GENERIC NAME: fosinopril sodium

BRAND NAME: Monopril

DRUG CLASS AND MECHANISM: Angiotensin converting enzyme (ACE) is the enzyme in blood which controls the formation of angiotensin II, a chemical in blood that causes constriction of arteries and veins. Constriction of arteries and veins elevates blood pressure. Fosinopril is in a class of drugs called ACE inhibitors which 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.

PRESCRIPTION: yes

GENERIC AVAILABLE: no

PREPARATIONS: Tablets (white-to-off-white): 10mg (biconvex-diamond-shaped); 20mg (oval)

STORAGE: Tablets should be stored between 15 and 30°C (86°F).

PRESCRIBED FOR: Fosinopril is used in treating high blood pressure. Its blood pressure lowering effect can be further enhanced by adding a diuretic medication ("water pill") such as hydrochlorothiazide . Fosinopril also is used in the treatment of congestive heart failure, a condition in which the heart is not able to pump enough blood. In patients with congestive heart failure, the ACE inhibitor class of medications has been shown to reduce symptoms and hospitalization and to improve survival. After a heart attack, ACE inhibitors improve the function of the damaged heart and reduce symptoms and hospitalizations due to congestive heart failure.

DOSING: 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.

DRUG INTERACTIONS: Although the combination of ACE inhibitors and diuretics is generally a favorable one (see above), fosinopril (and other ACE inhibitors) can work "too well" with diuretics and cause an excessive drop in blood pressure. This can cause symptoms of weakness, dizziness, and light-headedness. This is most likely to occur when patients already taking a diuretic start taking an ACE inhibitor. 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.

It is recommended that fosinopril not be taken at the same time as aluminum or magnesium-based antacids, such as Mylanta or Maalox, since these antacids 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 in the body in patients taking lithium, sometimes causing lithium- associated side effects.

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

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

SIDE EFFECTS: Fosinopril is generally well tolerated. The most common side effects are headache, cough, dizziness, diarrhea, fatigue, nausea, vomiting, complaints of sexual dysfunction, and abnormal liver tests. Impairment of kidney function has been reported with ACE inhibitors, especially in patients with severe heart failure or kidney disease. In rare instances, low white blood cell counts have been reported with the use of captopril , another ACE inhibitor. (Low white blood cells increase a patient's risk of infections.)

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