Monopril

Generic Name: Fosinopril sodium
Product Name: Monopril

Monopril has been discontinued in Australia.
The information on this page is therefore not up to date and will not be updated. 

Indication

Monopril is used in the treatment of mild to moderate hypertension. Monopril may be used alone or in combination with other agents. Effectiveness in severe hypertension has not been established.

Monopril is also useful as an adjunct (eg: with diuretics) in the treatment of heart failure.

Action

Fosinopril is an angiotensin-converting enzyme (ACE) inhibitor. ACE is an enzyme that converts angiotensin I to angiotensin II. Angiotensin II is a powerful modulator of vasoconstriction (narrowing of blood vessels) and it also stimulates secretion aldosterone, which promotes sodium and water retention. Inhibition of ACE, therefore inhibition of production of angiotensin II, results in reduction of two significant contributors to hypertension, vasoconstriction and fluid overload. ACE inhibitors are effective alone or in combination with other antihypertensive agents such as diuretics.

The vasodilatory (dilation of blood vessels) and volume depleting effects of Fosinopril also allow it to be effective in the treatment of heart failure, as it reduces the load on the heart. Little tolerance to Fosinopril develops with extended use.

Dose advice

Hypertension

Patients not being treated with diuretics:

• Initial dose of 10mg once daily is recommended;
• 10-40mg is generally required for maintenance of blood pressure;
• Dose should be adjusted according to blood pressure;
• Monopril should be taken at the same time each day.

Patients being treated with diuretics:

• Diuretic should preferably be discontinued for several days before initiation of therapy with Monopril;
• If Monopril does not achieve adequate blood pressure control within 4 weeks, diuretic may be restarted;
• If diuretic therapy cannot be discontinued, initial dose of Monopril of 10mg/day is recommended, with careful observation until blood pressure has stabilised;
• Potassium sparing diuretics should be used with caution.

Heart failure

• Initial dose of 10mg/day is recommended;
• Therapy should be initiated under close medical supervision;
• Hypotension does not indicate withdrawal of therapy, but careful dose titration is recommended after effective management of hypotension;
• Monopril should be used in conjunction with a diuretic.

Schedule

S4

Common side effects

• Hypotension;
• Cough;
• Increase in serum potassium;
• Headache;
• Dizziness;
• Fatigue;
• Nausea;
• Impairment in kidney function.

Uncommon side effects

• Hypersensitivity reactions (angioedema, anaphylaxis);
• Skin rash;
• Itching;
• Palpitations;
• Chest pain;
• Flushing;
• Fever;
• Taste disturbance;
• Vomiting;
• Loss of appetite;
• Diarrhoea;
• Constipation;
• Dry mouth;
• Sore throat;
• Hoarseness;
• Muscle cramps;
• Changes in liver enzymes;
• Abnormal dreams.

For further information talk to your doctor.

Reference

1. Manufacturer’s alert: Monopril Plus deletion [online]. Bristol-Meyers Squibb. [cited 2018]. Available from [URL link]