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fosinopril sodium
Monopril, Staril§

Pregnancy Risk Category C (D in second and third trimesters)

How supplied
Tablets:
10 mg, 20 mg, 40 mg

Action
Antihypertensive action not clearly defined. Inhibits ACE, preventing conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Reduced formation of angiotensin II decreases peripheral arterial resistance, thus decreasing aldosterone secretion.

Indications & dosage
Hypertension
--
Adults:
initially, 10 mg P.O. daily. Dosage is adjusted based on blood pressure response at peak and trough levels. Usual dose is 20 to 40 mg; maximum is 80 mg daily. Dosage is divided if needed.
Heart failure
--
Adults:
initially, 10 mg P.O. once daily. Dosage increased over several weeks to a maximum of 40 mg P.O. daily, if needed.
Adjust-a-dose:
For patients with moderate to severe renal failure or vigorous diuresis, initially, 5 mg P.O. once daily.

Adverse reactions
CNS: CVA,
headache, dizziness, fatigue, syncope, paresthesia, sleep disturbance.
CV:
chest pain, angina, MI, rhythm disturbances, palpitations, hypotension, orthostatic hypotension.
EENT:
tinnitus, sinusitis.
GI:
nausea, vomiting, diarrhea, pancreatitis, dry mouth, abdominal distention, abdominal pain, constipation.
GU:
sexual dysfunction, decreased libido, renal insufficiency, elevated BUN and serum creatinine levels.
Hematologic:
decreased hemoglobin level and hematocrit.
Hepatic: hepatitis,
elevated liver function test results.
Metabolic:
hyperkalemia.
Musculoskeletal:
arthralgia, musculoskeletal pain, myalgia.
Respiratory:
bronchospasm; dry, persistent, tickling, nonproductive cough.
Skin:
urticaria, rash, photosensitivity, pruritus.
Other: angioedema,
gout.

Interactions
Drug-drug.
Antacids: may impair absorption. Separate administration times by at least 2 hours.
Diuretics, other antihypertensives:
risk of excessive hypotension. Diuretic may need to be discontinued or fosinopril dosage lowered.
Lithium:
increased serum lithium levels and lithium toxicity. Monitor serum lithium levels.
Potassium-sparing diuretics, potassium supplements:
risk of hyperkalemia. Monitor closely during concomitant use.
Drug-food.
Salt substitutes containing potassium: risk of hyperkalemia. Monitor closely during concomitant use.

Effects on diagnostic tests
False low measurements of digoxin levels may result with the Digi-Tab radioimmunoassay kit for digoxin; other kits may be used.

Contraindications
Contraindicated in patients with hypersensitivity to drug or other ACE inhibitors and in breast-feeding women.

Nursing considerations

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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