Fosinopril

Fosinopril is a drug from the group of so-called angiotensin-conversion enzyme(ACE) inhibitors. Fosinopril is a prodrug. The substance is derived from the first ACE inhibitor captopril and has some advantages with regard to side effects. Average half-life: approx. 12.0 h.

ACE inhibitors inhibit the angiotensin converting enzyme inhibitor (ACE), a peptidase involved in the conversion of angiotensin-I to angiotensin-II. Angiotensin-II is an endogenous substance that binds to the receptors of the blood vessels and thus leads to vasoconstriction. The result is an increase in blood pressure. Fosinopril prevents the formation of angiotensin-II and thus causes the blood vessels to relax and blood pressure to fall. In addition, it develops effects on the heart that lead to an economization of the work of the heart.

In the liver, the prodrug fosinopril is converted into fosinoprilate (hepatic ester hydrolysis). The highest levels of the active form are found in the blood after about four hours. Fosinopril and fosinoprilate are excreted via the kidneys with the urine.

Fosinopril is used for

• non organ-related high blood pressure (essential hypertension)
• mild to moderate heart failure (NYHA II to III) after acute (2 to 9 days old) heart attack,
• Patients with non-diabetic glomerular nephropathy (creatinine clearance < 70 ml/min/1.73 m2 , protein excretion in urine > 1 g/day) - especially if arterial hypertension is present at the same time.
• kidney diseases associated with diabetes (glomerular diabetic nephropathy with microalbuminuria or macroproteinemia)
• following a heart attack (myocardial infarction) with consecutive heart failure
• Patients with an increased cardiovascular risk, e.g. manifest coronary heart disease), diabetes mellitus with at least one additional risk factor, circulatory disorders of the limbs (peripheral arterial occlusive disease) or a history of stroke.

Allergies to fosinopril, another ACE inhibitor

In case of angioneurotic edema in the medical history

Dialysis Patients

Renal artery stenosis

during the last 6 months of pregnancy

with simultaneous intake of aliskiren (renin inhibitor)

Pregnancy

Fosinopril should be discontinued during pregnancy. After the 3rd month of pregnancy serious harm to the unborn child may occur.

Breastfeeding: The use of fosinopril is not recommended in nursing mothers.

It makes sense to start therapy with fosinopril with small doses at first and then increase these over several weeks until the desired maintenance dose is reached.

Use in combination with other antihypertensive agents that act on the renin-angiotensin-aldosterone system (RAAS) should only be used in special individual cases, e.g. aliskiren (renin antagonist) and Sartane such as candesartan, losartan or valsartan (angiotensin-II inhibitor).

The combined intake of fosinopril and potassium-saving dehydrating agents (such as spironolactone, triamterene, amiloride) or potassium preparations can lead to greatly increased potassium blood levels.

The use of tricyclic antidepressants, neuroleptics and other anaesthetic drugs can also lead to an increased drop in blood pressure. The use of the mood stabilizer lithium should be monitored by blood level controls.

The use of non-steroidal anti-inflammatory drugs (such as ASA or ibuprofen) may reduce the effect of fosinopril.

Currently, only fixed combinations with hydrochlorothiazide are on the market (generics).