Lisinopril: Uses, Dosage, Side Effects, and More
1. Drug Name
Generic Name: Lisinopril
Brand Name(s):
- Pakistan: Listril, Lisinex
- India: Acemin, Hipril, Lisinace
- United States: Prinivil, Zestril
- United Kingdom: Zestril
2. Pharmacological Class
Class: ACE Inhibitor
Subclass: Angiotensin-Converting Enzyme (ACE) Inhibitor
3. Mechanism of Action
Lisinopril inhibits the angiotensin-converting enzyme (ACE) that catalyzes the conversion of angiotensin I to the vasoconstrictor angiotensin II. By blocking this enzyme, lisinopril reduces angiotensin II levels, which leads to vasodilation and decreases in aldosterone secretion.
4. Indications
Primary Indications:
- Hypertension
- Heart failure
- Myocardial infarction
Off-label Uses:
- Diabetic nephropathy
- Prevention of migraines
5. Dosage and Administration
Standard Dosage:
- Hypertension: Initial dose of 10 mg once daily; usual dose range 20-40 mg daily in one or two doses.
- Heart Failure: Initial dose of 2.5-5 mg once daily; titrate up to 20-40 mg once daily as tolerated.
- Myocardial Infarction: 5 mg within 24 hours of myocardial infarction, followed by 5 mg after 24 hours, then 10 mg daily; total treatment should not exceed 6 weeks.
Route of Administration: Oral (tablets).
Special Populations:
- Pediatric: Safety and effectiveness in pediatric patients have not been established.
- Geriatric: Consider lower starting doses due to increased risk of renal impairment.
6. Pharmacokinetics
Absorption: Rapidly absorbed from the gastrointestinal tract.
Distribution: Widely distributed, including into breast milk.
Metabolism: Minimal hepatic metabolism.
Excretion: Primarily excreted unchanged in the urine.
Half-life: Approximately 12 hours.
7. Contraindications
Lisinopril is contraindicated in patients who are hypersensitive to this product or any other ACE inhibitor. It should not be used in patients with a history of angioedema related to previous treatment with an ACE inhibitor.
8. Warnings and Precautions
Use with caution in patients with impaired renal function, hypovolemia, hyponatremia, or those undergoing surgery or anesthesia involving hypotension. Monitor for hypotension, renal function, and hyperkalemia.
9. Side Effects
Common Side Effects: Dizziness, headache, cough, hypotension.
Serious Side Effects: Angioedema, hyperkalemia, renal failure. Discontinue use and notify a healthcare provider immediately if these occur.
10. Drug Interactions
Major Interactions: Potassium-sparing diuretics, potassium supplements, and nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk of hyperkalemia.
Moderate Interactions: Lithium, aliskiren, and certain immunosuppressants may increase the risk of renal impairment.
Minor Interactions: Alcohol, certain antibiotics, and other antihypertensive medications.
11. Pregnancy and Lactation
Pregnancy Category: Category D - Use of drugs that act on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death. If pregnancy is detected, discontinue lisinopril as soon as possible.
Breastfeeding Considerations: Because of the potential for serious adverse reactions in nursing infants, decide whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.
12. Patient Counseling Information
Key Points for Patients:
- Take lisinopril exactly as directed. Do not exceed the recommended dose.
- Do not use salt substitutes containing potassium without consulting your healthcare provider.
- Monitor blood pressure regularly, and report any symptoms of hypotension or other side effects to your doctor.
Administration Tips:
- Take with or without food.
- If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose. Do not double the dose to catch up.