Fosinopril

MONOPRIL

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What it isACE inhibitor; hypertension and heart failure.

Why this oneThe only ACE inhibitor with substantial biliary clearance, so it needs no dose reduction in renal impairment.

What limits itCough, hyperkalemia and the hemodynamic creatinine rise. Contraindicated in pregnancy.

FDA-approved for

hypertension (1991)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Fetal toxicity: discontinue as soon as pregnancy is detected; drugs acting on the renin-angiotensin system can cause fetal injury and death.

FDA dosing	Population	Start	Target	Max
Hypertension	Adult	10 mg QD	20-40 mg QD	80 mg QD
Hypertension	Children >50 kg	5-10 mg QD	5-10 mg QD	10 mg QD
Heart failure	Adult	10 mg QD (5 mg if moderate-severe renal failure or vigorously diuresed)	20-40 mg QD	40 mg QD

Titration Increase over several weeks per response

Renal No dose adjustment based on renal function alone (clearance unchanged across renal insufficiency); use 5 mg starting dose in heart failure with moderate-severe renal failure

Hepatic Undefined

Instructions

In diuretic-treated patients, discontinue diuretic 2-3 days before starting if possible, or start 10 mg under supervision
Observe heart failure patients ≥2 hours after initial dose for hypotension

Contraindications

History of angioedema with any ACE inhibitor

Cautions

Angioedema (head/neck, and intestinal)
Anaphylactoid reactions during membrane exposure (dialysis) and desensitization
Hypotension, especially in volume/salt-depleted patients
Hyperkalemia (with potassium supplements, salt substitutes, K-sparing diuretics)
Impaired renal function
Neutropenia/agranulocytosis
Hepatic failure (cholestatic jaundice progressing to fulminant hepatic necrosis)
Cough

Adverse reactions

Cough
Dizziness
Hypotension/orthostasis
Upper respiratory symptoms
Nausea/vomiting

Pregnancy Can cause fetal injury and death; discontinue when pregnancy detected.

Lactation Undefined

⚠ BOXED WARNING

Fetal toxicity

Cost, est. cash$5–$150/month

Generic entry2003

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk4 / 4

Legacy pregnancy categoryD

Defining liabilityHyperkalemia, kidney injury, angioedema, fetal toxicity and increased lithium exposure.

Active metabolites

Fosinoprilat

Mechanism of action: Fosinopril ballicule

Fosinopril ballicule: receptor binding, kinetics and half-life diagram

Open Fosinopril in the interactive console ↗

Memory aids: mascots and interaction avatars

Fosinopril MONOPRIL mascot mnemonic cartoon — **“Monopoly Fossil”**
Easter/April theme → ACE inhibitor = -pril (aPril)
Bananas in bunches → ↑ serum potassium

Box: minimal PK interactions

Open Fosinopril in the interactive console ↗