Nurses Compass
Drug Guide
Fosinopril Sodium
Classification
Therapeutic: Antihypertensive
Pharmacological: ACE Inhibitor (Angiotensin-Converting Enzyme Inhibitor)
FDA Approved Indications
- Hypertension
- Heart failure (adjunctive therapy)
Mechanism of Action
Fosinopril inhibits angiotensin-converting enzyme, decreasing the conversion of angiotensin I to angiotensin II, leading to vasodilation, decreased blood volume, and reduced blood pressure.
Dosage and Administration
Adult: Initial dose typically 10-40 mg daily, single or divided doses. Dose adjustments based on response.
Pediatric: Limited data; not generally recommended for children.
Geriatric: Start at lower dose due to increased risk of hypotension and renal impairment.
Renal Impairment: Adjust dose based on renal function; monitor renal function closely.
Hepatic Impairment: Use caution; dose adjustment may be necessary, monitor hepatic function.
Pharmacokinetics
Absorption: Well absorbed orally.
Distribution: Widely distributed including crossing the placental barrier.
Metabolism: Biotransformed in the liver (less extensive than other ACE inhibitors).
Excretion: Excreted primarily via urine and feces.
Half Life: Approximately 12 hours.
Contraindications
- History of angioedema related to previous ACE inhibitor therapy
- Hereditary or idiopathic angioedema
- Bilateral renal artery stenosis
- Hypersensitivity to fosinopril or other ACE inhibitors
Precautions
- Pregnancy (teratogenic effects), Pregnant women should discontinue use; use only if clearly needed during pregnancy after evaluating risks.
- History of renal impairment, Hyperkalemia, Renal artery stenosis, Volume depletion
Adverse Reactions - Common
- Cough (Common)
- Dizziness, hypotension (Common)
- Headache (Common)
- Fatigue (Common)
Adverse Reactions - Serious
- Angioedema (Rare)
- Elevated serum potassium (hyperkalemia) (Rare)
- Renal function deterioration (Rare)
Drug-Drug Interactions
- Diuretics, especially potassium-sparing ones
- Other antihypertensives
- Potassium supplements
- Lithium
- NSAIDs
Drug-Food Interactions
- Limited data, but salt substitutes containing potassium should be used cautiously.
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood pressure, renal function (BUN, serum creatinine), and serum electrolytes (potassium). Watch for signs of angioedema.
Diagnoses:
- Ineffective tissue perfusion related to hypotension
- Risk for electrolyte imbalance
- Risk for renal insufficiently
Implementation: Administer drug as prescribed; monitor vital signs and labs frequently, especially at initiation and dose changes.
Evaluation: Assess blood pressure for therapeutic effect; monitor for adverse effects; evaluate renal function and electrolytes periodically.
Patient/Family Teaching
- Take medication exactly as prescribed, at the same time each day.
- Report signs of angioedema (swelling of face, lips, tongue, difficulty breathing).
- Avoid potassium-rich salt substitutes unless directed by healthcare provider.
- Notify healthcare provider if pregnancy is planned or suspected.
- Monitor blood pressure regularly.
Special Considerations
Black Box Warnings:
- Pregnancy—fetal injury and death when used during pregnancy.
Genetic Factors: Genetic variations can affect ACE inhibitor metabolism and response.
Lab Test Interference: May cause falsely elevated serum potassium and creatinine levels.
Overdose Management
Signs/Symptoms: Severe hypotension, reflex tachycardia.
Treatment: Discontinue medication; provide supportive care, monitor vital signs, administer IV fluids if needed, and consider vasopressor therapy.
Storage and Handling
Storage: Store at room temperature, 20-25°C (68-77°F).
Stability: Stable for at least 24 months when stored properly.