FOSINOPRIL
(fos-in'o-pril)
Monopril
Classifications: cardiovascular agent; angiotensin-converting enzyme (ace) inhibitor; antihypertensive agent
Prototype: Enalapril
Pregnancy Category: C (first trimester); D (second and third trimesters)
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10 mg, 20 mg, 40 mg tablets
Lowers BP by interrupting conversion sequences initiated by renin that lead to formation of angiotensin II, a potent vasoconstrictor.
Inhibition of ACE also leads to decreased circulating aldosterone, a secretory response to angiotensin II stimulation.
Lowers blood pressure and reduces peripheral arterial resistance (afterload) and improves cardiac output as well as activity
tolerance.
Mild to moderate hypertension, CHF.
Hypersensitivity to fosinopril or any other ACE inhibitor; pregnancy [category C (first trimester), category D (second or
third trimesters)], lactation.
Impaired kidney function, hyperkalemia, or surgery and anesthesia. Safety in children is not established.
Hypertension, CHF
Adult: PO 5–40 mg once/d (max: 80 mg/d)
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Oral
- Discontinue diuretics 2–3 d before initiation of therapy if possible. If diuretics cannot be discontinued, start initial
dose
10 mg.
- Store at 15°–30° C (59°–86° F) and protect from moisture.
CV: Hypotension. CNS: Headache, fatigue, dizziness. Endocrine: Hyperkalemia. GI: Nausea, vomiting, diarrhea. Urogenital: Proteinuria. Respiratory: Cough. Skin: Rash.
Drug: nsaids may decrease antihypertensive effects of fosinopril. potassium supplements, potassium-sparing diuretics increase risk of hyperkalemia. ACE inhibitors may increase lithium levels and toxicity.
Absorption: Readily absorbed from GI tract; converted to its active form, fosinoprilat, in the liver. Peak: 3 h. Duration: 24 h. Distribution: Approximately 90% protein bound; crosses placenta. Metabolism: Hydrolyzed by intestinal and hepatic esterases to its active form, fosinoprilat. Elimination: 44% excreted in urine, 46% in feces. Half-Life: 3–4 h (fosinoprilat).
Assessment & Drug Effects
- Monitor BP at the time of peak effectiveness, 2–6 h after dosing and at the end of the dosing interval just before next
dose.
- Report diminished antihypertensive effect toward the end of the dosing interval. An inadequate trough response may be an indication
for dividing the daily dose.
- Monitor for first-dose hypotension, especially in salt- or volume-depleted patients.
- Lab tests: Obtain BUN and serum creatinine periodically. Increases may necessitate dose reduction or discontinuation of the
drug. Monitor serum potassium.
- Observe for S&S of hyperkalemia (see Appendix F).
Patient & Family Education
- Discontinue fosinopril and report to physician any of the following: S&S of angioedema (e.g., swelling of face or extremities,
difficulty breathing or swallowing); syncope; chronic, nonproductive cough.
- Maintain adequate fluid intake and avoid potassium supplements or salt substitutes unless specifically prescribed by the physician.
- Report vomiting or diarrhea to physician immediately.
- Do not breast feed while taking this drug.
1%)
Canadian drug name; 
Prototype drug