Pregnancy Risk Category C (D in second and third trimesters)
How supplied
Tablets: 2.5 mg, 5 mg, 10 mg, 20 mg, 40 mg
Action
Unknown. Thought to result primarily from suppression of the renin-angiotensin-aldosterone system.
Indications & dosage
Hypertension--
Adults: initially, 10 mg P.O. daily for patients not receiving a diuretic. Most patients are well controlled on 20 to 40 mg daily as a single dose.
Adjust-a-dose: For patients receiving a diuretic, 5 mg P.O. daily. For patients with renal impairment, dosage is based on creatinine clearance: if clearance is 10 to 30 ml/minute, 5 mg P.O. daily; if clearance is below 10 ml/minute, 2.5 mg P.O. daily.
Treatment adjunct in heart failure (with diuretics and cardiac glycosides)--
Adults: initially, 5 mg P.O. daily; increased as needed to maximum of 20 mg P.O. daily.
Adjust-a-dose: For patients with serum sodium level less than 130 mEq/L or creatinine clearance below 30 ml/minute, initiate dose at 2.5 mg daily.
Hemodynamically stable patients within 24 hours of acute MI to improve survival--
Adults: initially 5 mg P.O.; then 5 mg after 24 hours, 10 mg after 48 hours, followed by 10 mg once daily for 6 weeks.
Adjust-a-dose: For patients with low systolic blood pressure (120 mm Hg or less) when treatment is started or during first 3 days after an infarct, dose should be decreased to 2.5 mg P.O. If hypotension occurs (systolic blood pressure 100 mm Hg or less), daily maintenance dose of 5 mg may be reduced to 2.5 mg if needed. If prolonged hypotension occurs (systolic blood pressure below 90 mm Hg for over 1 hour), drug should be withdrawn.
Adverse reactions
CNS: dizziness, headache, fatigue, paresthesia.
CV: hypotension, orthostatic hypotension, chest pain.
EENT: nasal congestion.
GI: diarrhea, nausea, dyspepsia.
GU: impaired renal function, impotence, increased BUN and creatinine levels.
Hepatic: increased liver enzymes and serum bilirubin levels.
Metabolic: hyperkalemia.
Respiratory: dyspnea; dry, persistent, tickling, nonproductive cough.
Skin: rash.
Interactions
Drug-drug. Allopurinol: increased risk of hypersensitivity reaction. Use with caution.
Capsaicin: may increase risk of ACE inhibitor-induced cough. Monitor patient.
Diuretics, thiazide diuretics: excessive hypotension with diuretics. Monitor closely.
Indomethacin, phenothiazines: attenuated hypotensive effect. Monitor closely.
Insulin, oral antidiabetics: risk of hypoglycemia, especially at initiation of lisinopril therapy. Monitor closely.
Potassium-sparing diuretics, potassium supplements: possible hyperkalemia. Monitor closely.
Drug-food. Potassium-containing salt substitutes: possible hyperkalemia. Monitor closely.
Effects on diagnostic tests
None reported.
Contraindications
Contraindicated in patients with hypersensitivity to ACE inhibitors or history of angioedema related to previous treatment with ACE inhibitor.
Nursing considerations
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING