Lisinopril

ACE Inhibitor · ACE inhibitor

Indications

Essential and renovascular hypertension when standard treatment is ineffective or inappropriate because of adverse effects. Adjunct to diuretics and/or digitalis in congestive cardiac failure. Hypertension, when used in addition to diuretic, in cardiac decompensation or in volume depletion, renal complications of Diabetes Mellitus.

Dosage

Hypertension: Adults: Initially 10 mg once daily increasing usually to a maintenance dose of 20 mg once daily; max 80 mg daily. Discontinue dose of any diuretic 2-3 days before initiating therapy. Congestive cardiac failure: Adults: Initially 2.5 mg once daily increasing gradually over 2-4 wk to maintenance of 5-20 mg once daily. Hypertension, when used in addition to diuretic, in cardiac decompensation or in volume depletion: Adults: Initially 2.5 mg once daily, maintenance 20 mg once daily, max 80 mg/day. Short-term treatment following MI in haemodynamically stable patients: Adults: Systolic BP >120 mmHg: 5 mg taken within 24 hrs of attack, then 5 mg to be taken 24 hrs after 1st dose, then 10 mg to be taken 24 hrs after 2nd dose then 10 mg once daily for 6 wks (or continued if heart failure), temporarily reduce maint dose to 5 mg and if required 2.5 mg daily if systolic BP 100 mmHg or…

Adverse Effects

Hypotension, renal failure, angioedema, rash, dizziness, headache, GI upset, cough, fatigue, palpitations, asthaenia, impotence, pruritus, rhinitis, neutropenia, agranulocytosis, thrombocytopenia, anaemia, sleep disturbances, dysgeusia, hepatic failure.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Contraindicated in pregnancy. Lactation: Caution advised or effect undetermined. Contraindications: Aortic stenosis, outflow obstruction, cor pulmonale. Angioneurotic oedema related to previous ACE-inhibitor therapy. Renal dysfunction. Systolic BP <100 mmHg in acute MI. Precautions: Renovascular hypertension, severe congestive heart failure, bilateral renal artery stenosis, ischaemic heart disease, cerebrovascular disease, low systolic BP in acute MI, haemodialysis, renal impairment; monitor renal function before and during treatment, white cell count before and during therapy. Risk factors for hypotension. Anaesthesia, aortic or mitral valve stenosis, outflow obstruction, collagen vascular disease, diabetes, LDL apheresis. Monitor serum electrolytes.

Interactions

K+ sparing diuretics or K+ supplements, lithium, other antihypertensives, trimethoprim, heparin, anaesthetics, TCADs, antipsychotics, allopurinol, NSAIDs, rifampicin, immunosuppressants, antidiabetic agents, sympathomimetics, procainamide, hyposensitising agents, high flux dialysis membranes, vasodilators, sodium aurothiomalate (gold), alcohol, mTOR inhibitors (e.g., everolimus, temsirolimus, sirolimus), tissue plasminogen activator, racecadotril.

Advice to Patient

Take 1 hour before or 2 hours after meals. Take first dose at bedtime. Do not take potassium supplement or salt substitutes without consulting prescriber. Change position slowly when climbing stairs and from lying or sitting to standing position. If you have diabetes, regularly check blood glucose level and inform prescriber about changes. Contact prescriber if there is dizziness, chest pain, palpitations, mouth sores, fever, chills, swelling of ankles/feet/face/lips/mouth/tongue/throat, skin rash, numbness, tingling, muscle pain, difficulty in breathing or unusual dry cough.

Pharmacokinetics

Onset of action: 1 hr. Peak effect: Hypotensive: Oral: Approx. 6 hrs. Duration: 24 hrs. Metabolism: Not metabolized. Bioavailability: Children 2-15 yrs: 20%-36%. 6-16 yrs: Approx. 28%. Adults: Approx. 25%; reduced to 16% with NYHA Class II-IV heart failure. Half-life elimination: 12 hrs. Time to peak: Paediatric patients 6 mth-15 yrs: 5-6 hrs. Adults: Approx. 7 hrs. Excretion: Primarily urine.

Unlicensed Use

Children: ORAL: Hypertension, proteinuria in nephritis: 6-12 yr, initially 70 mcg/kg (max 5 mg) once daily, increased in intervals of 1-2 wk to max. 600 mcg/kg (or 40 mg) once daily; 12-18 yr, initially 5 mg once daily; usual maintenance dose 10-20 mg once daily, max 80 mg once daily. Diabetic nephropathy: 12-18 yr, initially 5 mg once daily; usual maintenance dose 10-20 mg once daily, max 80 mg once daily. Heart failure (adjunct): 12-18 yr, initially 2.5 mg once daily; increased in steps no greater than 10 mg at intervals of at least 2 wk up to max 35 mg once daily if tolerated.

Brands with this active ingredient

Compiled by Healify Pharmacy from published drug references. How we compile it →

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