FOSINOPRIL

Indications & Dose:

Adult and Child >16 yr 

•  BY MOUTH

Hypertension:

PO 10 mg qd; usual dose range, 20-40 mg qd; maximal dose 40 mg qd, though dose response curve usually flat after 40 mg qd

Congestive heart failure

PO 5 (for volume-depleted, moderate to severe renal failure) = 10 mg qd; usual dose range 20-40 mg qd or titrate to systolic blood pressure of 100 mm Hg

Myocardial infarction

PO 5 mg initial dose, repeated in 24 hr, with progressive doubling to a maximum dose of 20 mg qd, if systolic blood pressure remains over 100 mm Hg (fosinopril in acute myocardial infarction study, FAMIS)

Renal failure

PO <7.5 mg qd if CrCi < 10 ml/min 

Contraindications:

Side Effects:

CNS: Anxiety, dizziness, fatigue, headache, insomnia, paresthesia

CVS: Angina, hypotension, palpitations, postural hypotension, syncope (especially with 1st dose)

GI: Abdominal pain, constipation, melena, nausea, vomiting

GU: Decreased libido, impotence, increased BUN, creatinine, UTI

HEME: Agranulocytosis, neutropenia

METAB: Hyperkalemia, hyponatremia

MS: Arthralgia, arthritis, myalgia

RESP: Asthma, bronchitis, cough, dyspnea, sinusitis

SKIN: Angioedema, flushing, rash, sweating

Cautions:

Precautions:

History of anaphylaxis, renal insufficiency (<30 ml/min), hypotension (CHF, elderly, volume depletion-diuretics, dialysis, cirrhosis), aortic stenosis, hyperkalemia (potassium supplements, potassium sparing diuretics, renal disease, diabetes), neutropenia (autoimmune diseases, collagen vascular, febrile illness, immunosuppressant drug therapy), proteinuria, renal artery stenosis, surgery/anesthesia (excessive hypotension, correctable with fluids)  

BREAST FEEDING Not recommended; alternative treatment options, with better established safety information during breast-feeding, are available. l

HEPATIC IMPAIRMENT Fosinopril is a prodrug and requires close monitoring in patients with hepatic impairment

Interaction:

Drugs 

Allopurinol: Combination may predispose to hypersensitivity reactions

a adrenergic blockers: Exaggerated first dose hypotensive response when added to fosinopril

10 Aspirin: May reduce hemodynamic effects of fosinopril; less likely at doses under 236 mg; less likely with nonacetylated salicylates

Azathioprine: Increased myelosuppression

Cyclosporine: Combination may cause renal insufficiency

Insulin: Fosinopril may enhance insulin sensitivity

Iron: Fosinopril may increase chance of systemic reaction to IV iron

Lithium: Reduced lithium clearance

Loop diuretics: Initiation of fosinopril may cause hypotension and renal insufficiency in patients taking loop diuretics

NSAIDs: May reduce hemodynamic effects of fosinopril

Potassium-sparing diuretics: Increased risk of hyperkalemia

Trimethoprim: Additive risk of hyperkalemia, especially in patient predisposed to renal insufficiency

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: