fosinopril sodium Nursing Considerations & Management

 Drug Name

Generic Name :  fosinopril sodium

Brand Name: Monopril

Classification:  Antihypertensive, ACE inhibitor

  • Pregnancy Category C (first trimester)
  • Pregnancy Category D (second and third trimesters)
Dosage & Route
  • Available forms : Tablets—10, 20, 40 mg
  • Initial dose, 10 mg PO daily. Maintenance dose, 20–40 mg/day PO as a single dose or two divided doses. In patients receiving diuretic therapy, begin fosinopril therapy with 10 mg. Do not exceed maximum dose of 80 mg.
  • Safety and efficacy not established.
Therapeutic actions
  • Fosinopril competitively inhibits ACE from converting angiotensin I to angiotensin II resulting in decreased levels of angiotensin II which causes increased plasma renin activity and reduced aldosterone secretion. It also reduces sodium and water retention. By these mechanisms, fosinopril produces hypotensive effect.
  • Treatment of hypertension, alone or in combination with thiazide-type diuretics
  • Management of CHF as adjunctive therapy
Adverse effects
  • Dizziness, orthostatic hypotension, palpitation, headache, weakness, fatigue, hyperkalaemia, chest pain, musculoskeletal pain, dry cough, nausea, vomiting, dyspepsia, diarrhoea.
  • Potentially Fatal: Cerebrovascular accident, rhythm disturbances, palpitations, hypotension, syncope, rashes, oedema, hypersensitivity reactions, angioedema.
  • Hypersensitivity, idiopathic or hereditary angioedema, history of angioedema related to previous treatment with an ACE inhibitor. Bilateral renal artery stenosis. Pregnancy (2nd and 3rd trimesters), lactation.
Nursing considerations
CLINICAL ALERT! Name confusion has occurred between fosinopril and lisinopril; use caution.
  • History: Allergy to fosinopril and other ACE inhibitors, impaired renal or hepatic function, hyperkalemia, salt or volume depletion, lactation, pregnancy
  • Physical: Skin color, lesions, turgor; T; P, BP, peripheral perfusion; mucous membranes, bowel sounds, liver evaluation; urinalysis, LFTs, renal function tests, CBC, and differential
  • WARNING: Alert surgeon and mark patient’s chart with notice that fosinopril is being taken; the angiotensin II formation subsequent to compensatory renin release during surgery will be blocked; hypotension may be reversed with volume expansion.
  • BLACK BOX WARNING: Suggest use of a contraceptive. Pregnancy should be avoided; fetal damage can occur.
  • Arrange to switch to a different drug if pregnancy occurs; suggest using barrier contraceptives.
  • Monitor patient closely for a fall in BP secondary to reduction in fluid volume (excessive perspiration and dehydration, vomiting, diarrhea); excessive hypotension may occur.
Teaching points
  • Do not stop taking the medication without consulting your health care provider.
  • Avoid pregnancy while taking this drug; using barrier contraceptives is advised.
  • Be careful with any conditions that may lead to a drop in blood pressure (such as diarrhea, sweating, vomiting, dehydration); if light-headedness or dizziness occurs, consult your health care provider.
  • You may experience these side effects: GI upset, loss of appetite (these may be transient); light-headedness (transient; change position slowly and limit activities to those that do not require alertness and precision); dry cough (not harmful).
  • Report mouth sores; sore throat, fever, chills; swelling of the hands, feet; irregular heartbeat, chest pains; swelling of the face, eyes, lips, tongue, difficulty breathing, persistent cough.