Fosinopril/Hydrochlorothiazide

DEA Class; Rx

Common Brand Names; Monopril-HCT

• ACEI/Diuretic Combos; 
• ACEI/HCTZ Combos

Oral combination of an angiotensin-converting enzyme inhibitor and a thiazide diuretic
Used for the treatment of hypertension
More effective than fosinopril monotherapy in Black patients

Indicated for the treatment of hypertension.

Hypersensitivity to ACE inhibitors, thiazides or sulfonamides

History of hereditary or angioedema associated with previous ACE inhibitor treatment

Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan

Anuria or renal artery stenosis

Do not coadminister with aliskiren in patients with diabetes mellitus or with renal impairment (ie, GFR <60 mL/min/1.73 m²)

Fosinopril

• Dizziness (1.6-11.9%)
• Cough (2.2-9.7%)
• Headache (3.2%)
• Hyperkalemia (2.6%)
• Diarrhea (2.2%)
• Orthostatic hypotension (1.4-1.9%)
• Fatigue (1-2%)
• Angioedema
• ARF if renal artery stenosis
• Aplastic anemia
• Neutropenia
• Arthralgia
• Interstitial nephritis
• Vasculitis
• Rash

Hydrochlorothiazide

• Anaphylaxis, anemia, confusion, erythema multiforme skin reactions including Stevens-Johnson syndrome, exfoliative dermatitis including toxic epidermal necrolysis, hypomagnesemia, hyponatremia, hypochloremia, dizziness, fatigue, headache, hypercalcemia, hyperuricemia, hyperglycemia, hyperlipidemia, hypercholesterolemia, muscle weakness or cramps, nausea, purpura, rash, vertigo, vomiting
• Anorexia
• Epigastric distress
• Hypotension
• Orthostatic hypotension
• Photosensitivity

Begin combination therapy only after failed monotherapy

Severe renal impairment, hepatic impairment

Risk of hypotension, especially with CHF

Coadministration with mTOR inhibitors (eg, temsirolimus) may increased risk for angioedema

Renal impairment may occur

Neutropenia/agranulocytosis reported

Cough may occur within the first few months

Cholestatic jaundice may occur

Dual blockade of the renin angiotensin system with ARBs, ACE inhibitors, or aliskiren associated with increased risk for hypotension, hyperkalemia, and renal function changes (including acute renal failure) compared to monotherapy

Pregnancy category: B

Lactation: Drug excreted in breast milk; use with caution (American Academy of Pediatrics states that it is “compatible with nursing”)