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Pharmacologic class: Angiotensin-converting enzyme (ACE) inhibitor
Therapeutic class: Antihypertensive
Pregnancy risk category C (first trimester), D (second and third trimesters)
FDA Box Warning
• When used during second or third trimester of pregnancy, drug may cause fetal harm or death. Discontinue as soon as pregnancy is detected.
Inhibits conversion of angiotensin I to angiotensin II (a potent vasoconstrictor), decreasing systemic vascular resistance, blood pressure, preload, and afterload. Also inactivates bradykinin and other vasodilatory prostaglandins, increases plasma renin levels, and reduces aldosterone levels.
Tablets: 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg
Indications and dosages
Adults: Initially, 10 mg P.O. daily, increased to a maintenance dosage of 20 to 40 mg/day. Maximum daily dosage is 80 mg. In patients on diuretics, start with 5 mg/day P.O.
➣ Heart failure
Adults: 5 mg/day P.O. (Prinivil), increased in increments, as ordered, to a maximum of 20 mg/day as a single dose. Or 5 to 40 mg P.O. (Zestril) as a single daily dose given with digitalis and diuretics, increased in increments of no more than 10 mg at intervals of at least 2 weeks, to highest dosage tolerated; maximum dosage is 40 mg/day P.O.
➣ Adjunctive therapy after acute myocardial infarction
Adults: Initially, 5 mg P.O., followed by 5 mg after 24 hours, 10 mg after 48 hours, and then 10 mg daily for 6 weeks (given with standard thrombolytic, aspirin, or beta-adrenergic blocker therapy). If systolic pressure is 120 mm Hg or lower, initial dosage is 2.5 mg for 2 days, then 2.5 to 5 mg/day.
• Impaired renal function
• Heart failure with hyponatremia
• Hypersensitivity to drug or other ACE inhibitors
• Angioedema (hereditary, idiopathic, or ACE-inhibitor induced)
• Pregnancy (second and third trimesters)
Use cautiously in:
• renal impairment, hypertension, cerebrovascular or cardiac insufficiency
• family history of angioedema
• concurrent diuretic therapy
• black patients (in whom drug may be less effective in treating hypertension)
• elderly patients
• pregnant patients in first trimester
• breastfeeding patients
• children (safety not established).
• Give once a day in morning, with or without food.
☞ Measure blood pressure before administering. Withhold drug, if appropriate, according to prescriber's blood pressure parameters. Adjust dosage according to blood pressure response.
• Expect prescriber to add low-dose diuretic if lisinopril alone doesn't control blood pressure.
CNS: dizziness, fatigue, headache, asthenia
CV: hypotension, orthostatic hypotension, syncope, chest pain, angina pectoris
GI: nausea, diarrhea, abdominal pain, anorexia
GU: erectile dysfunction, decreased libido, renal dysfunction
Metabolic: hyponatremia, hyperkalemia
Respiratory: cough, upper respiratory tract infection, bronchitis, dyspnea, asthma
Skin: rash, pruritus, angioedema
Other: altered taste, fever, anaphylaxis
Drug-drug. Cyclosporine, potassium-sparing diuretics, potassium supplements: hyperkalemia
Diuretics, other antihypertensives: excessive hypotension
Indomethacin: reduced antihypertensive effect
Lithium: increased lithium blood level, greater risk of lithium toxicity
Nonsteroidal anti-inflammatory drugs: further deterioration in patients with renal compromise, decreased antihypertensive effects
Drug-diagnostic tests. Blood urea nitrogen, creatinine, hematocrit, hemoglobin: slightly increased levels
Liver function tests, potassium: increased levels
Sodium: decreased level
Drug-food. Salt substitutes containing potassium: hyperkalemia
Drug-herbs. Capsaicin: cough
Ephedra (ma huang), licorice, yohimbine: antagonistic effects
Drug-behaviors. Acute alcohol ingestion: excessive hypotension
• Before and periodically during therapy, monitor CBC with white cell differential and kidney and liver function tests.
☞ Monitor for signs and symptoms of angioedema or anaphylaxis. If these occur, discontinue drug and contact prescriber immediately.
• Check blood pressure frequently to assess drug efficacy. Monitor closely for hypotension, especially in patients also taking diuretics.
• Check vital signs and ECG regularly. Assess cardiovascular status carefully.
• Monitor respiratory and neurologic status.
• Assess potassium intake and blood potassium level.
• Advise patient to take once a day in morning, with or without food.
☞ Tell patient to immediately report fainting, continuing cough, rash, itching, swelling (especially of face, lips, tongue, or throat), severe dizziness, difficulty breathing, extreme tiredness, or continuing nausea.
☞ Instruct female patient to notify prescriber if she becomes pregnant.
• Tell patient that drug may cause temporary blood pressure decrease if he stands up suddenly. Advise him to rise slowly and carefully.
• Explain that drug may cause muscle aches or headache. Encourage patient to discuss activity recommendations and pain relief with prescriber.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Instruct patient to avoid potassium-based salt substitutes or potassium supplements.
• Tell patient he'll undergo regular blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, herbs, and behaviors mentioned above.