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Fosinopril belongs to the class of angiotensin-converting enzyme (ACE) inhibitors used in cardiovascular conditions for nearly 3 decades. Fosinopril has received approval from the United States Food and Drug Administration (FDA) for the treatment of hypertension and heart failure. Being a competitive inhibitor of ACE, fosinopril prevents the conversion of angiotensin I to angiotensin II—a powerful vasoconstrictor. Other ACE inhibitors approved in the United States include captopril, enalapril, lisinopril, benazepril, quinapril, ramipril, moexipril, fosinopril, and trandolapril. Fosinopril is utilized off-label for conditions such as acute myocardial infarction, diabetic nephropathy, and HIV-associated nephropathy. The drug is distinguishable from enalapril and captopril due to its long half-life, hydrophilicity, and resistance to liver breakdown. This activity reviews the mechanism of action, pharmacology, adverse event profiles, eligible patient populations, and monitoring of fosinopril, highlighting the role of the interprofessional healthcare team in the management of hypertension with the drug. Objectives: Differentiate between FDA-approved indications for fosinopril, specifically in hypertension and heart failure, and recognize its off-label uses in acute myocardial infarction and diabetic nephropathy. Implement fosinopril therapy according to evidence-based guidelines, incorporating dosage adjustments and monitoring for optimal effectiveness and safety. Select fosinopril as an appropriate intervention in the management of hypertension, demonstrating a rationale based on patient-specific considerations. Collaborate with the interprofessional healthcare team to ensure coordinated care in fosinopril therapy, particularly in patients with complex medical histories. Access free multiple choice questions on this topic.

If the patient is experiencing fosinopril toxicity, they require supportive care and should discontinue fosinopril immediately. Angioedema requires discontinuation of fosinopril, treatment with epinephrine, and endotracheal intubation for airway compromise.[28] The first case study that documented uncommon adverse reactions due to fosinopril showed interactions with metoprolol and diazepam. Signs of asthenia, jaundice, and pruritus were present. When fosinopril was discontinued, and pruritus and cholestasis were treated, the signs of severe toxicity continued. Recovery lasted up to 18 months. The risk of developing acute liver injury due to fosinopril was categorized as a likelihood score of D. Other ACE inhibitors have shown similar risks for acute liver damage leading to a long period of hospitalization and recovery. As such, ursodiol, colestipol, and hydroxyzine are recommended for signs of liver damage, but the immediate cessation of fosinopril is one of the first steps in managing toxicity.

Fosinopril is a relatively safe and common medication used to treat hypertension and heart failure, but monitoring the treatment and reporting any adverse reaction is essential. Prescribing clinicians initiate fosinopril for hypertension and heart failure. A cardiologist consultation is vital for complicated HFrEF and acute decompensated heart failure. Patient education is critical; interprofessional healthcare team members should educate patients about possible adverse effects and receive instructions to avoid high-potassium diets. To ensure the patient is maximizing benefits from fosinopril, clinicians should schedule regular follow-ups to document any adverse effects and adjust the regimen accordingly. At the outset of therapy, a pharmacist should verify appropriate dosing, check for potential interactions, and counsel the patient on possible adverse effects. Nurses follow up with the patient, monitor therapy progress, and answer patient questions, alerting the prescriber to any concerns with recommended changes in therapy when indicated. Critical care consultation is required for overdose. Hepatologists or gastroenterologists can provide valuable inputs to prevent and manage drug-induced liver injury (DILI).[34] For complicated fosinopril overdose, a medical toxicologist should be consulted. Interprofessional strategies and open communication between prescribers, including specialists, pharmacists, and nurses, can optimize patient outcomes related to fosinopril therapy with fewer adverse effects.