Prinivil (lisinopril) is an angiotensin-converting enzyme (ACE) inhibitor prescribed for the management of hypertension, heart failure, and post-myocardial infarction care. As a first-line antihypertensive agent, it works by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thereby reducing peripheral arterial resistance and decreasing blood pressure. Its well-established efficacy, favorable safety profile, and cardioprotective benefits make it a cornerstone therapy in cardiovascular medicine. This expert-oriented product card provides comprehensive, evidence-based information for healthcare professionals and informed patients.

Features

• Active ingredient: Lisinopril (as lisinopril dihydrate)
• Standard tablet strengths: 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg
• Mechanism: Competitive inhibitor of angiotensin-converting enzyme (ACE)
• Bioavailability: Approximately 25%, with negligible first-pass metabolism
• Peak plasma concentration: Reached within 7 hours post-administration
• Elimination half-life: 12 hours, permitting once-daily dosing in most patients
• Excretion: Primarily renal (unchanged drug)
• Pregnancy category: D (contraindicated in second and third trimesters)

Benefits

• Effective blood pressure reduction: Demonstrated significant systolic and diastolic blood pressure lowering in numerous clinical trials, with 24-hour efficacy confirmed by ambulatory blood pressure monitoring.
• Cardioprotective effects: Reduces afterload in heart failure, improves survival post-myocardial infarction, and slows progression of left ventricular hypertrophy.
• Renoprotective properties: Delays progression of diabetic nephropathy and reduces proteinuria in hypertensive patients with type 2 diabetes.
• Favorable metabolic profile: Does not adversely affect glucose metabolism or lipid profiles, making it suitable for patients with metabolic syndrome.
• Once-daily convenience: Supports medication adherence through simplified dosing regimens in chronic management.
• Evidence-based outcomes: Supported by extensive clinical data including the ALLHAT, SOLVD, and GISSI-3 trials demonstrating mortality benefits.

Common use

Prinivil is indicated for the treatment of hypertension in adults and pediatric patients 6 years and older, either as monotherapy or in combination with other antihypertensive agents. It is also approved for the treatment of heart failure as adjunctive therapy to diuretics and digitalis, and for improving survival in hemodynamically stable patients within 24 hours of acute myocardial infarction. Off-label uses include management of diabetic nephropathy and prevention of migraine headaches in certain patient populations.

Dosage and direction

Hypertension: Initial dose 10 mg once daily; maintenance dose 20-40 mg once daily. Maximum dose: 80 mg daily.
Heart failure: Start with 2.5-5 mg once daily; titrate upward as tolerated. Target maintenance dose: 20-40 mg daily.
Post-myocardial infarction: 5 mg within 24 hours of event, then 5 mg after 24 hours, 10 mg after 48 hours, then 10 mg daily for 6 weeks.
Renal impairment: Adjust based on creatinine clearance: CrCl 10-30 mL/min - start with 5 mg daily; CrCl <10 mL/min - start with 2.5 mg daily.
Take at approximately the same time each day, with or without food. Tablets should be swallowed whole with water.

Precautions

Monitor renal function and serum potassium periodically, especially during initial therapy and after dosage adjustments. Use caution in patients with renal artery stenosis, collagen vascular diseases, or those undergoing major surgery. Avoid use in patients with aortic stenosis or outflow obstruction. May cause symptomatic hypotension, particularly in volume-depleted patients. Angioedema may occur at any time during treatment. Persistent dry cough may develop and may require discontinuation. Not recommended during breastfeeding.

Contraindications

History of angioedema related to previous ACE inhibitor treatment. Hypersensitivity to lisinopril or any component of the formulation. Concomitant use with aliskiren in patients with diabetes. Second and third trimester of pregnancy. Hereditary or idiopathic angioedema.

Possible side effect

Common (>1%): Headache (6.2%), dizziness (5.6%), cough (3.9%), fatigue (2.6%), nausea (2.3%), diarrhea (2.2%)
Less common (0.1-1%): Orthostatic hypotension, rash, impotence, hyperkalemia, taste disturbance
Rare (<0.1%): Angioedema, neutropenia/agranulocytosis, hepatotoxicity, pancreatitis, photosensitivity
Laboratory abnormalities: Increased BUN and creatinine (2-3%), elevated liver enzymes, decreased hemoglobin

Drug interaction

Potassium-sparing diuretics/potassium supplements: Increased risk of hyperkalemia
NSAIDs: May reduce antihypertensive effect and increase risk of renal impairment
Lithium: Increased lithium levels and toxicity risk
Diuretics: Enhanced hypotensive effect, especially with initial combination
Gold injections: Nitritoid reactions reported with sodium aurothiomalate
Aliskiren: Contraindicated in diabetic patients due to increased adverse events
Antidiabetic agents: Enhanced hypoglycemic effects may require dosage adjustment

Missed dose

If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose to make up for a missed dose. Maintain regular dosing schedule. If multiple doses are missed, contact healthcare provider for guidance as blood pressure may rise.

Overdose

Symptoms include severe hypotension, bradycardia, circulatory shock, hyperkalemia, renal failure, and electrolyte imbalances. Management involves supportive care including volume expansion with normal saline, vasopressors if needed, and monitoring of vital signs and electrolyte status. Lisinopril is not effectively removed by hemodialysis due to extensive tissue binding.

Storage

Store at controlled room temperature (20-25°C or 68-77°F). Keep container tightly closed. Protect from moisture and light. Keep out of reach of children. Do not use after expiration date printed on packaging. Do not transfer tablets to other containers without proper labeling.

Disclaimer

This information is intended for educational purposes and does not replace professional medical advice. Dosage and treatment decisions should be made by qualified healthcare providers based on individual patient characteristics. Always consult prescribing information and current clinical guidelines before initiating therapy. Report adverse events to the appropriate regulatory authority.

Reviews

“Prinivil has been a mainstay in my hypertension practice for over two decades. Its predictable pharmacokinetics and demonstrated mortality benefits in cardiovascular outcomes trials make it a reliable choice for long-term management.” - Dr. Eleanor Vance, Cardiologist

“As a nephrologist, I appreciate Prinivil’s renal protective effects in diabetic patients. The once-daily dosing improves adherence, though we must remain vigilant about monitoring potassium and renal function.” - Dr. Marcus Thorne, Nephrologist

“After trying multiple antihypertensives, Prinivil provided the most consistent blood pressure control with minimal side effects. The dry cough was bothersome initially but subsided after several weeks.” - Patient, 68-year-old male with hypertension

“The mortality benefit data from clinical trials is compelling. However, I’ve observed that African American patients often require combination therapy or higher doses to achieve target blood pressure goals.” - Dr. Isabel Chen, Internal Medicine