Prinivil (lisinopril) is an angiotensin-converting enzyme (ACE) inhibitor prescribed for the management of hypertension, heart failure, and post-myocardial infarction care. As a cornerstone therapy in cardiovascular medicine, it works by inhibiting the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, thereby reducing peripheral arterial resistance and decreasing blood pressure. Its well-established efficacy, favorable safety profile, and once-daily dosing regimen make it a first-line choice for clinicians aiming to mitigate long-term cardiovascular risk. This product card provides a comprehensive overview of Prinivil for healthcare professionals and informed patients.

Features

• Active ingredient: Lisinopril
• Drug class: Angiotensin-converting enzyme (ACE) inhibitor
• Available formulations: Oral tablets (2.5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg)
• Standard dosing: Once daily administration
• Bioavailability: Approximately 25%, not significantly affected by food
• Half-life: 12 hours
• Metabolism: Minimally metabolized; primarily excreted unchanged in urine
• Onset of action: Within 1 hour; peak antihypertensive effect at 6 hours

Benefits

• Effectively lowers systolic and diastolic blood pressure, reducing strain on the heart and arteries
• Decreases risk of myocardial infarction, stroke, and other major adverse cardiovascular events
• Slows progression of diabetic nephropathy and may preserve renal function in certain patient populations
• Improves survival and symptom management in patients with congestive heart failure
• Offers convenient once-daily dosing, enhancing medication adherence
• Demonstrates a well-characterized safety profile with decades of clinical use and evidence

Common use

Prinivil is indicated for the treatment of hypertension in adults and pediatric patients 6 years and older. It may be used alone or in combination with other antihypertensive agents. Additionally, it is approved for the management of heart failure as adjunctive therapy when diuretics and/or digitalis are insufficient. Prinivil is also indicated to improve survival in hemodynamically stable patients within 24 hours of acute myocardial infarction. Off-label uses may include prevention of migraine headaches and management of proteinuria in certain renal conditions, though these applications require careful clinical consideration.

Dosage and direction

Dosage must be individualized based on clinical response and tolerability. For hypertension in adults: initial dose is 10 mg once daily; maintenance dose is 20–40 mg once daily. Maximum dose: 80 mg daily. For pediatric hypertension (≥6 years): initial dose 0.07 mg/kg once daily (up to 5 mg); adjust based on blood pressure response. Maximum dose: 0.61 mg/kg or 40 mg. For heart failure: start with 5 mg once daily; increase as tolerated to 20–40 mg once daily. Post-myocardial infarction: start with 5 mg within 24 hours, then 5 mg after 24 hours, 10 mg after 48 hours, then 10 mg once daily. Administer with or without food; consistent timing is recommended. Crushing or splitting tablets is acceptable. Dosage adjustment required in renal impairment.

Precautions

Monitor blood pressure and renal function periodically during therapy. Assess serum potassium levels, particularly in patients with renal impairment, diabetes, or those using potassium-sparing diuretics. Observe for signs of angioedema, which may occur at any time during treatment. Use with caution in patients with collagen vascular disease, immunosuppressive therapy, or those undergoing dialysis with high-flux membranes due to increased risk of anaphylactoid reactions. Pregnancy must be avoided during treatment due to risk of fetal injury or death. Sodium and volume depletion should be corrected prior to initiation to reduce risk of symptomatic hypotension.

Contraindications

Hypersensitivity to lisinopril or any other ACE inhibitor. History of angioedema related to previous ACE inhibitor therapy. Concomitant use with aliskiren in patients with diabetes. Second and third trimester of pregnancy. Patients with hereditary or idiopathic angioedema. Severe renal impairment or anuria may require contraindication or extreme caution depending on clinical context.

Possible side effect

Most common side effects include dizziness (6–12%), headache (5–9%), cough (up to 10%), fatigue (3–5%), and nausea (2–4%). Less frequently observed: orthostatic hypotension, hyperkalemia, rash, impotence, diarrhea, and taste disturbance. Serious adverse reactions may include angioedema (0.1–0.7%), neutropenia/agranulocytosis, hepatic failure, pancreatitis, and renal impairment. Hypotension may occur particularly in volume-depleted patients. The incidence of cough is higher in women and non-smokers.

Drug interaction

Potassium supplements or potassium-sparing diuretics may increase risk of hyperkalemia. NSAIDs may diminish antihypertensive effect and increase risk of renal dysfunction. Diuretics may potentiate hypotensive effect. Lithium levels may increase. Gold injections may cause nitritoid reactions. Dual blockade of the renin-angiotensin system with ARBs or aliskiren increases risk of renal impairment, hyperkalemia, and hypotension. Insulin and oral hypoglycemics may enhance hypoglycemic effect. Alcohol may potentiate vasodilation and hypotension.

Missed dose

If a dose is missed, it should be taken as soon as remembered on the same day. If it is near the time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one. Consistent daily administration is important for maintaining stable blood pressure control. Patients should be educated on the importance of adherence while understanding this occasional management strategy.

Overdose

Symptoms of overdose may include hypotension, which can be severe, bradycardia, circulatory shock, electrolyte disturbances, and renal failure. Management involves supportive care with volume expansion with normal saline to restore blood pressure. Lisinopril is not effectively removed by hemodialysis due to extensive tissue binding. Angiotensin II infusion may be considered in severe cases. Continuous monitoring of vital signs, electrolyte status, and renal function is essential. Gastric lavage may be considered if ingestion was recent.

Storage

Store at controlled room temperature 20–25°C (68–77°F). Excursions permitted to 15–30°C (59–86°F). Keep container tightly closed. Protect from moisture and light. Keep out of reach of children. Do not use after expiration date printed on packaging. Do not store in bathroom or other areas with high humidity. Discard any medication that appears discolored or shows signs of deterioration.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions should be made by qualified healthcare professionals based on individual patient circumstances. The prescribing physician should be consulted for specific recommendations. Never discontinue or change medication without medical supervision. While every effort has been made to ensure accuracy, medical knowledge evolves and this information may not reflect the most current research or labeling updates.

Reviews

Clinical trials and decades of post-marketing surveillance demonstrate Prinivil’s consistent efficacy in blood pressure control with a generally favorable tolerability profile. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) confirmed lisinopril’s effectiveness as first-line antihypertensive therapy. Systematic reviews note its particular benefit in reducing cardiovascular events in high-risk populations. The characteristic dry cough remains the most frequently cited reason for discontinuation, occurring in approximately 5–10% of patients. Most clinicians appreciate its once-daily dosing and predictable pharmacokinetics, though individual patient response varies. Renal monitoring is emphasized in long-term management.