#monopril

Brand Name: Monopril

Generic Available

Common Dosage Forms:

Tablets: 10 mg, 20 mg, 40 mg

FDA Indications/Dosages:

For the treatment of hypertension, alone or in combination with thiazide diuretics: Initially give 10 mg daily. Maintenance dose is between 20 mg and 80 mg/day in one to two doses.

Initial dose when using diuretics: Bein with 10 mg daily or temporarily discontinue diuretic therapy beginning 3 days before initial dose.

Management of heart failure as adjunctive therapy when added to conventional therapy including diuretics or digitalis: Start with 10 mg daily. Titrate to a maximum of 40 mg daily.

No dosage adjustment is necessary in renal impairment.

Monitor: K, BP, CrCL, WBC

Pharmacology/Pharmacokinetics: Fosinopril is hydrolyzed to fosinoprilat which suppresses the renin-angiotensin-converting enzyme (ACE). ACE converts angiotensin I to angiotensin II, one of the most potent vasoconstrictors known. Inhibition of ACE decreases plasma angiotensin II which leads to decreased aldosterone secretion, The latter may cause a decrease in serum potassium. The net result is a decrease in peripheral arterial resistance. Peak plasma levels of fosinoprilat are reached in 3 hours. Protein binding is ≥95%. Half-life of fosinoprilat is 11.5 hours. Elimination occurs through the urine (50%) and the feces (50%).

Drug Interactions: Antacids decrease absorption. Indomethacin may decrease therapeutic effects. Capsaicin may increase the incidence of coughing. Because of potassium-sparing effect, use caution with potassium-sparing diuretics and potassium supplements. Lithium toxicity may occur. May cause a false low digoxin using Digi-Tab RIA Kit. Increased adverse effects may occur when used with other renin-angiotensin system blockers or aliskiren.

Contraindications/Precautions: Contraindicated in combinations with neprilysin inhibitor (sacubitril). DO NOT USE DURING PREGNANCY. Use with caution in nursing women, in patients with impaired renal function, collagen vascular disease (may cause agranulocytosis), or aortic stenosis, and in patients undergoing surgery or anesthesia. Rare occurrences of angioedema and neutropenia have been seen in patients taking ACEIs. Patients should report to their physician and sign  of facial swelling, difficulty in breathing, or infection (unexplained fever, or sore throat). Pregnancy Category D.

Adverse Effects: Mild adverse effects include cough, headache, dizziness, diarrhea, and fatigue. A potentially serious adverse effect is angioedema.

Patient Consultation:

Do not take antacids within 1-2 hours of taking medication.

Do not discontinue medications unless otherwise directed by your physician.

Avoid nonprescription cough, cold, and allergy medications unless otherwise directed.

Avoid salt substitutes containing potassium.

Report any sign of facial swelling, difficulty in breathing, or infection (fever, sore throat) to your physician.

Store in a cool, dry place away from sunlight and children.