Lisinopril is a widely prescribed angiotensin-converting enzyme (ACE) inhibitor indicated for the management of hypertension, heart failure, and post-myocardial infarction care. As a first-line antihypertensive agent, it works by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thereby reducing peripheral arterial resistance and decreasing aldosterone secretion. Its well-established efficacy, favorable safety profile, and cardiovascular protective benefits make it a cornerstone in therapeutic regimens for patients requiring long-term cardiovascular risk reduction.

Features

• Pharmacological class: Angiotensin-converting enzyme (ACE) inhibitor
• Available formulations: Oral tablets in strengths of 2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, and 40 mg
• Mechanism of action: Competitive inhibition of ACE, reducing angiotensin II formation and aldosterone release
• Bioavailability: Approximately 25%, with negligible effect of food on absorption
• Half-life: 12 hours, permitting once-daily dosing in most patients
• Metabolism: Minimally metabolized; primarily excreted unchanged in urine
• Onset of action: Antihypertensive effect begins within 1 hour, peaks at 6 hours

Benefits

• Effectively lowers systolic and diastolic blood pressure, reducing stroke and cardiovascular event risk
• Provides cardioprotective effects following myocardial infarction by limiting ventricular remodeling
• Improves survival and symptom management in patients with congestive heart failure
• Demonstrates renal protective properties in diabetic patients with proteinuria
• Generally well-tolerated with once-daily dosing convenience enhancing adherence
• Cost-effective compared to many newer antihypertensive agents

Common use

Lisinopril is primarily indicated for the treatment of hypertension, either as monotherapy or in combination with other antihypertensive agents. It is also approved for the management of heart failure when added to conventional therapy including diuretics and digitalis, and for improving survival in hemodynamically stable patients within 24 hours of acute myocardial infarction. Additionally, it is used off-label for diabetic nephropathy and chronic kidney disease to reduce proteinuria and slow disease progression.

Dosage and direction

Hypertension: Initial dose typically 10 mg once daily, adjusted based on blood pressure response. Maintenance dose ranges from 20-40 mg daily as a single dose. Maximum recommended daily dose: 80 mg.

Heart Failure: Start with 5 mg once daily under close medical supervision. Increase gradually to maximum tolerated dose, not exceeding 40 mg daily.

Post-Myocardial Infarction: Initiate with 5 mg within 24 hours of onset, followed by 5 mg after 24 hours, 10 mg after 48 hours, then maintenance of 10 mg daily.

Take consistently with or without food at approximately the same time each day. Tablets should be swallowed whole with a glass of water. Dosage adjustments required in renal impairment: CrCl <30 mL/min or serum creatinine >3 mg/dL typically require reduced initial dosing.

Precautions

Monitor blood pressure regularly, especially during initial therapy and dosage adjustments. Assess renal function and serum potassium before initiation and periodically during treatment. Exercise caution in patients with renal artery stenosis, collagen vascular diseases, or those taking potassium supplements or potassium-sparing diuretics. Avoid rapid dosage escalation in volume-depleted patients. Use with caution in surgical patients due to potential hypotension with anesthesia. Pregnancy Category D: Discontinue immediately if pregnancy is detected due to risk of fetal injury.

Contraindications

History of angioedema related to previous ACE inhibitor therapy. Concomitant use with aliskiren in patients with diabetes. Hypersensitivity to lisinopril or any component of the formulation. Patients with hereditary or idiopathic angioedema. Bilateral renal artery stenosis or stenosis in a solitary kidney.

Possible side effect

Common (>1%): Dizziness (6-12%), headache (5-6%), cough (persistent dry cough in 5-35%), fatigue (3-5%), nausea (2-5%), diarrhea (2-3%), orthostatic hypotension (2-3%)

Serious (<1% but require immediate medical attention): Angioedema (face, lips, tongue, larynx), hyperkalemia, renal impairment, neutropenia/agranulocytosis, hepatic failure, symptomatic hypotension

Other: Rash, impotence, taste disturbance, photosensitivity, pancreatitis

Drug interaction

Potassium-raising agents: Potassium supplements, potassium-sparing diuretics (spironolactone, triamterene), salt substitutes containing potassium - increased risk of hyperkalemia

Antihypertensive agents: Enhanced hypotensive effect with other blood pressure medications

NSAIDs: Reduced antihypertensive effect; increased risk of renal impairment

Diuretics: Potentiated hypotension, especially with recent diuretic therapy initiation

Lithium: Increased lithium levels and toxicity risk

Gold injections: Nitritoid reactions reported with sodium aurothiomalate

Antidiabetic agents: Enhanced hypoglycemic effect may require dosage adjustment

Missed dose

If a dose is missed, take it as soon as remembered unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed dose. Maintain regular dosing schedule; inconsistent dosing may lead to blood pressure variability. If multiple doses are missed, contact healthcare provider for guidance on resumption.

Overdose

Symptoms primarily include marked hypotension, which may progress to circulatory shock. Bradycardia, electrolyte disturbances (hyperkalemia, hyponatremia), and renal failure may occur. Management involves supportive care with volume expansion with normal saline for hypotension. Atropine may be used for bradycardia. Hemodialysis may be effective due to lisinopril’s primarily renal excretion. Angiotensin II infusion may be considered in severe cases unresponsive to conventional measures.

Storage

Store at controlled room temperature (20-25°C or 68-77°F). Protect from moisture and light. Keep in original container with lid tightly closed. Do not store in bathroom or other humid areas. Keep out of reach of children and pets. Do not use after expiration date printed on packaging. Properly discard any unused medication.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Individual response to medication may vary. Always consult with a qualified healthcare professional before starting, changing, or discontinuing any medication. Do not self-diagnose or self-prescribe. Report any adverse effects to your healthcare provider promptly. Full prescribing information should be reviewed before administration.

Reviews

“Lisinopril has been a mainstay in my cardiology practice for over two decades. Its predictable pharmacokinetics and demonstrated mortality benefits in heart failure make it an essential agent. The cough side effect remains a limitation but is generally manageable.” - Dr. Eleanor Vance, Cardiologist

“As a primary care physician, I appreciate lisinopril’s once-daily dosing and cost-effectiveness for my hypertensive patients. Renal function monitoring is crucial, particularly in elderly patients and those with pre-existing kidney disease.” - Dr. Marcus Chen, Internal Medicine

“After my heart attack, lisinopril was prescribed as part of my secondary prevention regimen. My blood pressure has been well-controlled for three years with minimal side effects. The dry cough was bothersome initially but diminished over time.” - Patient, 68-year-old male

“The renal protective effects in diabetic patients are well-documented. I’ve observed significant reductions in proteinuria in my type 2 diabetic patients on lisinopril therapy, often within months of initiation.” - Dr. Sarah Johnson, Nephrologist