Monace

Monace - Dosage | Interactions | Effects

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

Monace is a drug that contains fosinopril and belongs to the angiotensin converting enzyme inhibitors (so-called ACE inhibitors). It is available in Australia. According to the chemical structure, Monace is an ester that is hydrolyzed in the body by enzymes that are called esterases. It is hydrolyzed to fosinoprilat which is a long-acting inhibitor of AC enzyme. It works by preventing the formation of angiotensin II which is a potent vasoconstrictor agent (vasoconstriction means blood vessel narrowing), and thus leads to a decrease in blood pressure.

Decrease in angiotensin II blood levels also leads to a decrease in secretion of the hormone called aldosterone which is responsible for maintaining the levels of potassium and sodium. Therefore, Monace can lead to an increase in potassium and a decrease in sodium levels in the blood.

Studies have shown that Monace prevents the degradation of bradykinin - vasodilator agent (vasodilation is the widening of blood vessels). An increase in bradykinin levels leads to the dilation of blood vessels and consequently to decreased heart rate and lower blood pressure.

The hypotensive effects of Monace usually occur within 60 minutes and lasts up to 24 hours. The maximum effect is achieved after 3-6 hours.

Monace is used to treat hypertension and heart failure. Studies have shown that Monace reduces the incidence of hospitalization in patients with heart failure.

Contraindications and precautions

It is contraindicated in the following conditions:

  • Cardiogenic shock.
  • Renal artery stenosis.
  • If you have or have had angioneurotic edema.
  • If you are pregnant.
  • If you are allergic to the active substance fosinopril or other ACE inhibitors.

Cases of angioedema that may affect lips, face, tongue and larynx have been reported. Severe cases with fatal outcome have also been reported in patients who were taking ACE inhibitors! Therefore, you should contact your doctor immediately if you notice swelling of the lips, face or tongue.

Monace should be administered only under strict medical supervision in patients with:

  • Kidney problems.
  • Immune system disorders.
  • Cardiomyopathy.

Since it affects the level of electrolytes (potassium and sodium), Monace must be used very cautiously in patients with dehydration, or in patients who are on a low-sodium diet.

It should be used with extra precaution in diabetics, as it can affect the blood sugar levels.

Monace can cause hyperkalaemia, most commonly due to concomitant administration with other drugs that increase potassium levels. Symptoms of hyperkalaemia are difficulty breathing, chest pain, irregular heartbeat, palpitations, weakness, tingling, nausea and vomiting. If you are experiencing any of these symptoms, contact your doctor immediately.

Monace and its use during pregnancy and breastfeeding

Monace is absolutely contraindicated in pregnancy. Cases of fetal death have been reported when ACE inhibitors were administered during pregnancy. Monace can cause retardation of intrauterine growth, decreased renal function, decreased fetal lung development, and craniofacial deformation. Monace should not be used during pregnancy and you should discontinue this medicine if you find out that you are pregnant during the therapy.

Monace should not be used by nursing mothers because it is excreted in breast milk and can cause side effects in infants.

Dosage

The usual initial dose is 10 mg once a day. The dose may be increased up to 40 mg per day.

However, the dose should be determined depending on the antihypertensive effect of Monace. If once-daily dosing does not keep blood pressure in the normal range throughout the day, the Monace daily dose can be divided in two doses.

It is recommended to take tablets in the morning, before breakfast, with half a glass of water.

It is not recommended for use in patients under the age of 18.

Your doctor will recommend the dosage that is best for you.

Interactions

Simultaneous use of Monace tablets with the following medicines increases the risk of hyperkalaemia:

  • Potassium-sparing diuretics, such as: spironolactone, triamterene and amiloride.
  • Potassium-containing supplements.
  • Other ACE inhibitors, such as: captopril, lisinopril, enalapril, ramipril, and others.
  • Angiotensin-receptor blockers (medicines used to treat hypertension), such as: valsartan, candesartan, irbesartan, and losartan.
  • Aliskiren - a medicine used to treat hypertension.

Monace should not be used concomitantly with any of the following drugs:

  • Leflunomide - a medicine used to treat rheumatoid arthritis. Simultaneous administration increases the toxic effects on the liver.
  • Lomitapid and mipomersen - medicines used to lower cholesterol. Simultaneous administration increases the risk of hepatotoxicity.
  • Allopurinol - a medicine used to treat gout. Simultaneous administration with this medicine increases the risk of severe allergic reactions.
  • Azathioprine (an immunosuppressive drug). Simultaneous administration increases the risk of decreasing white blood cell count.
  • Lithium (antipsychotic). Monace can increase lithium levels in the blood, thereby increasing the risk of adverse lithium effects.
  • Non-steroidal anti-inflammatory drugs, such as: ibuprofen, diclofenac, ketoprofen, flurbiprofen, and others. These medicines can reduce the effects of Monace.
  • Oral antihyperglycemic medications. Monace can increase the effect of these drugs, and therefore it is recommended to adjust the dose of antihyperglycemic medications.

If you are taking antacids (medicines used for heartburn), you should not take them within 3 hours of taking Monace because this can reduce its absorption and therefore reduce its efficacy.

Tell your doctor about all the medicines you are taking.

Side effects

Monace can cause the following side effects:

  • Sore throat.
  • Respiratory infections (pharyngitis, tonsillitis, sinusitis, laryngitis, bronchitis and pneumonia).
  • Arrhythmias.
  • Coughing.
  • Nausea.
  • Vomiting.
  • Constipation.
  • Myalgia.
  • Arthralgia.
  • Impotence.
  • Dizziness.
  • Headache.
  • Mood changes.
  • Confusion.
  • Depression.
  • Visual disturbances.
  • Weakness
  • Loss of appetite.
  • Nosebleeds.
  • Dry mouth.
  • Hepatitis.
  • Hyperkalaemia.
  • Stroke.
  • Gout.
  • Renal insufficiency.
  • Weight gain.
  • Allergy.

Tell your doctor if you are experiencing any side effects.

References

  1. FDA

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