Hydrochlorothiazide + Fosinopril

Indications

Hydrochlorothiazide + Fosinopril is used for: Hypertension

Adult Dose

Child Dose

Renal Dose

Renal impairment CrCl <30 mL/min or serum creatinine > 3 mg/dL: Use not recommended CrCl > 30 mL/min: Dose adjustment not necessary

Administration

Contra Indications

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)

Precautions

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-Lactation

Pregnancy Category: C (1st trimester); D (2nd & 3rd trimesters) Lactation: enters breast milk; contraindicated

Interactions

Side Effects

Side effects of Hydrochlorothiazide + Fosinopril : Fosinopril >10% Dizziness (1.6-11.9%) 1-10% Cough (2.2-9.7%) Headache (3.2%) Hyperkalemia (2.6%) Diarrhea (2.2%) Orthostatic hypotension (1.4-1.9%) Fatigue (1-2%) Frequency Not Defined Angioedema ARF if renal artery stenosis Aplastic anemia Neutropenia Arthralgia Interstitial nephritis Vasculitis Rash Hydrochlorothiazide <1% 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 Frequency Not Defined Anorexia Epigastric distress Hypotension Orthostatic hypotension Photosensitivity

Mode of Action

Competitively inhibits angiotensin-converting enzymes, resulting in decreased plasma angiotensin II concentrations; BP may be reduced in part through decreased vasoconstriction, increased renin activity, and decreased aldosterone secretion; increases renal blood flow