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Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD

GENERIC NAME: lisinopril

BRAND NAME: Zestril, Prinivil

DRUG CLASS AND MECHANISM: Lisinopril is an angiotensin converting enzyme (ACE) inhibitor. Angiotensin is a chemical that is made by the body continuously. It narrows blood vessels and thereby maintains (elevates) blood pressure. When the enzyme is blocked by lisinopril, angiotensin cannot be converted into its active form. As a result, blood vessels dilate and blood pressure falls.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: 2.5, 5, 10, 20, and 40 mg oral tablets.

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).

DOSING: Lisinopril should be taken at doses specifically directed by the physician. Lisinopril can be taken with or without food. Lisinopril should be taken at the same time each day to maintain consistent blood levels of lisinopril. Lisinopril should not be taken within two hours of taking an antacid since the antacid binds lisinopril and prevents its absorption. The dose of lisinopril is often lowered slowly when discontinuing.

The starting dose of lisinopril is 5 mg daily, and the effective dose range for treating heart failure is 5-40 mg daily. The dose can be increased by 10 mg every 2 weeks to achieve the maximum effect. The maximum dose is 40 mg daily.

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 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.

Nitritoid reactions (symptoms includie facial flushing, nausea, vomiting and hypotension) may occur when injectable gold (sodium aurothiomalate), used in the treatment of rheumatoid arthritis, is combined with ACE inhibitors, including lisinopril.

PREGNANCY: Lisinopril should not be taken during pregnancy because fetuses and neonates have died when lisinopril was administered during pregnancy.

NURSING MOTHERS: It is not known whether lisinopril is excreted in breast milk.

SIDE EFFECTS: First doses of lisinopril can cause dizziness due to a drop in blood pressure. Lisinopril can cause nausea, headaches, anxiety, insomnia, drowsiness, nasal congestion and sexual dysfunction. Lisinopril should be stopped if there are symptoms or signs of an allergic reaction including feelings of swelling of the face, lips, tongue or throat. Severe allergic reactions (anaphylaxis) and hives occasionally occur. Rarely, lisinopril may cause a drop in red blood cells, white blood cells, and platelets.

Lisinopril can impair the function of the kidneys, and every person taking this medication should have their kidney function checked.

Reference: FDA Prescribing Information

Suggested Reading by Our Doctors

• ACE Inhibitors - Read about ACE inhibitors like Altace, lisinopril, enalapril, ramparil, Zestril and more. Information includes side effects, drug interactions, and pregnancy safety information.
• Kidney Failure - Learn about kidney failure, in which the body has fluid retention, risen blood pressure, toxin build up and lack of red blood cells. Symptoms include fatigue, nausea, and apetite loss.
• Drug Interactions - Learn about potential drug interactions you may be exposed to. Drug interactions can occur with prescription drugs, OTC medication, vitamins, herbs, and supplements.

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