Pharmacologic class: Angiotensin-converting enzyme (ACE) inhibitor
Therapeutic class: Antihypertensive
Pregnancy risk category C (first trimester), D (second and third trimesters)
Prevents conversion of angiotensin I to the vasoconstrictor angiotensin II, thereby reducing sodium and water retention and enhancing blood flow in circulatory system
Tablets: 10 mg, 20 mg, 40 mg
Indications and dosages
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.
• Renal impairment
• Adjunct in myocardial infarction
• Hypersensitivity to drug or other ACE inhibitors
• Angioedema (hereditary or idiopathic)
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).
• Don't administer within 2 hours of antacids.
• Give with or without food, but avoid giving with high-potassium foods or potassium supplements.
CNS: dizziness, drowsiness, fatigue, headache, insomnia, weakness, vertigo
CV: hypotension, angina pectoris, tachycardia
GI: nausea, vomiting, diarrhea, anorexia
GU: proteinuria, erectile dysfunction, decreased libido, renal failure
Hematologic: agranulocytosis, bone marrow depression
Respiratory: cough, bronchitis, dyspnea, asthma, eosinophilic pneumonitis
Skin: rash, angioedema
Other: altered taste, fever, hypersensitivity reactions including anaphylaxis
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
• 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.
☞ 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 is pregnant.
• Tell patient that he will 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.