lisinopril (Zestril, Prinivil, Qbrelis) ACE Inhibitor

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

  • Medical and Pharmacy Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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What is lisinopril, and how does it work (mechanism of action)?

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:

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.

What are the side effects of lisinopril?

First doses of lisinopril can cause dizziness due to a drop in blood pressure.

This drug also can cause:

Like all ACE inhibitors, lisinopril may cause a nonproductive cough that resolves when the drug is discontinued.

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 decrease in red blood cells (anemia), white blood cells (leukopenia), and platelets (thrombocytopenia).

Why does lisinpril cause a cough?

Like all ACE inhibitors, lisinopril may cause a nonproductive cough that resolves when the drug is discontinued.

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What is the dosage of lisinopril, and how should I take it?

  • The starting dose of lisinopril for treating heart failure 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 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 is started with an initial dose 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.

Which drugs or supplements interact with medication?

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.

Nitritoid reactions (symptoms of 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.

What brand names are available for lisinopril?

Zestril, Prinivil, and Qbrelis are the brand names available for this drug.

Is lisinopril available as a generic drug?

Yes, it's available in generic form.

Do I need a prescription for this medication?

Yes

Is this drug safe to take if I'm pregnant or breastfeeding?

  • Lisinopril should not be taken during pregnancy because fetuses and neonates have died when lisinopril was administered during pregnancy.
  • It is not known whether lisinopril is excreted in breast milk.

What else should I know about this medicaiton?

What preparations of lisinopril are available?

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

How should I keep lisinopril stored?

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

Reference: FDA Prescribing Information

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See more info: lisinopril on RxList
Reviewed on 5/22/2017
References
Reference: FDA Prescribing Information

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