Names and pronunciation
(foss′in-oh-pril)
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Drug reference
(foss′in-oh-pril)
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Func. class.: Antihypertensive
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Chem. class.: Angiotensin-converting enzyme (ACE) inhibitor
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ACTION: Selectively suppresses renin- angiotensin-aldosterone system; inhibits ACE; prevents conversion of angiotensin I to angiotensin II; results in dilation of arterial, venous vessels
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USES: Hypertension, alone or in combination with thiazide diuretics, sys- tolic HF
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Unlabeled uses: Proteinuria in nondia- betic nephropathy
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CONTRAINDICATIONS: Breast- feeding, children, hypersensitivity to ACE inhibitors, history of ACE-inhibitor– induced angioedema
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Black Box Warning: Pregnancy Precautions: Geriatric patients, impaired hepatic function, hypovolemia, blood dyscrasias, HF, COPD, asthma, angioedema, hyperkalemia, renal artery stenosis, renal disease, aortic stenosis, autoimmune disorders, collagen vascular disease, febrile illness, black patients Black Box Warning: Pregnancy: identify pregnancy before starting therapy; do not use in pregnancy, breastfeeding Black Box Warning: To notify prescriber if pregnancy is planned or suspected; to use contraception during treatment
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SIDE EFFECTS CNS: Headache, dizziness, fatigue, syn- cope, stroke, insomnia, weakness CV: MI, chest pain, angina, palpitations, flushing, hypotension, orthostatic hypo- tension, tachycardia GI: Nausea, constipation, vomiting, diarrhea, hepatotoxicity, pancreatitis, red, dry mouth, abdominal pain GU: Sexual dysfunction, urinary fre- quency, renal changes F HEMA: Decreased Hct, HB; eosinophilia, leukopenia, neutropenia, agranulocytosis META: Hyperkalemia INTEG: Rash, urticaria, photosensitivity, pruritus RESP: Cough, bronchospasm MS: Myalgia, arthralgia SYST: Anaphylaxis, angioedema
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INTERACTIONS Increase: hyperkalemia risk—potassium- sparing diuretics, potassium supplements Increase: hypotension—diuretics, other antihypertensives, ganglionic blockers, adrenergic blockers, nitrates, acute alco- hol ingestion Increase: toxicity—vasodilators, hydrAL- AZINE, prazosin, potassium-sparing diuretics, sympathomimetics, digoxin, lithium, NSAIDs Decrease: absorption—antacids Decrease: antihypertensive effect— salicylates Drug/Herb Increase: antihypertensive effect—haw- thorn Decrease: antihypertensive effect— ephedra Drug/Lab Test Increase: AST, ALT, alk phos, glucose, bilirubin, uric acid, BUN, potassium False positive: urine acetone Positive: ANA titer
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TREATMENT OF OVERDOSE: 0.9% NaCl IV infusion, hemodialysis
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DOSAGE AND ROUTES HF • Adult: PO 10 mg/day, then up to 40 mg/day increased over several wk; use lower dose for those diuresed before fo- sinopril, max 40 mg/day Hypertension • Adult: PO 10 mg/day initially, then 20- 40 mg/day divided bid or daily, max 80 mg/day • Child >50 kg: PO 5-10 mg daily, ini- tially, max 40 mg/day
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Available forms: Tabs 10, 20, 40 mg
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Administer: • May be taken without regard to meals • Store in tight container at ≤86° F (30° C)
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Assess: • Hypertension: B/P, orthostatic hypoten- sion, syncope • Collagen vascular disease: neutro- phils, decreased platelets; obtain WBC with differential baseline and monthly × 6 mo, then q2-3mo × 1 yr; if neutrophils <1000/mm3, discontinue Renal studies: protein, BUN, creatinine; increased levels may indicate nephrotic syndrome • Baselines of renal, hepatic studies be- fore therapy begins • Potassium levels • HF: edema in feet, legs daily; weigh daily • Allergic reactions: rash, fever, pruri- tus, urticaria; product should be discon- tinued if antihistamines fail to help; moni- tor for angioedema • Supine position for severe hypotension
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Evaluate: • Therapeutic response: decrease in B/P, decreased signs, symptoms in HF, prevention of early death due to MI, stroke
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Not to discontinue product abruptly; to take at same time of day • Not to use OTC products (cough, cold, allergy) unless directed by pre- scriber; not to use salt substitutes con- taining potassium without consulting prescriber • About the importance of complying with dosage schedule, even if feeling better • To rise slowly to sitting or standing position to minimize orthostatic hypotension • To notify prescriber of mouth sores, sore throat, fever, swelling of hands or feet, irregular heartbeat, chest pain, non- productive cough • To report excessive perspiration, dehy- dration, vomiting, diarrhea; may lead to fall in B/P • That product may cause dizziness, fainting, light-headedness during first few days of therapy • That product may cause skin rash or impaired perspiration • How to take B/P; normal readings for age group
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PHARMACOKINETICS Peak 3 hr, protein binding 99%, half-life 11.5-14 hr, metabolized by liver (metab- olites excreted in urine, feces, 50%)
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• Adult: PO 10 mg/day, then up to 40 mg/day increased over several wk; use lower dose for those diuresed before fo- sinopril, max 40 mg/day Hypertension
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• Adult: PO 10 mg/day initially, then 20- 40 mg/day divided bid or daily, max 80 mg/day
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