Medically reviewed on November 6, May cause fetal and neonatal morbidity and mortality if used during pregnancy. If pregnancy is detected, discontinue lisinopril as soon as possible. Management of hypertension alone or in combination with other classes of antihypertensive agents. ACE inhibitors are recommended as one of several preferred agents for the initial management of hypertension; other options include angiotensin II receptor antagonists, lisinopril and congestive heart failure, calcium-channel blockers, and thiazide diuretics.
ACE inhibitors may be preferred in hypertensive patients with heart failure, ischemic heart disease, diabetes mellitus, chronic kidney disease, or cerebrovascular disease or post-MI. Black hypertensive patients generally tend to respond better to monotherapy with calcium-channel blockers or thiazide diuretics than to ACE inhibitors.
The optimum BP threshold for initiating antihypertensive drug therapy is controversial. Management of heart failure as adjunctive therapy in patients with inadequate response to diuretics and a cardiac glycoside. Some evidence indicates that therapy with an ACE inhibitor may be less effective than angiotensin receptor-neprilysin inhibitor ARNI therapy e.
Used in conjunction with standard therapies e. Continue therapy indefinitely in patients with left ventricular dysfunction or other compelling indications e. Carefully monitor BP during initial titration or subsequent upward adjustment in dosage. When available, use evidence-based dosing information i, lisinopril and congestive heart failure. If adequate BP response not achieved with a single antihypertensive agent, add a second drug with demonstrated benefit; if goal BP still not achieved with optimal dosages of 2 antihypertensive agents, add a third drug.
Goal is to achieve and hormones and oily skin optimal control of BP; individualize specific target BP based on consideration of multiple factors, including patient age and comorbidities, and currently available evidence from clinical studies.
Administer orally once daily without regard to meals. May minimize risk of hypotension in patients currently receiving diuretic therapy by discontinuing the diuretic, reducing diuretic dosage, or cautiously increasing salt intake before initiating lisinopril.
JNC 8 expert panel recommends initial dosage of 10 luvox and coffee once daily and target dosage of 40 mg once daily based on dosages used in randomized controlled studies. Manufacturer recommends initial dosage of 10 mg once daily in patients not receiving a diuretic. In patients currently receiving diuretic therapy, discontinue diuretic, if possible, 2—3 days before initiating lisinopril.
If effectiveness diminishes toward end of dosing interval particularly likely with daily dosage of 10 mgconsider increasing dosage. If intolerable adverse effects occur, consider dosage reduction; if adverse effects worsen or fail to resolve, may need to discontinue and switch to another antihypertensive drug class.
Manufacturer states fixed-combination lisinopril and congestive heart failure should not be used for initial antihypertensive therapy. If BP is not adequately controlled by monotherapy with lisinopril or hydrochlorothiazide, can switch to the fixed-combination preparation containing lisinopril 10 mg and hydrochlorothiazide Can switch to the fixed-combination preparation if stable dosages of lisinopril or hydrochlorothiazide have been achieved.
If BP is controlled by monotherapy with hydrochlorothiazide 25 mg daily but potassium loss is problematic, can switch to fixed-combination preparation containing lisinopril 10 mg and hydrochlorothiazide Manufacturers recommend 5 mg within 24 hours of the onset of MI, followed by 5 mg 24 hours after initial dose, 10 mg 48 hours after initial dose, and then 10 mg daily. Other experts recommend 2. Dosages up to 80 mg daily have been used, but no additional benefit observed.
Generally titrate dosage carefully, initiate therapy at the low end of the dosage range. Concomitant use of lisinopril and aliskiren in patients with diabetes mellitus. Potential for excessive hypotension to result in MI or stroke in patients with acute MI 1 2 or ischemic cardiovascular or cerebrovascular disease.
To minimize potential for hypotension, consider recent antihypertensive therapy, extent of BP elevation, sodium intake, fluid status, and other clinical conditions. Ibuprofen and dextromethorphan patients at risk of excessive hypotension, lisinopril and congestive heart failure therapy under close medical supervision; monitor closely for first 2 weeks following initiation of lisinopril or any increase in lisinopril or diuretic dosage.
If excessive hypotension occurs, immediately place patient in a supine position and, if necessary, administer IV infusion of sodium chloride 0. Consider monitoring leukocyte counts in patients with collagen vascular disease and renal disease. Clinical syndrome that usually is manifested initially by cholestatic jaundice and may progress to fulminant hepatic necrosis occasionally fatal reported rarely with ACE inhibitors.
If jaundice or marked elevation of liver enzymes occurs, discontinue drug and monitor patient. Possible lisinopril and congestive heart failure and neonatal morbidity and mortality when used during pregnancy. Such potential risks occur throughout pregnancy, especially during the second and third trimesters.
Also may increase the risk of major congenital malformations when administered during the first trimester of pregnancy. Discontinue as soon as possible when pregnancy is detected, unless continued use is considered lifesaving.
Intestinal angioedema possible; consider in differential diagnosis of patients who develop abdominal pain. Sudden and potentially life-threatening anaphylactoid reactions reported in patients receiving ACE inhibitors while undergoing dialysis with high-flux membranes e. Anaphylactoid reactions reported in patients receiving ACE inhibitors while undergoing LDL apheresis with dextran sulfate absorption. Life-threatening anaphylactoid reactions reported in at least 2 patients receiving ACE inhibitors while genetically modified food and cancer desensitization treatment lesson plans holocaust and math hymenoptera venom.
Not recommended in patients with a history of angioedema associated with or unrelated to ACE inhibitors. Use with caution in patients with obstruction in the outflow tract of the left ventricle e. Transient increases in BUN and S cr possible; more likely to occur in patients with preexisting renal impairment or those receiving concomitant diuretic therapy.
Closely monitor renal function for the first few weeks of therapy in hypertensive patients with unilateral or bilateral renal-artery stenosis. Possible hyperkalemia, especially in patients with renal impairment or diabetes mellitus and those receiving drugs that can increase serum potassium concentration e. Persistent and nonproductive cough; resolves after drug discontinuance, lisinopril and congestive heart failure. Hypotension may occur in patients undergoing surgery or during anesthesia with agents that produce hypotension; recommended treatment is fluid volume expansion.
When used in fixed combination with hydrochlorothiazide, consider the cautions, precautions, and contraindications associated with hydrochlorothiazide, lisinopril and congestive heart failure. Category C 1st trimester ; Category D 2nd and 3rd trimesters. Distributed into milk in rats; not known whether lisinopril is distributed into milk in humans. Deterioration of renal function may occur in susceptible patients. BP reduction may be smaller in black patients compared with nonblack patients.
Higher incidence of angioedema reported with ACE inhibitors in black patients compared with other races. Headache, dizziness, cough, fatigue, diarrhea, upper respiratory tract infection, nausea. Patients with heart failure: Dizziness, hypotension, headache, diarrhea, chest pain, nausea, abdominal pain, rash, upper respiratory tract infection. Patients with acute MI: Increased risk of hypotension, syncope, lisinopril and congestive heart failure, and renal impairment e.
Monitor BP, renal function, and serum electrolytes closely Possible increased hypoglycemic effect, especially during initial weeks of combined treatment and in patients with renal impairment Clinically important adverse interactions not observed Increased hypotensive effect 1 2 3 4. If possible, discontinue diuretic before initiating lisinopril 1 2 3 4 see Dosage under Dosage and Administration. Enhanced hyperkalemic effect 1 2 3 4.
Use with caution; monitor serum potassium concentrations frequently. Rare nitritoid reactions facial flushing, nausea, vomiting, hypotension 1 3. Increased serum lithium concentrations; possible toxicity 1 2 3 4. Clinically important adverse interaction not observed 1 2, lisinopril and congestive heart failure. Possible decreased antihypertensive response to lisinopril 1 2 3 4 slightly decreased response observed with concomitant indomethacin 1 2. Potential for acute reduction of renal function in patients with impaired renal function 1 3 4.
Use with caution; monitor serum potassium concentrations frequently 1. Peak plasma concentrations achieved within 7 hours; time to reach peak plasma concentrations slightly delayed in patients with acute MI. Following a single oral dose, antihypertensive effects are observed within 1 hour, with peak BP reduction at 6 hours. During lisinopril and congestive heart failure therapy, maximum antihypertensive effect is achieved after 2—4 weeks.
Antihypertensive effect of a single dose persists for about 24 hours; effect at 24 hours substantially smaller than at 6 hours after dosing. Food does not affect absorption.
Crosses the blood-brain barrier poorly. Crosses the placenta and is distributed into milk in rats, lisinopril and congestive heart failure. Not bound to serum proteins other than ACE. Eliminated principally in urine as unchanged drug, lisinopril and congestive heart failure. In geriatric patients, peak plasma concentrations and AUCs increased i. Suppresses the renin-angiotensin-aldosterone system. Risk of angioedema, anaphylactoid reactions, or other sensitivity reactions.
Importance of reporting signs of infection e. Importance lung cancer and lower back pain adequate fluid intake; risk of volume depletion with excessive perspiration, dehydration, vomiting, or diarrhea, lisinopril and congestive heart failure. Risks of use during pregnancy.
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs including salt substitutes containing potassium. Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.
Importance of advising lisinopril and congestive heart failure of other important precautionary information. Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Prinivil lisinopril tablets prescribing information.
Whitehouse Station, NJ; Mar.