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