II. Indications

III. Mechanism

  1. See ACE Inhibitor
  2. Phosphinic acid-containing Angiotensin Converting Enzyme (ACE) inhibitor
  3. Fosinopril is a prodrug, converted to its active form Fosinoprilat via hydrolysis by esterases

IV. Dosing: Adults

  1. Adequate 24 hour Blood Pressure control may require twice daily dosing
  2. Hypertension
    1. Start 10 mg orally daily or divided twice daily
      1. Start 5 mg orally daily if elderly, renal dysfunction or concurrent Diuretic
    2. Target 20 mg to 40 mg/day
    3. Maximum 80 mg/day (no added benefit for doses >40 mg/day)
  3. Congestive Heart Failure (CHF)
    1. Start 5 to 10 mg orally daily
    2. Target 20-40 mg/day
    3. Maximum: 40 mg/day
  4. Diabetic Nephropathy (not FDA approved)
    1. Take 10 to 20 mg orally daily

V. Dosing: Children (age 6 to 16 years old, weight >=50 kg)

  1. Contraindicated in age <6 years old or weight <50 kg
  2. Hypertension
    1. Give 5 to 10 mg orally daily

VI. Supplied

  1. Available as scored tablets (10 mg) and unscored tablets (20 and 40 mg)

VII. Metabolism

  1. Excretion both renal and hepatic

VIII. Adverse Effects

IX. Safety

  1. See ACE Inhibitor
  2. Pregnancy Category X
  3. Avoid in Lactation

XI. References

  1. (2016) Presc Lett, Resource #321151, ACE Inhibitor Antihypertensive Dose Comparison
  2. (2020) Med Lett Drugs Ther 62(1598): 73-80
  3. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 68-9
  4. Hamilton (2020) Tarascon Pocket Pharmacopoeia

Images: Related links to external sites (from Bing)

Related Studies

Cost: Medications

fosinopril (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
FOSINOPRIL SODIUM 10 MG TAB Generic $0.17 each
FOSINOPRIL SODIUM 20 MG TAB Generic $0.17 each
FOSINOPRIL SODIUM 40 MG TAB Generic $0.21 each
FOSINOPRIL-HYDROCHLOROTHIAZIDE 10-12.5 MG TAB Generic $0.32 each
FOSINOPRIL-HYDROCHLOROTHIAZIDE 20-12.5 MG TAB Generic $0.65 each

Ontology: Fosinopril (C0118168)

Definition (NCI) A phosphinic acid-containing angiotensin-converting enzyme (ACE) inhibitor with antihypertensive activity. As an ester prodrug, fosinopril is hydrolysed by esterases to its active metabolite fosinoprilat. Fosinoprilat specifically and competitively inhibits angiotensin-converting enzyme thereby decreasing the formation of the potent vasoconstrictor angiotensin II, resulting in diminished vasopressor activity. In addition, angiotensin II-mediated aldosterone secretion by adrenal cortex is decreased, which results in a decrease of sodium retention and an increase in water outflow.
Definition (MSH) A phosphinic acid-containing angiotensin-converting enzyme inhibitor that is effective in the treatment of hypertension. It is a prodrug that is converted to its active metabolite fosinoprilat.
Concepts Pharmacologic Substance (T121) , Organophosphorus Compound (T115)
MSH D017328
SnomedCT 108569005, 372510000
LNC LP171400-7
English Fosenopril, Fosinopril, L-Proline, 4-cyclohexyl-1-(((2-methyl-1-(1-oxopropoxy)propoxy)(4-phenylbutyl)phosphinyl)acetyl)-, (1(S*(R*)),2alpha,4beta)-, fosinopril, Fosinopril [Chemical/Ingredient], FOSINOPRIL, Fosinopril (product), Fosinopril (substance)
Swedish Fosinopril
Czech fosinopril
Finnish Fosinopriili
Russian FOSENOPRIL, FOSINOPRIL, ФОСЕНОПРИЛ, ФОСИНОПРИЛ
Japanese ホセノプリル, ホシノプリル
Italian Fosenopril, Fosinopril
Polish Fozynopryl, Fosenopryl
Spanish fosinopril (producto), fosinopril (sustancia), fosinoprilo, fosinopril, Fosenopril, Fosinopril
French Fosénopril, Fosinopril
German Fosenopril, Fosinopril
Portuguese Fosenopril, Fosinopril

Ontology: Monopril (C0728957)

Concepts Amino Acid, Peptide, or Protein (T116) , Organophosphorus Compound (T115) , Pharmacologic Substance (T121)
MSH D017328
English monopril, Monopril, Staril, Bristol Myers Squibb Brand of Fosinopril Sodium, Bristol-Myers Squibb Brand of Fosinopril Sodium, Fosinorm, Newace