Brand Name for Fosinopril
The brand name for fosinopril is Monopril.
Fosinopril Overview
Fosinopril is an angiotensin-converting enzyme (ACE) inhibitor that is used primarily for the treatment of hypertension and heart failure. It has several unique characteristics compared to other ACE inhibitors:
- Fosinopril is a phosphinic acid prodrug that is hydrolyzed to its active form, fosinoprilat 1
- It has a dual elimination route (both hepatic and renal), which distinguishes it from many other ACE inhibitors 2, 3
- The recommended initial daily dose is 5-10 mg once daily, with a maximum dose of 40 mg once daily 4, 5
Clinical Applications
Fosinopril is indicated for:
- Hypertension management, with efficacy similar to other antihypertensive agents including enalapril, propranolol, hydrochlorothiazide, and nifedipine 1
- Heart failure treatment, where it has been shown to:
- Reduce pulmonary capillary wedge pressure
- Decrease mean arterial blood pressure
- Increase stroke volume and cardiac index 3
Unique Pharmacokinetic Properties
The dual elimination pathway of fosinoprilat (active form) offers distinct advantages:
- Unlike most other ACE inhibitors that are primarily excreted renally, fosinoprilat is eliminated through both renal and hepatic routes 2, 6
- This compensatory elimination mechanism allows for the same starting dosage regardless of renal function 6
- Studies have shown significantly less accumulation of fosinoprilat in patients with renal insufficiency compared to enalaprilat (76.6%) and lisinopril (161.7%) 7
Dosing Considerations
According to clinical guidelines, fosinopril dosing is as follows:
- Initial dose: 5-10 mg once daily
- Maximum dose: 40 mg once daily
- No dosage adjustment is typically needed in patients with renal impairment due to its dual elimination pathway 4, 5
Common Side Effects
Like other ACE inhibitors, fosinopril may cause:
- Dizziness (11.9% vs 5.4% for placebo)
- Cough (9.7% vs 5.1% for placebo)
- Hypotension (4.4% vs 0.8% for placebo) 3
- Angioedema (rare but potentially life-threatening, occurring in <1% of patients) 4
Fosinopril (Monopril) represents an effective option for managing hypertension and heart failure, with potential advantages for patients with renal or hepatic impairment due to its unique dual elimination pathway.