Drug Interaction:
ACE inhibitors include-
Benazepril, Captopril, Enalapril, Enalaprilat, Fosinopril, Lisonopril, Moexipril,
Perindopril, Quinapril, Ramipril, Trandolapril
Refer Captopril
Interacting drugs- summary
+ ACE inhibitors
Potassium salts
concurrent use result in elevated serum potsssium
concentrations in certain patients
Patients on diuretics may occassionally experience an excesive reduction in blood presure
after initiation of therapy with fosinopril sodium.
Fosinopril sodium can attentuate potassium loss caused by thiazide diuretics
Potassium sparing diuretics (sprionolactones, amiloride, triamterence, and others) or
potasium supplements can increase risk of hyperkalaemia.
Increased serum lithium levels and symptoms of lithium toxicity have been reported
in patients receiving ACE inhibitors during therapy with lithium
Antacids (aluminium hydroxide, Magnesium hydroxide,and simethicone) may impair
absorption of fosinopril. Thereforeif concomittant administration of these agents is indicated,
dosing should be separated by 2 hours.
Indication:
Hypertension
Approved by FDA in 1991
Approved by (DCI) Drug Controller GENERAL - India For Marketing
(Ref- IDMA Publication)
Name of Drug Indication Date of Approval
Fosinopril Sodium Antihypertensive 10-01-2002
ACE inhibitors include-
Benazepril, Captopril, Enalapril, Enalaprilat, Fosinopril, Lisonopril, Moexipril,
Perindopril, Quinapril, Ramipril, Trandolapril
Refer Captopril
Adverse Reaction:
Fosinopril is generally well tolerated and the adverse effects infrequently reported incude chest pain, edema, edema, hypertensive crisis, rhythm disturbances, palpitations, hypotension, syncope, rashes, hypersensitivity reactions, angioedema, and dizziness.
Contra-Indications:
Hypersensitivity to fosinopril or any other angiotensin converting enzyme inhibitor
Special precautions:
Dosages/ Overdosage Etc:
Approved by FDA in 1991
Indications:
Hypertension
Dosage:
Initial- 10mg once daily- adjust according to blood response at peak( 2 to 6 hours) and through
(about 24 hours after dosing) blood levels.
Maintenance- usual range is 20 to 40mg/day
Missed dose-
1. If you miss a dose of this medicine, and remember within 6 hours of take it as soon as possible unless the dose is less than 4 hours.
2. However, if you do not remember until later, skip the missed dose and go back to your regular dosing schedule.
3. Do not double doses.
Other Information:
List of entries
1. Congestive Heart Failure (CHF)
2. Atrial Fibrillation
3. Atrial Flutter
1. Congestive Heart Failure (CHF)
Heart failure is charaterized by well known symptoms and physical signs. Heart failure is
coinsidered to be pathophysiological state in which an abnormal cardiac function is responsible for the failure of the heart to pump blood at a rate communsurate with the requirement of the metabolizing tissues. Heart failure is frequently but not always caused by a defect in myocardial contraction, and then the term myocardial failure is appropiate,.
Increased cardiac output results in in diuresis and general amelioration of disturbances
characteristic of fight heart failure (venous congestion, edema) and left heart failure ) dyspnea, orthopnea, cardiac asthma). Digitalis is generaly most effective in "low output" failure and less effective in "high output " failure ) bronchopulmonary insufficiency, artriovenous fistula, anemia, hyperthyroidism.
2. Atrial fibrillation
This is a dysrhythmia in which the effective contraction of the atria is abolished and the AV node and the ventricles are bombarded with a very rapid and irregular series of stimuli.
Many of these impulses are blocked at the AV node, but many are passed through, so that the ventricular contracrtions in the untreated patient are usually rapid and irregularly irregular.
Digitalis rapidly reduces ventricular rates and eliminates the pulse deficit. Palpitation,precordial distress or weakness are relieved and concomittant congestive failure ameliorated. Continue digitalis in doses necessary to maintain the desired ventricular rate, both ar rest and in response to excercise and other clinical effects.
3. Atrial flutter
The dysrhythmia is less common than artial fibrillation. There is a considerable controversy
regarding its mechanism. A reciprocating rhythm or circus current movement is most likely.
The atria contracts at a rate of 250 to 350 rates per minute. AV block is almost always present and its ratio is usually even numbered.
Digitalis slows the heart; normal sinus rhythm appear. Digitalis slows the ventricular rate, by decreasing the degree of AV block, and commonly converts flutter to fibrillation. When the drug is withdrawn , the atrial flutter will frequently revert spontaneosuly to normal sinus rhythm. If this not occur quinidine may be employed to restore sinus rhythm.
Heart Failure
Evidence Based Medicine (MIMS March 2003)
Beneficial
ACE inhibitors such as captopril, enalapril,lisonopril,and perindopril
Digoxin
Appropriate use of beta-blockers
Spironolactoone in severe cases
Likely to be beneficial
Multidisciplinary intereventions (nutrition, counselling)
Excercise
Angiotensin II receptor blockers
Amiiodarone
Implatable cardiac defibrillators
Unlikely to be beneficial
Calcium channel blockers
Likely to beineffective or harmful
Positive inotropes(non-digitalis)
Non-amiodarone antiarrhythmic drugs
Key Points
1. There is conflicting evidence of the efficacy of multidisciplinary approach
2. Pescribed excercise training improves functional capacity and quality of life and reduces the rate of adverses
cardiac events
3. Ace inhibitors reduce mortality, admission to hospital for heart failue and ischaemic events in patients with heart
failure but are still under-used.
4. One critical trial has found that angiotensin II receptor blockers are at least as effective as ACE inhibitors for
reducing clinical events(death or admission to hospitals). They confer no advantage over ACE inhibitors but can
be useful if ACE inhibitors are not tolerated
5. Positve inotropic drugs improve symptoms but do not reduce mortality
6. Adding beta-blocker to ACE inhibitors decreases the rate of death and admission to hospitals
7. One clinical trial has found that in severe heart failure, adding an aldosterone receptor antagonist to an ACE
inhibitor reduces mortality compared with ACE inhibitors alone.
8. ACE inhibitors delay the onset of symptoms and reduce cardiovascular events in patients with asymtomatic left
ventricular systolic dysfunction
Patient Information:
Refer Captopril
1. Take captopril 1 hour before meals. Take moexipril in the fasting state
2. Do not interupt or discontinue medication without consulting physician
3. Notify physician if any of the following occur- sore throat, fever, swelling of hands or feet,
irregular heart beat , chest pains, signs of angioedema, excessive prespiration, dehydration,
vomiting and diarrhea may lead to a fall in blood pressure.
4. May cause dizziness, fainting or lightheadedness, especially during the first days of therapy;
avoid sudden changes in posture. If syncope occurs, discontinue drug until physician has
been contacted. Heart failure patients should avoid rapid increases in physical activity.
5. May cause skin rash or impaired taste perception. Notify physician if these persist.
6. Do not use salt substitutes containing potassium without consulting a physician
7. A persistent dry cough may occur and usually does not subside unless the medication is
stopped. If this effect become bothersome, consult a physician.
Pharmacology/ Pharmacokinetics:
Refer - Ramipril- ACE inhibitors
Interaction with Food:
Refer - Ramipril- ACE inhibitors
Pregnancy and lactation:
Refer - Ramipril- ACE inhibitors
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