Lisinopril(lyse in’ oh pril)
Prinivil, Zestril
PREGNANCY CATEGORY D
Drug Classes
ACE inhibitor
Antihypertensive
Therapeutic Actions
Renin, synthesized by the kidneys, is released into the circulation where it acts on a plasma precursor to produce angiotensin I, which is converted by ACE to angiotensin II, a potent vasoconstrictor that also causes release of aldosterone from the adrenals. Lisinopril blocks the conversion of angiotensin I to angiotensin II, leading to decreased BP, decreased aldosterone secretion, a small increase in serum potassium levels, and sodium and fluid loss.
Indications
Treatment of hypertension alone or in combination with other antihypertensives
Adjunctive therapy in heart failure for patients unresponsive to diuretics and digoxin alone
Treatment of stable patients within 24 hr of acute MI to improve survival with standard treatments
Contraindications and Cautions
Contraindicated with allergy to lisinopril, other ACE inhibitors, history of angioedema.
Use cautiously with impaired renal function, heart failure, salt or volume depletion, IHSS, pregnancy, lactation.
Available Forms
Tablets—2.5, 5, 10, 20, 30, 40 mg
Dosages
Adults not taking diuretics
Initial dose, 10 mg/day PO. Adjust dosage based on response. Usual range is 20–40 mg/day as a single dose.
Adults taking diuretics
Discontinue diuretic for 2–3 days. If it is not possible to discontinue, give initial dose of 5 mg, and monitor for excessive hypotension.
Heart failure: 5 mg PO daily with diuretics and digitalis. Effective range, 5–20 mg/day (Prinivil) and 5–40 mg/day (Zestril).
Acute MI: Start within 24 hr of MI with 5 mg PO followed in 24 hr by 5 mg PO; 10 mg PO after 48 hr, then 10 mg PO daily for 6 wk. Give with other recommended treatments.
Pediatric patients 6 yr and older
Usual starting dose is 0.07 mg/kg once daily up to 5 mg total.
Pediatric patients younger than 6 yr
Safety and efficacy not established; drug usually not recommended.
Geriatric patients and patients with renal impairment
Excretion is reduced in renal failure. Use smaller initial dose, and adjust upward to a maximum of 40 mg/day PO.
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