Fosinopril

Potassium-sparing diuretic that can increase risk of hyperkalemia when used with fosinopril. Requires caution and frequent monitoring of serum potassium levels.

May cause excessive reduction of blood pressure, especially in patients with intravascular volume depletion. Risk can be minimized by discontinuing diuretic, increasing salt intake, or reducing starting dose.

ACE inhibitors may increase serum lithium levels and cause lithium toxicity. Co-administer with caution and monitor serum lithium frequently. Risk increases if diuretic is also used.

Can increase risk of hyperkalemia when combined with fosinopril. Should be used with caution and serum potassium monitored frequently.

Injectable gold may cause nitritoid reactions (facial flushing, nausea, vomiting, hypotension) when combined with fosinopril.

Potassium-sparing diuretic that can increase risk of hyperkalemia when used with fosinopril. Requires caution and frequent monitoring of serum potassium levels.

mTOR inhibitor that may increase risk of angioedema when used concomitantly with fosinopril.

Potassium-sparing diuretic that can increase risk of hyperkalemia when used with fosinopril. Requires caution and frequent monitoring of serum potassium levels.

Antacid reduces serum levels and urinary excretion of fosinoprilat. Separate dosing by 2 hours if concomitant use is needed.

Drug Interactions Potassium supplements and potassium-sparing diuretics As noted above (“Derangements of Serum Electrolytes”), the net effect of fosinopril sodium and hydrochlorothiazide may be to elevate a patient’s serum potassium, to reduce it, or to leave it unchanged. Because renal clearance of lithium is reduced by thiazides, the risk of lithium toxicity is presumably raised further when, as in therapy with fosinopril sodium and hydrochlorothiazide tablets, a thiazide diuretic is coadministered with the ACE inhibitor. Fosinopril sodium and hydrochlorothiazide and lithium should be coadministered with caution, and frequent monitoring of serum lithium levels is recommended.

NSAIDs may cause renal function deterioration and acute renal failure in elderly, volume-depleted, or renally compromised patients; may attenuate antihypertensive effect.

Antacid reduces serum levels and urinary excretion of fosinoprilat. Separate dosing by 2 hours if concomitant use is needed.

Monitor renal function periodically in patients receiving quinapril and NSAID therapy.

Antacid reduces serum levels and urinary excretion of fosinoprilat. Separate dosing by 2 hours if concomitant use is needed.

Drug Interactions Diuretics Patients on diuretics, especially those with intravascular volume depletion, may occasionally experience an excessive reduction of blood pressure after initiation of therapy with fosinopril sodium tablets. The possibility of hypotensive effects with fosinopril sodium can be minimized by either discontinuing the diuretic or increasing salt intake prior to initiation of treatment with fosinopril sodium. Agents increasing serum potassium Coadministration of fosinopril with potassium sparing diuretics, potassium supplements, potassium-containing salt substitutes or other drugs that raise serum potassium levels may result in hyperkalemia.

In separate single or multiple dose pharmacokinetic interaction studies with chlorthalidone, nifedipine, propranolol, hydrochlorothiazide, cimetidine, metoclopramide, propantheline, digoxin, and warfarin, the bioavailability of fosinoprilat was not altered by coadministration of fosinopril with any one of these drugs.

In separate single or multiple dose pharmacokinetic interaction studies with chlorthalidone, nifedipine, propranolol, hydrochlorothiazide, cimetidine, metoclopramide, propantheline, digoxin, and warfarin, the bioavailability of fosinoprilat was not altered by coadministration of fosinopril with any one of these drugs.

In separate single or multiple dose pharmacokinetic interaction studies with chlorthalidone, nifedipine, propranolol, hydrochlorothiazide, cimetidine, metoclopramide, propantheline, digoxin, and warfarin, the bioavailability of fosinoprilat was not altered by coadministration of fosinopril with any one of these drugs.

Table 3: No observed clinically important drug interactions of Veltassa Angiotensin-converting enzyme (ACE) inhibitors Benazepril, captopril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril, trandolapril Angiotensin II receptor blockers (ARB) Azilsartan, candesartan, irbesartan, losartan, olmesartan, valsartan β-adrenoceptor blockers (β-blocker) Metoprolol Loop diuretics Furosemide, bumetanide, torasemide Mineralocorticoid receptor antagonists (MRA) Eplerenone, finerenone, spironolactone Neprilysin inhibitors Sacubitril Sodium-glucose cotransporter-2 (SGLT-2) inhibitors Canagliflozin, dapagliflozin, empagliflozin Antibiotics Trimethoprim, amoxicillin, cephalexin Anticoagulants Warfarin, apixaban, rivaroxaban Anti-parathyroid agents and Thyroid preparations Cinacalcet Antithrombotic agents Clopidogrel, acetylsalicylic acid Blood glucose lowering drugs Glipizide Calcium channel blockers Amlodipine, verapamil Immunosuppressants Tacrolimus Others Lithium, allopurinol, atorvastatin, digoxin, phenytoin, riboflavin, sevelamer

In separate single or multiple dose pharmacokinetic interaction studies with chlorthalidone, nifedipine, propranolol, hydrochlorothiazide, cimetidine, metoclopramide, propantheline, digoxin, and warfarin, the bioavailability of fosinoprilat was not altered by coadministration of fosinopril with any one of these drugs.