Lisinopril


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Hypertension Initial: 10 mg once daily at bedtime. Maintenance: 20-40 mg once daily. Max: 80 mg/day. Heart failure As adjunct: Initial: 2.5 mg once daily, may increase up to 20-40 mg at 4-week interval according to clinical response. Post MI Initial: 5 mg once daily within 24 hours of the onset of symptoms, followed by 5 mg after 24 hours; then 10 mg once daily for 6 weeks. Continue treatment in patients developing heart failure. Diabetic nephropathy Hypertensive with type 2 diabetes mellitus: Initial: 10 mg once daily. May increase to 20 mg once daily to achieve a sitting diastolic BP <90 mmHg.
Dosage Details
Oral
Hypertension
Adult: Initially, 10 mg once daily. Give 1st dose preferably at bedtime. Patient with renovascular hypertension, volume depletion, severe hypertension: Initially, 2.5-5 mg once daily. Patient on diuretic: 5 mg once daily. Maintenance dose: 20-40 mg once daily. Max: 80 mg daily.
Child: 6-16 years 20-<50 kg: Initially, 2.5 mg once daily. Max: 20 mg daily. ≥50 kg: 5 mg once daily. Max: 40 mg.

Oral
Diabetic nephropathy
Adult: Hypertensive with type 2 diabetes mellitus: 10 mg once daily. May increase to 20 mg once daily to achieve a sitting diastolic BP <90 mmHg.

Oral
Heart failure
Adult: As adjunct: Initially, 2.5 mg once daily, may increase up to 20-40 mg at 4-week interval according to clinical response.

Oral
Post-myocardial infarction
Adult: Initially, 5 mg once daily within 24 hours of the onset of symptoms, followed by 5 mg after 24 hours; then 10 mg once daily for 6 weeks. Continue treatment in patients developing heart failure.
Renal Impairment
Dose can be adjusted up to max 40 mg once daily based on patient's response.

Hypertension:
CrCl (mL/min) Dosage
<10 or on dialysis Initially, 2.5 mg once daily.
10-30 Initially, 2.5-5 mg once daily.
31-80
Initially, 5-10 mg once daily.

Heart failure; Post myocardial infarction; 
Diabetic nephropathy:
CrCl (mL/min) Dosage 
<10 or on dialysis Initially, 2.5 mg once daily.
10-30 Initially, 2.5-5 mg once daily.
 
Administration
May be taken with or without food.
Contraindications
History of angioedema related to previous ACE inhibitor treatment, hereditary or idiopathic angioedema. Concomitant use with aliskiren especially in patients with diabetes mellitus or renal impairment (GFR<60 mL/min/1.73 m2). Concomitant use with sacubitril. Pregnancy.
Special Precautions
Patient with severe aortic stenosis, hypertrophic cardiomyopathy, CV disease (e.g. ischaemic heart disease) collagen vascular disease, ascites, unstented unilateral and bilateral renal artery stenosis. Patients undergoing major surgery or during anaesthesia. Black race. Desensitisation treatment (e.g. hymenoptera venom). Renal and hepatic impairment. Lactation. Children.
Adverse Reactions
Significant: Hyperkalaemia, hypotension, cholestatic jaundice, chest pain, syncope, cough, haematologic effects (e.g. neutropenia, anaemia, thrombocytopenia).
Cardiac disorders: Tachycardia, palpitations.
Ear and labyrinth disorders: Tinnitus.
Gastrointestinal disorders: Nausea, diarrhoea, vomiting, abdominal pain, dry mouth, constipation.
General disorders and admin site conditions: Fatigue, asthenia.
Immune system disorders: Intestinal angioedema.
Investigations: Elevated serum creatinine, BUN increased.
Metabolism and nutrition disorders: Electrolyte imbalance.
Musculoskeletal and connective tissue disorders: Arthralgia, myalgia.
Nervous system disorders: Headache, vertigo, paresthesia, taste disturbance, dizziness.
Psychiatric disorders: Hallucinations, mood alterations, sleep disturbance, drowsiness.
Renal and urinary disorders: Renal dysfunction, oliguria, anuria.
Reproductive system and breast disorders: Impotence, gynaecomastia.
Respiratory, thoracic and mediastinal disorders: Rhinitis, sinusitis, dyspnoea.
Skin and subcutaneous tissue disorders: Pruritus, rash, psoriasis.
Vascular disorders: Raynaud’s phenomenon, flushing.
Potentially Fatal:
Anaphylactoid reactions (e.g. angioedema of face, lips, tongue, and extremities), arrhythmia, severe hypotension. Rarely, fulminant hepatic necrosis.
Patient Counseling Information
This drug may cause occasional dizziness, if affected, do not drive or operate machinery.
MonitoringParameters
Monitor BP, heart rate, BUN, CBC with differential LFT, serum K, and creatinine levels. Assess for signs of angioedema.
Overdosage
Symptoms: Hypotension, circulatory shock, tachycardia, palpitations, bradycardia, hyperventilation, renal failure, electrolyte disturbances, anxiety, dizziness and cough. Management: Administer IV infusion NaCl 0.9%. May perform gastric lavage if ingestion is recent. If hypotension occurs, place the patient in shock position. May also consider administration of angiotensin II infusion and/or IV catecholamines.
Drug Interactions
Increased hypotensive effect with antihypertensives, diuretics. Increased risk of hyperkalaemia with K-sparing diuretics (e.g. spironolactone, amiloride), K supplements, and drugs affecting serum K concentrations (e.g. trimethoprim, ciclosporin). May increase hypoglycaemic effect with insulin and oral hypoglycaemics agents. Concomitant use with NSAIDs including selective COX-2 inhibitors may result to renal function deterioration and reduced antihypertensive effect. May increase serum levels and toxicity of lithium. Coadministration with parenteral gold (e.g. Na aurothiomalate, aurothioglucose) may cause nitritoid reaction characterized by facial flushing, nausea, vomiting, and hypotension. Increased risk of angioedema with mammalian target of rapamycin (mTOR) inhibitors (e.g. temsirolimus, sirolimus, everolimus), tissue plasminogen activators (e.g. alteplase), neprilysin inhibitors (e.g. sacubitril) and neutral endopeptidase (NEP) inhibitors (e.g. racecadotril).
Potentially Fatal: Increased risk of hypotension, hyperkalaemia, and changes in renal failure with aliskiren. Increased risk of angioedema with neprilysin inhibitors (e.g. sacubitril). May cause anaphylactoid reactions with dextran sulfate in LDL apheresis.
Lab Interference
May result to false-negative aldosterone/renin ratio (ARR).
Action
Description: Lisinopril, a peptidyl dipeptidase inhibitor, is an ACE inhibitor which prevents conversion of angiotensin I to angiotensin II, thereby increasing plasma renin activity and decreasing aldosterone secretion.
Onset: Within 1-2 hours.
Duration: 24 hours.
Pharmacokinetics:
Absorption: Slowly and incompletely absorbed from the gastrointestinal tract. Bioavailability: Approx 25%. Time to peak plasma concentration: Approx 7 hours.
Distribution: Crosses placenta.
Excretion: Mainly via urine (unchanged drug). Elimination half-life: 12 hours.
Chemical Structure

Chemical Structure Image
Lisinopril

Source: National Center for Biotechnology Information. PubChem Database. Lisinopril, CID=5362119, https://pubchem.ncbi.nlm.nih.gov/compound/Lisinopril (accessed on Jan. 22, 2020)

Storage
Store between 15-30°C. Protect from moisture.
ATC Classification
C09AA03 - lisinopril ; Belongs to the class of ACE inhibitors. Used in the treatment of cardiovascular disease.
References
Anon. Lisinopril. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 27/02/2019.

Anon. Lisinopril. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 27/02/2019.

Buckingham R (ed). Lisinopril. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 27/02/2019.

Joint Formulary Committee. Lisinopril. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 27/02/2019.

Lisinopril (Aurobindo Pharma Limited). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 27/02/2019.

Disclaimer: This information is independently developed by MIMS based on Lisinopril from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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