BMA Concise Guide to Medicine & Drugs

Lisinopril

Brand names Carace, Zestril

Used in the following combined preparations Carace Plus, Zestoretic

QUICK REFERENCE

Drug group ACE inhibitor and antihypertensive drug

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Lisinopril is an ACE inhibitor drug used in the treatment of high blood pressure, diabetic nephropathy (kidney disease), heart failure, and following a heart attack. It works by relaxing the muscles in blood vessel walls, allowing them to dilate (widen), thereby easing blood flow. After a heart attack, it reduces the risk of heart failure if taken long-term. Lisinopril can initially cause a rapid fall in blood pressure, especially when taken with a diuretic drug. Therefore, treatment for heart failure is usually started under close medical supervision, in hospital in severe cases. The first dose is usually very small, and should be taken while lying down, preferably at bedtime.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets.

Frequency and timing of doses Once daily.

Adult dosage range Hypertension 2.5–10mg (starting dose) up to 80mg. Heart failure 2.5mg (starting dose) up to 35mg. Prevention of further heart attacks 2.5–5mg (starting dose) up to 10mg. Diabetic nephropathy 2.5-20mg

Onset of effect 1–2 hours; full beneficial effect may take several weeks.

Duration of action 12–24 hours.

Diet advice Your doctor may advise you to reduce your salt intake to help control your blood pressure.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next dose is due within 8 hours, take a single dose now and skip the next.

Stopping the drug Do not stop taking the drug without consulting your doctor. Stopping the drug may lead to worsening of the underlying condition.

Exceeding the dose An occasional unintentional extra dose is unlikely to be a cause for concern. Larger overdoses may cause dizziness or fainting. Notify your doctor.

POSSIBLE ADVERSE EFFECTS

Lisinopril may cause various minor adverse effects. All adverse effects should be reported to your doctor as it may be possible to minimize them by adjusting the dosage. The most common adverse effects are a rash and a persistent dry cough. More rarely, the drug may cause soreness of the mouth or mouth ulcers, dizziness, sore throat, and fever. If swelling of the mouth or lips or breathing difficulty occur, stop taking the drug and seek immediate medical advice.

INTERACTIONS

Potassium supplements, potassium-sparing diuretics, and ciclosporin Taken with lisinopril, these drugs increase the risk of high blood potassium levels.

Non-steroidal anti-inflammatory drugs (NSAIDs) Some of these drugs may reduce the effect of lisinopril, and the risk of kidney damage is increased.

Vasodilators, diuretics, and other drugs for hypertension These drugs may increase the blood-pressure-lowering effect of lisinopril.

Lithium Blood levels of lithium may be increased by lisinopril.

Insulin and antidiabetic drugs Lisinopril may increase the effect of these drugs.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have long-term kidney or liver problems.

· You have heart problems.

· You have had angioedema or a previous allergic reaction to ACE inhibitors.

· You are pregnant or intend to become pregnant.

· You are taking other medicines.

Pregnancy Not prescribed. There is evidence of harm to the developing fetus.

Breast-feeding Safety not established. Discuss with your doctor.

Infants and children Not recommended.

Over 60 Reduced dose may be necessary.

Driving and hazardous work Avoid such activities until you have learned how lisinopril affects you because the drug can cause dizziness and fainting.

Alcohol Avoid. Alcohol may increase the blood-pressure-lowering and adverse effects of the drug.

Surgery and general anaesthetics Lisinopril may have to be stopped before you have a general anaesthetic. Discuss with your doctor or dentist before any operation.

PROLONGED USE

No problems expected.

Monitoring Periodic checks on potassium levels, white blood cell count, kidney function, and urine are usually performed.