No evidence of significant CYP-dependent metabolism. Two references stating (probable) non- porphyrinogenicity. Risk for gastrointestinal adverse events in the form of nausea, vomiting, diarrhoea, abdominal pain and dyspepsia motivates vigilance against insufficient intake of food, especially of carbohydrate.

(To be edited, initial data ST OCT 04) Hydrolyzed by esterases in the liver to fosinoprilate, an ACE-inhibitor. Of this is 75% excreted in unchanged form by the kidneys, 20-30% as glucuriode conjugate and 1-5% as p-hydroxy metabolite. South African list:use with care. French list: authorized.

Common side effects that can be potentially porphyrinogenic through reduction in carbohydrate intake and that also can be confused with an acute porphyria attack are nausea, vomiting, diarrhoea, abdominal pain and dyspepsia. Other common side effects are musculoskeletal pain, myalgia, fatigue, chest pain and asthenia.

Uneventful use reported in 1 patient with acute porphyria.