Drugs: lisinopril

lisinopril
lye-SIN-oh-pril

Prinivil, , Qbrelis, , Zestril

Therapeutic class: Antihypertensives

Pharmacologic class: ACE inhibitors

Available Forms
Oral solution: 1 mg/mL
Tablets: 2.5 mg; 5 mg; 10 mg; 20 mg; 30 mg; 40 mg

Indications & Dosages

HTN
Adults: Initially, 10 mg PO daily for patients not taking a diuretic. Most patients are well controlled on 20 to
40 mg daily as a single dose. For patients taking a diuretic, initially, 5 mg PO daily.
Children age 6 and older: Initially, 0.07 mg/kg (up to 5 mg) PO once daily. Increase dosage based on
patient response and tolerance. Maximum dose, 0.61 mg/kg (don’t exceed 40 mg). Don’t use in children
with a CrCl of less than 30 mL/minute.
Adjust-a-dose: In adults, if CrCl is 10 to 30 mL/minute, give 5 mg PO daily; if CrCl is less than 10
mL/minute, give 2.5 mg PO daily. May titrate dosage up to 40 mg/day.
Adjunctive treatment (with diuretics and cardiac glycosides) for HF
Adults: Initially, 5 mg PO daily; increased as needed to maximum of 20 mg (40 mg for Zestril) PO daily.
Adjust-a-dose: If sodium level is less than 130 mEq/L, serum creatinine greater than 3 mg/dL, or CrCl less
than 30 mL/minute, start treatment at 2.5 mg daily.
Hemodynamically stable patients within 24 hours of acute MI to improve survival
Adults: Initially, 5 mg PO; then 5 mg after 24 hours, 10 mg after 48 hours, followed by 10 mg once daily
for 6 weeks.
Adjust-a-dose: For patients with systolic BP 120 mm Hg or less when treatment is started or during first 3
days after an infarct, decrease dosage to 2.5 mg PO. If systolic BP drops to 100 mm Hg or less, reduce daily
maintenance dose of 5 mg to 2.5 mg, if needed. If prolonged systolic BP stays under 90 mm Hg for longer
than 1 hour, withdraw drug.
If CrCl is 10 to 30 mL/minute, reduce initial dose to 2.5 mg PO daily and titrate as tolerated to a maximum
of 40 mg daily. If patient is on hemodialysis or CrCl is less than 10 mL/minute, start treatment at 2.5 mg
PO daily.

Administration
PO
Give drug without regard for food.
Oral solution is bioequivalent to lisinopril tablets.
Store oral solution at room temperature in a tightly closed container. Protect from freezing and excessive
heat.
If tablets are made into a suspension by pharmacist, store at or below 77° F (25° C) for up to 4 weeks;
shake before each use.

Action
Causes decreased production of angiotensin II and suppression of the RAAS.
Route Onset Peak Duration
PO 1 hr 7 hr 24 hr
Half-life: 12 hours.

Adverse Reactions
CNS: dizziness, headache, fatigue, paresthesia, syncope.
CV: orthostatic hypotension, hypotension, chest pain.
EENT: nasal congestion.
GI: diarrhea, nausea, dyspepsia.
GU: impaired renal function, impotence.
Metabolic: hyperkalemia.
Respiratory: dyspnea; dry, persistent, tickling, nonproductive cough.
Skin: rash.
Other: angioedema.

Interactions
Drug-drug
Aliskiren: May increase risk of renal impairment, hypotension, and hyperkalemia in diabetic patients and
those with moderate to severe renal impairment (GFR less than 60 mL/minute). Concomitant use is
contraindicated in diabetic patients. Avoid concomitant use in those with moderate to severe renal
impairment.
Allopurinol: May cause hypersensitivity reaction. Use together cautiously.
Azathioprine: May increase risk of anemia or leukopenia. Monitor hematologic studies if used together.
Diuretics, thiazide diuretics: May cause excessive hypotension with diuretics. Monitor BP closely.
Indomethacin, NSAIDs: May reduce hypotensive effects of drug. Adjust dose as needed.
Insulin, oral antidiabetics: May cause hypoglycemia, especially at start of lisinopril therapy. Monitor glucose
level.
Lithium: May cause lithium toxicity. Monitor lithium levels.
Neprilysin inhibitors (sacubitril): May increase risk of angioedema. Use together is contraindicated. Don’t
give lisinopril within 36 hours of switching to or from sacubitril/valsartan.
Phenothiazines: May increase hypotensive effects. Monitor BP closely.
Potassium-sparing diuretics, potassium supplements: May cause hyperkalemia. Monitor laboratory values.
Tizanidine: May cause severe hypotension. Monitor patient.
Drug-herb
Capsaicin: May cause ACE inhibitor–induced cough. Discourage use together.
Ma huang: May decrease antihypertensive effects. Discourage use together.
Drug-food
Potassium-containing salt substitutes: May cause hyperkalemia. Monitor laboratory values.

Effects on Lab Test Results

May increase BUN, creatinine, potassium, and bilirubin levels.
May increase LFT values.

Contraindications & Cautions

Contraindicated in patients hypersensitive to ACE inhibitors and in those with a history of angioedema
related to previous treatment with ACE inhibitor.
Use cautiously in patients with impaired renal function; adjust dosage.
Use cautiously in patients at risk for hyperkalemia or hypotension and in those with aortic stenosis or
hypertrophic cardiomyopathy. The safety and effectiveness of lisinopril on BP control in children younger
than age 6 or in children with GFR less than 30 mL/minute hasn’t been established.
 Although rare, angioedema, which can be fatal, may occur at any time during treatment, including after
first dose; it may involve the head and neck (potentially compromising the airway) or the intestine
(presenting with abdominal pain). Black patients and patients with idiopathic or hereditary angioedema
may be at increased risk. Patients concurrently receiving mammalian target of rapamycin (mTOR)
inhibitor therapy (temsirolimus, sirolimus, everolimus) also may be at increased risk.
Dialyzable drug: Yes.
Overdose Signs & Symptoms: Hypotension.

Pregnancy-Lactation-Reproduction
Black Box Warning: Drug acts directly on the RAAS and can cause injury and death to a developing
fetus. When pregnancy is detected, stop drug as soon as possible.
It isn’t known if drug appears in human milk. Patient should discontinue breastfeeding or discontinue
drug.

Nursing Considerations
When using drug in acute MI, give patient the appropriate and standard recommended treatment, such
as thrombolytics, aspirin, and beta blockers.
Although ACE inhibitors reduce BP in all races, BP reduction is less in Blacks taking an ACE inhibitor
alone. Black patients should take drug with a thiazide diuretic for a more favorable response.
Monitor BP frequently. If drug doesn’t adequately control BP, diuretics may be added.
Monitor WBC with differential counts before therapy, every 2 weeks for first 3 months of therapy, and
periodically thereafter.
Monitor serum potassium level periodically.
Look alike-sound alike: Don’t confuse lisinopril with fosinopril or Lioresal. Don’t confuse Zestril with
Zostrix, Zetia, Zebeta, or Zyrtec. Don’t confuse Prinivil with Proventil or Prilosec.

Patient Teaching
Alert: Rarely, facial and throat swelling (including swelling of the larynx) or intestinal swelling may
occur, especially after first dose. Advise patient to report abdominal pain, breathing problems, or swelling
of face, eyes, lips, or tongue.
Tell patient that light-headedness can occur, especially during first few days of therapy, to rise slowly to
minimize this effect, and to report symptoms to prescriber. If fainting occurs, advise patient to stop drug
and call prescriber immediately.
If unpleasant adverse reactions occur, tell patient not to stop drug suddenly but to notify prescriber.
Advise patient to report signs and symptoms of infection, such as fever and sore throat.
Tell female patient of childbearing potential to notify prescriber if pregnancy occurs. Drug will need to be
stopped.
Advise patient to report signs and symptoms of hyperkalemia, such as muscle fatigue, weakness,
nausea, or abnormal heart rhythm.
Instruct patient not to use salt substitutes that contain potassium without first consulting prescriber.
Inform patient that a dry, nonproductive cough may develop during therapy.