Lisinopril

Complete Guide with FAQs

Introduction

• Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor commonly prescribed to treat high blood pressure (hypertension), heart failure, and to improve survival after a heart attack.
• It helps relax blood vessels, improving blood flow and reducing the workload on the heart.
• Widely used due to its effectiveness and protective effects on the heart and kidneys.

Class and Mechanism of Action

• Drug Class: ACE inhibitor.
• Mechanism of Action:
  • Inhibits the ACE enzyme, which reduces the production of angiotensin II, a compound that narrows blood vessels.
  • Lowers blood pressure by relaxing and widening blood vessels.
  • Reduces strain on the heart and slows the progression of kidney disease, particularly in diabetics.

Indications

1. Hypertension (High Blood Pressure)
   • First-line treatment for managing elevated blood pressure.
2. Heart Failure
   • Improves symptoms and reduces hospitalizations.
3. Post-Myocardial Infarction (Heart Attack)
   • Enhances survival and prevents further heart damage.
4. Diabetic Nephropathy
   • Protects kidney function in patients with diabetes.

Dosage and Administration

Hypertension:

• Initial dose: 10 mg once daily.
• Maintenance dose: 20–40 mg once daily.

Heart Failure:

• Initial dose: 2.5–5 mg once daily.
• Maximum dose: 40 mg daily.

Post-Myocardial Infarction:

• Initial dose: 5 mg within 24 hours, followed by 10 mg daily.

Administration Guidelines:

• Take at the same time each day, with or without food.
• Stay hydrated to avoid dizziness from blood pressure drops.

Forms, Brand Names, Manufacturers, and Prices

Brand Name	Manufacturer	Form	Price Range
Prinivil	Merck	Tablets (5, 10, 20 mg)	~$5–$20 per pack
Zestril	AstraZeneca	Tablets	~$10–$30 per pack
Generic Lisinopril	Various	Tablets	~$2–$10 per pack

Contraindications and Precautions

Contraindications:

• History of angioedema related to ACE inhibitors.
• Pregnancy.
• Severe renal artery stenosis.
• Hypersensitivity to lisinopril or other ACE inhibitors.

Precautions:

• Use cautiously in patients with kidney impairment or hyperkalemia (high potassium levels).
• Monitor for signs of angioedema, especially in the face, lips, or tongue.
• Avoid concurrent use with aliskiren in patients with diabetes.

Side Effects

Common Side Effects

• Dry cough.
• Dizziness or lightheadedness.
• Fatigue.
• Headache.

Less Common Side Effects

• Nausea, diarrhea.
• Rash.

Rare but Serious Side Effects

• Angioedema (swelling of the face, lips, or throat).
• Severe hyperkalemia (high potassium levels).
• Kidney dysfunction (elevated creatinine levels).

Drug Interactions

• Potassium Supplements/Diuretics: May increase the risk of hyperkalemia.
• NSAIDs: Can reduce the effectiveness of lisinopril and worsen kidney function.
• Lithium: Increased risk of lithium toxicity.
• Aliskiren: Avoid combination in patients with diabetes.
• Diuretics: May enhance the blood pressure-lowering effect and risk of low blood pressure.

Monitoring Parameters

• Blood Pressure: Regularly monitor to ensure the medication is effective.
• Renal Function: Check kidney function (creatinine, GFR) before and during treatment.
• Potassium Levels: Monitor for hyperkalemia, particularly in high-risk patients.

Patient Counseling Points

• Take lisinopril as prescribed, even if you feel well.
• Stay hydrated but avoid excessive potassium intake (e.g., bananas, potassium supplements).
• Report any swelling of the face, lips, or throat immediately.
• Rise slowly from sitting or lying positions to prevent dizziness.
• Avoid non-prescription NSAIDs, as they may reduce the medication’s effectiveness.

Use in Children

• Approved for children 6 years and older with hypertension. Dosage is based on weight.

Use in Pregnancy

• Contraindicated due to the risk of fetal harm; discuss alternatives with your doctor.

Use in Elderly

• Start with lower doses due to increased sensitivity to side effects.

FAQs About Lisinopril

Q1: What is lisinopril used for?

• Lisinopril is used to treat high blood pressure, heart failure, and protect kidneys in diabetics.

Q2: How does lisinopril work?

• It lowers blood pressure by relaxing blood vessels and reducing the workload on the heart.

Q3: Can lisinopril cause a cough?

• Yes, a dry cough is a common side effect; consult your doctor if it becomes bothersome.

Q4: Is lisinopril safe for long-term use?

• Yes, it is generally safe and effective for long-term use with regular monitoring.

Q5: How long does it take for lisinopril to work?

• Blood pressure improvement can be seen within 1–2 weeks, but full effects may take 4–6 weeks.

Q6: Can lisinopril cause kidney problems?

• Rarely, it may affect kidney function, particularly in patients with existing kidney disease.

Q7: What should I avoid while taking lisinopril?

• Avoid potassium-rich foods and supplements, NSAIDs, and alcohol in excess.

Q8: Can lisinopril cause dizziness?

• Yes, especially when starting treatment or increasing the dose; it’s due to lowered blood pressure.

Q9: Is lisinopril safe during pregnancy?

• No, it is contraindicated as it can harm the developing fetus.

Q10: What should I do if I miss a dose?

• Take the missed dose as soon as you remember unless it’s close to the next dose. Do not double up.

Q11: Can lisinopril be taken with other medications?

• Yes, but caution is needed with certain drugs (e.g., diuretics, NSAIDs, potassium supplements).

Q12: How is lisinopril different from other ACE inhibitors?

• Lisinopril has a long duration of action, allowing for once-daily dosing.

Q13: Does lisinopril interact with diuretics?

• Yes, it may enhance the blood pressure-lowering effect and increase the risk of hyperkalemia.

Q14: Can I stop lisinopril if my blood pressure is normal?

• No, stopping suddenly can lead to a rebound increase in blood pressure; consult your doctor first.

Q15: Can lisinopril help with heart failure?

• Yes, it improves symptoms, reduces hospitalizations, and prolongs survival in heart failure patients.