about Lisinopril class, uses, side effects contraindications
Lisinopril
Short Description
Lisinopril is a medicine that belongs to a class of medicines called angiotensin-converting enzyme (ACE) inhibitors.
It works by reducing certain chemicals that cause blood vessels to constrict, which helps blood flow more smoothly and the heart can pump blood more efficiently.
It is used to treat patients with?high blood pressure?, patients with congestive heart failure in adults, or to support survival after a heart attack.
Various studies suggest that ACE inhibitors may delay the development of renal failure in patients with?diabetes?that involves excretion of protein in the urine, so the doctor may prescribe medication for this.
Category
Chemical class: Lysine ester of enalaprilat
Therapeutic class: Antihypertensive, vasodilator
Pregnancy category: C
(first trimester), D (later trimesters)
Indications
To manage uncomplicated essential hypertension
Adults. Initial: 10 mg daily. Maintenance: 20 to 40 mg daily. Maximum: 80 mg daily.
DOSAGE ADJUSTMENT For patients with renal failure, initial dosage reduced to 5 mg daily if creatinine clearance is 10 to 30 ml/ min/1.73 m2and to 2.5 mg daily if creatinine clearance is less than 10 ml/min/ 1.73 m2. For patients receiving a diuretic, initial dosage reduced to 5 mg daily. Children age 6 and over with a GFR of at least 30 ml/min/1.73 m2.Initial: 0.07 mg/ kg daily, adjusted according to blood pressure response up to 5 mg daily. Maximum: 0.61 mg/kg or 40 mg daily. To treat heart failure, along with digoxin and diuretics
Adults. Initial: 5 mg daily. Maintenance: 5 to 20 mg daily. Maximum: 80 mg daily.
DOSAGE ADJUSTMENT For patients with hyponatremia or creatinine clearance of 30 ml/min/1.73 m2or less, initial dosage reduced to 2.5 mg daily. To improve survival in hemodynamically stable patient after acute MI
Adults. 5 mg within 24 hr after onset of symptoms, followed by 5 mg after 24 hr and 10 mg after 48 hr. Maintenance: 10 mg daily for 6 wk. Maximum: 80 mg daily.
DOSAGE ADJUSTMENT For patients with baseline systolic blood pressure of 120 mm Hg or less, initial dosage decreased to 2.5 mg daily for first 3 days after MI. If systolic blood pressure falls to 100 mm Hg or less during therapy, maintenance dosage decreased to 2.5 to 5 mg as tolerated; if systolic blood pressure is 90 mm Hg or less for more than 1 hr, drug is discontinued. Route Onset Peak Duration P.O. 1 hr 6–8 hr 24 hr
Mechanism of Action
May reduce blood pressure by inhibiting conversion of angiotensin I to angiotensin II. Angiotensin II is a potent vasoconstrictor that also stimulates adrenal cortex to secrete aldosterone. Lisinopril may also inhibit renal and vascular production of angiotensin II. Decreased release of aldosterone reduces sodium and water reabsorption and increases their excretion, thereby reducing blood pressure.
Contraindications
Hypersensitivity to lisinopril, other ACE inhibitors, or their components; history of angioedema related to previous treatment with an ACE inhibitor; hereditary or idiopathic angioedema
Interactions
allopurinol, bone marrow depressants (such as methotrexate), procainamide, systemic corticosteroids: Increased risk of potentially fatal neutropenia or agranulocytosis cyclosporine, potassium-sparing diuretics, potassium supplements: Increased risk of hyperkalemia diuretics, other antihypertensives: Increased hypotensive effect insulin, oral antidiabetics: Increased risk of hypoglycemia lithium: Increased blood lithium level and risk of lithium toxicity
NSAIDs: Possibly reduced antihypertensive effect, reduced renal function in patients with preexisting renal dysfunction sympathomimetics: Possibly reduced antihypertensive effect high-potassium diet, potassium-containing salt substitutes: Increased risk of hyperkalemia
alcohol use: Possibly increased hypotensive effect
Side Efect
CNS: Ataxia, confusion, depression, dizziness, fatigue, headache, mood alterations, nervousness, stroke, syncope, transient ischemic attack, vertigo
CV: Arrhythmias, chest pain, hypotension, MI, orthostatic hypotension, palpitations, peripheral edema, vasculitis
ENDO: Hyperglycemia, syndrome of inappropriate ADH secretion
EENT: Olfactory disturbance
GI: Abdominal pain, anorexia, cholestatic jaundice, diarrhea, elevated liver enzyme levels, fulminant hepatic necrosis, gastritis, hepatitis, indigestion, nausea, pancreatitis, vomiting
GU: Acute renal failure, decreased libido, impotence, pyelonephritis
HEME: Agranulocytosis, anemia, hemolytic anemia, neutropenia, thrombocytopenia
MS: Muscle spasms, myalgia
RESP: Bronchospasm, cough, dyspnea, paroxysmal nocturnal dyspnea, pulmonary embolism and infarction, upper respiratory tract infection
SKIN: Alopecia, cutaneous pseudolymphoma, diaphoresis, erythema, flushing, herpes zoster, infections, pemphigus, photosensitivity, pruritus, rash, StevensJohnson syndrome, toxic epidermal necrolysis, urticaria
Other: Anaphylaxis, angioedema
Cautions
Use lisinopril cautiously in patients with fluid volume deficit, heart failure, impaired renal function, or sodium depletion. To prepare pediatric suspension, add 10 ml purified water to a polyethylene terephthalate (PET) bottle containing ten 20-mg tablets and shake for at least 1 minute. Add 30 ml of Bicitra diluent and 160 ml of Ora-Sweet SF to concentrate in PET bottle and shake gently for several seconds. Refrigerate up to 4 weeks. Shake suspension before each use. Monitor blood pressure often, especially early in treatment. If excessive hypotension develops, expect to withhold drug for several days.
WARNING If angioedema affects face, glottis, larynx, limbs, lips, mucous memlisinopril 600 branes, or tongue, notify prescriber immediately and expect to stop lisinopril and start appropriate therapy at once. If airway obstruction threatens, promptly give 0.3 to 0.5 ml of epinephrine 1:1,000 solution subcutaneously, as prescribed. Monitor patient for anaphylaxis, especially patient being dialyzed with high-flux membranes and treated with an ACE inhibitor such as lisinopril. If anaphylaxis occurs, stop dialysis immediately and treat aggressively (antihistamines are ineffective in this situation), as ordered. Anaphylaxis has also occurred with some patients undergoing low-density lipoprotein apheresis with dextran sulfate absorption. Notify prescriber if patient has persistent, nonproductive cough, a common adverse effect of ACE inhibitors such as lisinopril. Monitor for dehydration, which can lead to hypotension. Be aware that diarrhea and vomiting can cause dehydration. Monitor patient for hepatic dysfunction because lisinopril, an ACE inhibitor, may rarely cause a syndrome that starts with cholestatic jaundice or hepatitis and progresses to fulminant hepatic necrosis. If patient develops jaundice or a marked elevation in liver enzyme levels, withhold drug and notify prescriber. If patient takes insulin or an oral antidiabetic, monitor blood glucose level closely because risk of hypoglycemia increases, especially during first month of therapy. PATIENT SAFTY
Explain that lisinopril helps to control but doesn’t cure hypertension and that patient may need lifelong therapy. Advise patient to take lisinopril at the same time every day. Emphasize need to take drug as ordered, even if patient feels well; caution her not to stop drug without consulting prescriber. Instruct patient to report dizziness, especially during first few days of therapy. Inform patient that persistent, nonproductive cough may develop during lisinopril therapy. Urge her to notify prescriber immediately if cough becomes difficult to tolerate. Advise patient to drink adequate fluid and avoid excessive sweating, which can lead to dehydration and hypotension. Make sure she understands that diarrhea and vomiting also can cause hypotension. Caution patient not to use salt substitutes that contain potassium. Instruct patient to report signs of infection, such as fever and sore throat, which may indicate neutropenia. Advise patient to change position slowly to minimize orthostatic hypotension. If patient has diabetes and takes insulin or an oral antidiabetic, urge her to monitor her blood glucose level closely and watch for symptoms of hypoglycemia. Caution female patient to notify prescriber immediately if she is or could be pregnant.
Trade Name & Company Name
effect of Lisinopril in Pregnancy, Fetal Health
and Breast feeding
Pregnancy
. There are no adequate reports or well-controlled studies of lisinopril in pregnant women. In general, inhibitors of the renin- angiotensin system are contraindicated throughout pregnancy. The lowest dose effective should be used when lisinopril is required during Pregnancy
for BP control. Fetal Health
There are no adequate reports or well-controlled studies in human fetuses. Lisinopril crosses the human placenta. No adverse fetal effects are reported following 1st trimester exposure. However, such adverse events are well-documented after the ingestion of other ACEIs. Later exposure is associated with cranial hypoplasia, anuria, reversible or irreversible renal failure, death, oligohydramnios, prematurity, IUGR, and PDA. The mechanism of renal dysfunction is likely related to fetal hypotension and prolonged decreased glomerular filtration. If oligohydramnios is detected, lisinopril should be discontinued unless lifesaving for the mother. Antenatal surveillance should be initiated (e.g., BPP) if the fetus is potentially viable. Oligohydramnios may not appear until after the fetus has irreversible injury. Neonates exposed in utero to ACEIs should be observed closely for hypotension, oliguria, and hyperkalemia. If oliguria occurs despite adequate pressure and renal perfusion, exchange transfusion or peritoneal dialysis may be required. Breastfeeding
There is no published experience in nursing women. It is unknown whether lisinopril enters human breast milk. Other ACEIs (e.g., captopril) are excreted in the milk at low concentrations.
the follwing drugs will increse Lisinopril by inhepiting cyp450
the follwing drugs will decrease Lisinopril by inhancing cyp450
trad drugs based on Lisinopril
| Gen name | Trade name | Catagory name |
| hydrochlorothiazide / lisinopril | Prinzide | ACE inhibitors with thiazides |
| hydrochlorothiazide / lisinopril | Zestoretic | ACE inhibitors with thiazides |
| Lisinopril | LISOPHAR 10MG TABLETS | |
| Lisinopril | LISOPHAR 20MG TABLETS | |
| Lisinopril | ZESTORETIC 20 TAB | |
| Lisinopril | ZESTRIL 10MG TAB | |
| Lisinopril | ZESTRIL 20MG TAB | |
| Lisinopril | ZESTRIL 5MG TAB | |
| Lisinopril | ZORIL 10MG FILM COATED TABLETS | |
| Lisinopril | ZORIL 20MG FILM COATED TABLETS | |
| Lisinopril | ZORIL 5MG FILM COATED TABLETS | |
other drugs from same cataogory