Fosinopril sodium

How it works

It is a prodrug hydrolysed to fosinoprilat, which inhibits ACE to reduce the conversion of angiotensin I to angiotensin II, causing vasodilatation and reducing aldosterone-mediated salt and water retention.

Prescribing in practice

• It is contraindicated in pregnancy and in patients with a history of angioedema, including ACE-inhibitor-associated angioedema, and should be stopped if angioedema occurs.
• Use with caution in renal impairment, renovascular disease and volume depletion, and avoid concurrent potassium-sparing diuretics or potassium supplements unless hyperkalaemia is monitored.
• Symptomatic hypotension can occur, particularly with the first dose, in volume-depleted or diuretic-treated patients.

Monitoring

Check renal function and serum potassium before starting and after initiation or dose changes, and monitor blood pressure.

Counselling the patient

• Report any swelling of the face, lips, tongue or throat, or difficulty breathing, urgently.
• A dry persistent cough can occur; report it so alternatives can be considered.
• Tell your clinician if you may be pregnant, and avoid potassium-containing salt substitutes unless advised.

Evidence & guidelines

ACE inhibitors have strong trial evidence for benefit in heart failure and hypertension, and NICE guidance includes them as core therapy in these conditions.