Fosetic

Fosetic - ACE inhibitor | Dosage | Effects

This article was medically reviewed by M.Pharm, Marko Tanaskovic on August 12, 2018. To read more about an author, click here.

Fosetic is a drug that contains two active substances - fosinopril and hydrochlorothiazide. Fosinopril belongs to a group of medicines called angiotensin-converting enzyme inhibitors (ACE inhibitors), while hydrochlorothiazide belongs to the group of thiazide diuretics.

Fosinopril works by inhibiting angiotensin-converting enzyme which prevents the conversion of angiotensin I into angiotensin II (which is considered a potent vasoconstrictor substance) and thus reduces vasoconstriction (narrowing of the blood vessels) and aldosterone secretion (aldosterone is adrenal gland hormone that increases the reabsorption of sodium and water, thereby increasing blood pressure). It is thought that fosinopril increases the concentration of bradykinin (a substance that has a vasodilatory effect - widening of blood vessels). All of these mechanisms lead to a decrease in blood pressure.

Hydrochlorothiazide exerts diuretic and natriuretic effects - it increases the secretion of water and sodium from the body, which also lowers blood pressure. Hydrochlorothiazide increases the excretion of potassium, while fosinopril spares potassium, which is why Fosetic is considered to have no significant effect on potassium levels in the blood.

The combination of these two active substances leads to an additive antihypertensive effect.

Fosetic is used in the treatment of essential hypertension.

Precautions

Fosetic is contraindicated in the following conditions:

  • In patients who are allergic to active substances: fosinopril or hydrochlorothiazide or other chemically similar substances, such as: lisinopril, ramipril, enalapril, captopril, and others.
  • In patients with severe renal impairment (creatinine clearance less than 30 ml / min). Cases of acute kidney injury due to administration of hydrochlorothiazide have been reported, and therefore Fosetic should be avoided in such patients.
  • In patients with severe hepatic impairment. Hepatotoxicity induced by the use of fosinopril has been reported, and Fosetic is therefore not recommended in patients with hepatic impairment.
  • In patients who have a positive history of angioedema.

Signs of symptomatic hypotension (decrease in blood pressure) have been reported in patients taking Fosetic. In patients who have a higher risk of symptomatic hypotension (e.g. patients with heart failure), Fosetic should be used with extra precaution because an excessive drop in blood pressure can lead to a myocardial infarction or stroke.

Fosetic should be used with extra precaution in patients with mitral valve stenosis, aortic stenosis, or hypertrophic cardiomyopathy.

Decrease in the number of blood cells (erythrocytes, leukocytes, and blood platelets) have been reported after the use of Fosetic. Decrease in the number of leukocytes may weaken your immune system, and this can lead to infections that are very difficult to treat. If you are experiencing flu-like symptoms, you should contact your doctor immediately.

Persistent and dry cough occurs very often due to the use of ACE inhibitors, including Fosetic. This cough rapidly disappears after discontinuation of therapy.

The use of Fosetic can lead to an increase in blood potassium levels, especially in patients with diabetes or kidney damage. If you are taking potassium preparations or other medicines that can increase blood potassium levels (e.g. spironolactone), you should inform your doctor.

Fosetic can affect the level of blood glucose, and should be used with extra precaution in patients with diabetes.

Fosetic, Pregnancy and Breastfeeding

The use of Fosetic is absolutely contraindicated in the second and third trimesters of pregnancy. The use of Fosetic during the 3-9 month of pregnancy period significantly increases the risk of kidney damage and cranial growth retardation in the fetus.

The use of Fosetic during the first three months of pregnancy is also not recommended. Talk to your doctor if you are pregnant or you discover that you are pregnant while taking Fosetic.

Fosetic should not be used during breastfeeding because the safety of use during breastfeeding has not been established.

Dosage

The usual dose in the treatment of hypertension is one Fosetic tablet (containing 20 mg fosinopril and 12.5 mg hydrochlorothiazide) daily. It is best to take the tablet half an hour after getting up with a full glass of water before breakfast.

Interactions

Fosetic should not be used concurrently with the following drugs:

  • Potassium preparations. Concomitant use with potassium preparations may lead to a significant increase in potassium in the blood, which can cause cardiac arrhythmias.
  • Potassium-sparing diuretics, such as spironolactone, traimterene, amiloride and eplerenone.
  • Aliskiren - a renin inhibitor that is used to treat hypertension. Simultaneous administration increases the risk of nephrotoxicity and hyperkalaemia.
  • Allopurinol - medicine used to treat gout. Simultaneous administration increases the risk of allergic reactions.
  • Angiotensin-receptor blockers (ARBs), such as: valsartan, olmesartan, losartan, and candesartan. Simultaneous administration increases the risk of hypotension, hyperkalaemia, and kidney damage.
  • Leflunomide (brand name Arava) and teriflunomide - medicines used in the treatment of rheumatoid arthritis. Concurrent use increases the risk of hepatotoxicity (damage to the liver).
  • Mipomersen - medicine used to lower blood cholesterol. Concurrent use is not recommended due to an increased risk of liver damage.
  • Lithium - antipsychotic. Concomitant use can lead to kidney damage.
  • Insulin and oral antidiabetic drugs. Concomitant use increases the risk of hypoglycaemia, and it is recommended to adjust the dose of antidiabetic medicines if taken together with Fosetic.
  • Non-steroidal anti-inflammatory drugs, such as: acetylsalicylic acid (Aspirin), ibuprofen, flurbiprofen, ketoprofen and others. These drugs reduce the antihypertensive effect of Fosetic.
  • Gold - used in the treatment of rheumatic diseases. Concurrent use may result in a nitritoid reaction that is manifested with following symptoms: nausea, redness, and hypotension.
  • Antacids - medicines used in the treatment of heartburn. Antacids can affect Fosetic absorption, and it is recommended to take antacids at least three hours before or after taking Fosetic.
  • Digitalis preparations used in cardiac insufficiency therapy.
  • Carbamazepine - medicine used in the treatment of epilepsy. Concurrent use increases the risk of hyponatraemia (low blood sodium levels).
  • Bactrim (trimethoprim / sulfamethoxazole) - medicine used in the treatment of infections. Concurrent use increases the risk of hyperkalaemia.

Concurrent use with alcoholic beverages increases the risk of hypotension, and therefore alcoholic beverages must be avoided while using Fosetic.

Tell your doctor about all the medicines you are taking.

Side Effects

Fosetic can cause the following side effects:

  • Dizziness.
  • Headache.
  • Dry mouth.
  • Increased thirst.
  • Tachycardia.
  • Tiredness.
  • Difficulty in urinating.
  • Gout.
  • Increase in potassium levels in the blood.
  • Decreased appetite.
  • Decrease in the number of leukocytes in the blood.
  • Anemia.
  • Thrombocytopenia.
  • Redness.
  • Stroke.
  • Insomnia.
  • Ringing in the ears.
  • Heart attack.
  • Dry cough.
  • Pancreatitis.
  • Liver damage.
  • Kidney damage.
  • Inflammation of the joints.
  • Impotence.
  • Low blood sodium levels.
  • Blurred vision.
  • Arrhythmias.
  • Photosensitivity.
  • Fever.
  • Flu-like symptoms.
  • Angioedema and other allergic reactions.

Tell your doctor if you are experiencing any side effects.

References

  1. NCBI link 1
  2. NCBI link 2

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