Lisinopril
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Generic Name of Lisinopril - Learn More
Lisinopril
Lisinopril Precaution - What You Need to Know
Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, should be used with caution in patients with a history of kidney disease, as it can lead to an elevation in serum creatinine and blood urea nitrogen (BUN). It should be avoided in patients with a history of angioedema related to previous ACE inhibitor treatment, as it may cause a similar reaction. Lisinopril may also cause hypotension, especially after the first dose, particularly in patients who are volume-depleted (e.g., those on diuretics or with salt depletion), so careful monitoring of blood pressure is recommended after initiating treatment. If a patient is undergoing surgery or anesthesia, it is important to inform the anesthesiologist that they are on lisinopril, as it may interact with certain anesthetic agents. Lisinopril should be used cautiously in pregnant women, as it may cause fetal harm, including kidney failure, low blood pressure, or death of the fetus, particularly in the second and third trimesters. It is also excreted in breast milk, so its use in breastfeeding women should be avoided unless the potential benefits outweigh the risks. Lisinopril can increase potassium levels in the blood (hyperkalemia), so it should be used with caution in patients taking potassium supplements or potassium-sparing diuretics. Patients with a history of liver disease should also use this medication cautiously, as ACE inhibitors can affect liver function. Regular monitoring of kidney function and electrolytes is essential during treatment.
Lisinopril Indication - Uses and Benefits
Lisinopril is primarily used to treat high blood pressure (hypertension) and heart failure. By inhibiting the angiotensin-converting enzyme (ACE), lisinopril reduces the production of angiotensin II, a hormone that constricts blood vessels and increases blood pressure. This results in vasodilation, leading to a reduction in blood pressure and improved heart function in patients with heart failure. Lisinopril is also used in the management of chronic kidney disease in patients with diabetes, as it can reduce the progression of kidney damage. Additionally, it is prescribed for the treatment of post-myocardial infarction (heart attack) to improve survival rates and reduce the risk of heart failure development. Off-label uses of lisinopril may include the treatment of diabetic nephropathy (kidney damage from diabetes) and migraine prophylaxis, although its use in these contexts should be guided by a healthcare provider. Evidence supports its effectiveness in managing hypertension and heart failure, with proven benefits in reducing morbidity and mortality rates, especially in patients with underlying cardiovascular conditions.
Lisinopril Contraindications - Important Warnings
Lisinopril is contraindicated in patients who are allergic to ACE inhibitors, as it can lead to severe allergic reactions, including angioedema. It should also be avoided in pregnant women, particularly in the second and third trimesters, due to the risk of fetal harm, including renal failure, hypotension, and death. Patients with a history of angioedema related to ACE inhibitors or hereditary/idiopathic angioedema should not use lisinopril. It is contraindicated in patients with a history of severe renal impairment (e.g., those with anuria) or in patients undergoing dialysis, as it may exacerbate kidney dysfunction. Lisinopril should also not be used in combination with aliskiren in diabetic patients due to an increased risk of renal impairment, hyperkalemia, and hypotension. If a patient experiences significant hypotension after the first dose, it may be a sign that lisinopril should be discontinued or the dose reduced. Finally, it is contraindicated in patients with hyperkalemia (elevated potassium levels), as lisinopril can increase potassium levels further and potentially lead to dangerous arrhythmias.
Lisinopril Side Effects - What to Expect
Common side effects of lisinopril include dizziness, headache, fatigue, and a dry cough. The dry cough, which occurs in some patients, is a hallmark side effect of ACE inhibitors and can be bothersome enough to require discontinuation of the drug. Other gastrointestinal side effects include nausea and diarrhea. Lisinopril can also cause hyperkalemia, leading to elevated potassium levels, which may result in symptoms such as muscle weakness, fatigue, or irregular heartbeats. Renal dysfunction is another serious side effect, with some patients experiencing increased serum creatinine and decreased urine output. Angioedema (swelling of the face, lips, tongue, or throat) is a rare but serious side effect that requires immediate medical attention. If severe enough, angioedema can obstruct the airways and be life-threatening. Other serious side effects, though rare, include hypotension (especially after the first dose), elevated blood urea nitrogen (BUN), and liver dysfunction. Long-term use of lisinopril can also lead to electrolyte imbalances, particularly with prolonged elevation of potassium levels. Patients should monitor for signs of electrolyte disturbances, such as muscle cramps or irregular heartbeats, and seek medical attention if these symptoms occur.
Lisinopril Pregnancy Category ID - Safety Information
4
Lisinopril Mode of Action - How It Works
Lisinopril works by inhibiting the enzyme angiotensin-converting enzyme (ACE), which plays a key role in the renin-angiotensin-aldosterone system (RAAS). ACE converts angiotensin I to angiotensin II, a potent vasoconstrictor that raises blood pressure by narrowing blood vessels. By blocking ACE, lisinopril reduces the production of angiotensin II, leading to vasodilation and a subsequent reduction in blood pressure. Additionally, the reduction in angiotensin II levels decreases the release of aldosterone, a hormone that can cause sodium and water retention, further lowering blood pressure. This mechanism of action is beneficial in treating hypertension, heart failure, and chronic kidney disease by decreasing the workload on the heart and improving kidney function. Lisinopril’s effects also help to improve blood flow and prevent fluid buildup, which is particularly helpful in patients with heart failure. The reduction in angiotensin II also limits the remodeling of heart tissue and blood vessels that can occur after heart attacks, providing protection against further cardiovascular events.
Lisinopril Drug Interactions - What to Avoid
Lisinopril can interact with several medications, potentially leading to adverse effects. The most significant interaction is with potassium-sparing diuretics (e.g., spironolactone), potassium supplements, and salt substitutes containing potassium, as they can increase the risk of hyperkalemia (high potassium levels). Elevated potassium levels can cause serious heart arrhythmias, which may be life-threatening. Additionally, lisinopril can interact with diuretics, particularly when a patient is volume-depleted. The use of diuretics with lisinopril can enhance its hypotensive effect, leading to a significant drop in blood pressure, especially after the first dose. It is recommended to monitor blood pressure and renal function closely when these medications are combined. Lisinopril may also interact with nonsteroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors, which can reduce its antihypertensive effects and worsen kidney function, particularly in patients with pre-existing renal impairment. Lithium levels may increase when taken with lisinopril, leading to lithium toxicity, which requires monitoring of serum lithium levels. Concurrent use with other antihypertensive medications, including calcium channel blockers, can lead to enhanced blood pressure-lowering effects, so blood pressure should be monitored closely. Lastly, combining lisinopril with other ACE inhibitors or angiotensin receptor blockers (ARBs) should generally be avoided to prevent an increased risk of adverse effects such as hyperkalemia or renal dysfunction.
Lisinopril Adult Dose - Recommended Dosage
For the treatment of hypertension in adults, the typical starting dose of lisinopril is 10 mg once daily. The dose can be increased to 20-40 mg per day, depending on the patient’s response to treatment and tolerance, with a maximum dose of 80 mg per day if necessary. For heart failure, the usual starting dose is 2.5-5 mg once daily, and the dose can be gradually increased to 20-40 mg per day. For post-myocardial infarction, lisinopril is typically started at 5 mg once daily, with the dose gradually increasing to 10 mg once daily over several weeks, depending on the patient's tolerance. For patients with renal impairment, the dose may need to be reduced, and careful monitoring of kidney function is essential. It is important to begin treatment with a lower dose in elderly patients or those who are volume-depleted to reduce the risk of excessive blood pressure lowering.
Lisinopril Child Dose - Dosage for Children
Lisinopril is not typically used in children for the treatment of hypertension unless other treatment options are not effective or appropriate. The pediatric dose for hypertension varies based on the child's weight and age. For children over 6 years of age, the usual starting dose is 0.07 mg/kg once daily, up to a maximum of 5 mg per day. The dose can be increased gradually based on the child's blood pressure response, with a maximum dose of 40 mg per day. In pediatric patients with renal impairment, the dose should be adjusted based on renal function. Lisinopril should be used cautiously in children with underlying kidney or liver problems, and kidney function should be monitored regularly during treatment. Additionally, the potential risks and benefits should be carefully considered when prescribing this medication to children, particularly since there are limited studies on its long-term use in the pediatric population.
Lisinopril Renal Dose - Dosage for Kidney Conditions
In patients with renal impairment, the dose of lisinopril should be adjusted based on the degree of renal dysfunction. For patients with a creatinine clearance of 30-50 mL/min, the starting dose is typically 5 mg once daily, with gradual dose adjustments based on clinical response. For patients with a creatinine clearance of less than 30 mL/min, the dose should be further reduced, typically to 2.5 mg once daily, and should be closely monitored to avoid excessive blood pressure reduction and further renal compromise. Lisinopril should be used with caution in these patients, and renal function should be monitored regularly, as the drug can further impair renal function in patients with pre-existing kidney disease. It may also increase serum creatinine levels, requiring dose adjustments or discontinuation if renal function worsens.
