Hydrochlorothiazide + Fosinopril

Hypertension

Hypertension 10 mg/12.5 mg PO qDay initially Dosage range: 10-80 mg/12.5-50 mg per day PO Combination therapy indicated for patients whose blood pressure is not adequately controlled with fosinopril or hydrochlorothiazide monotherapy Hepatic impairment Metabolism of active metabolite fosinoprilat will be reduced in progressive liver disease; use caution

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

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)

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

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

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

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