BLACK BOX WARNING
- fetal toxicity
fosinopril
Brand: Monopril
⚠ BBW Prototype: lisinopril
Drug Class: ACE inhibitor
Drug Family: antihypertensive
Subclass: phosphonate prodrug ACE inhibitor
Organ Systems: cardiovascularrenal
Mechanism of Action
Phosphonate-containing prodrug; converted to fosinoprilat; inhibits ACE.
ACE (angiotensin-converting enzyme)
Indications
- hypertension
- heart failure
Contraindications
- pregnancy
- ACE-inhibitor angioedema
Adverse Effects
Common
- cough
- hyperkalemia
- dizziness
Serious
- angioedema
- AKI
- teratogenicity
Pharmacokinetics (ADME)
| Absorption | 36% bioavailability |
| Distribution | moderate |
| Metabolism | hepatic and GI mucosa to fosinoprilat |
| Excretion | 50% renal, 50% fecal (balanced dual excretion) |
| Half-life | 12 hours |
| Onset | 1 hour |
| Peak | 3-6 hours |
| Duration | 24 hours |
| Protein Binding | >97% |
| Vd | moderate |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| antacids | impaired absorption (separate by 2 hours) | minor |
| potassium-sparing diuretics | additive hyperkalemia | major |
Nursing Considerations
- Balanced dual excretion makes it preferred in ESRD
- Separate dosing from antacids by 2 hours
- Monitor BP and electrolytes
Clinical Pearls
- Only ACE inhibitor with phosphonate binding to ACE active site
- Balanced 50/50 renal-hepatic clearance preferred in severe CKD/ESRD
Safety Profile
Pregnancy contraindicated
Lactation avoid
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.