Overview
Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used primarily for hypertension and heart failure. It works by inhibiting ACE, reducing angiotensin II formation and aldosterone secretion, leading to vasodilation and decreased blood pressure. It is also indicated for reducing mortality after myocardial infarction and slowing diabetic nephropathy progression.
Mechanism of Action
Lisinopril inhibits angiotensin-converting enzyme (ACE), preventing conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. This reduces vasoconstriction, aldosterone secretion, and sodium/water retention, leading to decreased peripheral vascular resistance and blood pressure.
Indications
- Treatment of hypertension
- Adjunctive therapy for heart failure
- Reduction of mortality after acute myocardial infarction
- Treatment of diabetic nephropathy in patients with type 1 diabetes
Common Doses
- 2.5 mg
- 5 mg
- 10 mg
- 20 mg
- 30 mg
- 40 mg
Dosage
For hypertension: Initial dose 10 mg once daily, maintenance 20-40 mg daily (max 80 mg). For heart failure: Start 2.5-5 mg daily, titrate to target 20-40 mg daily. Post-MI: Start 5 mg within 24 hours, then 5 mg after 24 hours, 10 mg after 48 hours, then 10 mg daily.
Black Box Warning
Black Box Warning: ACE inhibitors can cause injury and death to developing fetus when used during second and third trimesters
Contraindications
- History of angioedema related to ACE inhibitor therapy
- Hypersensitivity to lisinopril or any component
- Concomitant use with aliskiren in patients with diabetes
- Concomitant use with neprilysin inhibitors (e.g., sacubitril)
Side Effects
- Common: Dizziness, headache, cough, fatigue, hypotension
- Serious: Angioedema, hyperkalemia, renal impairment, neutropenia/agranulocytosis
- Other: Orthostatic effects, diarrhea, nausea, rash, muscle cramps
Interactions
- Potassium supplements/potassium-sparing diuretics (risk of hyperkalemia)
- NSAIDs (may reduce antihypertensive effect and increase renal risk)
- Lithium (increased lithium levels)
- Diuretics (increased risk of hypotension)
- Aliskiren (contraindicated in diabetes)
Counseling Points
- Take at same time daily, with or without food
- Report signs of angioedema (swelling of face, lips, tongue, throat) immediately
- Monitor for dizziness, especially with first dose or dose increases
- Avoid potassium supplements/salt substitutes unless prescribed
- Report persistent dry cough
- Use effective contraception during treatment