Lisinopril (Prinivil, Zestril)

Category:

  • Anytihypertensive

Description:

  • Angiotensin-converting enzyme (ACE) inhibitor

Indications:

  • Hypertension

  • CHF

  • Acute MI

  • Diabetic nephropathy (non FDA approved)

Precautions:

  • Pregnancy category C (1st trimester), D (2nd and 3rd trimester); ACE inhibitors can cause fetal and neonatal morbidity and death when administered to pregnant women

  • Impaired renal function, dialysis patients, hypovolemia

  • Diuretic therapy, collagen-vascular diseases, elderly, bilateral renal artery stenosis

Adverse Reactions (Side Effects):

  • CNS: anxiety, dizziness, fatigue, headache, insomnia, paresthesia

  • CV: angina, hypotension, palpitations, postural hypotension, syncope (especially with 1st dose)

  • GI: abdominal pain, constipation, melena, nausea, vomiting

  • GU: acute renal failure, decreased libido, impotence, increased BUN, creatinine

  • HEME: agranulocytosis, neutropenia

  • METAB: hyperkalemia, hyponatremia

  • MS: arthralgia, arthritis, myalgia

  • RESP: asthma, bronchitis, cough, dyspnea, sinusitis

  • SKIN: angioedema, flushing, rash, sweating

 

Dosage:

Administered orally

  • Adult:            

    • Hypertension: PO 10mg daily; usual dose 20-40mg daily

    • CHF: PO 5mg daily; usual range 5-20mg daily

    • Acute MI: PO in hemodynamically stable patients within 24 hours of acute MI, 5mg followed by 5mg after 24 hours, 10mg after 48 hours, then 10mg daily; continue 6 weeks (or longer if concurrent hypertension or CHF)

    • Renal impairment: PO initial dose 5mg daily (serum creatinine > or = to 3 mg/dl); initial dose 2.5mg daily (dialysis patients)

Drug interactions:

  • Allopurinol: predisposition to hypersensitivity reactions to ACE inhibitors

  • Aspirin, NSAIDs: inhibition of the antihypertensive response to ACE inhibitors

  • Prazosin, terazosin, doxazosin: exaggerated first-dose hypotensive response to a-blockers

    

 
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