Lisinopril (Prinivil, Zestril)
Pregnancy Category: C
Antihypertensive, ACE inhibitor
Angiotensin-Converting Enzyme Inhibitors
Both supine and standing BPs are reduced, although the drug is less effective in blacks than in Caucasians. Although food does not alter the bioavailability of lisinopril, only 25% of a PO dose is absorbed.
Onset: 1 hr.
Peak serum levels: 7 hr.
Duration: 24 hr.
1/2: 12 hr. 100% of the drug is excreted unchanged in the urine.
Alone or in combination with a diuretic (usually a thiazide) to treat hypertension. In combination with digitalis and a diuretic for treating CHF not responding to other therapy. Use within 24 hr of acute MI to improve survival in hemodynamically stable clients (clients should receive the standard treatment, including thrombolytics, aspirin, and beta blockers).
Use with caution during lactation. Safety and efficacy have not been established in children. Geriatric clients may manifest higher blood levels. Reduce the dosage in clients with impaired renal function.
CV: Hypotension, orthostatic hypotension, angina, tachycardia, palpitations, rhythm disturbances,
stroke chest pain, orthostatic effects, peripheral edema,
MI, CVA worsening of heart failure, chest sound abnormalities, PVCs, TIAs, decreased blood pressure, atrial fibrillation.
CNS: Dizziness, headache, fatigue, vertigo, insomnia, depression, sleepiness, paresthesias, malaise, nervousness, confusion, ataxia, impaired memory, tremor, irritability, hypersomnia, peripheral neuropathy, spasm.
GI: Diarrhea, N&V, dyspepsia, anorexia, constipation, dysgeusia, dry mouth, abdominal pain, flatulence, dry mouth, gastritis, heartburn, GI cramps, weight loss/gain, taste alterations, increased salivation.
Respiratory: Cough, dyspnea, bronchitis, upper respiratory symptoms, nasal congestion, sinusitis, pharyngeal pain,
bronchospasm, asthma pulmonary edema,
pulmonary embolism, pulmonary infarction paroxysmal nocturnal dyspnea, chest discomfort, common cold, nasal congestion, pulmonary infiltrates, pleural effusion, wheezing, painful respiration, epistaxis, laryngitis, pharyngitis, rhinitis, rhinorrhea, orthopnea.
Musculoskeletal: Asthenia, muscle cramps, neck/hip/leg/knee/arm/joint/shoulder/back/pelvic/flank pain, myalgia, arthralgia, arthritis, lumbago.
Hepatic: Hepatitis, hepatocellular/cholestatic jaundice, pancreatitis, hepatomegaly.
Dermatologic: Rash, pruritus, flushing, increased sweating, urticaria, alopecia, erythema multiforme, photophobia.
GU: Impotence, oliguria, progressive azotemia, acute renal failure, UTI, anuria, uremia, renal dysfunction, pyelonephritis, dysuria.
Ophthalmic: Blurred vision, visual loss, diplopia.
Angioedema (may be fatal if laryngeal edema occurs) hyperkalemia, neutropenia, anemia,
bone marrow depression decreased libido, fever, syncope, vasculitis of the legs, gout, eosinophilia, fluid overload, dehydration, diabetes mellitus, chills, virus infection, edema,
anaphylactoid reaction malignant lung neoplasms, hemoptysis, breast pain.
Laboratory Test Alterations:
Serum potassium, BUN, serum creatinine.
Treatment: Supportive. To correct hypotension, IV normal saline is treatment of choice. Lisinopril may be removed by hemodialysis.
Diuretics / Excess
Indomethacin / Possible
Potassium-sparing diuretics / Significant
Tablet: 2.5 mg, 5 mg, 10 mg, 20 mg, 40 mg
Essential hypertension, used alone.
Initial: 10 mg once daily. Adjust dosage depending on response (range: 20-40 mg/day given as a single dose). Doses greater than 80 mg/day do not give a greater effect.
Essential hypertension in combination with a diuretic.
Initial: 5 mg. The BP-lowering effects of the combination are additive. Reduce dosage in renal impairment as follows: C
CR, 10-30 mL/min; give an initial dose of 5 mg /day for hypertension. C
CR, less than 10 mL/min; give an initial dose of 2.5 mg/day and adjust dose depending on BP response.
Initial: 5 mg once daily (2.5 mg/day in clients with hyponatremia) in combination with diuretics and digitalis.
Dosage range: 5-20 mg/day as a single dose.
First dose: 5 mg;
then 5 mg after 24 hr, 10 mg after 48 hr, and then 10 mg daily. Continue dosing for 6 weeks. In clients with a systolic pressure less than 120 mm Hg when treatment is started or within 3 days after the infarct should be given 2.5 mg. If hypotension occurs (systolic BP less than 100 mm Hg), the dose may be temporarily reduced to 2.5 mg. If prolonged hypotension occurs, withdraw the drug.