fosinopril sodium: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
fosinopril sodium: clinical details
Prescribing considerations
- Assess volume depletion, hypotension, renal impairment, renovascular disease, valve obstruction and concomitant diuretic or potassium-raising therapy before initiation.
- Symptomatic hypotension is more likely with heart failure, dehydration, sodium depletion, dialysis or diuretic treatment.
- Use caution around major surgery or anaesthesia because hypotension may be enhanced.
- Angioedema can have delayed onset after weeks or years; discontinue permanently if ACE-inhibitor angioedema is suspected.
- Paediatric safety and effectiveness are not established for the selected product.
Contraindications and cautions
- Hypersensitivity to fosinopril, another ACE inhibitor or a formulation component.
- Previous ACE-inhibitor-associated angioedema, or hereditary or idiopathic angioedema.
- Second or third trimester of pregnancy.
- Sacubitril/valsartan use without the required washout.
- Aliskiren-containing treatment in diabetes or specified renal impairment.
Monitoring
- Check baseline blood pressure, renal function, potassium and sodium.
- Reassess blood pressure, renal function and electrolytes after initiation or treatment changes and during acute illness that may compromise renal function.
- Monitor more closely with chronic kidney disease, diabetes, older age, heart failure, volume depletion or interacting medicines.
- Investigate clinically important rises in creatinine or potassium and assess dehydration, renal artery stenosis and interacting medicines.
Clinical pharmacology
Fosinopril is an ester prodrug rapidly converted to active fosinoprilat. ACE inhibition reduces angiotensin II and aldosterone and limits bradykinin breakdown. Fosinoprilat is highly protein-bound and eliminated through renal and hepatic routes.
Formulation and product differences
- The selected product is an uncoated tablet containing lactose.
- It contains less than 1 mmol sodium per tablet and is considered essentially sodium-free.
- Food does not materially alter the extent of absorption.
fosinopril sodium preparations and strengths
Tablet
Route: Oral
Strengths: 10 mg, 20 mg
fosinopril sodium interactions
Check prescribed, non-prescription and complementary products with a pharmacist or prescriber. Important interactions include:
Sacubitril/valsartan
Concomitant use is contraindicated because it increases angioedema risk; a defined washout period is required when switching.
Potassium supplements, potassium-containing salt substitutes and potassium-sparing diuretics
May cause clinically important hyperkalaemia. Avoid unsupervised use and monitor potassium when combination treatment is necessary.
Trimethoprim, co-trimoxazole, ciclosporin or heparin
Can further increase potassium, requiring caution and monitoring.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.