Lisinopril

DEA Class; Rx

Common Brand Names; Prinivil, Zestril, Qbrelis

• ACE Inhibitors

Long-acting, oral ACE inhibitor
Used for hypertension, congestive heart failure, post-myocardial infarction, and diabetic nephropathy
Can be dosed once daily; slower onset and a longer duration of action than either captopril or enalapril

Indicated for the treatment of hypertension

Hypersensitivity to lisinopril/other ACE inhibitors

History of ACE inhibitor-induced angioedema, hereditary or idiopathic angioedema

Coadministration of neprilysin inhibitors (eg, sacubitril)

Coadministration with aliskiren in patients with diabetes mellitus or with renal impairment (ie, GFR <60 mL/min/1.73m²

Heart failure

• Creatinine increased (10%)
• Syncope (7%)
• Hyperkalemia (4.8-6%)
• Hypotension (4.4%)
• Diarrhea (3.7%)
• Chest pain (3.4%)
• Abdominal pain (2.2%)
• Rash (1.7%)
• Infection (1.5%)
• Asthenia
• Angina pectoris
• Nausea
• Dyspnea
• Cough
• Pruritus

Hypertension

• Headache (5.7%)
• Dizziness (5.4%)
• Hyperkalemia (serum potassium >5.7 mEq/L) (2.2%)
• Increased BUN and serum creatinine (2%)

Acute myocardial infarction

• Hypotension (9%)
• Renal dysfunction (2.4%)
• Body as a whole: Fatigue, asthenia, orthostatic effects
• Digestive: Pancreatitis, constipation, flatulence, dry mouth, diarrhea
• Hematologic: Rare cases of bone marrow depression, hemolytic anemia, leukopenia/neutropenia and thrombocytopenia
• Endocrine: Diabetes mellitus, inappropriate antidiuretic hormone secretion
• Metabolic: Gout
• Skin: Urticaria, alopecia, photosensitivity, erythema, flushing, diaphoresis, cutaneous pseudolymphoma, toxic epidermal necrolysis, Stevens Johnson syndrome, and pruritus
• Special senses: Visual loss, diplopia, blurred vision, tinnitus, photophobia, taste disturbances, olfactory disturbances
• Urogenital: Impotence
• Miscellaneous: A symptom complex has been reported which may include a positive ANA, an elevated erythrocyte sedimentation rate, arthralgia/arthritis, myalgia, fever, vasculitis, eosinophilia, leukocytosis, paresthesia and vertigo
• Rash, photosensitivity or other dermatological manifestations may occur alone or in combination with these symptoms

Anaphylactoid reactions reported in some patients dialyzed with high-flux membranes

Hematologic effects including agranulocytosis and neutropenia/agranulocytosis reported especially in patients with renal impairment and collagen vascular disease; monitor CBC periodically with differential

Less effective in African Americans

Excessive hypotension with concomitant diuretics, hypovolemia, hyponatremia may occur

Neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan

Risk of hyperkalemia, especially in patients with renal impairment or DM or in patients taking concomitant K+-elevating drugs

ACE inhibition also causes an increase in bradykinin levels, which putatively mediates angioedema; in comparison with other patients, a higher incidence of angioedema caused by ACE inhibitors has been observed in black patients

A dry hacking cough may occur within a few months of initiating drug therapy with ACE inhibitors; exclude other causes of cough before discontinuing therapy

Cholestatic jaundice associated with ACE inhibitors; discontinue if marked elevation of hepatic transaminases or jaundice occurs

Coadministration with mTOR inhibitors (eg, temsirolimus, everolimus) may increased risk for angioedema

Discontinue STAT if patient becomes pregnant

Therapy can cause fetal harm when administered to a pregnant woman; use of drugs that act on renin- angiotensin system during second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death

No data are available regarding presence of lisinopril in human milk or effects on the breastfed infant or on milk production

The drug is present in rat milk; because many drugs are secreted in human milk, and because of thepotential for serious adverse reactions in breastfed infants from ACE inhibitors, discontinue breastfeeding or discontinue therapy