Table of contents

  • Brand Names
  • Drug Combinations
  • Chemistry
  • Pharmacologic Category
  • Mechanism of Action
  • Therapeutic Use
  • Pregnancy and Lactation Implications
  • Contraindications
  • Warnings and Precautions
  • Adverse Reactions
  • Toxicological Effects
  • Caution and personalized dose adjustment in patients with the following genotypes
  • Other genes that may be involved
  • Drug Interactions
  • Nutrition/Nutraceutical Interactions
  • Dosage
  • Pharmacokinetics and Pharmacodynamics
  • Special Considerations

Brand Names


Austria: Fosinopril, Fositens; Belgium: Fosinil; Bulgaria: Fosicard, Fosinopril, Monopril; Czech Republic: Apo-Fosinop, Fenosimed, Fosinogen, Fosinopril, Monace, Monopril; Estonia: Fosinopril, Monopril, Monotens; France: Fosinopril, Fozitec; Germany: Dynacil, Fosino, Fosinopril, Fosinorm, Fositens; Greece: Fosinopril, Monopril; Hungary: Fosicard, Fosinogen, Monace, Monopril, Noviform; Italy: Eliten, Fosinopril, Fosipres, Tensogard; Latvia: Fosinopril, Monopril, Monotens; Lithuania: Fosinopril, Monopril, Monotens; Luxembourg: Fosinil; Malta: Fosinopril; Netherlands: Fosinopril, Newace; Poland: Fosinopril, Fozin, Monopril; Portugal: Fosinopril, Fositen; Romania: Fenosimed, Fosinopril, Fosypril, Monopril, Monotens; Slovakia: Fosinogen, Fosinopril, Monopril, Monace; Slovenia: Fozinopril, Monopril; Spain: Fosinopril, Fositens, Hiperlex, Tenso Stop; Sweden: Fosavis, Fosinopril; UK: Fosinopril, Staril.

North America

Canada: Fosinopril, Monopril; USA: Fosinopril, Monopril.

Latin America

Brazil: Fosinopril, Monopril; Mexico: Monopril.

Drug combinations

Fosinopril and Hydrochlorothiazide


Fosinopril Sodium: C~30~H~45~NNaO~7~P. Mw: 585.64. (1) L-Proline, 4-cyclohexyl-1-[[[2-methyl-1-(1-oxopropoxy)propoxy](4-phenylbutyl)phosphinyl]acetyl]-, sodium salt, [1[S*(R*)],2a,4b]-; (2)(4S)-4-Cyclohexyl-1-[(R)-[(S)-1-hydroxy-2-methylpropoxy](4-phenylbutyl)phosphinyl]acetyl-L-proline propionate (ester), sodium salt. CAS-88889-14-9; CAS-98048-97-6 (fosinopril)(1986).

Pharmacologic Category

Angiotensin-Converting Enzyme Inhibitors. (ATC-Code: C09AA09).

Mechanism of action

Competitive inhibitor of angiotensin-converting enzyme. Prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Results in lower levels of angiotensin II, which causes increase in plasma renin activity and reduction in aldosterone secretion. Vasoactive kallikreins may be decreased in conversion to active hormones by ACEIs, thus reducing blood pressure.

Therapeutic use

Used alone or in combination with other classes of antihypertensive agents in management of hypertension. Also used in conjunction with cardiac glycosides, diuretics, and β-blockers in management of symptomatic CHF.

Pregnancy and lactiation implications

ACEIs not recommended during pregnancy to treat maternal hypertension or heart failure, since they might cause injury and death to developing fetus. Use not recommended during lactation.

Unlabeled use


Hypersensitivity to fosinopril or any component of the formulation. Angioedema related to previous treatment with an ACEI. Pregnancy (2^nd^ and 3^rd^ trimesters).

Warnings and precautions

Angioedema might occur rarely (especially following first dose), and may involve head and neck (potentially compromising airway) or intestine (presenting with abdominal pain). African-Americans and patients with idiopathic or hereditary angioedema may be at an increased risk. Use in previous angioedema associated with ACEI therapy contraindicated. A rare toxicity associated with ACEIs includes cholestatic jaundice, which may progress to fulminant hepatic necrosis. A dry, hacking, nonproductive cough usually occurs within first few months of treatment (generally resolves after discontinuation). Hyperkalemia might occur (risk factors include renal dysfunction, diabetes mellitus, concomitant use of potassium-sparing diuretics, potassium supplements, and/or potassium-containing salts). Anaphylactic/anaphylactoid reactions can occur. Symptomatic hypotension with or without syncope can occur, usually with first several doses (effects most often observed in volume-depleted patients). Patients with renal impairment are at high risk of developing neutropenia; with both renal impairment and collagen vascular disease (e.g. systemic lupus erythematosus) they are at even higher risk of developing neutropenia. May be associated with deterioration of renal function and/or increases in serum creatinine, particularly in low renal blood flow (e.g. renal artery stenosis, heart failure). Use with caution in severe aortic stenosis (may reduce coronary perfusion resulting in ischemia), and in ischemic heart disease or cerebrovascular disease, due to potential consequences posed by falling blood pressure (e.g. MI, stroke). Use with caution in collagen vascular disease especially with concomitant renal impairment (may be at increased risk for hematologic toxicity), in hypertrophic cardiomyopathy and outflow tract obstruction (reduction in afterload may worsen symptoms), in unstented unilateral/bilateral renal artery stenosis, or in pre-existing renal insufficiency. Can cause injury and death to developing fetus when used in 2^nd^ and 3^rd^ trimesters. Use with caution before, during, or immediately after major surgery.



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