Fosinopril sodium
Fosinopril sodium (Monopril)
Fosinopril sodium
(foh- SIN-oh-prill)
Pregnancy Category: D Monopril (Rx)

Classification: Angiotensin-converting enzyme inhibitor

See Also: See also Angiotensin-Converting Enzyme Inhibitors .

Action/Kinetics: Onset: 1 hr. Time to peak serum levels: About 3 hr. Metabolized in the liver to the active fosinoprilat. Peak effect: 2-6 hr. Over 99% bound to plasma proteins. t 1/2: 12 hr for fosinoprilat (prolonged in impaired renal function) following IV administration. Duration: 24 hr. Approximately 50% excreted through the urine and 50% in the feces. Food decreases the rate, but not the extent, of absorption of fosinopril.

Uses: Alone or in combination with other antihypertensive agents (especially thiazide diuretics) for the treatment of hypertension. Adjunct in treating CHF in clients not responding adequately to diuretics and digitalis. Diabetic hypertensive clients show a reduction in major CV events.

Contraindications: Use during lactation.

Side Effects: CV: Orthostatic hypotension, chest pain, hypotension, palpitations, angina pectoris, CVA, MI rhythm disturbances, TIA, tachycardia, hypertensive crisis claudication, bradycardia, hypertension, conduction disorder, sudden death, cardiorespiratory arrest, shock. CNS: Headache, dizziness, fatigue, confusion, memory disturbance, depression, behavior change, tremors, drowsiness, mood change, insomnia, vertigo, sleep disturbances. GI: N&V;, diarrhea, abdominal pain, constipation, dry mouth, dysphagia, taste disturbance, abdominal distention, flatulence, heartburn, appetite changes, weight changes. Hepatic: Hepatitis, pancreatitis, hepatomegaly, hepatic failure. Respiratory: Cough, sinusitis, dyspnea, URI, bronchospasm asthma, pharyngitis, laryngitis, tracheobronchitis, abnormal breathing, sinus abnormalities. Hematologic: Leukopenia, eosinophilia, decreases in hemoglobin (mean of 0.1 g/dL) or hematocrit, neutropenia. Dermatologic: Diaphoresis, photosensitivity, flushing, exfoliative dermatitis, pruritus, rash, urticaria. Body as a whole: Angioedema, muscle cramps, fever, syncope, influenza, cold sensation, pain, myalgia, arthralgia, arthritis, edema, weakness, musculoskeletal pain. GU: Decreased libido, sexual dysfunction, renal insufficiency, urinary frequency, abnormal urination, kidney pain. Miscellaneous: Paresthesias, tinnitus, gout, lymphadenopathy, rhinitis, epistaxis, vision disturbances, eye irritation, swelling/weakness of extremities, abnormal vocalization, pneumonia, muscle ache.

Laboratory Test Alterations: Serum potassium. Transient H&H.; False low measurement of serum digoxin levels with DigiTab RIA Kit for Digoxin.

How Supplied: Tablet: 10 mg, 20 mg, 40 mg

Dosage
?Tablets Hypertension.
Initial: 10 mg once daily; then, adjust dose depending on BP response at peak (2-6 hr after dosing) and trough (24 hr after dosing) blood levels. Maintenance: Usually 20-40 mg/day, although some clients manifest beneficial effects at doses up to 80 mg.
In clients taking diuretics.
Discontinue diuretic 2-3 days before starting fosinopril. If diuretic cannot be discontinued, use an initial dose of 10 mg fosinopril.
Congestive heart failure.
Initial: 10 mg once daily; then following initial dose, observe the client for at least 2 hr for the presence of hypotension or orthostasis (if either is present, monitor until BP stabilizes). An initial dose of 5 mg is recommended in heart failure with moderate to severe renal failure or in those who have had significant diuresis. Increase the dose over several weeks, not to exceed a maximum of 40 mg daily (usual effective range is 20-40 mg once daily).