Lisinopril

What is Lisinopril?

Lisinopril is an oral medication that belongs to a class of drugs called ACE (angiotensin-converting enzyme) inhibitors. It is primarily prescribed to treat high blood pressure, heart failure, and to protect the kidneys in people with diabetes. This medication works by relaxing blood vessels, which helps lower blood pressure and reduces the workload on the heart.

Uses

Hypertension (High Blood Pressure): Lisinopril is commonly prescribed as a first-line treatment for high blood pressure, either alone or in combination with other antihypertensive medications.

Heart Failure: The medication helps improve symptoms and survival in patients with heart failure by reducing the strain on the heart and improving blood flow throughout the body.

Post-Heart Attack Treatment: Lisinopril is used to improve survival rates and prevent future cardiovascular events in patients who have recently suffered a heart attack.

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Diabetic Nephropathy: The drug helps protect kidney function in people with diabetes by reducing protein in the urine and slowing the progression of kidney disease.

Prevention of Cardiovascular Events: In high-risk patients, lisinopril may be prescribed to reduce the risk of stroke, heart attack, and cardiovascular death.

How it works

Lisinopril blocks the action of angiotensin-converting enzyme (ACE), which normally converts angiotensin I to angiotensin II, a powerful substance that causes blood vessels to narrow. By inhibiting this enzyme, lisinopril prevents the formation of angiotensin II, allowing blood vessels to relax and widen. This action reduces blood pressure, decreases the workload on the heart, and improves blood flow to vital organs.

Side effects

Common side effects:

• Dry, persistent cough
• Dizziness or lightheadedness
• Headache
• Fatigue or weakness
• Nausea
• Low blood pressure (hypotension)
• Elevated potassium levels
• Skin rash

Serious side effects requiring immediate medical attention:

• Angioedema (swelling of face, lips, tongue, or throat)
• Severe kidney problems or kidney failure
• Extremely low blood pressure with fainting
• High potassium levels causing irregular heartbeat
• Severe allergic reactions

Warnings and precautions

Pregnancy: Lisinopril is contraindicated during pregnancy as it can cause serious harm or death to the developing fetus, particularly during the second and third trimesters.

Kidney Function: Patients with kidney disease require careful monitoring, as ACE inhibitors can worsen kidney function in some individuals, especially those with renal artery stenosis.

Hyperkalemia Risk: The medication can cause dangerous elevations in blood potassium levels, particularly in patients with kidney problems, diabetes, or those taking potassium supplements.

Angioedema History: Patients with a previous history of angioedema should not take lisinopril, as they have an increased risk of experiencing this potentially life-threatening reaction.

Volume Depletion: Patients who are dehydrated or taking diuretics may experience severe drops in blood pressure when starting lisinopril.

Interactions

Potassium supplements and salt substitutes: Can increase the risk of hyperkalemia when combined with lisinopril.

NSAIDs (ibuprofen, naproxen): May reduce the blood pressure-lowering effects of lisinopril and increase the risk of kidney problems.

Diuretics: Can enhance the blood pressure-lowering effects, potentially causing excessive hypotension, especially when starting treatment.

Lithium: Lisinopril may increase lithium levels in the blood, leading to lithium toxicity.

Diabetes medications: ACE inhibitors may enhance the blood sugar-lowering effects of insulin and oral diabetes drugs.

Aliskiren: Should not be used with lisinopril in patients with diabetes or kidney problems due to increased risk of kidney problems and high potassium.

Trimethoprim-sulfamethoxazole: May increase the risk of high potassium levels when used with lisinopril.

Gold compounds: Rarely, may cause facial flushing and low blood pressure when combined with ACE inhibitors.

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Dosage

Hypertension: The typical starting dose is 10 mg once daily, with a usual maintenance dose ranging from 20-40 mg once daily. The maximum recommended dose is 80 mg per day.

Heart Failure: Treatment usually begins with 2.5-5 mg once daily, gradually increased to a target dose of 20-35 mg once daily, as tolerated.

Post-Heart Attack: Initial dose is typically 5 mg within 24 hours of symptom onset, followed by 5 mg after 24 hours, then 10 mg daily thereafter.

Dosage adjustments may be necessary for patients with kidney problems or those taking other medications. All dosing should be individualized and determined by a healthcare provider based on the patient’s specific condition, response to treatment, and other factors.

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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