, fatigue, headache, insomnia, weakness, vertigo

CV: hypotension, angina pectoris, tachycardia

EENT: sinusitis

GI: nausea, vomiting, diarrhea, anorexia

GU: proteinuria, erectile dysfunction, decreased libido, renal failure

Hematologic: agranulocytosis, bone marrow depression

Metabolic: hyperkalemia

Respiratory: cough, bronchitis, dyspnea, asthma, eosinophilic pneumonitis

Skin: rash, angioedema

Other: altered taste, fever, hypersensitivity reactions including anaphylaxis

Interactions

Drug-drug. Allopurinol: increased risk of hypersensitivity reaction

Antacids: decreased fosinopril absorption

Antihypertensives, diuretics, general anesthetics, nitrates, phenothiazines: additive hypotension

Cyclosporine, indomethacin, potassium-sparing diuretics, potassium supplements: hyperkalemia

Digoxin, lithium: increased blood levels of these drugs, greater risk of toxicity

Indomethacin: decreased hypotensive effects

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, potassium: increased levels

Antinuclear antibody titer: false-positive result

Sodium: decreased level

Drug-food. Salt substitutes containing potassium: hyperkalemia

Drug-herbs. Capsaicin: increased incidence of cough

Drug-behaviors. Acute alcohol ingestion: additive hypotension

Patient monitoring

• Monitor cardiovascular, respiratory, and neurologic status.
• Monitor CBC and liver and kidney function tests.
• Measure blood pressure to assess drug efficacy and detect hypotension.
• Assess patient's potassium intake; monitor serum potassium level.
☞ Monitor for signs and symptoms of angioedema and anaphylaxis. If these occur, withdraw drug and contact prescriber immediately.

Patient teaching

☞ Instruct patient to immediately report rash or difficulty breathing.
• Tell patient to report dizziness, fainting, bleeding tendency, change in urination pattern, swelling, or persistent cough.
• Encourage patient to drink enough fluids to stay well hydrated.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Instruct female patient to notify prescriber if she suspects she's pregnant.
• Tell patient that he'll undergo regular blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.