Fosinopril

General Toxicity Notes
Blood pressure is the best guide to dose and interval. Hypotensive effects magnified by natriuretic agents or sodium depletion. May cause hyperkalemia, metabolic acidosis. Acute renal dysfunction with bilateral or transplant renal artery stenosis, low renal perfusion pressure. Dry cough in 5-10% of patients.
Excreted Unchanged %
50
Half-Life (Normalesrd) Hours
12/14-32
Plasma Protein Binding %
99
Volume Of Distribution L/Kg
0.15
Dose For Normal Renal Function
10 mg q24h
Second Dose
Second Dose: 10-40 mg q12-24h
Adjustment For Renal Failure Method
D
Adjustment For Renal Failure Gfr, Ml/Min >50 [Recommended Level]
100% [A]
Adjustment For Renal Failure Gfr, Ml/Min 10-50 [Recommended Level]
100% [A]
Adjustment For Renal Failure Gfr, Ml/Min <10 [Recommended Level]
75-100% [B]
Supplement For Dialysis [Recommendation Level]: Ihd
IHD: None, [A]
Supplement For Dialysis [Recommendation Level]: Pd
PD: None, [A]
Supplement For Dialysis [Recommendation Level]: Crrt
CRRT: Dose for GFR 10-50, titrate, [D]
References
Gehr TW, Sica DA, Grasela DM, Fakhry I, Davis J, Duchin KL. Fosinopril pharmacokinetics and pharmacodynamics in chronic ambulatory peritoneal dialysis patients. Eur J Clin Pharmacol. 1991; 41: 165-9. [PMID: 1835932] / Gehr TW, Sica DA, Grasela DM, Duchin KL. The pharmacokinetics and pharmacodynamics of fosinopril in haemodialysis patients. Eur J Clin Pharmacol. 1993; 45: 431-6. [PMID: 8112372] / Greenbaum R, Zucchelli P, Caspi A, Nouriel H, Paz R, Sclarovsky S, et al. Comparison of the pharmacokinetics of fosinoprilat with enalaprilat and lisinopril in patients with congestive heart failure and chronic renal insufficiency. Br J Clin Pharmacol. 2000; 49: 23-31. [PMID: 10606834] / O&#146; Grady P, Yee KF, Lins R, Mangold B. Fosinopril/hydrochlorothiazide: single dose and steady-state pharmacokinetics and pharmacodynamics. Br J Clin Pharmacol. 1999; 48: 375-81. [PMID: 10510149] / Wagstaff AJ, Davis R, McTavish D. Fosinopril: a reappraisal of its pharmacology and therapeutic efficacy in essential hypertension. Drugs. 1996; 51: 777-91. [PMID: 8861547]
Toxicity Notes
Fosinoprilat is its active moiety formed in liver. Drug less likely than other ACE inhibitors to accumulate in renal failure.