Lisinopril Drug Profile

What is Lisinopril?

Lisinopril is an oral medication belonging to the class of drugs known as angiotensin-converting enzyme (ACE) inhibitors. It is primarily prescribed to treat high blood pressure (hypertension) and heart failure, and to improve survival after heart attacks. This medication works by relaxing blood vessels, which helps lower blood pressure and reduces the workload on the heart.

Uses

Lisinopril has several approved medical uses:

• Hypertension: Used as a first-line treatment to lower blood pressure in adults and children over 6 years old, helping to reduce the risk of stroke, heart attack, and kidney problems
• Heart failure: Prescribed to improve symptoms and survival in patients with reduced heart function, often used in combination with other heart medications
• Post-heart attack treatment: Given to stable patients within 24 hours of a heart attack to improve survival and reduce further cardiovascular complications
• Diabetic kidney disease: Used to slow the progression of kidney damage in patients with diabetes and protein in their urine
• Chronic kidney disease: Helps protect kidney function and slow disease progression in patients with various forms of kidney disease

How it works

Lisinopril blocks the action of angiotensin-converting enzyme (ACE), which normally converts angiotensin I to angiotensin II, a powerful substance that narrows blood vessels and stimulates the release of hormones that increase blood pressure. By inhibiting this enzyme, lisinopril prevents the formation of angiotensin II, leading to relaxed and widened blood vessels, reduced blood pressure, and decreased strain on the heart. This mechanism also helps reduce the amount of water and sodium retained by the kidneys.

Side effects

Common side effects include:

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• Dry, persistent cough
• Dizziness or lightheadedness
• Headache
• Fatigue or weakness
• Nausea
• Low blood pressure
• Elevated potassium levels
• Kidney function changes

Serious side effects to watch for:

• Angioedema (swelling of face, lips, tongue, or throat)
• Severe kidney problems or kidney failure
• Dangerously high potassium levels
• Severe drop in blood pressure
• Liver problems or jaundice

Warnings and precautions

• Pregnancy: Lisinopril is contraindicated during pregnancy, especially in the second and third trimesters, as it can cause serious harm or death to the developing fetus, including kidney problems and skull defects
• Kidney disease: Patients with existing kidney problems require careful monitoring, as lisinopril can worsen kidney function or cause acute kidney failure, particularly in those with renal artery stenosis
• Angioedema risk: Patients with a history of angioedema or hereditary angioedema should not take lisinopril, as ACE inhibitors can trigger life-threatening swelling reactions
• Electrolyte monitoring: Regular blood tests are necessary to monitor potassium levels and kidney function, especially in elderly patients or those taking potassium supplements or potassium-sparing diuretics
• Surgery considerations: Patients should inform their healthcare providers about lisinopril use before any surgical procedures, as it may interact with anesthesia and cause severe low blood pressure

Interactions

• Potassium supplements and salt substitutes: Can cause dangerously high potassium levels when combined with lisinopril
• Diuretics: May cause excessive blood pressure lowering, particularly when starting treatment
• NSAIDs (ibuprofen, naproxen): Can reduce the effectiveness of lisinopril and increase the risk of kidney problems
• Lithium: Lisinopril can increase lithium levels in the blood, potentially leading to lithium toxicity
• Diabetes medications: ACE inhibitors may enhance the blood sugar-lowering effects of insulin and other diabetes drugs
• Aliskiren: Should not be used together in patients with diabetes or kidney disease due to increased risk of kidney problems and high potassium
• Trimethoprim-sulfamethoxazole: May increase the risk of elevated potassium levels
• Gold injections: Rarely, may cause severe reactions including flushing, nausea, and low blood pressure

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Dosage

Typical adult dosages vary based on the condition being treated. For hypertension, the usual starting dose is 10 mg once daily, which may be increased to 20-40 mg daily based on blood pressure response. For heart failure, treatment typically begins with 2.5-5 mg once daily and may be gradually increased to 20-35 mg daily as tolerated. Post-heart attack treatment usually starts with 5 mg within 24 hours, followed by 5 mg after 24 hours, then 10 mg daily. Dosages must be adjusted for patients with kidney impairment, and all dosing decisions should be made by a qualified healthcare provider based on individual patient factors and response to treatment.

Sources: FDA DailyMed drug labels (public domain), BNF, WHO Essential Medicines List. This article is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider before starting or stopping any medication.

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