Drug Detail:Monopril hct (Hydrochlorothiazide and fosinopril [ hye-droe-klor-oh-thy-a-zide-and-foe-sin-oh-pril ])
Drug Class: ACE inhibitors with thiazides
Usual Adult Dose for Hypertension
Fosinopril 10 to 40 mg-Hydrochlorothiazide 12.5 to 37.5 mg orally per day
Comments: The effect of fosinopril 10 mg-hydrochlorothiazide 12.5 mg was similar to the effect seen with monotherapy using either fosinopril 40 mg or hydrochlorothiazide 37.5 mg.
Use: Treatment of hypertension when the desired effect has not been achieved with monotherapy or as substitution for the titrated individual components.
Renal Dose Adjustments
Mild to moderate renal dysfunction (CrCl 30 mL/min/1.73 m2 or greater): No adjustment recommended
Severe renal dysfunction (CrCl less than 30 mL/min/1.73 m2, serum creatinine roughly greater than or equal to 3 mg/dL or 265 mcmol/L): Not recommended
Liver Dose Adjustments
Use with caution
Precautions
US BOXED WARNING:
- FETAL TOXICITY: If pregnancy is detected, discontinue this drug as soon as possible. Drugs that act directly on the renin-angiotensin system (RAS) can cause injury and death to the developing fetus.
Safety and efficacy have not been established in patients younger than 18 years.
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Monitoring:
- Hematologic: White blood cell counts in patients with collagen vascular disease, especially if the disease is associated with impaired renal function.
- Metabolic: Serum electrolytes prior to starting treatment and periodically thereafter.
- Renal: Kidney function during the first few weeks of therapy and periodically thereafter.
Patient advice:
- Advise patients to immediately report any signs or symptoms of angioedema (breathing difficulty or swelling of face, eyes, lips, or tongue) and to stop taking this drug until consulting a physician.
- Females of childbearing age should be informed of the consequences of exposure to this drug during pregnancy; ask these patients to report pregnancies as soon as possible.
- Encourage patients to report any lightheadedness that may occur during treatment initiation and to stop taking this drug until consulting a physician.
- Caution patients to consult their physician if excessive perspiration, dehydration, vomiting, or diarrhea occurs as it may lead to excessive blood pressure reduction due to reduced fluid volume.
- Advise patients against using potassium-sparing diuretics, potassium supplements or potassium-containing salt substitutes without consulting their physician.
- Tell patients to promptly report any sign of infection (e.g., sore throat, fever), which may be a sign of neutropenia.
