Class: ACEI, Antihypertensive
Dosage Forms. Tablet: 10 mg, 20 mg, 40 mg
Common FDA Label Indication, Dosing, and Titration.
1. CHF: 5-10 mg po daily, may titrate to 40 mg po daily
2. Hypertension: Adults, 10 mg po daily, may titrate to 80 mg po daily; Children 6-16 y and weighing >50 kg, 5-10 mg po daily, may titrate to 40 mg po daily
Off-Label Uses.
1. Diabetic nephropathy: 20-40 mg po daily
2. Kidney disease: 10-30 mg po daily or in divided doses
3. Myocardial infarction: 5 mg po daily, may titrate to 20 mg po daily
MOA. Fosinopril is a competitive ACE inhibitor. It also reduces serum aldosterone, leading to decreased sodium retention, potentiates the vasodilator kallikrein-kinin system, and can alter prostanoid metabolism, inhibit the sympathetic nervous system, and inhibit the tissue renin-angiotensin system.
Drug Characteristics: Fosinopril
Medication Safety Issues: Fosinopril
Drug Interactions: Fosinopril
Adverse Reactions: Fosinopril
Efficacy Monitoring Parameters. Decreased BP, decrease in signs of CHF.
Toxicity Monitoring Parameters. Signs/symptoms of angioedema (swelling of the face, eyes, lips, tongue, or throat), severe persistent cough, hypotension; monitor baseline and periodic electrolytes, SCr, BUN, urine protein.
Key Patient Counseling Points. Full effect may require 2-4 wk. Avoid pregnancy. Use potassium supplements or salt substitutes only under medical supervision. May cause dizziness that may worsen if dehydrated.
Clinical Pearls. Observe patients who are volume depleted for at least 2 h after taking the initial dose of fosinopril. Discontinue if renal deterioration occurs.