Prinivil (Lisinopril)
Class and Category of Drug
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Chemical class: Lysine ester of enalaprilat
Therapeutic class: Antihypertensive, vasodilator
Pregnancy category: C (first trimester), D (later trimesters)
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Drug Indications and Dosages
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To manage uncomplicated essential hypertension
Tablets
Adults. Initial: 10 mg daily. Maintenance: 20 to 40 mg daily. Maximum: 80 mg daily.
Dosage Adjustment For patients with renal failure, initial dosage reduced to 5 mg daily if creatinine clearance is 10 to 30 ml/ min/1.73 m2 and to 2.5 mg daily if creatinine clearance is less than 10 ml/min/ 1.73 m2. For patients receiving a diuretic, initial dosage reduced to 5 mg daily. Children age 6 and over with a GFR of at least 30 nil/min/1.73 m2. Initial: 0.07 mg/ kg daily, adjusted according to blood pressure response up to 5 mg daily. Maximum: 0.61 mg/kg or 40 mg daily.
To treat heart failure, along with digoxin and diuretics
Tablets
Adults. Initial: 5 mg daily. Maintenance: 5 to 20 mg daily. Maximum: 80 mg daily.
Dosage Adjustment For patients with hyponatremia or creatinine clearance of 30 ml/min/1.73 m2 or less, initial dosage reduced to 2.5 mg daily.
To improve survival in hemodynamically stable patient after acute Ml
Tablets
Adults. 5 mg within 24 hr after onset of symptoms, followed by 5 mg after 24 hr and 10 mg after 48 hr. Maintenance: 10 mg daily for 6 wk. Maximum: 80 mg daily.
Dosage Adjustment For patients with baseline systolic blood pressure of 120 mm
Hg or less, initial dosage decreased to 2.5 mg daily for first 3 days after MI. If systolic blood pressure falls to 100 mm Hg or less during therapy, maintenance dosage decreased to 2.5 to 5 mg as tolerated; if systolic blood pressure is 90 mm Hg or less for more than 1 hr, drug is discontinued.
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Contraindications of Drug
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Hypersensitivity to lisinopril, other ACE inhibitors, or their components; history of angioedema related to previous treatment with an ACE inhibitor; hereditary or idiopathic angioedema
Generic Drug Interactions
Drugs
allopurinol, bone marrow depressants (such as methotrexate), procainamide, systemic corticosteroids: Increased risk of potentially fatal neutropenia or agranulocytosis
cyclosporine, potassium-sparing diuretics, potassium supplements: Increased risk of hyperkalemia
diuretics, other antihypertensives: Increased hypotensive effect
insulin, oral antidiabetics: Increased risk of hypoglycemia
lithium: Increased blood lithium level and risk of lithium toxicity
NSAIDs: Possibly reduced antihypertensive effect, reduced renal function in patients with preexisting renal dysfunction
sympathomimetics: Possibly reduced antihypertensive effect
Foods
high-potassium diet, potassium-containing salt substitutes: Increased risk of hyperkalemia
Activities
alcohol use: Possibly increased hypotensive effect
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Drugs Adverse Reactions
Central Nervous System: Ataxia, confusion, depression, dizziness, fatigue, headache, mood alterations, nervousness, stroke, syncope, transient ischemic attack, vertigo
Cardiovascular: Arrhythmias, chest pain, hypotension, MI, orthostatic hypotension, palpitations, peripheral edema, vasculitis
Endocrine: Hyperglycemia, syndrome of inappropriate ADH secretion
Eyes, Ears, Nose, And Throat: Olfactory disturbance
Gastrointestinal: Abdominal pain, anorexia, cholestatic jaundice, diarrhea, elevated liver enzyme levels, fulminant hepatic necrosis, gastritis, hepatitis, indigestion, nausea, pancreatitis, vomiting
Genitourinary: Acute renal failure, decreased libido, impotence, pyelonephritis
Hematologic: Agranulocytosis, anemia, hemolytic anemia, neutropenia, thrombocytopenia
Musculoskeletal: Muscle spasms, myalgia
Respiratory: Bronchospasm, cough, dyspnea, paroxysmal nocturnal dyspnea, pulmonary embolism and infarction, upper respiratory tract infection
Skin: Alopecia, cutaneous pseudolymphoma, diaphoresis, erythema, flushing, herpes zoster, infections, pemphigus, photosensitivity, pruritus, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria
Other: Anaphylaxis, angioedema
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