What it's for (Indications)
- Fosinopril sodium is indicated for the treatment of hypertension (high blood pressure), including cases where single drug therapy is insufficient.
- It is also used in the management of congestive heart failure.
Dosage Information
| Type | Guideline |
|---|---|
| Standard | For hypertension in adults, the recommended initial dose is 10 mg once daily, both as monotherapy and when the drug is added to a diuretic. Dosage should then be adjusted according to blood pressure response at peak (2 to 6 hours) and trough (about 24 hours after dosing) blood levels. The usual dosage range needed to maintain a response at trough is 20 mg to 40 mg daily, but some patients may have a further response to 80 mg. If the antihypertensive effect diminishes toward the end of the dosing interval, dividing the daily dose should be considered. If blood pressure is not adequately controlled with fosinopril sodium alone, a diuretic may be added. |
Safety & Warnings
Common Side Effects
- Generally mild and transient, common side effects include dizziness, cough (which can be persistent), headache, fatigue, diarrhea, nausea, vomiting, and stomach disturbances.
- Elevated transaminases have also been observed.
- The frequency and incidence of adverse events in elderly patients (≥65 years old) were similar to those seen in younger patients.
Serious Warnings
- Black Box Warning: WARNING: FETAL TOXICITY. When pregnancy is detected, discontinue fosinopril sodium tablets as soon as possible. Drugs that act directly on the renin-angiotensin system can cause injury and death to the developing fetus.
- Caution is advised in patients undergoing hemodialysis, those with renovascular hypertension (hypertension due to kidney problems), and in patients with congestive heart failure.
- Concomitant use with potassium supplements, potassium salt substitutes, or potassium-sparing diuretics may lead to increased serum potassium levels.
- Patients should be advised against driving or operating machinery if experiencing dizziness.
- Alcohol consumption should be avoided.
- Monitoring for persistent cough and liver function (due to potential elevated transaminases) is recommended.
How it Works (Mechanism of Action)
Fosinopril sodium is a prodrug that is hydrolyzed by esterases to its pharmacologically active form, fosinoprilat. Fosinoprilat is a specific competitive inhibitor of angiotensin-converting enzyme (ACE), a peptidyl dipeptidase that catalyzes the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II. Angiotensin II also stimulates aldosterone secretion by the adrenal cortex. Inhibition of ACE results in decreased plasma angiotensin II, leading to decreased vasopressor activity and decreased aldosterone secretion. The latter decrease may result in a small increase of serum potassium. Removal of angiotensin II negative feedback on renin secretion leads to increased plasma renin activity.