Fosinopril Sodium

Indications

Fosinopril Sodium is used for: Hypertension, Congestive heart failure

Adult Dose

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. 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.

Child Dose

Oral Hypertension Child: <50 kg: Limited data suggests 0.1-0.6 mg/kg PO qDay >50 kg: 5-10 mg PO qDay initially, not to exceed 40 mg/day

Renal Dose

Renal impairment: 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.

Contra Indications

Hypersensitivity, idiopathic or hereditary angioedema, history of angioedema related to previous treatment with an ACE inhibitor. Bilateral renal artery stenosis. Pregnancy (2nd and 3rd trimesters), lactation.

Precautions

Severely impaired renal function; hyperkalaemia, hypovolaemia, collagen vascular diseases, valvular stenosis; before, during or immediately after anaesthesia, unilateral renal artery stenosis. Lactation: excreted in breast milk; not recommended

Pregnancy-Lactation

Pregnancy Category: D Discontinue as soon as pregnancy detected; during the second and third trimesters of pregnancy, drugs that act directly on the renin-angiotensin have been associated with fetal injury that includes hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death Lactation: excreted in breast milk; not recommended

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).

Adverse Effects

Side effects of Fosinopril Sodium : >10% Dizziness (1.6-11.9%) 1-10% Cough (2.2-9.7%), Headache (3.2%), Hyperkalemia (2.6%), Diarrhea (2.2%), Orthostatic hypotension (1.4-1.9%), Fatigue (1-2%) Frequency Not Defined Angioedema, ARF if renal artery stenosis, Aplastic anemia, Neutropenia, Arthralgia, Interstitial nephritis, Vasculitis, Rash. Potentially Fatal: Cerebrovascular accident, rhythm disturbances, palpitations, hypotension, syncope, rashes, oedema, hypersensitivity reactions, angioedema.

Mechanism of Action

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.