Fosinopril

DEA Class; Rx

Common Brand Names; Monopril

• ACE Inhibitors

Oral ACE inhibitor; prodrug metabolized to active fosinoprilat; used once daily or in divided doses for both HTN and CHF; also has been used post-MI, but not FDA-approved; does not require dosage adjustment in renal failure, hepatic impairment, or dialysis.

Indicated for the treatment of hypertension

Hypersensitivity

History of hereditary or angioedema associated with previous ACE inhibitor treatment

Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan

Bilateral renal artery stenosis

Do not coadminister with aliskiren in patients with diabetes mellitus or with renal impairment (ie, GFR <60 mL/min/1.73 m²)

• Dizziness (1.6-11.9%)
• Cough (2.2-9.7%)
• Headache (3.2%)
• Hyperkalemia (2.6%)
• Diarrhea (2.2%)
• Orthostatic hypotension (1.4-1.9%)
• Fatigue (1-2%)
• Angioedema
• ARF if renal artery stenosis
• Aplastic anemia
• Neutropenia
• Arthralgia
• Interstitial nephritis
• Vasculitis
• Rash

Renal impairment, hepatic impairment, volume depletion, electrolyte abnormalities

Risk of hyperkalemia, especially with renal impairment, DM, or those taking concomitant K+-elevating drugs

Dual blockade of the renin angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for hypotension, hyperkalemia, and renal function changes (including acute renal failure) compared to monotherapy

ACE inhibition also causes increased bradykinin levels which putatively mediates angioedema

Coadministration with mTOR inhibitors (eg, temsirolimus) may increased risk for angioedema

Discontinue STAT if pregnant (see Contraindications and Black Box Warnings)

Less effective in blacks

Renal impairment may occur

Neutropenia/agranulocytosis reported

Cough may occur within the first few months

Cholestatic jaundice may occur

Use caution in severe aortic stenosis

Excessive hypotension if concomitant diuretics, hypovolemia, hyponatremia

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