Hey all, welcome back to the Real Life Pharmacology podcast. I'm your host pharmacist Eric Christensen.

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All right, let's get into the drug of the day today, and that is phosphynapril.

This medication, as you can maybe tell by the ending, is an ACE inhibitor.

Now, if you remember what ACE stands for, its angiotensin converting enzyme, ultimately by blocking this enzyme with an ACE inhibitor like Fosinopor,

we can prevent the formation of angiotensin 2. Angiotensin 2 is a potent vasoconstrictor.

So reducing angiotensin 2 ultimately leads to lower blood pressure,

which is indeed what fascinopril, or brand name monopril, is used for.

So usage is hypertension. Usual dosage range I've seen in practice is 10 to 40 milligrams.

I've probably seen 10 and 20 milligrams most commonly, but can go up to 40.

A package insert does allow up to 80 milligrams per day. I can't say I've seen that very

often in practice, but it is something to consider in patients maybe where we don't have

other alternative blood pressure medications that we can use. Maybe you'd consider pushing the

dose as long as they were tolerating it there.

And then heart failure with reduced ejection fraction, it is approved for that as well.

And we're going to try to target higher doses if we can, specifically up to 40 milligrams.

Generally, we don't go up to 80 milligrams for the target dose of heart failure,

just because I don't believe that has been studied, if that's correct in my recollection.

So heart failure with reduced ejection fraction, we do want to target 40 milligrams, if possible.

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