lisinopril, Zestril, Prinivil

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GENERIC NAME: lisinopril

BRAND NAME: Zestril, Prinivil

DRUG CLASS AND MECHANISM: Lisinopril is an angiotensin converting enzyme (ACE) inhibitor used for treating high blood pressure, heart failure and for preventing kidney failure due to high blood pressure and diabetes. Other ACE inhibitors include enalapril (Vasotec), quinapril (Accupril), captopril (Capoten), fosinopril (Monopril), benazepril (Lotensin), ramipril (Altace), moexipril (Univasc) and trandolapril (Mavik).

ACE is important because it is an enzyme responsible for producing the chemical, angiotensin II. Angiotensin II causes muscles in most arteries, including the arteries of the heart, to contract, thereby narrowing the arteries and elevating blood pressure. ACE inhibitors such as lisinopril lower blood pressure by reducing the production of angiotensin II, thereby relaxing arterial muscle and enlarging arteries. When the blood pressure is lower, the heart - including the failing heart - does not have to work as hard to pump blood. The arteries supplying the heart with blood also enlarge during treatment with ACE inhibitors. This increases the flow of blood and oxygen to the heart, further improving the ability of the heart to pump blood.

The effects of ACE inhibitors are particularly beneficial to people with congestive heart failure. In the kidneys, the narrowing of the arteries by angiotensin II decreases blood flow and damages the kidneys. ACE inhibitors enlarge and reduce the blood pressure in the arteries going to the kidney. This reduces damage to the kidneys caused by the high blood pressure. The FDA approved lisinopril in December 1987.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: Tablet: 2.5, 5, 10, 20, 30 and 40 mg

STORAGE: Lisinopril should be stored in a dry place at 15-30 C (59-86 F).

PRESCRIBED FOR: Lisinopril is used to treat elevated blood pressure, heart failure and to improve survival after a heart attack (myocardial infarction). Like other ACE inhibitors it is also used for preventing kidney failure due to high blood pressure or diabetes even though it is not FDA approved for this use.

DOSING: The starting dose of lisinopril is 5 mg daily, and the effective dose range for treating heart failure is 5-20 mg daily. The dose can be increased by 10 mg every 2 weeks to achieve the maximum effect.

The starting dose of lisinopril for treating high blood pressure is 10 mg daily. The usual dose range is 20-40 mg daily. A dose of 80 mg is not much more effective than 40 mg.

Treatment of heart attack (myocardial infarction) is started with individual doses of 5 mg followed by 5 mg after 24 hours, 10 mg after 48 hours and then 10 mg daily. Treatment is continued for 6 weeks.

DRUG INTERACTIONS: In general, lisinopril should not be taken with potassium supplements or diuretics that conserve potassium, for example, hydrochlorothiazide/triamterene (Dyazide), since blood potassium levels may rise to dangerous levels.

There have been reports of increased lithium (Eskalith, Lithobid) levels when lithium is used in combination with ACE inhibitors. The reason for this interaction is not known.

There have been reports that aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, and many others), indomethacin (Indocin, Indocin-SR), and naproxen (Anaprox, Naprelan, Naprosyn, Aleve) may reduce the effects of ACE inhibitors.




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