Staril

Action

Prevents conversion of angiotensin I to the vasoconstrictor angiotensin II, thereby reducing sodium and water retention and enhancing blood flow in circulatory system

Availability

Tablets: 10 mg, 20 mg, 40 mg

Indications and dosages

➣ Hypertension

Adults: 10 mg P.O. daily. May increase as required up to 80 mg/day; typical range is 20 to 40 mg P.O. daily.

➣ Heart failure

Adults: 10 mg P.O. daily. May increase over several weeks up to 40 mg/day; typical range is 20 to 40 mg/day.

Dosage adjustment

• Renal impairment

Off-label uses

• Adjunct in myocardial infarction

• Nephropathy

Contraindications

• Hypersensitivity to drug or other ACE inhibitors

• Angioedema (hereditary or idiopathic)

• Pregnancy

Precautions

Use cautiously in:

• aortic stenosis, cardiomyopathy, cerebrovascular or cardiac insufficiency, renal or hepatic impairment, hyponatremia, hypovolemia

• black patients with hypertension

• patients receiving diuretics concurrently

• elderly patients

• breastfeeding patients (safety not established)

• children (safety not established).

Administration

• Don't administer within 2 hours of antacids.

• Give with or without food, but avoid giving with high-potassium foods or potassium supplements.

Adverse reactions

CNS: dizziness, drowsiness, fatigue, headache, insomnia, weakness, vertigo

CV: hypotension, angina pectoris, tachycardia

EENT: sinusitis

GI: nausea, vomiting, diarrhea, anorexia

GU: proteinuria, erectile dysfunction, decreased libido, renal failure

Hematologic: agranulocytosis, bone marrow depression

Metabolic: hyperkalemia

Respiratory: cough, bronchitis, dyspnea, asthma, eosinophilic pneumonitis

Skin: rash, angioedema

Other: altered taste, fever, hypersensitivity reactions including anaphylaxis

Interactions

Drug-drug. Allopurinol: increased risk of hypersensitivity reaction

Antacids: decreased fosinopril absorption

Antihypertensives, diuretics, general anesthetics, nitrates, phenothiazines: additive hypotension

Cyclosporine, indomethacin, potassium-sparing diuretics, potassium supplements: hyperkalemia

Digoxin, lithium: increased blood levels of these drugs, greater risk of toxicity

Indomethacin: decreased hypotensive effects

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, potassium: increased levels

Antinuclear antibody titer: false-positive result

Sodium: decreased level

Drug-food. Salt substitutes containing potassium: hyperkalemia

Drug-herbs. Capsaicin: increased incidence of cough

Drug-behaviors. Acute alcohol ingestion: additive hypotension

Patient monitoring

• Monitor cardiovascular, respiratory, and neurologic status.

• Monitor CBC and liver and kidney function tests.

• Measure blood pressure to assess drug efficacy and detect hypotension.

• Assess patient's potassium intake; monitor serum potassium level.

See Monitor for signs and symptoms of angioedema and anaphylaxis. If these occur, withdraw drug and contact prescriber immediately.

Patient teaching

See Instruct patient to immediately report rash or difficulty breathing.

• Tell patient to report dizziness, fainting, bleeding tendency, change in urination pattern, swelling, or persistent cough.

• Encourage patient to drink enough fluids to stay well hydrated.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

• Instruct female patient to notify prescriber if she suspects she is pregnant.

• Tell patient that he will undergo regular blood testing during therapy.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.