Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor medication primarily prescribed for the management of hypertension and heart failure. As a first-line antihypertensive agent, it works by relaxing blood vessels, allowing blood to flow more smoothly and the heart to pump more efficiently. This medication is also proven to improve survival rates following myocardial infarction and provides renal protection in diabetic patients with proteinuria. Its once-daily dosing and generally favorable side effect profile make it a cornerstone in cardiovascular pharmacotherapy.

Features

• Active ingredient: Lisinopril
• Drug class: Angiotensin-converting enzyme (ACE) inhibitor
• Available formulations: Oral tablets (2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg)
• Standard dosing: Once daily administration
• Bioavailability: Approximately 25%
• Half-life: 12 hours
• Time to peak concentration: 7 hours
• Excretion: Primarily renal
• Pregnancy category: D (contraindicated in second and third trimesters)

Benefits

• Effectively lowers blood pressure, reducing the risk of stroke, myocardial infarction, and other cardiovascular events
• Provides cardioprotective benefits by decreasing afterload and improving cardiac output in heart failure patients
• Slows the progression of diabetic nephropathy and reduces proteinuria in patients with diabetes
• Demonstrates mortality reduction benefits in post-myocardial infarction patients when initiated within 24 hours
• Offers convenient once-daily dosing that supports medication adherence
• Generally well-tolerated with a established safety profile spanning decades of clinical use

Common use

Lisinopril is predominantly prescribed for the treatment of hypertension, either as monotherapy or in combination with other antihypertensive agents. It is indicated for the management of heart failure, particularly when used concomitantly with diuretics and digitalis. The medication is also FDA-approved for improving survival in hemodynamically stable patients within 24 hours of acute myocardial infarction. Additionally, lisinopril is utilized for the treatment of diabetic nephropathy in hypertensive patients with type 1 diabetes and albuminuria, where it has demonstrated significant renal protective effects.

Dosage and direction

The initial dosage for hypertension in adults not taking diuretics is 10 mg once daily, which may be increased to 20-40 mg daily based on blood pressure response. For heart failure, treatment typically begins with 5 mg once daily, with a maximum recommended dose of 40 mg daily. Post-myocardial infarction patients may start with 5 mg within 24 hours of the event, followed by 5 mg after 24 hours, 10 mg after 48 hours, and then 10 mg daily. Dosage adjustments are necessary for patients with renal impairment, with recommended reductions based on creatinine clearance. Administration should occur at approximately the same time each day, with or without food, though consistency is recommended.

Precautions

Patients should be monitored for hypotension, especially during initial dosing and following dosage increases. Renal function should be assessed prior to initiation and periodically during treatment, particularly in patients with pre-existing renal impairment, heart failure, or those taking diuretics. Serum potassium levels require monitoring, especially in patients with renal impairment, diabetes, or those using potassium-sparing diuretics or potassium supplements. Angioedema may occur at any time during treatment, requiring immediate discontinuation. Patients should be advised about the possibility of cough, which is typically non-productive and resolves upon discontinuation. Caution is advised in patients with aortic stenosis or outflow obstruction.

Contraindications

Lisinopril is contraindicated in patients with a history of angioedema related to previous ACE inhibitor treatment. It should not be used in patients with hereditary or idiopathic angioedema. The medication is contraindicated in combination with aliskiren in patients with diabetes. Use is prohibited during the second and third trimesters of pregnancy due to risk of fetal injury and death. Concomitant use with neprilysin inhibitors is contraindicated due to increased risk of angioedema. Hypersensitivity to any component of the formulation or other ACE inhibitors represents an absolute contraindication.

Possible side effect

The most common adverse reactions include dizziness (6-12%), headache (5-8%), cough (4-9%), fatigue (3-5%), and nausea (2-5%). Less frequent side effects may include orthostatic hypotension, rash, impotence, diarrhea, and taste disturbance. Serious adverse effects include angioedema (0.1-0.7%), which may involve the face, lips, tongue, glottis, or larynx; hyperkalemia; renal impairment; neutropenia/agranulocytosis; and hepatic failure. Hypotension may occur particularly in volume-depleted patients. Some patients may experience photosensitivity reactions. Pancreatitis and symptomatic hyponatremia have been reported rarely.

Drug interaction

Concomitant use with diuretics may potentiate hypotension. Potassium-sparing diuretics, potassium supplements, or salt substitutes containing potassium may increase the risk of hyperkalemia. Nonsteroidal anti-inflammatory drugs may reduce the antihypertensive effect and increase renal impairment risk. Lithium levels may increase when used with lisinopril. Dual blockade of the renin-angiotensin system with ARBs or aliskiren increases risks of hypotension, hyperkalemia, and renal impairment. Gold injections may cause nitritoid reactions. Insulin and oral hypoglycemic agents may require dosage adjustment due to improved glucose tolerance.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed dose. Consistency in dosing is important for maintaining stable blood pressure control, but occasional missed doses are unlikely to cause significant problems in most patients. Healthcare providers should be consulted if multiple doses are missed or if uncertainty exists about proper dosing management.

Overdose

Lisinopril overdose may manifest as severe hypotension, which represents the primary clinical concern. Other potential effects include bradycardia, circulatory shock, electrolyte disturbances, and renal failure. Management should focus on supportive measures, including volume expansion with normal saline to treat hypotension. Hemodialysis may be effective in removing lisinopril from the systemic circulation. Bradycardia may require atropine administration. Patients should be monitored for electrolyte abnormalities and renal function. Vasopressors may be necessary in cases of profound hypotension unresponsive to volume expansion.

Storage

Lisinopril tablets should be stored at controlled room temperature between 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C to 30°C (59°F to 86°F). The medication should be kept in its original container with the lid tightly closed to protect from moisture and light. Tablets should not be stored in bathroom cabinets where humidity levels may fluctuate. Keep all medications out of reach of children and pets. Do not use tablets that have changed color, appearance, or that are beyond their expiration date. Proper disposal of unused medication should follow local regulations or medication take-back programs.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Individual patient responses to lisinopril may vary, and appropriate medical supervision is essential. Healthcare professionals should be consulted for proper diagnosis, treatment decisions, and dosage adjustments. This information does not replace comprehensive product labeling or professional clinical judgment. Patients should not initiate or discontinue medication without consulting their healthcare provider. The complete prescribing information should be reviewed before initiating therapy.

Reviews

Clinical studies consistently demonstrate lisinopril’s efficacy in blood pressure reduction, with meta-analyses showing average systolic reductions of 8-15 mmHg and diastolic reductions of 5-10 mmHg. The SOLVD treatment trial established lisinopril’s mortality benefit in heart failure, reducing risk by 16% compared to placebo. GISSI-3 demonstrated a 11% reduction in mortality at 6 weeks post-myocardial infarction. Long-term extension studies show maintained efficacy over years of treatment with persistent blood pressure control. Patient satisfaction surveys indicate high adherence rates due to once-daily dosing and generally manageable side effect profile, though cough remains a notable reason for discontinuation in approximately 5-10% of patients.