Lisinopril

A to Z Drug Facts

(lie-SIN-oh-prill)

Prinivil, Zestril,  Apo-Lisinopril

Class: Antihypertensive/ACE inhibitor

 Action Competitively inhibits angiotensin I–converting enzyme, prevention of angiotensin I conversion to angiotensin II, a potent vasoconstrictor that also stimulates aldosterone secretion. Results in decrease in sodium and fluid retention, decrease in BP and increase in diuresis.

 Indications Treatment of hypertension; treatment of heart failure not responding to diuretics and digitalis; treatment of acute myocardial infarction within 24 hours in hemodynamically stable patients.

 Contraindications Hypersensitivity to ACE inhibitors.

 Route/Dosage

Hypertension

ADULTS: PO Initial dose: 10 mg qd. Maintenance: 20 to 40 mg/day; may add diuretic if needed and decrease dose.

CHF

ADULTS: PO Initial dose: 5 mg qd with diuretics and digitalis; reduce concomitant diuretic dose, if possible, to minimize hypovolemia. In patients with hyponatremia, initiate with 2.5 mg qd. Usual dose: 5 to 20 mg/day.

MI

ADULTS: PO Initial dose: 5 mg, then 5 mg after 24 hours, then 10 mg after 48 hours. Maintenance: 10 mg/day for 6 weeks. Patients should receive, as appropriate, the standard recommended treatments such as thrombolytics, aspirin, and beta blockers.

 Interactions

Allopurinol: Greater risk of hypersensitivity possible with coadministration. Antacids: Lisinopril bioavailability may be decreased. Separate administration times by 1 to 2 hrs. Capsaicin: Cough may be exacerbated. Digoxin: May increase plasma digoxin levels. Indomethacin: Reduced hypotensive effects, especially in low-renin or volume-dependent hypertensive patients. Lithium: Increased lithium levels and symptoms of lithium toxicity. Potassium-sparing diuretics, potassium preparations: May increase serum potassium levels. Phenothiazines: May increase pharmacological effect of phenothiazines.

 Lab Test Interferences False elevation of liver enzymes, serum bilirubin, uric acid or blood glucose may occur.

 Adverse Reactions

CV: Chest pain; hypotension; orthostatic hypotension. CNS: Headache; dizziness; fatigue. DERM: Rash; pruritus. GI: Nausea; vomiting; diarrhea. HEMA: Small decreases in hemoglobin and hematocrit; neutropenia; bone marrow depression; eosinophilia. META: Hyperkalemia; hyponatremia. RESP: Cough (especially in females); upper respiratory symptoms; dyspnea. OTHER: Asthenia; angioedema.

 Precautions

Pregnancy: Category D (second and third trimester); Category C (first trimester). Can cause injury or death to fetus if used during second or third trimester. Lactation: Undetermined. Avoid use in nursing women if possible. Children: Safety and efficacy not established. Elderly: Reduced dosage may be necessary. Angioedema: Use with extreme caution in patients with hereditary angioedema. Hypotension/First-dose effect: Significant decreases in BP may occur after first dose, especially in severely salt- or volume-depleted patients or those with heart failure. Minimize risk by discontinuing diuretics, decreasing dose or increasing salt intake approximately 1 wk prior to initiating drug. Neutropenia and agranulocytosis: May occur; risk appears greater in patients with renal dysfunction, heart failure or immunosuppression. Renal impairment: Reduce dose and give less frequently. In renal insufficiency, stable elevations in BUN and serum creatinine may occur due to inadequate renal perfusion; monitor renal function during first few weeks of therapy and adjust dosage carefully, especially if glomerular filtration rate < 30 mL/min.

 Administration/Storage

• May be administered with or without food.
• Store at room temperature in tightly-closed, light-resistant container.

 Assessment/Interventions

• Acute myocardial infarction patients: patients with a low systolic blood pressure (£ 120 mmHg) when treatment is started or during the first 3 days after the infarct should be given lower 2.5 mg dose. If hypotension occurs (systolic blood pressure £ 100 mmHg), a daily maintenance dose of 5 mg may be given with temporary reductions to 2.5 mg if needed. If prolonged hypotension occurs (systolic blood pressure < 90 mmHg for > 1 hour), withdraw lisinopril. For patients who develop symptoms of heart failure, see Dosage for CHF.
• Obtain patient history, including drug history and any known allergies. Note history of angioedema, hypersensitivity to ACE inhibitors, renal disease, CHF and use of diuretics/dialysis.
• Ensure that baseline blood, renal and thyroid function studies have been obtained before administration and monitor during treatment.
• Obtain baseline BP and pulse and monitor closely for at least 2 hr after initial dose and during first 2 wk of therapy. If systolic BP is < 90 mm Hg, withhold medication and notify physician.
• If patient develops sudden severe dyspnea, swelling of lips or eyes or edema of hands and feet, withhold medication and notify physician.
• Monitor for hyperkalemia in patients with impaired renal function or diabetes mellitus and in patients receiving potassium supplements or potassium-sparing diuretics.
• Assist patient with position changes and ambulation during initial phase of therapy. Orthostatic hypotension is common.
• Keep side rails raised if hypotension or dizziness occur.

 Patient/Family Education

• Instruct patient not to discontinue medication suddenly. Tell patient that missed doses should be taken as soon as possible unless close to time of next dose. Do not double up doses.
• Explain that chronic cough may occur. Instruct patient to avoid cough, cold or allergy medications and to notify physician.
• Instruct patient not to use potassium-containing salt substitute without consulting physician.
• Tell patient to avoid sudden position changes to prevent orthostatic hypotension.
• Instruct patient to report the following symptoms to physician: Dyspnea, loss of taste; swelling of eyes, face, lip, tongue or throat; difficulty breathing, speaking or swallowing.
• Advise patient to use caution while driving or performing other tasks requiring mental alertness until response to medication is known.
• Instruct patient to avoid intake of alcoholic beverages and not to take otc medications without consulting physician.
• Emphasize importance of follow-up visits and frequent assessment of BP while taking drug.
• Advise patient and family that life-style changes (eg, exercise, salt restriction, weight loss) will enhance effectiveness of medication and may facilitate lower medication doses.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts