Lisinopril

CLINICAL USE

Angiotensin-converting enzyme inhibitor:Hypertension, heart failure, following myocardial infarction in haemodynamically stable patientsDiabetic nephropathy

DOSE IN NORMAL RENAL FUNCTION

2.5–80 mg dailyAfter a myocardial infarction: 2.5–10 mg daily

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :441.5

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :0

%Excreted unchanged in urine &nbsp &nbsp : 80–90

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :0.44–0.51

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :12/40–50

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 &nbsp &nbsp : Initial dose 2.5 mg daily and titrate according to response

10 to 20 &nbsp &nbsp : Initial dose 2.5 mg daily and titrate according to response

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : Initial dose 2.5 mg daily and titrate according to response

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in GFR <10 mL/min

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Dialysed. Dose as in GFR

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : mL/min

HDF/high flux &nbsp :Dialysed. Dose as in GFR

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : mL/min

CAV/VVHD &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in GFR 10 to 20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: enhanced hypotensive effect

Analgesics: antagonism of hypotensive effect and increased risk of renal impairment with NSAIDs; hyperkalaemia with ketorolac and other NSAIDs

Ciclosporin: increased risk of hyperkalaemia and nephrotoxicity

Diuretics: enhanced hypotensive effect; hyperkalaemia with potassium-sparing diuretics

Epoetin: increased risk of hyperkalaemia; antagonism of hypotensive effect

Lithium: reduced excretion (possibility of enhanced lithium toxicity)

Potassium salts: increased risk of hyperkalaemia

Tacrolimus: increased risk of hyperkalaemia and nephrotoxicity

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Close monitoring of renal function during therapy is necessary in those with renal insufficiencyRenal failure has been reported in association with ACE inhibitors and has been mainly in patients with severe congestive heart failure, renal artery stenosis, and post renal transplantHigh incidence of anaphylactoid reactions has been reported in patients dialysed with high-flux polyacrylonitrile membranes and treated concomitantly with an ACE inhibitor – this combination should therefore be avoidedHyperkalaemia and other side effects are more common in patients with impaired renal function.

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