Sacubitril Valsartan
Contraindicated
Textbook
Increased risk of angioedema.
Do not use in conjunction with ACEIs.
Source: G&G 14e · p602
Drug reference
Fosinopril
ACE Inhibitor · Antihypertensive
Also known as Fosinopril sodium
ACE InhibitorAntihypertensive
CDSCO approvedSchedule H
EXCRETION
—
not curated
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
—
not curated
Top interactionssee all 12 →
- Sacubitril ValsartanContraindicatedTextbookG&G 14e · p602
- AminoglycosidesSevereTextbookG&G 14e
- Angiotensin Receptor BlockersSevereTextbookHarrison 22e · p2396
- AzilsartanSevereTextbookG&G 14e
Mechanism
Fosinopril is a prodrug that is converted to fosinoprilat, an active angiotensin-converting enzyme (ACE) inhibitor. ACE inhibits the enzyme peptidyl dipeptidase, which is responsible for converting angiotensin I to the potent vasoconstrictor angiotensin II and for inactivating bradykinin, a vasodilator. This dual action leads to reduced levels of the vasoconstrictor angiotensin II and increased levels of the vasodilator bradykinin. Consequently, peripheral vascular resistance decreases, contributing to a hypotensive effect.
Indications
HypertensionCongestive heart failure (adjunct)cardiovascular diseaseheart failurediabetic nephropathyacute myocardial infarctionhigh risk of cardiovascular eventscoronary artery disease (without heart failure)Congestive heart failure (CHF)Myocardial infarction (MI)Prophylaxis in high cardiovascular risk subjectsNondiabetic nephropathyScleroderma crisis
Dosing
- Adult
- Hypertension: Initially 10 mg daily for 4 weeks, then increased if necessary up to 40 mg daily. Congestive heart failure (adjunct): Initially 10 mg once daily, then increased if tolerated to 40 mg once daily, doses to be increased gradually.
- Renal adjustment
- Initial dose 2.5 mg daily if eGFR 30 mL/minute/1.73 m2 or more (avoid if less than 30 mL/minute/1.73 m2).
- Hepatic adjustment
- Manufacturer advises caution (risk of increased exposure). Initial dose 2.5 mg daily.
- Max dose
- 40 mg daily
Pharmacokinetics
Peak effect
Fosinoprilat in plasma occur in about 3 h
Duration
24 hr
Half-life
Fosinoprilat has an effective plasma t1/2 of approximately 11.5 h
Bioavailability
incompletely (36%) after oral administration (the rate but not extent is reduced by food)
Metabolism
Prodrug, converted to active agents by hydrolysis, primarily in the liver.
Excretion
excreted in both the urine and the bile
Contraindications
- Renal impairment (eGFR less than 30 mL/minute/1.73 m2)
Side effects
Common
coughhypotensionhyperkalemiaskin rashcough (5%-10%)First dose hypotension (more likely)
Serious
- Cerebrovascular disorder
- Increased risk of infection
- Joint swelling
- Limb pain
- Oedema
- Anaemia
- angioedema
- acute renal failure
- fetopathic syndrome
- neutropenia
- glycosuria
- anemia
- hepatotoxicity
- dysgeusia
- hepatic failure (rare)
- agranulocytosis (rare)
Pregnancy & lactation
Lactation
Not recommended; alternative treatment options, with better established safety information during breast-feeding, are available.
Drug interactions
Aminoglycosides
Severe
Textbook
Increased risk and severity of renal impairment and nephrotoxicity.
Not explicitly stated, but implies careful monitoring of renal function and cautious co-administration.
Source: G&G 14e
Angiotensin Receptor Blockers
Severe
Textbook
Greater incidence of acute kidney injury (AKI) and adverse cardiac events.
The combination of these two classes should be avoided.
Source: Harrison 22e · p2396
Azilsartan
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Candesartan
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Dipeptidyl Peptidase Iv Inhibitor
Severe
Textbook
Increased risk of angioedema.
Avoid combination.
Source: G&G 14e · p600
Losartan + Hydrochlorothiazide
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Olmesartan + Amlodipine
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Olmesartan + Hydrochlorothiazide
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Olmesartan Medoxomil
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Sacubitril With Valsartan
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Telmisartan + Amlodipine
Severe
Textbook
Increased worsening of renal function, hypotension, syncope, and hyperkalemia without increased efficacy.
Not recommended for the treatment of hypertension. Previous studies indicate more harm than benefit.
Source: G&G 14e
Related guidelines
Other ACE Inhibitor drugs
Ask House about Fosinopril
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-10 · House clinical team