What is lisinopril?

lye-SIN-oh-pril

Commonly used brand name(s)

In the U.S.

Prinivil
Zestril

Available Dosage Forms:

Tablet

Therapeutic Class: Antihypertensive

Pharmacologic Class: ACE Inhibitor

Uses For lisinopril

Lisinopril is used alone or together with other medicines to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys resulting in a stroke, heart failure, or kidney failure. Lowering blood pressure can reduce the risk of strokes and heart attacks.

Lisinopril works by blocking a substance in the body that causes the blood vessels to tighten. As a result, lisinopril relaxes the blood vessels. This lowers blood pressure and increases the supply of blood and oxygen to the heart.

Lisinopril is also used to help treat heart failure. It is also used in some patients after a heart attack. After a heart attack, some of the heart muscle is damaged and weakened. The heart muscle may continue to weaken as time goes by. This makes it more difficult for the heart to pump blood. Lisinopril may be started within 24 hours after a heart attack to increase survival rate.

lisinopril is available only with your doctor's prescription.

Before Using lisinopril

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For lisinopril, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to lisinopril or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of lisinopril to treat hypertension in children 6 to 16 years of age. However, safety and efficacy have not been established in children younger than 6 years of age.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of lisinopril in the elderly. However, elderly patients are more likely to have age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving lisinopril.

Pregnancy

Pregnancy Category Explanation All Trimesters D Studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy in a life threatening situation or a serious disease, may outweigh the potential risk.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking lisinopril, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using lisinopril with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Aliskiren

Using lisinopril with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Alteplase, Recombinant
Amiloride
Azathioprine
Azilsartan Medoxomil
Candesartan Cilexetil
Canrenoate
Eplerenone
Eprosartan
Everolimus
Irbesartan
Lithium
Losartan
Olmesartan Medoxomil
Potassium
Sirolimus
Spironolactone
Telmisartan
Triamterene
Trimethoprim
Valsartan

Using lisinopril with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Aceclofenac
Acemetacin
Amtolmetin Guacil
Aspirin
Azosemide
Bemetizide
Bendroflumethiazide
Benzthiazide
Bromfenac
Bufexamac
Bumetanide
Bupivacaine
Bupivacaine Liposome
Buthiazide
Capsaicin
Celecoxib
Chlorothiazide
Chlorthalidone
Choline Salicylate
Clonixin
Clopamide
Cyclopenthiazide
Cyclothiazide
Dexibuprofen
Dexketoprofen
Diclofenac
Diflunisal
Dipyrone
Ethacrynic Acid
Etodolac
Etofenamate
Etoricoxib
Felbinac
Fenoprofen
Fepradinol
Feprazone
Floctafenine
Flufenamic Acid
Flurbiprofen
Furosemide
Gold Sodium Thiomalate
Hydrochlorothiazide
Hydroflumethiazide
Ibuprofen
Ibuprofen Lysine
Indapamide
Indomethacin
Ketoprofen
Ketorolac
Lornoxicam
Loxoprofen
Lumiracoxib
Meclofenamate
Mefenamic Acid
Meloxicam
Methyclothiazide
Metolazone
Morniflumate
Nabumetone
Naproxen
Nepafenac
Nesiritide
Niflumic Acid
Nimesulide
Oxaprozin
Oxyphenbutazone
Parecoxib
Phenylbutazone
Piketoprofen
Piretanide
Piroxicam
Polythiazide
Pranoprofen
Proglumetacin
Propyphenazone
Proquazone
Quinethazone
Rofecoxib
Salicylic Acid
Salsalate
Sodium Salicylate
Sulindac
Tenoxicam
Tiaprofenic Acid
Tizanidine
Tolfenamic Acid
Tolmetin
Torsemide
Trichlormethiazide
Valdecoxib
Xipamide

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Proper Use of lisinopril

In addition to the use of lisinopril, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium (salt). Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.

Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.

Remember that lisinopril will not cure your high blood pressure but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.

If your child cannot swallow the tablets, an oral liquid may be given. Shake the oral liquid well just before each use. Ask your doctor or pharmacist about this.

Dosing

The dose of lisinopril will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of lisinopril. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (tablets):
- For high blood pressure:
  - Adults—At first, 10 milligrams (mg) once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 40 mg per day.
  - Children 6 years of age and older—Dose is based on body weight and must be determined by your doctor. The starting dose is usually 0.07 mg per kilogram (kg) of body weight per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 0.61 mg per kg of body weight or 40 mg per day.
  - Children younger than 6 years of age—Use is not recommended.
- For heart failure:
  - Adults—At first, 5 milligrams (mg) once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 40 mg per day.
  - Children—Use and dose must be determined by your doctor.
- For immediate treatment after a heart attack:
  - Adults—At first, 5 milligrams (mg), followed by 5 mg after 24 hours, followed by 10 mg after 48 hours, and then 10 mg once a day.
  - Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of lisinopril, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Store the mixed oral liquid at or below room temperature for up to 4 weeks.

Precautions While Using lisinopril

It is very important that your doctor check your progress at regular visits to make sure lisinopril is working properly. Blood tests may be needed to check for unwanted effects.

Using lisinopril while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using lisinopril, tell your doctor right away.

lisinopril may cause serious types of allergic reactions, including anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, mouth, or throat while you are using lisinopril.

Call your doctor right away if you have severe stomach pain (with or without nausea or vomiting). This could be a symptom of intestinal angioedema.

Dizziness, lightheadedness, or fainting may also occur, especially when you get up from a lying or sitting position or if you have been taking a diuretic (water pill). Make sure you know how you react to the medicine before you drive, use machines, or do other things that could be dangerous if you are dizzy or not alert. If you feel dizzy, lie down so you do not faint. Then sit for a few moments before standing to prevent the dizziness from returning.

Check with your doctor right away if you become sick while taking lisinopril, especially with severe or continuing nausea, vomiting, or diarrhea. These conditions may cause you to lose too much water or salt and may lead to low blood pressure. You can also lose water by sweating, so drink plenty of water during exercise or in hot weather.

Check with your doctor if you have a fever, chills, or sore throat. These could be symptoms of an infection resulting from low white blood cells.

Hyperkalemia (high potassium in the blood) may occur while you are using lisinopril. Check with your doctor right away if you have the following symptoms: abdominal or stomach pain, confusion, difficulty with breathing, irregular heartbeat, nausea or vomiting, nervousness, numbness or tingling in the hands, feet, or lips, shortness of breath, or weakness or heaviness of the legs. Do not use supplements or salt substitutes containing potassium without first checking with your doctor.

Check with your doctor right away if you have upper stomach pain, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or skin. These could be symptoms of a serious liver problem.

lisinopril may affect blood sugar levels. If you notice a change in the results of your blood or urine sugar tests, or if you have any questions, check with your doctor.

Make sure any doctor or dentist who treats you knows that you are using lisinopril. You may need to stop using lisinopril several days before having surgery.

lisinopril may be less effective in patients. Black patients also have an increased risk of angioedema (swelling of the hands, arms, face, mouth, or throat).

Do not take other medicines unless they have been discussed with your doctor. This includes over-the-counter (nonprescription) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may tend to increase your blood pressure.

lisinopril Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Blurred vision
cloudy urine
confusion
decrease in urine output or decrease in urine-concentrating ability
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
sweating
unusual tiredness or weakness

Less common

Abdominal or stomach pain
body aches or pain
chest pain
chills
common cold
cough
diarrhea
difficulty breathing
ear congestion
fever
headache
loss of voice
nasal congestion
nausea
runny nose
sneezing
sore throat
vomiting

Rare

Arm, back, or jaw pain
chest discomfort, tightness, or heaviness
fast or irregular heartbeat
general feeling of discomfort or illness
joint pain
loss of appetite
muscle aches and pains
shivering
trouble sleeping

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

Decreased interest in sexual intercourse
inability to have or keep an erection
lack or loss of strength
loss in sexual ability, desire, drive, or performance
rash

Rare

Acid or sour stomach
belching
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
feeling of constant movement of self or surroundings
heartburn
indigestion
muscle cramps
sensation of spinning
stomach discomfort or upset
swelling

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

How to use lisinopril?

Usual Adult Dose for Hypertension

Initial dose: 10 mg orally once a day; 5 mg orally once a day
Maintenance dose: 20 to 40 mg orally once a day
Maximum dose: 80 mg orally once a day

Comments:
-The initial dose is 5 mg orally once a day in patients receiving a diuretic.
-The 80 mg dose is used but does not appear to give greater effect.
-If blood pressure is not controlled with lisinopril alone, a low dose of a diuretic may be added (e.g., hydrochlorothiazide, 12.5 mg). After the addition of a diuretic, it may be possible to reduce the dose of lisinopril.

Usual Adult Dose for Congestive Heart Failure

Initial dose: 2.5 to 5 mg orally once a day
Maintenance dose: Dosage should be increased as tolerated
Maximum dose: 40 mg orally once a day

Comments:
-The diuretic dose may need to be adjusted to help minimize hypovolemia, which may contribute to hypotension. The appearance of hypotension after the initial dose of lisinopril does not preclude subsequent careful dose titration with the drug.

Usual Adult Dose for Myocardial Infarction

Initial dose: 5 mg orally (within 24 hours of the onset of acute myocardial infarction)
Subsequent doses: 5 mg orally after 24 hours, then 10 mg orally after 48 hours.
Maintenance dose: 10 mg orally once a day. Dosing should continue for at least 6 weeks.

Comments:
-Therapy should be initiated at 2.5 mg in patients with a low systolic blood pressure (less than or equal to 120 mm Hg and greater than 100 mmHg) during the first 3 days after the infarct. If prolonged hypotension occurs (systolic blood pressure less than 90 mmHg for more than 1 hour) therapy should be withdrawn.

Uses: Reduction of mortality in acute myocardial infarction

Usual Adult Dose for Diabetic Nephropathy

Initial dose: 10 to 20 mg orally once a day
Maintenance dose: 20 to 40 mg orally once a day
Dosage may be titrated upward every 3 days

Comments:
-Not an approved indication.

Usual Geriatric Dose for Hypertension

Initial dose: 2.5 to 5 mg orally once a day
Maintenance dose: Dosages should be increased at 2.5 mg to 5 mg per day at 1 to 2 week intervals.
Maximum dose: 40 mg orally once a day

Usual Pediatric Dose for Hypertension

Pediatric patients greater than or equal to 6 years of age:
Initial dose: 0.07 mg/kg orally once a day (Maximum initial dose is 5 mg once a day)
Maintenance dose: Dosage should be adjusted according to blood pressure response at 1 to 2 week intervals.
Maximum dose: Doses above 0.61 mg/kg or greater than 40 mg have not been studied in pediatric patients

Comments:
-This drug is not recommended in pediatric patients less than 6 years old or in pediatric patients with glomerular filtration rate less than 30 mL/min.

Renal Dose Adjustments

CrCl greater than 30 mL/min: No adjustment recommended
CrCl 10 mL/min to less than or equal to 30 mL/min: Recommended initial dose is half of the usual recommended dose (i.e., hypertension, 5 mg; systolic heart failure, 2.5 mg, and acute MI, 2.5 mg. Up titrate as tolerated to a maximum of 40 mg daily)
CrCl less than 10 mL/min or on hemodialysis: Recommended initial dose is 2.5 mg orally once a day

Liver Dose Adjustments

Patients who develop jaundice or marked elevations of hepatic enzymes should discontinue therapy and receive appropriate medical treatment.

Dose Adjustments

-The antihypertensive effect may diminish toward the end of the dosing interval regardless of the administered dose, but most commonly with a dose of 10 mg or less daily. This can be evaluated by measuring blood pressure just prior to dosing to determine whether satisfactory control is being maintained for 24 hours. If it is not, an increase in dose should be considered. If blood pressure is not adequately controlled with lisinopril alone, a diuretic may be added. After the addition of a diuretic, it may be possible to reduce the dose of lisinopril.
-In all high risk patients, such as patients with ischemic heart or cerebrovascular disease, in whom excessive falls in blood pressure may lead to myocardial infarction or cerebrovascular accident the manufacturer advises treatment initiation at lower dosages.
-Dosage adjustments in the elderly should be made with particular caution.
-In patients who are currently being treated with a diuretic, symptomatic hypotension occasionally can occur following the initial dose. To reduce the likelihood of hypotension, the diuretic should, if possible, be discontinued 2 to 3 days prior to beginning therapy. Then, if blood pressure is not controlled with lisinopril alone, diuretic therapy should be resumed. If diuretic therapy cannot be discontinued, an initial dose of 5 mg should be used with careful medical supervision for several hours and until blood pressure has stabilized.

Precautions

US BOXED WARNINGS:
-FETAL TOXICITY: Angiotensin converting enzyme (ACE) inhibitor use during pregnancy can cause morbidity and death to the developing fetus. When used during the second and third trimesters, ACE inhibitors have been associated with fetal and neonatal injury, including hypotension, neonatal skull hypoplasia, anuria, reversible or irreversible renal failure, and death. Oligohydramnios has also been reported, presumably resulting from decreased fetal renal function; oligohydramnios in this setting has been associated with fetal limb contractures, craniofacial deformation, and hypoplastic lung development. Exposure to ACE inhibitors during the first trimester of pregnancy has been associated with prematurity, intrauterine growth retardation, patent ductus arteriosus, other structural cardiac malformations, and neurological malformations. When pregnancy is detected, ACE inhibitors should be discontinued as soon as possible. If no alternative to ACE inhibitor therapy is available, patients should be made aware of the risks to their fetuses and the intra-amniotic environment should be evaluated by serial ultrasound examinations. If oligohydramnios develops, this drug should be discontinued unless it is considered lifesaving for the mother. Depending on the week of pregnancy, contraction stress testing, a nonstress test, or biophysical profiling may be appropriate. Oligohydramnios may not show until after the fetus has suffered irreversible injury.

Safety and efficacy have not been established in patients younger than 6 years.

Consult WARNINGS section for additional precautions.

Dialysis

This drug can be removed by hemodialysis.

Other Comments

Administration advice:
-Should be given as a single daily dose.
-May be given with or without food.
-In some patients with heart failure who have normal or low blood pressure, additional lowering of systemic blood pressure may occur with this drug. This effect is anticipated and is not usually a reason to discontinue treatment. If hypotension becomes symptomatic, a reduction of dose or discontinuation of may be necessary.

General:
-This drug is indicated as adjunctive therapy with diuretics and digitalis for treating heart failure.
-Following first time MI, all ACE inhibitors, at comparable appropriate dosages, appear to be equally effective for reducing mortality and recurrent MI rates.
-Prior to therapy, patients at high risk of symptomatic hypotension such as patients with salt depletion with or without hyponatremia, hypovolemia or those receiving vigorous diuretic therapy should have these conditions corrected. Renal function and serum potassium should be monitored.
-If it is not feasible to discontinue diuretic therapy prior to starting lisinopril, the patient should be closely monitored for several hours following the initial dose of this drug, and until the blood pressure has stabilized. The antihypertensive effects of lisinopril and diuretics used in combination are approximately additive.
-Achievement of optimal blood pressure reduction may require 2 to 4 weeks of therapy.
-Acute myocardial infarction: in addition to this drug, patients should receive, if appropriate, standard treatments, such as thrombolytics, aspirin, and a beta-blocker.
-Antihypertensive effects of this drug are maintained during long-term therapy. Abrupt withdrawal has not been associated with a rapid increase in blood pressure, or a significant increase in blood pressure compared to pretreatment levels.

Patient advice:
-This drug may be taken with or without food, but should be taken at the same time each day.
-This drug may impair your ability to drive or operate machinery.

What are the side effects of lisinopril?

Lisinopril Side Effects

Common side effects of lisinopril include:

Cough
Dizziness
Headache
Extreme tiredness
Nausea
Diarrhea
Weakness
Sneezing
Runny nose
Low sex drive
Rash

Serious side effects can also occur. If you have any of these side effects, call your doctor right away:

Swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
Hoarseness
Trouble breathing or swallowing
Signs of infection, such as fever, sore throat, and chills
Yellowing of the skin or eyes
Lightheadedness or fainting
Chest pain