Drug Guide
Lisinopril
Classification
Therapeutic: Antihypertensive, Heart failure agent
Pharmacological: ACE inhibitor (Angiotensin-Converting Enzyme Inhibitor)
FDA Approved Indications
- Hypertension
- Acute myocardial infarction (to improve survival after MI)
- Heart failure (with reduced ejection fraction)
Mechanism of Action
Lisinopril inhibits the angiotensin-converting enzyme (ACE), decreasing the formation of angiotensin II, leading to vasodilation, reduced blood pressure, and decreased afterload and preload in heart failure.
Dosage and Administration
Adult: Typically 10-40 mg once daily for hypertension; dose may be adjusted based on response.
Pediatric: Dosing varies; generally starts at 0.07 mg/kg once daily, adjusted based on response.
Geriatric: Start at lower doses due to increased risk of hypotension and renal impairment; typical starting dose 5 mg once daily.
Renal Impairment: Reduce dose or increase dosing interval based on severity of impairment.
Hepatic Impairment: Use with caution; no specific dose adjustment indicated.
Pharmacokinetics
Absorption: Well absorbed orally; peak plasma levels reached in about 6 hours.
Distribution: Widely distributed; plasma protein binding is low (~15%).
Metabolism: Minimal; primarily excreted unchanged.
Excretion: Excreted mainly unchanged by the kidneys.
Half Life: Approximately 12.5 hours.
Contraindications
- History of angioedema related to previous ACE inhibitor therapy
- Hereditary or idiopathic angioedema
- Concurrent use with aliskiren in patients with diabetes or renal impairment
Precautions
- Pregnancy (avoid during second and third trimester due to fetopathic effects), breastfeeding, renal artery stenosis, volume depletion, electrolyte imbalances (hyperkalemia)
Adverse Reactions - Common
- Headache (Common)
- Dizziness (Common)
- Cough (Common)
- Hypotension (Common)
Adverse Reactions - Serious
- Angioedema (Rare)
- Hypotension leading to syncope (Uncommon)
- Hyperkalemia (Uncommon)
- Acute kidney injury (Uncommon)
Drug-Drug Interactions
- Diuretics (potassium-sparing, thiazide)
- Other antihypertensives
- Potassium supplements and potassium-sparing diuretics
- Lithium
- NSAIDs
Drug-Food Interactions
- Excess potassium intake can increase the risk of hyperkalemia
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood pressure, renal function (BUN, serum creatinine), and serum electrolytes regularly.
Diagnoses:
- Risk for decreased cardiac output
- Risk for electrolyte imbalance
- Risk for renal impairment
Implementation: Administer as prescribed, monitor for signs of hypotension, angioedema, and cough, educate patient on non-pharmacologic measures to control blood pressure.
Evaluation: Assess for decrease in blood pressure to target levels, monitor for adverse effects, check renal function and electrolytes periodically.
Patient/Family Teaching
- Take medication exactly as prescribed, even if feeling well.
- Rise slowly from sitting or lying position to prevent dizziness.
- Notify healthcare provider if swelling of face, lips, or tongue occurs.
- Avoid potassium supplements and salt substitutes containing potassium.
- Report any signs of angioedema or persistent cough.
Special Considerations
Black Box Warnings:
- Pregnancy: Use during second and third trimester can cause injury or death to the fetus.
Genetic Factors: Genetic variations in ACE genes may affect response.
Lab Test Interference: May increase serum creatinine and blood urea nitrogen (BUN).
Overdose Management
Signs/Symptoms: Severe hypotension, dizziness, hyperkalemia, renal impairment.
Treatment: Discontinue lisinopril, administer intravenous fluids for hypotension, monitor electrolytes and renal function, consider vasopressors if needed.
Storage and Handling
Storage: Store at room temperature, away from moisture, heat, and light.
Stability: Stable under normal conditions for at least 2 years.