lisinopril (Rx)

Brand and Other Names:Prinivil, Zestril, more...Qbrelis
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 2.5mg
  • 5mg
  • 10mg
  • 20mg
  • 30mg
  • 40mg

oral solution

  • 1mg/mL (Qbrelis)

Acute Myocardial Infarction

5 mg PO within 24 hours of onset of symptoms of acute MI, THEN 5 mg after 24 hours, 10 mg after 48 hours, and 10 mg qDay for 6 weeks

If patient has low systolic blood pressure (ie, ≤120 mm Hg) when treatment initiated or during the first 3 days, administer a lower dose of 2.5 mg

If hypotension occurs (systolic BP ≤100 mm Hg), a daily maintenance dose of 5 mg may be given, with temporary reductions to 2.5 mg if needed

Dosing considerations

  • Discontinue with prolonged hypotension (ie, systolic BP <90 mm Hg for >1 hr)

Hypertension

Uncomplicated essential hypertension

Not taking diuretic: 10 mg PO qDay initially; usual range is 20-40 mg/day as single daily dose

Dosing considerations

  • Taking diuretic: Discontinue diuretic for 2-3 days before initiating lisinopril to reduce chance of hypotension; may resume diuretic if blood pressure is not controlled; if diuretic cannot be discontinued, initial dose of lisinopril 5 mg should be used under supervision for at least 2 hours and until blood pressure has stabilized for at least 1 hour

Heart Failure

Adjunctive therapy with diuretics and (usually) digitalis

5 mg PO qDay initially; increase by ≤10 mg no more frequent than 2 week intervals to 20-40 mg PO qDay

Patients with hypnatremia (<130 mEq/L serum sodium): 2.5 mg PO qDay initially; increase by ≤10 mg no more frequent than 2 week intervals to 20-40 mg PO qDay

Usual effective dosage range: 5-40 mg PO qDay (Zestril); 5-20 mg PO qDay (Prinivil)

Dosage Modifications

Renal impairment

  • Acute myocardial infarction: Use caution in renal dysfunction (serum creatinine >2 mg/dL)
  • Hypertension and CrCl >30 mL/min: 10 mg PO qDay initially; not to exceed 40 mg/day
  • Hypertension and CrCl 10-30 mL/min: 5 mg PO qDay initially; not to exceed 40 mg/day
  • Hypertension and CrCl <10 mL/min or hemodialysis: 2.5 mg PO qDay initially; not to exceed 40 mg/day
  • Heart failure and CrCl <30 mL/min: 2.5 mg PO qDay initially; not to exceed 40 mg/day

Diabetic Nephropathy (Off-label)

Initial: 5 mg PO qDay (with diuretic)

May gradually increase dose according to blood pressure response; dosage range is 20-40 mg/day

Dosing considerations

  • Long-term treatment with ACE inhibitors, usually combined with diuretics, reduces blood pressure and albuminuria and protects kidney function in patients with hypertension, diabetes mellitus, and nephropathy

Dosage Forms & Strengths

tablet

  • 2.5mg
  • 5mg
  • 10mg
  • 20mg
  • 30mg
  • 40mg

oral solution

  • 1mg/mL (Qbrelis)

Hypertension

Indicated for hypertension in pediatric patients aged ≥6 yr to lower blood pressure

Age <6 years or GFR <30 mL/min/1.73m²: Safety and efficacy not established

≥6 years and GFR ≥30 mL/min/1.73m²: 0.07 mg/kg PO qDay initially, not to exceed 5 mg/day; may slowly titrate upward and adjusted according to blood pressure; not to exceed 0.61 mg/kg/day or >40 mg/day  

Primary Hypertension (Orphan)

Oral solution: Orphan designation for treatment of primary hypertension with complications and secondary hypertension in pediatric patients (ages 0 through 16 years of age)

Sponsors

  • codaDose, Inc; 5659 Southfield Drive; Flowery Branch, GA 30542
  • Silvergate Pharmaceuticals, Inc; 6251 Greenwood Plaza Blvd, Suite 101; Greenwood Village, CO 80111

Hypertension

Uncomplicated essential hypertension

Consider lower initial dose of 2.5-5 mg and titrate to response in the elderly

Usual range is 20-40 mg/day as single daily dose

Adjust dose to blood pressure response; doses up to 80 mg have been used but do not appear to have a greater effect

Dosing considerations

Taking diuretic: Discontinue diuretic for 2-3 days before initiating lisinopril to reduce chance of hypotension; may resume diuretic if blood pressure is not controlled; if diuretic cannot be discontinued, initial dose of lisinopril 2.5 mg should be used under supervision for at least 2 hours and until blood pressure has stabilized for at least 1 hour

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Interactions

Interaction Checker

and lisinopril

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            Contraindicated (3)

            • aliskiren

              lisinopril decreases effects of aliskiren by Other (see comment). Contraindicated. Comment: Aliskiren use contraindicated with ACE-inhibitors in patients with diabetes; avoid coadministration with ACE-inhibitors if GFR. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of ACE-inhibitors with drugs that affect RAAS may increase the risk of renal impairment (including acute renal failure) and cause loss of antihypertensive effect. Monitor renal function periodically.

            • protein a column

              lisinopril, protein a column. Other (see comment). Contraindicated. Comment: Risk of anaphylactic reaction. Mechanism: buildup of bradykinin d/t deactivation of kininase by ACE inhibitors. D/C ACE inhibitor 72h prior to use of protein A column.

            • sacubitril/valsartan

              sacubitril/valsartan, lisinopril. Either increases toxicity of the other by Other (see comment). Contraindicated. Comment: Coadministration of 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.

            Serious - Use Alternative (37)

            • aspirin

              aspirin, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • aspirin rectal

              aspirin rectal, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • azilsartan

              azilsartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • candesartan

              candesartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • celecoxib

              celecoxib, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • choline magnesium trisalicylate

              choline magnesium trisalicylate, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • diclofenac

              diclofenac, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • diflunisal

              diflunisal, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • eprosartan

              eprosartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • etodolac

              etodolac, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • fenoprofen

              fenoprofen, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • flurbiprofen

              flurbiprofen, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • ibuprofen

              ibuprofen, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • ibuprofen IV

              ibuprofen IV, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • indomethacin

              indomethacin, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • irbesartan

              irbesartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • ketoprofen

              ketoprofen, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • ketorolac

              ketorolac, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • ketorolac intranasal

              ketorolac intranasal, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • lofexidine

              lofexidine, lisinopril. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

            • losartan

              losartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • meclofenamate

              meclofenamate, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • mefenamic acid

              mefenamic acid, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • meloxicam

              meloxicam, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • nabumetone

              nabumetone, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • naproxen

              naproxen, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • olmesartan

              olmesartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • oxaprozin

              oxaprozin, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • piroxicam

              piroxicam, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • potassium phosphates, IV

              lisinopril and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.

            • pregabalin

              lisinopril, pregabalin. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration results in additive risk of developing angioedema of face, mouth, and neck. Angioedema may result in respiratory compromise.

            • sacubitril/valsartan

              sacubitril/valsartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • salsalate

              salsalate, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • sulindac

              sulindac, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • telmisartan

              telmisartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            • tolmetin

              tolmetin, lisinopril. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration may result in a significant decrease in renal function. NSAIDs may diminish the antihypertensive effect of ACE inhibitors. The mechanism of these interactions is likely related to the ability of NSAIDs to reduce the synthesis of vasodilating renal prostaglandins.

            • valsartan

              valsartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

            Monitor Closely (107)

            • albiglutide

              lisinopril increases effects of albiglutide by unknown mechanism. Use Caution/Monitor. ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor. .

            • aldesleukin

              aldesleukin increases effects of lisinopril by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • alfuzosin

              lisinopril, alfuzosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • aluminum hydroxide

              aluminum hydroxide decreases effects of lisinopril by unspecified interaction mechanism. Use Caution/Monitor.

            • amifostine

              amifostine, lisinopril. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.

            • amiloride

              lisinopril, amiloride. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

            • asenapine

              lisinopril, asenapine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • aspirin

              lisinopril, aspirin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly with high dose aspirin, in elderly or volume depleted individuals.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate decreases effects of lisinopril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

              lisinopril, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • avanafil

              avanafil increases effects of lisinopril by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • azathioprine

              lisinopril, azathioprine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of neutropenia.

            • bretylium

              lisinopril, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

            • bumetanide

              lisinopril, bumetanide. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.

            • calcium carbonate

              calcium carbonate decreases effects of lisinopril by unspecified interaction mechanism. Use Caution/Monitor.

            • canagliflozin

              lisinopril and canagliflozin both increase serum potassium. Use Caution/Monitor.

            • carbidopa

              carbidopa increases effects of lisinopril by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.

            • celecoxib

              lisinopril, celecoxib. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • chlorpropamide

              lisinopril increases effects of chlorpropamide by pharmacodynamic synergism. Use Caution/Monitor.

            • choline magnesium trisalicylate

              lisinopril, choline magnesium trisalicylate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • dalteparin

              dalteparin increases toxicity of lisinopril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • diclofenac

              lisinopril, diclofenac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • diflunisal

              lisinopril, diflunisal. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • digoxin

              lisinopril increases levels of digoxin by unspecified interaction mechanism. Use Caution/Monitor.

            • doxazosin

              lisinopril, doxazosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • drospirenone

              lisinopril, drospirenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

            • enoxaparin

              enoxaparin increases toxicity of lisinopril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • eplerenone

              lisinopril, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

            • ethacrynic acid

              lisinopril, ethacrynic acid. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.

            • etodolac

              lisinopril, etodolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • everolimus

              lisinopril, everolimus. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration increases risk of angioedema.

            • exenatide injectable solution

              lisinopril increases effects of exenatide injectable solution by Other (see comment). Use Caution/Monitor. Comment: ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor. .

            • exenatide injectable suspension

              lisinopril increases effects of exenatide injectable suspension by Other (see comment). Use Caution/Monitor. Comment: ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor.

            • fenoprofen

              lisinopril, fenoprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • finerenone

              lisinopril and finerenone both increase serum potassium. Modify Therapy/Monitor Closely. Finerenone dose adjustment based on current serum potassium concentration. Monitor serum potassium and adjust finerenone dose as described in the prescribing information as necessary.

            • flurbiprofen

              lisinopril, flurbiprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • furosemide

              lisinopril, furosemide. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.

            • glimepiride

              lisinopril increases effects of glimepiride by pharmacodynamic synergism. Use Caution/Monitor.

            • glipizide

              lisinopril increases effects of glipizide by pharmacodynamic synergism. Use Caution/Monitor.

            • glyburide

              lisinopril increases effects of glyburide by pharmacodynamic synergism. Use Caution/Monitor.

            • gold sodium thiomalate

              lisinopril, gold sodium thiomalate. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Combo of ACE inhibitors and injectable gold has caused rare cases of nitritoid reaction (flushing, N/V, hypot'n).

            • heparin

              heparin increases toxicity of lisinopril by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

            • ibuprofen

              lisinopril, ibuprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • ibuprofen IV

              lisinopril, ibuprofen IV. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • indomethacin

              lisinopril, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • insulin aspart

              lisinopril increases effects of insulin aspart by pharmacodynamic synergism. Use Caution/Monitor.

            • insulin degludec

              lisinopril, insulin degludec. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.

            • insulin degludec/insulin aspart

              lisinopril, insulin degludec/insulin aspart. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.

            • insulin detemir

              lisinopril increases effects of insulin detemir by pharmacodynamic synergism. Use Caution/Monitor.

            • insulin glargine

              lisinopril increases effects of insulin glargine by pharmacodynamic synergism. Use Caution/Monitor.

            • insulin glulisine

              lisinopril increases effects of insulin glulisine by pharmacodynamic synergism. Use Caution/Monitor.

            • insulin inhaled

              lisinopril, insulin inhaled. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.

            • insulin lispro

              lisinopril increases effects of insulin lispro by pharmacodynamic synergism. Use Caution/Monitor.

            • insulin NPH

              lisinopril increases effects of insulin NPH by pharmacodynamic synergism. Use Caution/Monitor.

            • insulin regular human

              lisinopril increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor.

            • ketoprofen

              lisinopril, ketoprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • ketorolac

              lisinopril, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • ketorolac intranasal

              lisinopril, ketorolac intranasal. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • lanthanum carbonate

              lanthanum carbonate decreases levels of lisinopril by cation binding in GI tract. Use Caution/Monitor. Administer ACE inhibitor at least 2 hr before or after lanthanum.

            • levodopa

              levodopa increases effects of lisinopril by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.

            • liraglutide

              lisinopril increases effects of liraglutide by unknown mechanism. Use Caution/Monitor. ACE inhibitors may increase hypoglycemic effect. Monitor glycemic control especially during the first month of treatment with an ACE inhibitor. .

            • lithium

              lisinopril increases toxicity of lithium by unknown mechanism. Use Caution/Monitor. ACE inhibitor induced Na+ depletion may increase reabsorption of lithium from renal tubule.

            • lurasidone

              lurasidone increases effects of lisinopril by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.

            • maraviroc

              maraviroc, lisinopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.

            • meclofenamate

              lisinopril, meclofenamate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • mefenamic acid

              lisinopril, mefenamic acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • meloxicam

              lisinopril, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • metformin

              lisinopril increases toxicity of metformin by unspecified interaction mechanism. Use Caution/Monitor. Increases risk for hypoglycemia and lactic acidosis.

            • methylphenidate

              methylphenidate will decrease the level or effect of lisinopril by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

            • mipomersen

              mipomersen, lisinopril. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

            • moxisylyte

              lisinopril, moxisylyte. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • nabumetone

              lisinopril, nabumetone. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • naproxen

              lisinopril, naproxen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • nesiritide

              nesiritide, lisinopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

            • nitroglycerin rectal

              nitroglycerin rectal, lisinopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Observe for possible additive hypotensive effects during concomitant use. .

            • oxaprozin

              lisinopril, oxaprozin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • phenoxybenzamine

              lisinopril, phenoxybenzamine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • phentolamine

              lisinopril, phentolamine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • piroxicam

              lisinopril, piroxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • potassium acid phosphate

              lisinopril increases levels of potassium acid phosphate by decreasing elimination. Use Caution/Monitor. Risk of hyperkalemia.

            • potassium chloride

              lisinopril increases levels of potassium chloride by decreasing elimination. Use Caution/Monitor. Risk of hyperkalemia.

            • potassium citrate

              lisinopril increases levels of potassium citrate by decreasing elimination. Use Caution/Monitor. Risk of hyperkalemia.

            • potassium citrate/citric acid

              lisinopril and potassium citrate/citric acid both increase serum potassium. Use Caution/Monitor.

            • potassium iodide

              potassium iodide and lisinopril both increase serum potassium. Use Caution/Monitor. Potassium salts may increase the hyperkalemic effects of ACE inhibitors; the effect may be the result of aldosterone suppression in patients receiving ACE inhibitors.

            • prazosin

              lisinopril, prazosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • salsalate

              lisinopril, salsalate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • silodosin

              lisinopril, silodosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • sirolimus

              lisinopril, sirolimus. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration increases risk of angioedema.

            • sodium bicarbonate

              sodium bicarbonate decreases effects of lisinopril by unspecified interaction mechanism. Use Caution/Monitor.

            • sodium citrate/citric acid

              sodium citrate/citric acid decreases effects of lisinopril by unspecified interaction mechanism. Use Caution/Monitor.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of lisinopril by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of lisinopril by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • spironolactone

              lisinopril, spironolactone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

            • sulfasalazine

              sulfasalazine decreases effects of lisinopril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

              lisinopril, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • sulindac

              lisinopril, sulindac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • synthetic human angiotensin II

              lisinopril increases effects of synthetic human angiotensin II by unspecified interaction mechanism. Use Caution/Monitor.

            • tadalafil

              tadalafil increases effects of lisinopril by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

            • temsirolimus

              lisinopril, temsirolimus. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Coadministration increases risk of angioedema.

            • terazosin

              lisinopril, terazosin. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            • tolazamide

              lisinopril increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor.

            • tolbutamide

              lisinopril increases effects of tolbutamide by pharmacodynamic synergism. Use Caution/Monitor.

            • tolmetin

              lisinopril, tolmetin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

            • torsemide

              lisinopril, torsemide. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypotension, renal insufficiency.

            • triamterene

              lisinopril, triamterene. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

            • trimethoprim

              trimethoprim and lisinopril both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.

            • voclosporin

              voclosporin and lisinopril both increase serum potassium. Use Caution/Monitor.

              voclosporin, lisinopril. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            • xipamide

              xipamide increases effects of lisinopril by pharmacodynamic synergism. Use Caution/Monitor.

            • zotepine

              lisinopril, zotepine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Exaggerated first dose hypotensive response.

            Minor (28)

            • aceclofenac

              aceclofenac decreases effects of lisinopril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

            • acemetacin

              acemetacin decreases effects of lisinopril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

            • agrimony

              agrimony increases effects of lisinopril by pharmacodynamic synergism. Minor/Significance Unknown.

            • brimonidine

              brimonidine increases effects of lisinopril by pharmacodynamic synergism. Minor/Significance Unknown.

            • capsicum

              capsicum, lisinopril. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increase ACE inhibitor induced cough.

            • chlorpromazine

              chlorpromazine increases effects of lisinopril by unspecified interaction mechanism. Minor/Significance Unknown.

            • cornsilk

              cornsilk increases effects of lisinopril by pharmacodynamic synergism. Minor/Significance Unknown.

            • creatine

              creatine, lisinopril. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction) Combination may have additive nephrotoxic effects.

            • entecavir

              lisinopril, entecavir. Either increases effects of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.

            • fluphenazine

              fluphenazine increases effects of lisinopril by unspecified interaction mechanism. Minor/Significance Unknown.

            • lornoxicam

              lornoxicam decreases effects of lisinopril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

            • maitake

              maitake increases effects of lisinopril by pharmacodynamic synergism. Minor/Significance Unknown.

            • octacosanol

              octacosanol increases effects of lisinopril by pharmacodynamic synergism. Minor/Significance Unknown.

            • parecoxib

              parecoxib decreases effects of lisinopril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

            • perphenazine

              perphenazine increases effects of lisinopril by unspecified interaction mechanism. Minor/Significance Unknown.

            • probenecid

              probenecid increases effects of lisinopril by unspecified interaction mechanism. Minor/Significance Unknown.

            • prochlorperazine

              prochlorperazine increases effects of lisinopril by unspecified interaction mechanism. Minor/Significance Unknown.

            • promazine

              promazine increases effects of lisinopril by unspecified interaction mechanism. Minor/Significance Unknown.

            • promethazine

              promethazine increases effects of lisinopril by unspecified interaction mechanism. Minor/Significance Unknown.

            • reishi

              reishi increases effects of lisinopril by pharmacodynamic synergism. Minor/Significance Unknown.

            • rifampin

              rifampin decreases levels of lisinopril by increasing metabolism. Minor/Significance Unknown.

            • salicylates (non-asa)

              salicylates (non-asa) decreases effects of lisinopril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

            • shepherd's purse

              shepherd's purse, lisinopril. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.

            • thioridazine

              thioridazine increases effects of lisinopril by unspecified interaction mechanism. Minor/Significance Unknown.

            • tizanidine

              tizanidine increases effects of lisinopril by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

            • tolfenamic acid

              tolfenamic acid decreases effects of lisinopril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.

            • treprostinil

              treprostinil increases effects of lisinopril by pharmacodynamic synergism. Minor/Significance Unknown.

            • trifluoperazine

              trifluoperazine increases effects of lisinopril by unspecified interaction mechanism. Minor/Significance Unknown.

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            Adverse Effects

            >10%

            Heart failure

            • Dizziness (19%)
            • Hypotension (11%)

            Hypertension

            • Cough (3.5-69%)

            1-10%

            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%)
            • ≥1%
              • 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%)
            • ≥1%
              • 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

            <1%

            Acute myocardial infarction

            • Cough (0.5%)
            • Generalized edema (0.01%)
            • Angioedema (0.01%)

            Postmarketing Reports

            • Metabolism and nutrition disorders: Hyponatremia, cases of hypoglycemia in diabetic patients on oral antidiabetic agents or insulin
            • Nervous system and psychiatric disorders: Mood alterations (including depressive symptoms), mental confusion
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            Warnings

            Black Box Warnings

            Discontinue as soon as possible when pregnancy is detected; affects renin-angiotensin system, causing oligohydramnios, which may result in fetal injury and/or death

            Contraindications

            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

            Cautions

            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

            Use caution in patients with renal impairment; renal deterioration reported in patients with low renal blood flow

            Use caution in patients with severe aortic stenosis, cardiovascular disease, collagen vascular disease, hypertrophic cardiomyopathy

            Dual blockade of the renin-angiotensin-aldosterone system (ie, ARB plus an ACE inhibitor) in patients with established atherosclerotic disease or heart failure or with diabetes with end organ damage is associated with a higher frequency of hypotension, syncope, hyperkalemia, and changes in renal function (including acute renal failure), as compared with use of a single renin-angiotensin-aldosterone system agent; limit dual blockade to individually defined cases, with close monitoring of renal function

            Neonates with history of in utero exposure: If oliguria or hypotension occurs, support of blood pressure and renal perfusion; exchange transfusions or dialysis may be required

            Angioedema of the face, extremities, lips, tongue, glottis and/or larynx, including some fatal reactions, at any time during treatment; patients with involvement of the tongue, glottis or larynx are likely to experience airway obstruction, especially patients with history of airway surgery; promptly discontinue and provide appropriate therapy and monitoring until complete and sustained resolution of signs and symptoms of angioedema has occurred

            Intestinal angioedema reported; patients presented with abdominal pain (with or without nausea or vomiting); in some cases there was no prior history of facial angioedema and C-1 esterase levels were normal; symptoms resolved after stopping the ACE inhibitor

            Hypotension may occur sometimes complicated by oliguria, progressive azotemia, acute renal failure or death; patients at risk of excessive hypotension include heart failure with systolic blood pressure below 100 mmHg, ischemic heart disease, cerebrovascular disease, hyponatremia, high dose diuretic therapy, renal dialysis, or severe volume and/or salt depletion of any etiology; in such patients initiate therapy under medical supervision and follow such patients for the first two weeks of treatment and whenever dose of lisinopril and/or diuretic is increased; avoid use in patients who are hemodynamically unstable after acute MI; symptomatic hypotension also possible in patients with severe aortic stenosis or hypertrophic cardiomyopathy

            Patients undergoing major surgery or during anesthesia with agents that produce hypotension, lisinopril may block angiotensin II formation secondary to compensatory renin release; if hypotension occurs and considered to be due to this mechanism, it can be corrected by volume expansion

            Monitor renal function periodically; changes in renal function including acute renal failure can be caused by drugs that inhibit renin-angiotensin system; patients whose renal function may depend in part on activity of the renin-angiotensin system (eg, patients with renal artery stenosis, chronic kidney disease, severe congestive heart failure, post-myocardial infarction or volume depletion) may be at particular risk of developing acute renal failure; consider withholding or discontinuing therapy in patients who develop a clinically significant decrease in renal function

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            Pregnancy & Lactation

            Pregnancy category: D

            Discontinue as soon as pregnancy detected; during the second and third trimesters of pregnancy, drugs that act directly on the renin-angiotensin system have been associated with fetal injury, including hypotension, neonatal skull hypoplasia, anuria, reversible and irreversible renal failure, and death

            Lactation: Not known if excreted into breast milk; not recommended

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Angiotensin converting enzyme (ACE) inhibitors dilate arteries and veins by competitively inhibiting the conversion of angiotensin I to angiotensin II (a potent endogenous vasoconstrictor) and by inhibiting bradykinin metabolism; these actions result in preload and afterload reductions on the heart

            ACE inhibitors also promote sodium and water excretion by inhibiting angiotensin-II induced aldosterone secretion; elevation in potassium may also be observed

            ACE inhibitors also elicit renoprotective effects through vasodilation of renal arterioles

            ACE inhibitors reduce cardiac and vascular remodeling associated with chronic hypertension, heart failure, and myocardial infarction

            Absorption

            Bioavailability: 25%

            Onset: 1 hr (initial); 6 hr (peak)

            Duration: 24 hr

            Peak plasma time: 6-8 hr

            Therapeutic plasma concentration: 1-5 ng/mL

            Distribution

            Protein bound: 25%

            Vd: 124 L

            Metabolism

            Does not undergo metabolism

            Elimination

            Half-life: 12 hr

            Renal clearance: 106 mL/min

            Total body clearance: 250 mL/min

            Excretion: Excreted unchanged entirely in the urine

            Dialysis: Removed by hemodialysis

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            Administration

            Extemporaneous Preparation

            To make 200 mL of suspension at 1.0 mg/mL, add 10 mL of Purified Water USP to a polyethylene terephthalate (PET) bottle containing ten 20-mg tablets of lisinopril

            Shake for at least one min; add 30 mL of sodium citrate and citric acid oral solution or cytra-2 diluent and 160 mL of Ora-Sweet SF to concentrate in PET bottle

            Gently shake for several seconds to disperse ingredientsShake suspension before each use

            Oral Administration

            Take with or without food

            Missed dose

            • Take as soon as possible
            • Do not take the missed dose if it is too close to the next scheduled dose; just take the next dose at the regular scheduled time

            Storage

            Prepared suspension: Refrigerate 2-8ºC(36-36ºF) for up to 4 weeks

            Tablets: Store at 15-30ºC (59-86ºF), protect from moisture; dispense in a tight container

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            lisinopril oral
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            Zestril oral
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            Prinivil oral
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            Prinivil oral
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            Qbrelis oral
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            1 mg/mL solution

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            Patient Handout

            Patient Education
            lisinopril oral

            LISINOPRIL - ORAL

            (lyse-IN-oh-pril)

            COMMON BRAND NAME(S): Prinivil, Zestril

            WARNING: This medication can cause serious (possibly fatal) harm to an unborn baby if used during pregnancy. It is important to prevent pregnancy while taking this medication. Consult your doctor for more details and to discuss the use of reliable forms of birth control while taking this medication. If you are planning pregnancy, become pregnant, or think you may be pregnant, tell your doctor right away.

            USES: Lisinopril is used to treat high blood pressure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. It is also used to treat heart failure and to improve survival after a heart attack.Lisinopril belongs to a class of drugs known as ACE inhibitors. It works by relaxing blood vessels so blood can flow more easily.

            HOW TO USE: Take this medication by mouth with or without food as directed by your doctor, usually once daily.If you are using the suspension form of this medication, shake the bottle well before each dose. Carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.The dosage is based on your medical condition and response to treatment. For children, the dosage is also based on weight.To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day. Keep taking this medication even if you feel well. Most people with high blood pressure do not feel sick.For the treatment of high blood pressure, it may take 2 to 4 weeks before you get the full benefit of this medication. For the treatment of heart failure, it may take weeks to months before you get the full benefit of this medication. Tell your doctor if your condition does not get better or if it gets worse (for example, your blood pressure readings remain high or increase).

            SIDE EFFECTS: Dizziness, lightheadedness, tiredness, or headache may occur as your body adjusts to the medication. Dry cough may also occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: fainting, symptoms of a high potassium blood level (such as muscle weakness, slow/irregular heartbeat).Although lisinopril may be used to prevent kidney problems or treat people who have kidney problems, it may also rarely cause serious kidney problems or make them worse. Your doctor will check your kidney function while you are taking lisinopril. Tell your doctor right away if you have any signs of kidney problems such as a change in the amount of urine.Lisinopril may rarely cause serious (possibly fatal) liver problems. Get medical help right away if you have any symptoms of liver damage, such as: nausea/vomiting that doesn't stop, loss of appetite, stomach/abdominal pain, yellowing eyes/skin, dark urine.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking lisinopril, tell your doctor or pharmacist if you are allergic to it; or to other ACE inhibitors (such as benazepril); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: history of an allergic reaction which included swelling of the face/lips/tongue/throat (angioedema), blood filtering procedures (such as LDL apheresis, dialysis), high level of potassium in the blood.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Too much sweating, diarrhea, or vomiting may cause dehydration and increase your risk of lightheadedness. Report prolonged diarrhea or vomiting to your doctor. Be sure to drink enough fluids to prevent dehydration unless your doctor directs you otherwise.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).This product may increase your potassium levels. Before using potassium supplements or salt substitutes that contain potassium, consult your doctor or pharmacist.Older adults may be more sensitive to the side effects of this drug, especially dizziness and increases in potassium level.This medication is not recommended for use during pregnancy. It may harm an unborn baby. Consult your doctor for more details. (See also Warning section.)It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: See also Precautions section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: aliskiren, certain drugs that weaken the immune system/increase the risk of infection (such as everolimus, sirolimus), lithium, drugs that may increase the level of potassium in the blood (such as ARBs including losartan/valsartan, birth control pills containing drospirenone), sacubitril.Some products have ingredients that could raise your blood pressure or worsen your heart failure. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).A very serious reaction may occur if you are getting injections for bee/wasp sting allergy (desensitization) and are also taking lisinopril. Make sure all your doctors know which medicines you are using.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe dizziness, fainting.

            NOTES: Do not share this medication with others.Lifestyle changes that may help this medication work better include exercising, stopping smoking, and eating a low-cholesterol/low-fat diet. Consult your doctor for more details.Lab and/or medical tests (such as kidney function, potassium levels) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.Check your blood pressure and pulse (heart rate) regularly while taking this medication. Learn how to check your own blood pressure and pulse at home, and share the results with your doctor.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store the tablets and suspension at room temperature away from light and moisture. Do not store in the bathroom. Discard any unused suspension after 4 weeks. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.