Classifications: angiotensin-converting enzyme (ace) inhibitor; antihypertensive agent; Therapeutic: antihypertensive; ace inhibitor
Pregnancy Category: C first trimester; D second and third trimesters
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
Mild to moderate hypertension, CHF.
Hypersensitivity to fosinopril or any other ACE inhibitor; history of angioedema; renal artery stenosis; pregnancy [category
C (first trimester), category D (second or third trimester)], lactation.
Impaired kidney function, hepatic disease; hyperkalemia, or surgery and anesthesia; aortic stenosis or cardiomyopathy; elderly.
Safety in children is not established.
Route & Dosage
Adult: PO 540 mg once/d (max: 80 mg/d)
- Discontinue diuretics 23 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.
Adverse Effects (≥1%)CV:
, dizziness. Endocrine:
Nausea, vomiting, diarrhea
s may decrease antihypertensive effects of fosinopril. potassium supplements
, potassium-sparing diuretics
increase risk of hyperkalemia. ACE inhibitors
may increase lithium
levels and toxicity
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% in urine, 46% in feces. Half-Life:
34 h (fosinoprilat).
Assessment & Drug Effects
- Monitor BP at the time of peak effectiveness, 26 h after dosing and at the end of the dosing interval just before next
- 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.