Monograph
C09BA09 - Fosinopril and Diuretics |
Propably not porphyrinogenic |
PNP |
Rationale
Fosinopril:No evidence of significant CYP-dependent metabolism. Two references stating (probable) non- porphyrinogenicity. Hydrochlorthiazide: Not metabolised. Probably no CYP-affinity. Clinical experience of non-porphyrinogenicity. Conflicting evidence.
Chemical description
Fosinopril: Hydrolyzed by esterases in the liver to fosinoprilate, an ACE-inhibitor. Of this 75% is excreted in unchanged form by the kidneys, 20-30% as glucuriode conjugate and 1-5% as p-hydroxy metabolite. Hydrochlorthiazide: thiazide diuretic, sulfonamide congener. Eliminated in urine in unchanged form. Probably no CYP-affinity. Fosinopril: South African list:use with care French list: authorized. Hydrochlorthiazide: South African list: use. French list: authorized. Australian list: unsafe associated with attacks. Thunell, patient report (n=1): tolerated. Andersson, patient reports (n=10): tolerated. Martindale: Hydrochlorthiazide has been associated with acute attacks of porphyria and is considred unsafe in porphyric patients. EPI-list: sulfonamides on the unsafe list.
IPNet drug reports
Uneventful use reported in 1 patient with acute porphyria.
Similar drugs
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