Fosinopril Dosage
This dosage information may not include all the information needed to use Fosinopril safely and effectively. See additional information for Fosinopril.
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Usual Adult Dose for:
Usual Pediatric Dose for:
Additional dosage information:
Usual Adult Dose for Hypertension
Initial dose: 10 mg orally once a day, both as monotherapy and when the drug is added to a diuretic.
Maintenance dose: 20 to 40 mg orally once a day.
Some patients appear to have a further response to 80 mg.
Usual Adult Dose for Left Ventricular Dysfunction
Initial dose: 10 mg orally once a day (5 mg if volume depleted or hypotensive).
Maintenance dose: 20 to 40 mg orally once a day.
Dosage should be increased, over a several week period, to a dose that is maximal and tolerated but not exceeding 40 mg once a day.
Usual Adult Dose for Diabetic Nephropathy
Initial dose: 10 mg orally once a day.
Usual Pediatric Dose for Hypertension
In children, doses of fosinopril between 0.1 and 0.6 mg/kg have been studied and shown to reduce blood pressure to a similar extent as adults. The recommended dose in children weighing more than 50 kg is 5 to 10 mg once per day as monotherapy. An appropriate dosage strength is not available for children weighing less than 50 kg.
Renal Dose Adjustments
Impaired renal function decreases total clearance of fosinoprilat and approximately doubles AUC. In general, no adjustment of dosing is needed. However, patients with heart failure and severely reduced renal function may be more sensitive to the hemodynamic effects
Liver Dose Adjustments
Data not available
Dose Adjustments
Dosage should be adjusted according to blood pressure response at peak (2 to 6 hours) and trough (about 24 hours after dosing) blood levels.
In some patients treated with once daily dosing, the antihypertensive effect may diminish toward the end of the dosing interval. If trough response is inadequate, dividing the daily dose should be considered. If blood pressure is not adequately controlled with fosinopril alone, a diuretic may be added.
Precautions
In patients who are currently being treated with a diuretic, symptomatic hypotension occasionally can occur following the initial dose of fosinopril. To reduce the likelihood of hypotension, the diuretic should, if possible, be discontinued 2 to 3 days prior to beginning therapy with fosinopril. Then, if blood pressure is not controlled with fosinopril alone, diuretic therapy should be resumed. If diuretic therapy cannot be discontinued, an initial dose of 10 mg of fosinopril should be used with careful medical supervision for several hours and until blood pressure has stabilized.
Safety and effetiveness have not been established in pediatric patients weighing less than 50 kg.
Dialysis
Fosinopril is not well dialyzed. Clearance by hemodialysis and peritoneal dialysis averages 2% and 7%, respectively.
Other Comments
Digitalis is not required for fosinopril to manifest improvements in exercise tolerance and symptoms. Most placebo-controlled clinical trial experience has been with both digitalis and diuretics present as background therapy.
Compared with Caucasian patients, Black patients have a reduced blood pressure response to monotherapy with angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers; however, the reduced response is largely eliminated if combination therapy that includes an adequate dose of a diuretic is instituted.
Following first-time MI, all ACE inhibitors, at comparable appropriate dosages, appear to be equally effective for reducing mortality and recurrent MI rates.
