fosinopril sodium (Monopril)

Fosinopril is in a class of drugs called angiotensin converting enzyme (ACE) inhibitors. ACE inhibitors are used for treating high blood pressure, heart failure and for preventing kidney failure due to high blood pressure and diabetes. Other ACE inhibitors include enalapril (Vasotec), quinapril (Accupril), captopril (Capoten), ramipril (Altace), benazepril (Lotensin), lisinopril (Zestril, Prinivil), moexipril (Univasc) and trandolapril (Mavik). ACE is an enzyme in blood which controls the formation of angiotensin II, a chemical that circulates in blood and causes constriction of arteries and veins. Constriction of arteries and veins elevates blood pressure. ACE inhibitors inhibit ACE and block the formation of angiotensin II. By blocking the formation of angiotensin II, fosinopril relaxes the arteries and veins and lowers blood pressure. By reducing blood pressure, fosinopril also reduces the work that the heart must do to pump blood through the arteries and veins. This improves the output of blood from the heart especially when the heart is failing. The FDA approved fosinopril in May 1991.

Is fosinopril sodium available as a generic drug?

GENERIC AVAILABLE: Yes

Do I need a prescription for fosinopril sodium?

Yes

Fosinopril is generally well tolerated. The most common side effects are:

• headache,
• cough,
• dizziness,
• diarrhea,
• fatigue,
• nausea,
• vomiting, and
• increase in potassium levels.

Sexual dysfunction and abnormal liver tests also occur. Impairment of kidney function has been reported with ACE inhibitors, especially in patients with severe heart failure or kidney disease.

Other important and serious side effects, although rare, include:

• liver failure,
• low white blood cell counts (neutropenia) and
• angioedema (swelling of lips and throat that can obstruct breathing).

The recommended adult dose for treating hypertension or heart failure is 10-40 mg once or twice daily. The maximum dose is 80 mg daily. Fosinopril is generally prescribed once daily, although some patients may need two doses per day. Patients with reduced kidney function need lower doses since their kidneys do not eliminate fosinopril from the body as well as normal kidneys. Fosinopril may be taken with or without food.

Combining fosinopril with potassium supplements, potassium containing salt substitutes, or potassium-conserving diuretics such as amiloride (Moduretic), spironolactone (Aldactone), and triamterene (Dyazide, Maxzide), can lead to dangerously high blood levels of potassium (hyperkalemia) since fosinopril has a tendency to reduce the excretion of potassium. Fosinopril should not be taken at the same time as aluminum or magnesium-based antacids, such as simethicone (Mylanta, Gas-X, etc.) or Maalox since these antacids bind fosinopril and decrease the amount of fosinopril that is absorbed from the intestine. Patients should take antacids and fosinopril at least two hours apart.

Fosinopril can cause an increase in the amount of lithium (Eskalith, Lithobid) in the body in patients taking lithium, sometimes causing lithium-associated side effects.

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, Medipren, Nuprin, PediaCare Fever, etc.), indomethacin (Indocin, Indocin-SR), and naproxen (Anaprox, Naprelan, Naprosyn, Aleve) may reduce the effects of ACE inhibitors on blood pressure. Combining fosinopril or other ACE inhibitors with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients who are elderly, volume-depleted (including those on diuretic therapy), or with poor kidney function may result in reduced kidney function, including kidney failure. These effects usually are reversible. Nitritoid reactions (symptoms include facial flushing, nausea, vomiting, and hypotension) may occur when injectable gold sodium aurothiomalate (Myochrysine), used in the treatment of rheumatoid arthritis, is combined with ACE inhibitors, including fosinopril.

ACE inhibitors, including fosinopril, can be harmful to the fetus and should not be taken by pregnant women.

Fosinopril is secreted in breast milk and is not recommended for nursing mothers.

What preparations of fosinopril sodium are available?

Tablets: 10, 20, and 40 mg

How should I keep fosinopril sodium stored?

Tablets should be stored between 15-30 C (59-86 F).