Zestril: Effective Blood Pressure Control and Heart Failure Management
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Synonyms | |||
Zestril (lisinopril) is an angiotensin-converting enzyme (ACE) inhibitor prescribed for the management of hypertension and heart failure, and to improve survival following a myocardial infarction. This medication works by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, leading to vasodilation and a subsequent reduction in blood pressure. Its proven efficacy and well-documented safety profile have established it as a cornerstone in cardiovascular therapeutic regimens, offering patients a reliable option for long-term cardiovascular risk management under appropriate medical supervision.
Features
- Active ingredient: Lisinopril
- Drug class: Angiotensin-converting enzyme (ACE) inhibitor
- Available in tablet formulations: 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg
- Standard dosing: Once-daily administration
- Prescription-only medication
- Proven mechanism of action: Inhibition of the renin-angiotensin-aldosterone system (RAAS)
Benefits
- Effectively lowers elevated blood pressure, reducing the risk of stroke, myocardial infarction, and kidney damage
- Improves survival rates in patients following a heart attack when initiated within 24 hours
- Manages symptoms of heart failure and can improve exercise tolerance
- Provides renal protective effects in hypertensive patients with diabetes by reducing proteinuria
- Offers convenient once-daily dosing that supports medication adherence
- Demonstrates a well-established long-term safety profile in clinical practice
Common use
Zestril is primarily indicated for the treatment of hypertension, either as monotherapy or in combination with other antihypertensive agents. It is also approved for the management of heart failure as adjunctive therapy when diuretics and/or digitalis prove insufficient. Additionally, it is used to improve survival in hemodynamically stable patients who have experienced acute myocardial infarction. Off-label uses may include the management of diabetic nephropathy and certain forms of chronic kidney disease, though these applications require careful medical supervision.
Dosage and direction
The dosage of Zestril must be individualized based on the patient’s clinical condition and therapeutic response. For hypertension in patients not on diuretics, the initial dose is typically 10 mg once daily, with maintenance doses ranging from 20-40 mg daily. For heart failure, treatment should be initiated under close medical supervision with a starting dose of 2.5-5 mg once daily, which may be titrated upward as tolerated. Following acute myocardial infarction, dosing should begin at 5 mg within 24 hours of onset, followed by 5 mg after 24 hours, 10 mg after 48 hours, and then 10 mg once daily. Tablets should be taken orally, with or without food, at approximately the same time each day.
Precautions
Patients should be monitored for hypotension, especially following the initial dose and during dosage adjustments. Renal function and serum potassium should be assessed prior to initiation and periodically during therapy. Use with caution in patients with renal impairment, collagen vascular disease, or those receiving concomitant diuretics. Angioedema may occur at any time during treatment, requiring immediate discontinuation. A persistent dry cough may develop and typically resolves upon discontinuation. Patients should be advised to avoid potassium supplements or salt substitutes containing potassium unless specifically directed by their physician.
Contraindications
Zestril is contraindicated in patients with a history of angioedema related to previous ACE inhibitor treatment or hereditary angioedema. It should not be used during pregnancy, particularly in the second and third trimesters, due to the risk of fetal injury and death. Concomitant use with aliskiren in patients with diabetes is contraindicated. Additional contraindications include hypersensitivity to lisinopril or any component of the formulation and concomitant use with sacubitril/valsartan.
Possible side effect
Common adverse reactions may include dizziness (6-12%), headache (5-6%), cough (3-9%), fatigue (3-5%), and diarrhea (2-4%). Less frequently, orthostatic hypotension, rash, and impotence may occur. Serious side effects requiring immediate medical attention include angioedema (0.1-0.7%), hyperkalemia, renal impairment, neutropenia/agranulocytosis, and hepatic failure. The incidence of side effects may be higher in patients with renal impairment, heart failure, or those receiving concomitant diuretic therapy.
Drug interaction
Zestril may interact with several medication classes. Diuretics may potentiate the hypotensive effect. Concurrent use with potassium-sparing diuretics, potassium supplements, or salt substitutes may significantly increase the risk of hyperkalemia. Nonsteroidal anti-inflammatory drugs (NSAIDs) may diminish the antihypertensive effect and increase renal impairment risk. Lithium levels may increase with concomitant use. Dual blockade of the RAAS with ARBs or aliskiren increases risks of hypotension, hyperkalemia, and renal impairment. Gold injections may rarely cause nitritoid reactions.
Missed dose
If a dose is missed, it should be taken as soon as possible on the same day. However, if it is nearly time for the next scheduled dose, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed one. Consistency in dosing is important for maintaining stable blood pressure control, so establishing a routine is recommended.
Overdose
The most likely manifestation of overdose is hypotension, which may be severe. Other symptoms may include bradycardia, circulatory shock, electrolyte disturbances, and renal failure. Management should include supportive measures with volume expansion with normal saline to restore blood pressure. Lisinopril may be removed from the body by hemodialysis. Patients should seek immediate medical attention if overdose is suspected, and bring the medication container for identification.
Storage
Store Zestril tablets at controlled room temperature between 20-25°C (68-77°F), with excursions permitted between 15-30°C (59-86°F). Keep the medication in its original container, tightly closed, and protected from light and moisture. Store out of reach of children and pets. Do not use tablets that have expired or show signs of physical deterioration. Proper disposal of unused medication should follow local regulations, typically through medication take-back programs.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Zestril is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual response to medication may vary, and only a physician can determine the appropriate treatment based on a patient’s specific medical condition, concurrent medications, and overall health status. Patients should not initiate, discontinue, or change dosage without consulting their healthcare provider.
Reviews
Clinical studies and post-marketing surveillance demonstrate that Zestril is generally well-tolerated and effective for indicated conditions. In the ATLAS study, high-dose lisinopril (32.5-35 mg daily) significantly reduced the combined endpoint of mortality and hospitalization for heart failure compared to low-dose therapy. The GISSI-3 trial showed that lisinopril started within 24 hours of myocardial infarction significantly reduced 6-week mortality. Patient reviews often note effective blood pressure control with once-daily convenience, though some report the characteristic ACE inhibitor cough as a reason for discontinuation. Overall satisfaction rates remain high among appropriately selected patients who tolerate the medication well.