Fosinopril is a long-acting ACE inhibitor used in hypertension and heart failure.

It is unique among ACE inhibitors because it undergoes both hepatic and renal elimination.

Class: → ACE Inhibitors

• Inhibits Angiotensin-Converting Enzyme (ACE) • ↓ Angiotensin II • ↓ Aldosterone • ↑ Bradykinin

Net Effects: • ↓ Systemic vascular resistance • ↓ Blood pressure • ↓ Ventricular remodeling • ↓ Sodium retention

Mechanism identical to other ACE inhibitors.

• Prodrug → converted to fosinoprilat • Dual elimination (hepatic + renal) • Less dose adjustment required in mild-to-moderate renal impairment compared to other ACE inhibitors

This dual clearance is its major distinguishing feature.

• Effective once-daily ACE inhibitor

→ Hypertension Module

• Mortality benefit expected as class effect • Used similarly to other ACE inhibitors

→ Heart Failure Module

Hypertension: • Start: 10 mg once daily • Usual range: 10–40 mg once daily • Max: 40 mg daily

Heart Failure: • Start: 5–10 mg once daily • Titrate as tolerated

Once-daily dosing.

• Prodrug → activated in liver • Eliminated via both liver and kidneys • Half-life ~12 hours

Because of dual clearance, less accumulation in isolated renal impairment compared to purely renally cleared ACE inhibitors.

Class Effects: • Dry cough • Hyperkalemia • Hypotension • Angioedema (rare) • Mild creatinine elevation

No major differences in side-effect profile.

Monitor: • Serum creatinine • Potassium

Recheck labs 1–2 weeks after initiation or dose change.

Mild creatinine increase (<30%) is expected.

• Pregnancy • History of ACE inhibitor–induced angioedema • Bilateral renal artery stenosis

✔ Unique dual hepatic + renal elimination ✔ Useful when renal function is reduced ✔ Once-daily dosing ✔ No proven superiority over other ACE inhibitors ✔ Monitor potassium and renal function

Related:

→ ACE Inhibitors → Lisinopril → Heart Failure Module → Return to CV Modules